RU2504339C1 - Method of bone cavity replacement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and can be used in replacement of bone cavities in conditions of impaired blood supply. Periosteum is separated from adjoining cavity abovelying or underlying bone section. Bone fragment is formed and rotated until external surface faces the side of remaining cavity wall, displaced to opposite cavity pole on tangent to it, and after that in dosed manner, transversally, until bone contour is restored in defect zone.

EFFECT: method ensures recovery of supportability of extremity, replacement of bone defect with restoration of its contours, prevention of development of tissue necrosis.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with defects of limb bones, including the consequences of gunshot wounds.

There is a method of replacing a bone cavity, including its processing, the formation of bone fragments from the opposite wall of the cavity of the bone fragments and their movement along the bone perimeter until comparison with subsequent fixation using a compression-distraction apparatus (application for the grant of a patent of the Russian Federation No. 96123194, publ. 02/10/1999).

However, in conditions of impaired blood supply, especially with the consequences of gunshot wounds, the regenerative ability of the bone is significantly reduced, and the dosed movement of the selected fragment causes tissue necrotization, which does not exclude the development of postoperative complications.

A known method of replacing a marginal bone defect, which involves processing it, forming from the adjacent, lower or overlying portion of the bone the size of the defect of the marginal fragment and its metered movement using an external fixation device (Transosseous osteosynthesis in the treatment of patients with chronic osteomyelitis: in 2 hours / V .I. Shevtsov, A.I. Lapynin, N.M. Klyushin. - Kurgan, 2001; p.20-21).

However, in conditions of impaired blood supply, the use of this method is also fraught with the possibility of developing postoperative complications.

The objective of the invention is to develop a method that prevents the development of tissue necrosis when replacing bone cavities in conditions of impaired blood supply.

This problem is solved by the fact that in the method of replacing the bone cavity, including its processing, the formation of a fragment from the adjacent portion of the bone and its metered movement in the defect zone using an external fixation apparatus, the periosteum is peeled from the adjacent to the cavity of the bone above or below the bone, a bone is formed fragment, rotate it until the outer surface faces the side of the preserved cavity wall, is displaced tangentially to it to the opposite pole of the cavity, and then is dosed transversely to restore Nia bone contour in the area of the defect.

The method is illustrated by a description, an example of practical use and illustrative material, which shows:

Figure 1 - X-ray of the leg of the patient before treatment;

Figure 2 - X-ray of the lower leg of the patient in the process of replacing the cavity;

Figure 3 - Photo of the patient during treatment;

Figure 4 - X-ray of the lower leg of the patient after dismantling the apparatus.

The method is as follows.

After anesthesia and treatment of the surgical field with known techniques, osteosynthesis of the affected limb segment is performed using an external fixation apparatus. When it is performed, distal and proximal to the affected area of the bone, two or three spokes are carried out, which are attached to the supports of the external fixation device in a taut state. Supports displaceable relative to each other are connected by threaded rods and, if necessary, by hinged nodes. In cases of periarticular localization of the cavity, the adjacent segment of the limb is fixed.

Through the incision of the integumentary tissues, access is made to the cavity, the walls of which are treated with the removal of non-viable structures. After that, the periosteum is peeled off from the adjacent to the cavity (depending on its location) above or below the lying portion of the bone, and then a bone fragment is formed from it. The latter is rotated until its outer surface is turned towards the preserved wall of the cavity, brought into contact with it and shifted to the opposite pole of the cavity. In the attached position, the fragment is fixed by cantilever-inserted knitting needles, the free ends of which are fixed in an additional mounted traction unit of the apparatus. The operation is completed by suturing the wound with an aseptic dressing, performing control radiography and stabilization of the apparatus.

In the postoperative period, starting from the third to fifth day, in order to replace the cavity, the selected fragment is dosed transversely until the bone contour in the defect zone is restored. The pace of movement varies from 0.5 to 1 mm per day.

By replacing the cavity prior to bone consolidation, a mode of stable limb hardware fixation is maintained.

The practical use of the method is illustrated by the following clinical observation.

Patient K., 62 years old, was admitted to the hospital with a diagnosis of Chronic post-traumatic (gunshot) osteomyelitis of the right tibia, fistulous form, with the presence of a destruction cavity in the proximal metaepiphysis.

To restore the integrity of the bone and replace the bone cavity, the patient underwent surgery: necrectomy of the tibia, the formation of a bone fragment to replace the bone cavity; osteosynthesis of the lower leg and thigh with an external fixation apparatus.

In the course of the operation, after anesthesia and treatment of the surgical field, two or three spokes were carried out distally and proximal to the affected area of the tibia, as well as through the distal third of the femur, which were secured in tensioned position on the supports of the external fixation apparatus. Supports with the possibility of displacement relative to each other were connected by threaded rods.

Through an incision in the integumentary tissues, access was made to the cavity, the walls of which were treated to remove non-viable structures. After that, the periosteum was exfoliated from the adjacent underlying portion of the bone and a bone fragment was formed from the same portion of the bone. The latter was rotated until its outer surface turned towards the remaining cavity wall, brought into contact with it, and then shifted towards the opposite pole of the cavity. In the attached position, the fragment was fixed by two cantilevered spokes, the free ends of which were fixed in the traction unit of the apparatus. The operation was completed by suturing the wound with an aseptic dressing, performing control radiography and stabilizing the systems of the apparatus.

In the postoperative period, starting from the fifth day, the selected fragment was dosed transversely until the bone contour was restored in the defect zone. The rate of movement ranged from 0.5 to 1 mm per day. The duration of the traction was 5 days; the period of subsequent stable fixation is 86 days. After dismantling the apparatus, the patient underwent a course of exercise therapy.

As a result of treatment, the patient's limb support ability was restored, the cavity defect of the tibia metaphysis was replaced with the restoration of the anatomical contours of its proximal section. There were no signs of tissue necrotization during dosed replacement of the bone defect and during the entire treatment period.

At the follow-up examination after 1 year the achieved treatment result is saved: the patient walks with full load on the operated limb, the axis of which is correct; movements in the knee joint within 90 degrees.

Using the method showed that its use prevents the development of tissue necrosis during bone replacement in conditions of impaired blood supply.

Claims (1)

A method for replacing a bone cavity, including its processing, formation of a fragment from the adjacent bone site and its metered movement in the defect zone using an external fixation device, characterized in that the periosteum is peeled off from the adjacent upper or lower bone area, the bone fragment is formed, rotated it is facing the outer surface of the cavity toward the preserved wall of the cavity, tangentially to it is shifted to the opposite pole of the cavity, and then dosed, transversely - until the contour is restored to STI in the defect area.

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