RU2521536C1 - Method for functional recovery of elbow joint in pseudarthrosis of condyle of humerus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prior to cuneiform osteotomy of an olecranon and an osteosynthesis of elbow and humeral bones in the position of a corrected humeral bone axis, in a valgus position and maximum elbow flexion, a condyle of humerus is tunnelled with pins through a pseudarthrosis region. Two support-tipped pins are brought through a fragment of the condyle of humerus from the outside in a diagonal frontal plane. Three pins are brought through an internal fragment of the condyle of humerus from the inside, two of which are support-tipped. After an X-ray control, the pins are fastened onto an open support. In the upper one-third of the humerus, two support-tipped pins are brought towards each other, fixed and pulled on a semi-ring. Further, two pins are brought in the middle one-third of the humerus, one of which is support-pinned, thereafter the pins are fixed and pulled on a ring. All the supports are connected with rods, and pulled one by one in the lower one-third of the humerus.

EFFECT: functional recovery of the elbow joint.

1 ex, 5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, in particular to methods for treating the musculoskeletal system, and is aimed at restoring the function of the elbow joint.

A known method of closed compression osteosynthesis with pseudarthrosis of the lower third of the humerus with persistent flexion-extensor contracture of the elbow joint, which consists in closed fusion of fragments (Pseudarthrosis, defects of long bones of the upper limb and contracture of the elbow joint / Shevtsov V.I., Makushin V.D., Kuftyrev L.M., Soldatov Yu.P. - Kurgan, Zauralie, 2001. - S.134-144).

However, the known method is used for pseudoarthrosis of the lower third of the humerus and does not provide an increase in the amplitude of motion in the elbow joint in patients with contractures for pseudarthrosis of the condyle of the humerus.

A known method of eliminating the flexion contracture of the elbow joint, including the application of a device to eliminate contractures on the upper limb with fixation of the ulnar process, osteotomy of the ulnar process, simultaneous transformation of the proximal part of the ulna by crushing the bone structure of the fragments of the ulna in the area of partial osteotomy in the apparatus and the subsequent development of transosseous fixation (RU 2074666 C1).

However, this method involves the elimination of flexion contracture of the elbow joint, not accompanied by pseudarthrosis of the condyle of the humerus.

The objective of the invention is to develop a method of restoring the function of the elbow joint with pseudoarthrosis of the condyle of the humerus, which allows the consolidation of the zone of pseudarthrosis with the subsequent restoration of the function of the elbow joint.

The problem is solved in that before conducting a wedge-shaped osteotomy of the ulnar process and osteosynthesis of the ulnar and humerus - in the position of the corrected axis of the humerus, valgus position and maximum flexion in the elbow joint tunneling of the condyle of the humerus with knitting needles through the pseudoarthrosis area with two spokes, then two conducted through a fragment of the condyle of the humerus from the outside in an oblique plane; three knitting needles - through the inner fragment of the condyle of the humerus from the inside, two of which are with thrust pad, and after the X-ray control is carried out, the knitting needles are fixed on an open support, then in the upper third of the shoulder two knitting needles are thrust with the thrust pad facing each other, fixed and pulled on the half ring , then two knitting needles are carried out in the middle third of the shoulder, one of them with a thrust pad, after which the knitting needles are fixed and pulled on the ring, all supports are connected by rods and in the lower third of the shoulder the knitting needles are pulled alternately.

The present invention is illustrated by a detailed description, a clinical example and illustrations, in which:

Figure 1 (a, b) is a radiograph of the elbow joint of patient S., 55 years old, with maximum extension of the forearm in the direct and lateral projections, with maximum flexion in the lateral, before treatment.

Figure 2 - x-ray of the elbow joint of the patient S., 55 years old, in the course of treatment.

Figure 3 (a, b) is a radiograph of the elbow joint of patient S., 55 years old, after treatment.

Figure 4 (a, b) is a photographic radiograph of the elbow joint of patient C, 55 years old, during treatment, after a wedge-shaped osteotomy of the ulnar process.

Figure 5 is a photographic radiograph of the elbow joint of patient C, 55 years old, after treatment, with maximum extension of the forearm in direct and lateral projections, with maximum flexion in the lateral.

The method is as follows.

The first stage consists in a closed reposition of fragments of the condyle of the humerus, tunnelization of the pseudarthrosis zone. Closed osteosynthesis of the humerus by the Ilizarov apparatus.

In the operating room, after conduction anesthesia at the position of maximum flexion in the elbow joint and the position of the corrected axis of the humerus, tunneling of the condyle of the humerus with spokes through the pseudoarthrosis zone is performed. Two spokes with thrust pads are carried out through a fragment of the condyle of the humerus from the outside in an oblique-frontal plane; three spokes - through the inner fragment of the condyle of the humerus from the inside, two of which are with persistent sites. After the X-ray control is carried out, the spokes are fixed on an open support.

In the upper third of the shoulder carry two knitting needles with thrust pads towards each other, fasten and pull on a half ring. Two spokes are carried out in the middle third of the shoulder, one of them with a thrust pad from the front-outer surface. Knitting needles fasten and pull on the ring. All three supports are connected by rods. In the lower third of the shoulder, the needles are alternately pulled.

The second stage of treatment is carried out after dismantling the apparatus on the shoulder and consists in conducting a wedge-shaped osteotomy of the ulnar process of the ulnar bone and osteosynthesis of the shoulder and forearm with the Ilizarov apparatus. Under conduction anesthesia in the upper third of the shoulder carry two knitting needles with thrust pads, in the lower third of the shoulder - one knitting needle with a thrust pad outside. Knitting needles are fixed and pulled on half rings. In the upper third of the forearm, three knitting needles are passed through the ulnar bone, two of them with thrust pads towards, in the lower third of the forearm two knitting pins with pads toward, one of which is through both bones. Then they are fixed and pulled on a half ring and a ring. Supports are connected by rods.

Four console spokes are passed through the ulnar process and fixed on a half ring.

Then, through the arcuate incision of the skin above the ulnar process, a size equal to the base of the ulnar process, with a bulge in the proximal direction, produce a wedge-shaped osteotomy of the ulnar process.

The wound is washed with hydrogen peroxide and a solution of furatsilina. The maximum possible extension in the elbow joint is performed with the transposition of the ulnar process at the same time until the bone fragments of the base of the ulnar process are closed. The supports of the ulnar process and the upper third of the forearm are connected by rods to the hinged nodes. The wound is sutured in layers and bandages are applied.

Clinical example.

Patient C, 55 years old, (case history No. 67087) was admitted to the hospital with a diagnosis of post-traumatic pseudarthrosis of the condyle of the left humerus, combined contracture of the left elbow joint (Fig. 1 a, b).

In the operating room after conduction anesthesia and triple treatment of the limb with a chlorhexidine solution in the position of maximum flexion in the elbow joint and the position of the corrected axis of the humerus, the condyle of the humerus was tunneled through the area of pseudoarthrosis with needles. Through the fragment of the condyle of the humerus, two spokes with persistent sites in the oblique plane were drawn from its outer side; through the inner fragment of the condyle of the humerus, three spokes were drawn from the inside, two of them with persistent pads. After X-ray control, the spokes are mounted on an open support.

Then, in the upper third of the shoulder, two knitting needles were held with thrust pads towards each other, fixed and stretched on a half ring. In the middle third of the shoulder two spokes were made, one of them with a thrust pad from the front-outer surface. Knitting needles are fixed and stretched on the ring. All three supports were connected by rods.

In the lower third of the shoulder, the spokes are alternately stretched (Figure 2).

After the fusion of pseudoarthrosis - after 4 months - the apparatus on the shoulder is dismantled (Fig.3 a, b).

1 year after the first stage of treatment in the operating room, under the conduction anesthesia in the upper third of the shoulder 2 spokes were held with thrust pads towards each other, in the lower third of the shoulder one spoke with a thrust pad outside. The knitting needles are fixed and stretched on half rings. In the upper third of the forearm, 3 spokes were drawn through the ulnar bone, two of them with thrust pads towards, in the lower third two spokes with thrust pads towards, one of which was through both bones, fixed and stretched on a half ring and ring. The supports are connected by rods.

Through the ulnar process 4 cantilever spokes are held, fixed on a semicircle.

Through the arcuate incision of the soft tissues above the base of the ulnar process, a wedge-shaped osteotomy of the ulnar process was performed.

The wound is washed with hydrogen peroxide and a solution of furatsilina. The maximum possible extension in the elbow joint with simultaneous transposition of the ulnar process to the closure of the bone fragments of the base of the ulnar process was made. The supports of the ulnar process and the upper third of the forearm are connected by rods with hinged nodes. The wound was sutured in layers, and bandages were applied (Fig. 4 a, b). On the second day after surgery, the development of the elbow joint is prescribed. The device is dismantled after 60 days. Achieved an increase in range of motion in the elbow joint (Figure 5).

The proposed method is used in the clinic RSC "WTO" them. Academician G.A. Ilizarov for consolidation of nonunion of the condyle of the humerus in patients with impaired function of the elbow joint. The implementation of this method allows you to restore the integrity of the humerus and the function of the elbow joint.

The method involves the use of well-known tools produced by the medical industry: vibropiles, drills, knitting needles. In addition, it does not require additional accessories, devices, expensive materials, it is not difficult to perform.

Claims (1)

A method of restoring the function of the elbow joint with pseudoarthrosis of the condyle of the humerus, including osteosynthesis of the humerus, sphenoid osteotomy of the ulnar process, its transformation and subsequent development of the elbow joint, characterized in that before the sphenoid osteotomy of the ulnar process and osteosynthesis of the ulnar bone and the osteosynthesis of the ulnar axis of the humerus, valgus position and maximum flexion in the elbow joint tunnel the condyle of the humerus with knitting needles through Well pseudarthrosis, then two spokes with thrust pads carried by a fragment of condyle of humerus on the outer side in kosofrontalnoy plane; three knitting needles - through the inner fragment of the condyle of the humerus from the inside, two of which with the thrust pads and after the X-ray control are carried out, the knitting needles are fixed on an open support, then in the upper third of the shoulder two knitting needles are thrust with the thrust pads facing each other, fixed and pulled to the half ring, then two knitting needles are carried out in the middle third of the shoulder, one of them with a thrust pad, after which the knitting needles are fixed and pulled on the ring, all supports are connected by rods and in the lower third of the shoulder the knitting needles are pulled alternately.

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