RU2538050C1 - Method for hip replacement in deformed shaft of femur - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to traumatology and orthopaedics, and can be used for the hip replacement in a deformed shaft of the femur. The first stage involves implanting an endoprosthesis with immersing its pedicle to the femoral deformity apex; a segment of the greater trochanter with attached muscles, and its fragments are fixed with cerclage sutures. The second stage provides femoral osteosynthesis; the hip joint is stabilised, and femoral osteotomy is performed at the level of its deformity in the distal direction of the implanted endoprosthesis with a long axis of the segment to be recovered.

EFFECT: method enables reducing a risk of dislocation of the endoprosthesis head, preventing the shortening of the extremity.

3 cl, 1 ex, 5 dwg

Description

The invention relates to medicine, in particular to orthopedics, and in particular to methods of treating patients with coxarthrosis, accompanied by complex multiplanar deformation of the femur.

A known method of hip arthroplasty, including performing an osteotomy at one or two levels, aligning the axis of the thigh and installing an endoprosthesis. (Abeltsev V.P. Surgical treatment of dysplastic coxarthrosis. - M .: OJSC "Publishing House" Medicine ", 2008. - 224 p.: Ill.)

However, this method is traumatic, accompanied by a large amount of blood loss and the duration of the surgical intervention.

A known method of hip arthroplasty with angular deformity of the femoral diaphysis, comprising a wedge-shaped resection of the femoral portion at the apex of the deformity, overshot of the trochanteric artery, resection of the head and neck of the femur, placement of the endoprosthesis with the introduction of its legs into the distal fragment, fixation of the thigh with the aid of the Ilizar apparatus bones. (Method of endoprosthetics for angular deformity of the thigh. Patent No. 23429112 of the Russian Federation. Published on January 10, 2009) However, this method involves the loss of a significant part of the bone substance of the bone, which leads to its shortening. In addition, the implementation of the method does not exclude the development in the postoperative period of both dislocations of the endoprosthesis head and tear-off spit fractures due to the traction of the contracted pelvic muscles.

The objective of the invention is to develop a method of hip replacement in the presence of deformation of the diaphysis of the hip, preventing shortening of the limb and the development of postoperative complications.

This problem is solved by the fact that in the method, including osteotomy of the thigh and trochanteric, resection of the head and neck of the thigh, installation of an endoprosthesis, correction of deformation and stabilization of fragments using an external fixation device, the endoprosthesis is installed at the first stage, immersing its leg to the level of the apex of the hip deformation , separate the site of the greater trochanter with the muscles attached to it and fix its fragments with cerclage sutures, and at the second stage, perform hip osteosynthesis, stabilize the hip joint and perform m femoral osteotomy at the top of its deformation distal legs mounted endoprosthesis followed by reduction of the longitudinal segment axis. It provides for:

- hip osteosynthesis and correction of deformity are performed delayed;

- restoration of the axis of the thigh with deformations of more than 30 ° is carried out dosed.

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

Figure 1 - radiograph of the right thigh of patient D. before treatment;

Figure 2 - x-ray of the right thigh of patient D. after the installation of the endoprosthesis, osteotomy of the greater trochanter and its osteosynthesis with cerclage sutures;

Figure 3 is a radiograph of the right thigh of patient D. after hip osteosynthesis with stabilization of the hip joint and performing an osteotomy at the level of the deformation apex;

Figure 4 - x-ray of the right thigh of patient D. after dismantling the apparatus;

Figure 5 - photo of patient D. 2 months after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, through an access through Changli, an osteotomy of the greater trochanter was performed with the selection of the edge fragment with abduction muscles attached to it. The selected fragment is allocated proximal. After that, an osteotomy of the femoral neck and head extraction are performed. Known methods produce the treatment of the acetabulum and establish the pelvic component of the endoprosthesis. From the side of the proximal end of the thigh, a hole is formed that communicates with the bone marrow cavity, which is then processed with a rasp to a depth to the top of the bone deformity. A leg of the femoral component of the endoprosthesis is inserted into the treated cavity, while the latter is selected so that the end of the inserted leg is at the level of the apex of the femoral deformity. Moreover, before installing the legs at an appropriate level, it is advisable to drill a hole in the side wall of the bone, so that when installing the legs, if its length is slightly longer than the length of the proximal part of the thigh, an unexpected fracture of the bone does not occur in this place. Following this, the selected fragment of the greater trochanter is fixed to its mother bed with cerclage seams.

In the second stage, which can be performed delayed, 10-14 days after the first, after the abatement of acute postoperative phenomena, using a soft tissue incision made to form an opening in the lateral surface of the bone, transverse osteotomy at the same level is performed at the same level of deformation . Following this, transosseous fixation of fragments of the thigh, including the greater trochanter, and the ilium is performed. The free ends of the clamps - spokes and rods - are mounted on the supports of the external fixation apparatus that are installed at the appropriate level, which are connected with threaded rods and hinged nodes with the possibility of multi-plane displacement. At the same time, the position of the hip joint due to the rigid connection of the pelvic and proximal femoral supports is stabilized. At the same time, with a strain angle of less than 30 °, the longitudinal axis of the thigh is restored simultaneously by removing its distal fragment. The operation is completed with radiography, stabilization of the apparatus systems and wound closure.

In the postoperative period, in cases where the longitudinal axis of the thigh has not been restored, its dosed correction is made by traction of its distal fragment in the direction of abduction. The rate of traction varies between 0.5-1.5 mm per day. To restore the axis of the femur, also dosed, bring the lower limb to a functionally advantageous position. After 2-3 weeks, the supports of the apparatus from the pelvic bone are dismantled. Stable fixation of fragments of the femur continues until the reconstruction of the site of the formed bone regenerate into mature bone tissue. After receiving a reliable picture of consolidation, the apparatus is dismantled.

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

Patient D., 34 years old, was admitted to the hospital with a diagnosis of Right-sided coxarthrosis of the III degree. Hallux valgus in the middle third of the thigh 70 °. To restore the function of the hip joint and correct the axis of the thigh, the patient underwent surgery for the endoprosthesis of the right hip joint, transverse osteotomy of the thigh at the apex of deformation, and osteosynthesis by the Ilizarov apparatus.

At the first stage, after anesthesia and processing of the surgical field, through the access through Changli, an osteotomy of the greater trochanter was performed with the selection of the edge fragment with abduction muscles attached to it. The selected fragment is allocated proximal. After that, an osteotomy of the femoral neck and head extraction were performed. The acetabulum was treated and the pelvic component of the endoprosthesis was installed. A hole was formed from the side of the proximal end of the thigh, communicating with the bone marrow cavity, which was then processed using rasps to the top of the bone deformity. A leg of the femoral component of an endoprosthesis of the appropriate size was introduced into the treated cavity. In this case, before installing the legs at the level of the apex of the femoral deformity, a hole was drilled in its side wall. Following this, the selected fragment of the greater trochanter was fixed to its mother bed with cerclage seams.

14 days after the first stage, a transverse osteotomy of the femur was performed at the level of the apex of deformation. Following this, transosseous fixation of fragments of the thigh, including the greater trochanter, and the ilium was carried out. At the same time, 4 spokes were passed through the distal fragment of the femur, 3 through the proximal fragment, 2 rods were introduced into the iliac crests on each side. At the same time, one spoke was passed through a previously osteotomized fragment of the greater trochanter. The free ends of the clamps - spokes and rods - secured to the arc and ring supports. At the same time, the ends of a spoke drawn through a fragment of a large trochanter were curved arcuately. The supports are interconnected by threaded rods and hinged nodes. The position of the hip joint was stabilized.

In the postoperative period, a metered correction of the longitudinal axis of the thigh was carried out by traction of its distal fragment in the direction of abduction at a rate of 1 mm per day. The duration of the traction was 28 days. To restore the axis of the femur, the limb, also dosed, was set in the reduction position. After 19 days of fixation, the fixation of the hip joint was removed. The duration of the fixation of bone fragments was 73 days, after which the apparatus was dismantled. There were no complications of the treatment process.

As a result of treatment, the patient restored the function of the hip joint and normalized the axis of the segment. The patient walks with a full load on the operated limb, not limping, the length of the limbs is equal, movement in the knee and ankle joint is within normal limits.

At the control examination after 1 year, the achieved treatment result is saved; there are no signs of endoprosthesis destabilization, the longitudinal axis of the thigh is correct.

Using the proposed method showed that its use prevents shortening of the limb and the development of postoperative complications during hip replacement in patients with hip diaphysis deformity.

Claims (3)

1. A method of hip joint replacement in the presence of hip diaphysis deformity, including hip and trochanteric osteotomy, resection of the head and neck of the thigh, installation of an endoprosthesis, correction of deformation and stabilization of fragments using an external fixation device, characterized in that the endoprosthesis is installed at the first stage by immersion his leg to the level of the apex of the femoral deformity, osteotomize a portion of the greater trochanter with muscles attached to it and fix its fragments with cerclage sutures, and at the second stage dissolved osteosynthesis hips and stabilize the hip joint femoral osteotomy is performed at the top of its deformation distal legs mounted endoprosthesis followed by reduction of the longitudinal segment axis. 2. The method according to claim 1, characterized in that the hip osteosynthesis and correction of the deformity are delayed. 3. The method according to claim 1, characterized in that the restoration of the axis of the thigh with deformations above 30 ° is carried out in a dosed manner.

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