RU2558461C2 - Surgical method of treating metatarsalgia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to traumatology and orthopaedics, and can be used for treating metatarsalgia. A metatarsophalangeal articulation is surgically approached from a plantar surface by incising the skin 1 cm long up to the subcutaneous fat in a projection of the metatarsophalangeal articulation. A nerve innervating the metatarsophalangeal articulation and paraarticular structures is destructed by cold plasma ablation by placing Topaz needle electrode guided visually or by an electronically optical converter (EOC) through a mini-incision in the proximal direction from a head of the metatarsal bone, where a finger nerve extends; 0.9% normal saline is further supplied continuously to a working portion of the electrode by means of a drop mechanism; the electrode is activated from both sides of the articulation; the electrode is used to create holes up to 0.5 mm deep successively at 1 mm from each other in a capsule of the metatarsophalangeal articulation. The wound is closed with a coetaneous suture and coated with an antiseptic dressing.

EFFECT: method enables minimising pain syndrome, reducing the length of rehabilitation.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of metatarsalgia.

Various approaches to the treatment of metatarsalgia are known, including conservative and surgical methods. Conservative include: rest, NSAIDs, vascular therapy, intravenous steroid infusion, physiotherapy, exercise therapy, external orthopedic devices (interdigital splints, metatarsal pads or orthoses to reduce plantar flexion), functional intra-shoe orthoses, local steroid injections (http: // www.podiatrytoday.com, Jamie Yakel, DPM. A Guide Orthotic Treatment For Metatarsalgia: 4 - April 2012, 74-78 c).

If conservative treatment is ineffective and the expressed pain is preserved, surgical treatment is used, including metatarsal osteotomy or resection of the heads of the metatarsal bones (L.S. Barouk, 2002). However, after such operations a long rehabilitation is required and they are not always successful.

The closest analogue (prototype) to the claimed invention is a surgical method for the treatment of metatarsalgia. This method includes the implementation of any of the known types of osteotomy, the purpose of which is to normalize the metatarsal parabola, reduce the pressure under the heads of the metatarsal bones, and correct the malignant deformity. Additionally, if necessary, carry out various kinds of tenotomy, contributing to the restoration of finger function.

However, not all patients agree to radical surgical treatment. Also, with this method of treatment, a number of complications are possible: relapse of symptoms, development of symptoms in neighboring joints with excessive shortening of the metatarsal bone, loss of finger function, restriction of movement in the metatarsophalangeal joint as a result of excessive elevation of the metatarsal bone, secondary degenerative changes or osteonecrosis, improper fusion of osteotomized fragments with the formation of bone coalitions, the development of contracture of the metatarsophalangeal joint (Vincent J. Hetherington, Textbook of Hallux Valgus & Forefoot Surgery: 2000, 429-453c.).

The technical task of the invention is the development and use of less traumatic surgical treatment of metatarsalgia, which can significantly reduce the intensity of the pain syndrome and shorten the rehabilitation time.

The essence of the claimed invention consists in minimally invasive surgical treatment of metatarsalgia in adults, including the implementation of minimal surgical access, performing denervation of the metatarsophalangeal joints, improving vascularization of paraarticular tissues due to exposure to plasma flow. The metatarsophalangeal joints are denervated by the destruction of the branches of the common interdigital nerves innervating the joints by cold-plasma ablation. Improving the vascularization of paraarticular tissues is achieved by subsequent, sequentially making holes in the plantar plate of holes of different depths spaced 1 mm apart by a plasma stream, creating the so-called three-dimensional “lattice”.

A minimally invasive surgical treatment of metatarsalgia is claimed, in which pain is minimized by denervation of the metatarsophalangeal joints by destruction of the branches of the common interdigital nerves that innervate the joints by cold plasma ablation.

The reduction of pain is also achieved by reducing inflammation in the paraarticular tissues due to improved vascularization and blood circulation when exposed to a cold plasma flow.

Effect: a significant decrease in the intensity of metatarsalgia and a reduction in the period of rehabilitation and temporary disability to three weeks. The use in this invention of minimal surgical access and a cold plasma ablator for denervation of the metatarsophalangeal joints by destruction of the branches of the common interdigital nerves innervating the joints provides the possibility of a highly accurate local destructive effect on the treated tissues, minimizing the invasiveness of the operation.

The creation of a three-dimensional “lattice” in the plantar plate of the metatarsophalangeal joint by alternately making holes of different depths spaced about 1 mm apart by a needle electrode for cold plasma ablation “Topaz” stimulates vascularization, improves blood circulation in paraarticular tissues and, as a result, reduces inflammation and pain.

Due to minimal surgical trauma, gypsum immobilization and absolute functional unloading are not required.

The method of cold plasma coblation is a minimally invasive, safe and effective technology in the treatment of overload metatarsalgia in the absence of surgical and postoperative complications or adverse events in patients without pronounced bone deformation of the forefoot and massive corns.

As a result of a significant reduction in the pain syndrome, the biomechanical parameters of walking are normalized, which in turn leads to the disappearance of pathological processes for compensating for these disorders and to an increase in the body's “independent” capabilities for adaptation and, as a rule, an increase in the “quality” of life.

The use of cold plasma coblation in the treatment of overload metatarsalgia provides a reduction in the length of hospital stay, patient rehabilitation and, as a result, a reduction in the period of temporary disability.

The inventive minimally invasive surgical treatment of metatarsalgia in adults is as follows.

In the preoperative period, the patient undergoes mandatory clinical, radiological and baropodometry examinations.

First step. Anesthesia: conduction (ankle block).

Second phase. The patient is placed on the operating table on the stomach, a roller under the ankle joints, in the lower third of the lower leg they apply a pneumatic braid. The surgical field is treated three times with an antiseptic solution. In the operating room, the power of the equipment is pre-configured: position 4 is set on the controller, the appropriateness of choosing the position is based on statistical and experimental studies.

The third stage. Surgical access is made to the metatarsophalangeal joint from the plantar surface by performing a skin incision to subcutaneous fat about 1 cm long in the projection of the metatarsophalangeal joint (Figs. 1 and 2), and a mini-expander is installed. Destruction of the nerve innervating the metatarsophalangeal joint and paraarticular tissue is performed, which is carried out by carrying out cold-plasma ablation. For this, through a mini-incision, a Topaz needle electrode is placed proximal to the head of the metatarsal bone into the wound under the control of vision and the electron-optical transducer (EOP), in the place where the digital nerve passes. Using the drip mechanism, a 0.9% physiological saline solution is continuously supplied to the working part of the electrode during the implementation of cold plasma ablation. Cold plasma ablation is performed by activating the electrode by pressing for 0.5 seconds, while the feasibility of activating the electrode for 0.5 seconds is based on statistical and experimental studies. This procedure is performed on both sides of the joint (Fig. 1). Then, using an electrode in the capsule of the metatarsophalangeal joint (Fig. 2), holes with a depth of up to 0.5 mm, spaced 1 mm apart, are alternately made, thus creating a three-dimensional “lattice” (Fig. 3). After that, a skin suture and an antiseptic dressing are applied to the wound.

In the postoperative period, functional unloading of the forefoot (the use of special postoperative footwear) for 10-12 days, dressing, suturing on the 7th day, physiotherapy is indicated.

Example

Patient N., 51 years old, in January 2012 complained of pain under the heads of II-IV metatarsophalangeal joints of both feet for YOUR pain (http://doctorspb.ru) on the right - 8, on the left - 8; deformation of 1 pfs of the right foot, hammer-like deformation of II-IV toes of both feet. The above complaints have been troubling for 2 years. Over the past 6 months, the pain has intensified significantly. On examination, a moderately pronounced deformation of the first ray of the right foot is determined (valgus deformity of 1 toe, varus I of the metatarsal bone); flattening of the front, compensatory varus of the front of both feet; hammer-like deformation of the II-IV toes of both feet. Determined by severe pain on palpation in the distal heads of the II-V metatarsal bones of both feet. Rigidity of both feet of the II degree. Deformation of the II-IV fingers due to soft tissues, with effort is eliminated. On the R-gram of both feet in a direct projection with a load (Fig. 4), the right angle is M _I P _I - 28 °, M _I M _II - 9 °; on the left, the angle M _I P _I is 10 °, M _I M _II is 7 °, which corresponds to a right-sided transverse flat-footedness of the 1st degree, hallux valgus deviation of 1 finger of the right foot of the 2nd degree; left angular parameters within normal values.

The patient underwent corrective osteotomy of the first metatarsal bone of the right foot (Shevron osteotomy), II, III, IV metatarsal bones (Weill osteotomy). On the left, due to the fact that the angular parameters are normal, subcutaneous lengthening of the long extensor II-IV of the fingers with transossal fixation with needles in the correct position for 3 weeks was performed to eliminate the hammer-like deformation. To eliminate metatarsalgia and improve microcirculation, denervation of the metatarsophalangeal joints was performed and holes were alternately applied in the capsule of the II-IV metatarsophalangeal joints with the Topaz electrode using the Atlas apparatus. Evaluation of the treatment of metatarsalgia was performed according to YOUR pain (Fig. 5).

Claims (1)

Surgical treatment of metatarsalgia, including surgical access to the metatarsophalangeal joint, destruction of the nerve innervating the metatarsophalangeal joint and paraarticular tissue, characterized in that surgical access to the metatarsophalangeal joint is performed from the plantar surface by performing a skin incision to the subcutaneous fat about 1 cm long in the projection of the metatarsophalangeal joint, destruction is carried out by carrying out cold plasma ablation, for which, through the performed m an ini-incision in the wound under the control of vision and an electron-optical transducer (EOP) place a Topaz needle electrode proximal to the metatarsal head in the place where the digital nerve passes, then 0.9% physiological is continuously applied to the working part of the electrode using the drip mechanism the solution and activate the electrode on both sides of the joint, then using the electrode in the capsule of the metatarsophalangeal joint, holes are made alternately with a depth of 0.5 mm, spaced 1 mm apart, a skin suture is applied to the wound and an antiseptic dressing.

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