RU2570771C1 - Method for vascularised humeral periosteal grafting for treating false joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for vascularised humeral periosteal grafting for treating false joints. Periosteal U-grafts with a base being in vascular connection to the bone are formed on proximal and distal fragments. The periosteal graft of the proximal fragment is turned and moved towards the distal fragment, and the periosteal graft of the distal fragment - to the proximal fragment so that the grafts overlap a false joint region, whereas a cambial layer of the periosteum is placed onto the humeral bone. The graft borders are placed under a plate and fixed to the proximal and distal fragments by means of interrupted sutures through plate openings.

EFFECT: method enables reducing a risk of pathological fracture and providing blood supply in distal portion of an extremity.

5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat false joints of the humerus.

A known method of transplantation nekrovosnabzheniya bone autograft to replace the bone defect of the victim. The graft is formed from the bone of the patient himself and transplanted into the area of the bone defect. The limb is immobilized with a plaster cast until the graft merges with the recipient bone bed (VD Chaklin. Bone grafting. - M .: Medicine, 1971. - Ch. 4. Bone grafting with fresh fractures, delayed consolidation and pseudoarthrosis. - P. 37 -63). However, the described method has significant disadvantages. The transplanted bone autograft resolves and secrete necrohormones that activate osteogenesis. This requires prolonged immobilization with a plaster cast. Complications such as fracture of a transplanted graft or its resorption, which leads to failure of the surgical intervention, can occur.

Closest to the proposed method is the treatment of defects and pseudoarthrosis of both limbs of the forearm when two blood-supplying bone grafts are isolated from the radial bone - from the distal metaepiphysis and from the site at the border of the proximal and middle third of the radial bone - on a single proximal vascular leg - the radial vascular bundle they move bone grafts while preserving the supply vessels and fix them in areas of damage to the radius and ulna (PM Tikhilov et al. The method of instantaneous non-free bone autoplasty for defects and pseudoarthrosis of both bones of the forearm. Patent of the Russian Federation No. 2360632. Publish. July 10, 2009, Bull. No. 19). The disadvantages of the described method is the following. The formation of two bone grafts from the radius of 10 and 6 cm long, 1/3 width and thickness of the radius of the radius leads to a decrease in the strength of the radius and the risk of developing a pathological fracture. After the intersection of the radial artery, the blood supply to the lower third of the forearm and hand decreases, which manifests itself in a decrease in the strength of the hand, as well as the occurrence of trophic disorders.

The technical result of the invention is the improvement of treatment results due to the fact that a bone transplant is not formed from the cortical layer of the bone, therefore, the bone strength is preserved and there is no danger of its pathological fracture. When performing surgery, the main vessels do not bandage, as a result of which the blood circulation of the distal extremities does not decrease. The periosteum grafts are formed on the proximal and distal fragments after fixation of the fragments by the plate, the periosteal grafts are moved to the opposite fragment, the periosteum grafts are closed over the area of the false joint and fixed with interrupted sutures through the plate openings.

The solution to this problem is provided by the fact that in the method of transplanting blood-supplied periosteal grafts, including excision of inter-fragment scar tissue, plate osteosynthesis, transplanting of the periosteum, which is part of the bone graft at the proximal and distal fragments, form the periosteal U-shaped transplants with the base (section) having a vascular connection with the bone, which overlap the false joint with its cambial layer. Transplanted blood supply periosteum grafts activate bone tissue regeneration and lead to the battle of false joints.

The figures depict:

FIG. 1. Scheme of transplantation of periosteal grafts of the humerus.

FIG. 2. Radiographs before surgery.

FIG. 3. Type of surgical wound. The periosteal graft is formed. The arrows indicate: 1 - the "line" of the false joint; 2 - formed periosteal graft.

FIG. 4. Type of surgical wound. The arrow indicates: 1 - the "line" of the false joint is blocked by a periosteal graft.

FIG. 5. Radiographs after 4 weeks. after operation.

The method was performed as follows. The inter-fragment tissues of the pseudoarthrosis were excised, the fragments were fixed with a plate. An L-shaped incision along the anteroposterior surface of the proximal humerus fragment was crossed and the periosteum was removed at the site of attachment of the pectoralis major muscle, retreating 3.5 cm from the edge of the fragment. In the same section along the posterior-outer surface of the distal fragment, the periosteum was crossed and the periosteum was peeled off at the site of attachment of the brachioradial muscle, departing 3.0 cm from the edge of the fragment. A periosteum graft was formed with dimensions of 3.5 × 2.0 cm with a base of 3 cm on the proximal fragment, and also a graft of dimensions 2.5 × 2.0 cm with a base of 2.5 cm on the distal fragment. The periosteal graft of the proximal fragment was turned and moved to the distal fragment, and the periosteal graft of the distal fragment was turned to the proximal fragment. Transplants blocked the pseudoarthrosis region. The cambial layer of the periosteum was laid on the humerus (Fig. 1). The edges of the grafts were placed under the plate and fixed to the proximal and distal fragments by interrupted sutures through the plate openings (Figs. 3, 4). The left upper limb was immobilized with a kerchief bandage for 4 weeks.

CLINICAL OBSERVATION

S., 64 years old, regarding the pseudoarthrosis of the left humerus in the middle third (Fig. 2), on April 26, 2013, a rod located in the bone marrow canal was removed in the clinic, inter-fragment tissues were excised, and the ends of the fragments were resected. The latter did not bleed, were fragile and crumbled. Performed osteosynthesis and surgery according to the proposed methodology (Fig. 1, 3, 4). The postoperative course is smooth. On radiographs performed after 4 weeks. after the operation, it is determined that the fragments of the false joint are fixed with a plate on eight screws, there are cloud-like shadows located between the fragments, the space between the fragments is filled with bone regenerate (Fig. 5).

According to the developed technique, 7 patients were operated on. All achieved fusion.

Claims (1)

A method for transplanting blood-supplied periosteal grafts of the humerus for the treatment of pseudoarthrosis, including excising interfragmental scar tissue, osteosynthesis with a plate, characterized in that on the proximal and distal fragments form periosteal transplants of a U-shaped form with a base having a vascular connection with the bone, periosteal the fragment is rotated and moved to the distal fragment, and the periosteal graft of the distal fragment to the proximal fragment so that the implants overlap the pseudoarthrosis region, and the cambial layer of the periosteum is laid on the humerus, the edges of the grafts are placed under the plate and fixed to the proximal and distal fragments by interrupted sutures through the holes of the plate.

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