RU2582051C2 - Method for replacement of osteomyelitis cavity metaphyseal region of tibia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: perform sequestrectomy of the cavity in the area of distal metaphysis of the shin bone. Perform resection of joint the fibular bone epiphysis. Place a formed homogenous spongious autoplast into the cavity. Perform osteotomy of the fibular bone diaphysis. Proportionally move the fragment into epiphysis's defect. Using a compression-distraction apparatus perform fixation and traction. During formation of fibular bone regenerate put it into contact with the shin bone autoplast.

EFFECT: method provides for restoration of anatomic contours of zone of the distal tibiofibular syndesmosis due to combined restructuring and regeneration of the spongious cavity autoplast and replacing bone regenerate in the zone of their contact and fixing it when treating patients with chronic osteomyelitis.

1 cl, 3 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics. and can be used in the treatment of patients with metaphysical osteomyelitis cavities of the distal end of the tibia and the presence of severe scar tissue damage.

A known method for the compensation of the osteomyelitis cavity by dosed compensation of a bone defect after complete resection of the affected bone area (1).

However, this technique is associated with long periods of treatment.

A known method of replacing the osteomyelitis cavity of the tibia, comprising resecting a portion of the fibula and introducing the formed autograft into the cavity. In this case, an osteotomy of the end of one of the fragments of the fibula is carried out and dosed to reduce it to contact with the end of the opposing fragment. (2).

However, this method does not provide restoration of the anatomical contours of the distal and proximal syndesmosis zones, which negatively affects the cosmetic and functional results of treatment.

The objective of the invention is to develop a method of compensating the osteomyelitis cavity of the metadiaphyseal region of the tibia, which ensures the restoration of the anatomical contours of the distal and proximal syndesmosis zones.

This problem is solved in that in a method including resection of the articular end of the fibula and insertion of the formed autograft into the tibial cavity, as well as fixation of the tibia using a compression-distraction apparatus, additional osteotomy of the fibula is performed and the formed fragment is dosed in the defect of its articular end until it is replaced and the anatomical contours of the zone of the corresponding tibiofibular syndesmosis are restored, the one formed during I regenerate the bone defect lead position in contact with the projecting end of the cavity autograft.

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

FIG. 1 - fistulogram of the patient Α., Before treatment.

FIG. 2 (a, b) - radiographs of the patient Α., During treatment.

FIG. 3 (a, b) - radiographs of the patient Α., After treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, osteosynthesis of the lower leg and foot is performed. When it is performed, the fixing knitting needles are carried out outside the zone of the osteomyelitis focus. In a tense state, the spokes are mounted on apparatus supports installed at the appropriate level, which are interconnected by threaded rods. After this, sequestrnecrectomy of the osteomyelitis cavity and separation of the adjacent tibiofibular syndesmosis are performed.

Through an additional incision in the soft tissues, an osteotomy of the articular end of the fibula is performed. The fragment formed as a result of this is inserted into the osteomyelitis cavity, fixing it with traction rods or knitting needles so that the free end of the fragment partially protrudes from the cavity. At the same time, an osteotomy of the diaphysis of the fibula is performed with the formation of an end fragment, which is also fixed with traction needles. In the case of the osteomyelitis region of the proximal tibia metaphysis, the proximal articular end of the fibula is similarly treated.

The operation is completed by performing control radiography, suturing wounds, stabilizing the apparatus systems and applying aseptic dressings.

In the postoperative period, starting from 5-7 days, a metered traction of the isolated fragment of the fibular diaphysis in the defect zone is performed until the anatomical contours of the syndesmosis zone are restored and fusion with the posterolateral surface of the tibia. Moreover, during the formation of the bone regenerate, it is brought into contact with the end of the autograft introduced into it from the osteomyelitis cavity. The rate of movement of the fragment of the fibular diaphysis varies between 0.5-1.0 mm per day. After the defect has been compensated, the apparatus is put into fixation mode, which is maintained until the regenerated regions of the regenerate are rebuilt into mature bone tissue. After dismantling the apparatus, the patient is shown wearing a removable longet and regular exercise therapy for a month and a half - two months.

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

Patient Α., 38 years old, was admitted with a diagnosis of chronic post-traumatic osteomyelitis of the left lower leg of the fistulous form, an osteomyelitis cavity in the area of the distal metaphysis of the tibia 3.0 × 2.0 cm in size. Ankylosis of the left ankle joint. Shortening of the lower leg 3 cm. Disabled group II.

The disease is 7 years old, previously operated four times, but the fistula continued to function. Upon receipt, cicatricial changes in the skin with edema, fistula in the lower third of the leg, pain.

The patient underwent surgery: sequestrnecrectomy, double osteotomy of the fibula, osteosynthesis by Ilizarov apparatus.

During the operation, after anesthesia and treatment of the surgical field, osteosynthesis of the lower leg and foot was performed using an external fixation apparatus. Fixing knitting needles were carried out of the osteomyelitis focus area through the proximal and middle third of the lower leg, as well as the bones of the foot.

In this case, the tibia in the middle third was fixed separately. In a tense state, the spokes were fixed on the supports of the apparatus, which were connected to each other by threaded rods. After this, sequestration necrectomy of the osteomyelitis cavity and separation of the adjacent tibiofibular syndesmosis were performed.

An osteotomy of the articular end of the fibula was performed through an additional soft tissue incision. The fragment formed as a result of this was introduced into the osteomyelitis cavity, fixing it with traction needles so that the free end of the fragment partially protruded from the cavity. At the same time, an osteotomy of the fibula diaphysis was additionally performed with the formation of an end fragment, which was also fixed with traction knitting needles.

The operation was completed by performing control radiography, suturing wounds, stabilizing the systems of the apparatus and applying aseptic dressings.

In the postoperative period, starting from 5-7 days, a metered traction of the isolated fragment of the fibular diaphysis in the defect zone was carried out until the anatomical contours of the distal syndesmosis were restored and fused with the posterolateral surface of the tibia. At the same time, during the formation of the bone regenerate, he was brought into contact with the end of the autograft introduced into it from the osteomyelitis cavity. The rate of movement of the fragment of the fibular diaphysis varied within 0.5-1.0 mm per day. The duration of dosed traction was 53 days. After the compensation of the defect, the apparatus was transferred to the fixation mode, which was maintained for 106 days until the regenerated regions of the formed regeneration were transformed into mature bone tissue. After dismantling the apparatus, the patient used a removable span for one and a half to two months and was engaged in exercise therapy.

As a result of treatment, the osteomyelitis process was eliminated, the osteomyelitis cavity was replaced, and the anatomical contours of the distal tibiofibular syndesmosis zone were preserved.

At the control examination after 1 year, the treatment result is saved. Clinically and radiologically, restoration of bone integrity and structure is noted. There is no recurrence of osteomyelitis. The patient walks with a full load on the operated limb, uses ordinary shoes, there is no pain syndrome.

The implementation of the method provides the restoration of the anatomical contours of the distal and proximal syndesmosis zones.

Information sources

1. Ilizarov treatment of patients with osteomyelitis cavities: method. Recommendations / Ministry of Health of the Russian Federation, RRC "WTO"; Comp .: A.M. Aranovich, A.I. Lapynin.

2. RF application number 9711642, publ. 08/10/1999.

Claims (1)

A method of compensating the osteomyelitis cavity of the metadiaphyseal region of the tibia, including resection of the articular end of the fibula and introducing the formed autograft into the tibial cavity, as well as fixation of the tibia using a compression-distraction apparatus, characterized in that additional osteotomy of the fibula is carried out and the shaped fragment is moved into the tibia and defect of its articular end to its replacement and restoration of the anatomical contours of the zone, respectively vuyuschego tibiofibular syndesmosis, wherein during the forming regenerate bone defect substitution is brought into contact with a position projecting from the cavity end autograft.

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