RU2604039C1 - Method of corrective femoral osteotomy in youth femoral head epiphysiolysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopedics and can be used for corrective osteotomy of femoral bone. Channel is formed for subsequent introduction of blade with angled plate at front-side surface of femur towards center of femoral head epiphysis. Intertrochanteric femur osteotomy is made perpendicular to axis of femoral diaphysis at distance from created channel. Distal fragment is rotated inside by value of required femoral neck anteversion. Fragments are fixed with angled plate with introduction of its blade from front-side surface of femoral bone towards center of femoral head epiphysis.

EFFECT: method enables preventing of subluxation, varus deformation of femoral neck, delaying of arthrosis progression.

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Description

The invention relates to medicine, namely to orthopedics and can be used in the surgical treatment of children with youthful epiphysiolysis of the femoral head. When the epiphysis of the femoral head relative to the neck is displaced by more than 20-30 degrees posteriorly and / or downward, restoration of the correct anatomical proportions in the hip joint can be achieved by corrective osteotomy of the femur.

At present, in cases of juvenile epiphysiolysis of the femoral head, variants of the intertrochanteric or subtrochanteric osteotomy of the femur with fixation of fragments by an angular plate with screws are used.

A known method of corrective osteotomy of the femur in adolescent epiphysiolysis of the femoral head according to Imhauser (Imhauser G: Zur Pathogenese und Therapie der jugendlichen Huftkopflosung, Orthopedics 88: 716, 1957). However, no Imhauser operation involves only the flexion and torsion deformation correction components, followed by fixation with an angular plate. Such correction leads to a pronounced angular deformation of the femur in the sagittal plane, which negatively affects the biomechanics of the hip joint and causes difficulties in subsequent arthroplasty.

Known methods for corrective osteotomy of the thigh in adolescent epiphysiolysis of the femoral head according to: 1. Southwick (Southwick WO: Osteotomy through the lesser trochanter for slipped capital femoral epiphysis, J Bone Joint Surg. Am. 49: 807, 1967) and 2. A.I. . Krasnov (AI Krasnov, Method for reconstruction of the proximal femur in adolescent epiphysiolysis of the femoral head. RF patent No. 2364365. Publication of the patent on 08/20/2009. Bull. No. 23.)

These methods are pathogenetically more justified because they correct deformation simultaneously in three planes - frontal, horizontal and sagittal with fixation of fragments by an angular plate. However, they are technically difficult, because they are associated with the need to perform complex curly sections of the femur, which often causes technical errors.

The main disadvantage of the considered methods is that the rotation component of the correction during these interventions is carried out according to the blade of the angular plate introduced, i.e. around the longitudinal axis of the femoral neck. In those frequent anatomical situations when the epiphysis of the head is displaced mainly posteriorly, by more than 40 degrees, and slightly downward, the rotation of the proximal femur fragment around the axis of the femoral neck leads to the valgus position of the epiphysis of the head and the varus position of the neck. Thus, in the hip joint there is a position of subluxation (along the epiphysis of the head) and / or varus deformity of the femoral neck with a high standing of the greater trochanter, which, accordingly, leads to gluteal muscle dysfunction and lameness. Such violations cause restriction of abduction in the hip joint, the occurrence of "impingement syndrome", pain, due to mechanical contact of the apex of the greater trochanter with the outer edge of the acetabular fragment when trying to abduct the hip. The above is the cause of the development of early arthrosis of the hip joint.

The objective of the invention is to increase the efficiency of surgical treatment of children with juvenile epiphysiolysis of the femoral head using corrective osteotomy of the femur by changing the axis of rotation of the proximal femur, which, together with restoring the correct center of the epiphysis of the femoral head, helps to prevent angular deformation of the femoral diaphysis, the development of subluxation and varus deformity , thereby slowing down the progression of arthrosis of the hip joint and delaying the need for repeated surgery interventions (hip arthroplasty).

The technical result of the task is achieved by the fact that in the method of performing corrective osteotomy of the thigh, which consists in performing intertrochanteric osteotomy of the thigh and correction of the proximal fragment in the frontal, horizontal and sagittal planes with subsequent fixation of the fragments by an angular plate with screws, it is proposed to introduce a blade of an angular plate with an anterior-lateral plate surface of the femur towards the center of the pineal gland of the femoral head.

In FIG. 1 shows a diagram of a reconstructed femur of a patient with juvenile epiphysiolysis of the femoral head - a general front-side-top-view.

Pos. 1 - epiphysis of the femoral head.

Pos. 2 - diaphysis of the femur.

Pos. 3 - a large trochanter of the femur.

Pos. 4 - the neck of the femur.

In FIG. Figure 2 shows a diagram of the reconstructed femur of a patient with juvenile epiphysiolysis of the femoral head with the indicated level of introduction of the angular plate and the level of osteotomy of the femur.

Pos. 5 - angular plate and the level of its introduction from the anterolateral

the surface of the femur.

Pos. 6 - level of osteotomy of the femur.

Pos. 7 - axis of the femoral neck.

Pos. 8 - axis of the diaphysis of the femur.

In FIG. 3 is a diagram of a reconstructed femur after fixation of fragments in the position of correction of femoral fragments of an angular plate. Side view.

Pos. 9 - screws in the angular plate 5, fixing fragments of the femur in the correction position.

In FIG. Figure 4 shows a radiograph of the right hip joint in the anteroposterior projection and the Lauenstein projection of a patient with juvenile epiphysiolysis of the femoral head before surgery.

In FIG. 5 presents a radiograph of the right hip joint in the anteroposterior projection and the Lauenstein projection of a patient with juvenile epiphysiolysis of the femoral head of the same patient after surgery according to the proposed method.

The method is as follows:

The patient's position on the operating table on a healthy side. Under aseptic conditions, an angular incision is made in the skin and subcutaneous tissue along the outer thigh in the upper third - from the anteroposterior iliac spine to the apex of the greater trochanter and further down the thigh. The broad fascia of the thigh is dissected crosswise. After a T-shaped dissection of the lateral head of the quadriceps femoris muscle along with the periosteum, the femur in the upper third is exposed periosteally.

5 mm away from the growth zone of the greater trochanter 3, a channel for an angular plate 5 is formed with a spear-shaped punch or chisel from the front-side surface of the thigh towards the center of the pineal gland 1 of the femoral head. In the sagittal plane, the deviation of the punch plane from the axis of the diaphysis of the femur 8 corresponds to the displacement of the epiphysis of the femoral head posteriorly, but not more than 60 degrees.

1 cm away from the formed channel for the plate, the oscillatory saw performs intertrochanteric osteotomy of the femur 6 perpendicular to the axis of the diaphysis of the femur 8.

The distal fragment of the femur 2 rotates inward by the amount of the necessary anteversion of the femoral neck (15 degrees) and fragments of the femur are fixed in the position of correction with an angled plate 5 (with a given cervical-diaphyseal angle) with screws 9.

The wound is sutured in layers leaving the drainage of Redon. An aseptic dressing is applied. A control x-ray and immobilization of the lower limb with a plaster boot are performed.

The positive effect of the invention is as follows: changing the axis of rotation of the proximal femur allows for its full correction in the frontal, horizontal and sagittal planes, preventing angular deformation of the femoral diaphysis, the development of subluxation and varus deformity of the neck.

Claims (1)

Method of corrective osteotomy of the femur, which consists in an intertrochanteric osteotomy of the femur with subsequent correction of deformation and fixation of fragments of the femur with an angled plate with screws, characterized in that a channel is formed for subsequent insertion of the blade of the angled plate from the anterior lateral surface of the femur towards the center of the epiphysis of the femoral head , departing from the formed channel, perform intertrochanteric osteotomy of the femur perpendicular to the axis of the diaphysis of the femur, turn inward the distal frame range by the amount necessary hip anteverzii, fragments angularly fixed plate blade with its introduction to the antero-lateral surface of the femur toward the center of the femoral head epiphysis.

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