RU2607189C1 - Method for bone defect replacement in tibial condyle in total knee replacement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be used for bone defect replacement in tibial condyle in total knee replacement. Tibial and femoral condyles are resected, autograft is formed. During resecting tibial condyle trapezoidal support platform corresponding to the bone defect is formed. During resecting femoral condyle trapezoidal autograft, corresponding to the support platform is formed. Repairing bone defect is performed so that the autograft is tightly adjoined to the support platform.

EFFECT: method enables eliminating the risk of early endoprosthesis component instability.

1 cl, 9 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended to restore a bone defect in the condyle of the tibia of the knee joint with total arthroplasty.

A known method of repairing tibial defects defects (patent No. 2200494, 1999), including total knee replacement, forming a graft and bed for it, draws a line along the edge of the defect along the radiograph, draws a perpendicular through its middle and determines the condyle defect height from the radiograph of the contralateral, perpendicular the axis of the tibia intersect the pineal gland so that the height of its medial part is equal to the height of the perpendicular restored from the defect, form a flat on the surface of the tibial condyle defect plane slice stack severed fragment formed on a flat bed and its spokes fixed to the underlying bone, the graft is combined with the outer edge of the defect edge and projecting into the joint portion of the graft is cut along a plane section of the condyles of the tibia.

The disadvantage of this method is the presence of additional fixation with knitting needles, which increases the risk of infectious complications, which leads to a long period of hospital stay on bed and affects the deterioration of somatic pathology, also leads to a long period of autograft engraftment to the tibia and, subsequently, to the development of early instability of components endoprosthesis.

Closest to the claimed one is the prototype method of replacing bone defects of the condyles of the tibia or femur with total knee arthroplasty (patent No. 2465855, 2011), which includes performing resection of the condyles of the femur and tibia and installing test components of the bone endoprosthesis of the bone condyle defects substitute material, when resecting the condyle of the bone without a bone defect, it is sawn 2-6 mm from the planned level, then at the planned constant level to form a plate-shaped cancellous autograft as a bone substitute material is osteoconductive material after bone defect plastics on the reconstructed surface of the resulting stack autograft.

The disadvantage of this method is that the quality of the fixation of the graft with bone-replacing osteoconductive material is low, since its destruction, displacement, leading to the development of early instability of the components of the endoprosthesis, is possible. There is a low result of bone fusion, leading to atrophy of the bone structure.

The technical result of the invention is the creation of a method free from the above disadvantages.

The indicated technical result is achieved in that a method for replacing a bone defect in the tibial condyle with total knee replacement, including resection of the condyles of the femur and tibia, formation of an autograft, installation of test components of the endoprosthesis, plastic bone defect, forming a tibial condyle resection form a trapezoid corresponding to a bone defect, an autotransplant is formed during resection of the femoral condyle atm trapezoidal shape corresponding to the support pad size plastic bone defect is performed so that the graft lies against the support platform.

The invention is illustrated by the following graphic materials, where in FIG. 1 is a radiograph, a direct projection of the knee joint before surgery, FIG. 2 and 3 are photographs of the intermuscular box and the supporting platform, FIG. 4 and 5 - photograph, installation of an autograft, FIG. 6 is a radiograph, a direct projection of the knee joint after surgery, FIG. 7 is a radiograph, a direct projection of the knee joint before surgery, FIG. 8 is a radiograph, a direct projection of the knee joint after surgery, FIG. 9 is a radiograph, a direct projection of the knee joint 8 months after the implementation of the method.

An embodiment of the invention.

X-ray examination is performed (Fig. 1). The patient is placed on the operating table. Impose a tourniquet on the thigh. Use anteromedial access. Cut through the skin, subcutaneous tissue, own fascia. Stupidly and acutely identify the tendon of the quadriceps muscle and cut it longitudinally. The patella is circumvented before attaching its own patellar ligament. The patella is mobilized outwards. The knee joint is opened, the synovial membrane is excised within sight. The remains of the anterior cruciate ligament are removed, the menisci are resected. After the plateau of the tibia is released, the extramedullary tibial guide is placed on the plateau in the position provided for determining the sawdust of the tibia. According to this technology, using the distal template, the depth of sawdust is determined and the joint surface of the tibia is resected, the resected part is removed.

According to the international classification of the Anderson Orthopedic Research Institute (AORI), a residual bone defect is determined by the type of bone defect from T1 to T2a of the tibial condyle. Next, the bone marrow canal of the femur is traced with an awl, an extramedullary femoral guide pin is inserted into it. Then control the axis of the thigh, fix the distal template on the femur and resect the distal condyles of the femur, the resected part is removed. Then, a resection of the distal femur is performed and an intercondylar box is formed, while the autograft is taken from the distal femur. The residual bone defect of the tibial condyle is processed to “blood dew”, with the formation of a trapezoidal support pad in it with the aim of tightly fitting the autograft (Fig. 2, Fig. 3).

Taking into account the previously obtained data on the type of defect from T1 to T2a, in accordance with the international classification of the Anderson Orthopedic Research Institute (AORI) of the residual bone defect of the tibial condyle and in accordance with the dimensions of the supporting platform, an anatomical autograft of the bone defect of the tibial condyle is made, giving it a geometric shape, such as a trapezoid. Then the autograft is installed on a previously formed supporting platform of the tibial condyle, for example (by driving) until it is firmly fixed to the tibial condyle (Fig. 4, 5).

Then, using the test components, the spatial position of the femoral component on the femur and the tibial component on the tibia are tested. Then, the test components are removed and implantation of a permanent endoprosthesis on a biocompatible material with astringent properties, for example (bone cement) is performed, first of all, the tibial component on the tibia, then the femoral component of the endoprosthesis on the femur. Then, an insert made of polymeric materials, for example (polyethylene), is fixed onto the tibial component, collecting the endoprosthesis in a single design. Resection of the ossification of the patella is performed. After solidification of a biocompatible material with astringent properties, such as bone cement, a test movement of the endoprosthesis is carried out in order to determine the amplitude of movement and restore the biomechanics of the patella. Then the area of surgical intervention is treated with an antiseptic solution, for example, aqueous chlorhexidine. The surgical wound is sutured with preliminary drainage. Remove the tourniquet from the hip. Perform bleeding control, x-ray control (Fig. 6). Postoperative conservative therapy is performed. Subsequently, a course of rehabilitation treatment is prescribed.

Example.

Patient S., born in 1939, was admitted to the Novosibirsk NIITO with complaints of pain in the knee joint of the left leg. From the anamnesis of the disease it was found that pain in the knee appeared since 1999 after an injury (falling from a height of one's own height). Conservative treatment was carried out at the place of residence with a short-term positive effect.

At the end of 2013, she turned to the Novosibirsk NIIIT, where she was diagnosed with: Bilateral post-traumatic gonarthrosis of the 3rd degree. Varus deformity of the lower extremities. Defect of the internal condyle of the left tibia, cyst of the proximal metaepiphysis of the left tibia. Combined contracture of the knee. Syndrome of bilateral gonalgia. In 2014, treatment was carried out according to the proposed method with subsequent management. Radiograph performed before surgery (Fig. 7). Radiograph after surgery (Fig. 8). A control x-ray was performed 8 months after the operation (Fig. 9). The patient does not show complaints at the control examination. Marks an increase in the range of motion in the left knee joint and satisfaction with the results.

The advantage of the proposed method compared to existing ones is that there is no additional fixation with knitting needles, which leads to a minimal risk of infectious complications. The period of stay in the hospital decreases, patients begin to walk the day after the operation. Patients note an improvement in their somatic state. Fusion (consolidation) of the autograft to the tibia takes place in a shorter period of time with minimal risk of complications. The risk of bone atrophy is minimal. The degree of quality of fixation of the autograft and in the subsequent endoprosthesis increases due to tight fixation to the condyle of the tibia, which leads to a decrease in the risk of early instability of the components of the endoprosthesis.

A method for replacing a bone defect in the tibial condyle with total knee replacement is implemented using modern equipment using modern technologies and materials.

Claims (1)

A method for replacing a bone defect in the tibial condyle with total knee arthroplasty, including resection of the condyles of the femur and tibia, formation of an autograft, installation of test components of the endoprosthesis, plastic bone defect, characterized in that when resecting the condyle of the tibia, the trapezoidal bone is formed corresponding to the trapezoid shape defect, during resection of the femoral condyle, a trapezoidal autograft is formed, respectively corresponding to the size of the supporting platform, plastic bone defect is performed in such a way that the autograft adheres tightly to the supporting platform.

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