RU2607567C1 - Method of radial bone distal end plastics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopedics and can be used for repair of distal end of radial bone. Autograft is taken from fibular bone, including section of thumb flexor muscle of foot, which is sutured to muscle long flexor muscle of thumb. Distal end of autograft is modelled with rasp for congruence with semilunar bone of wrist, which is fixed to it with transosseous capron suture at level of dissected transverse carpal ligament. Autograft and ulnar bone are clamp type covered and fixed with lavsan tape. Autograft is fixed to radial bone with reconstructive plate with angular stability.

EFFECT: method enables creating conditions for reparative osteogenesis, restore congruence of articular surfaces.

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Description

The invention relates to medicine, namely to traumatology, orthopedics and oncology, and can be used in the surgical treatment of patients with neoplasms, post-traumatic defects, osteomyelitis, false joints of the distal radius of the radial bone.

A known method for the surgical treatment of cysts and neoplasms of the metaepiphyseal area of the tubular bones, which consists in resection of the neoplasm within healthy tissues with subsequent processing and chaotic filling of the cavity with cancellous bone allografts (1).

The disadvantage of this method is the reduced supportability of the limb due to a decrease in the mechanical strength of the bone, deformation of the limb, which further disrupts its function, the absence of fixation of allografts, the likelihood of migration of the latter, prolonged bone remodeling, and the high likelihood of immune reactions caused by the use of allocosti.

A known method for repairing a radius defect is that its length is restored due to the autologous fibula on the vascular pedicle in the form of a portion of the fibula by the method of microsurgical transplantation of the latter with the application of an external fixation apparatus and elimination of existing deformity of the upper limb (2).

The disadvantages of this method are its increased complexity, the high probability of postoperative complications, such as wound infection, migration of plastic material, the lack of favorable conditions for reparative osteogenesis, the absence of ligamentous apparatus plasticity and the restoration of congruence of the articular surfaces of the radius and wrist bones. This method is taken by us as a prototype.

The technical result of the method is the restoration of the radial bone with the creation of favorable conditions for reparative osteogenesis, plastic surgery of the ligamentous apparatus of the wrist, restoration of congruence of the articular surfaces of the radial bone and wrist bone, and the prevention of migration of plastic material.

This result is achieved by the fact that the autograft from the fibula further includes a portion of the muscle of the flexor of the big toe, which is sutured to the muscle of the long flexor of the big toe of the hand, the distal end of the autograft is modeled with a rasp to ensure its congruency with the lunate bone of the wrist, which is fixed transosseously to it a nylon seam at the level of the dissected transverse ligament of the wrist, the autograft and the ulna are covered by the type of clamp and fixed with mylar ribbon ; the autograft is fixed to the radius using a reconstruction plate with angular stability.

The presence of a portion of the thumb flexor muscle in the autograft, which is sutured to the muscle with the long flexor of the thumb of the hand, creates favorable conditions for successful bone tissue regeneration in the plastic area. Modeling of the distal end of the autograft and its transossal fixation with a nylon seam with a lunate bone provides restoration of congruence of articular surfaces. Clamp-type coverage and fixation of the autograft and ulna with mylar ribbon provide additional stability to the wrist. All this creates the prerequisites for the successful restoration of the function of the wrist joint. Osteosynthesis with a reconstructive plate with angular stability ensures reliable fixation of the autograft and prevents its migration.

The method for plastic surgery of the distal end of the radius includes the sampling of an autograft in the form of the fibula with a portion of the fibula artery, fixation of the autograft. The fibula autograft further includes a portion of the flexor of the big toe, which is sutured to the muscle by the long flexor of the big toe. The distal end of the autograft is modeled with a rasp to ensure its congruency with the lunate wrist bone, which is fixed to it with a transossal nylon seam. At the level of the dissected transverse ligament of the wrist, the autograft and the ulnar bone are covered by the type of a clamp and fixed with an mylar ribbon. An autograft is fixed to the radius using a reconstruction plate with angular stability.

The method of plastic surgery of the distal end of the radius is illustrated by drawings.

The figure 1 shows the fixation of an autograft, where 1 is the radius; 2 - an autograft from the fibula with a portion of the fibular artery and a portion of the flexor muscle of the thumb; 3 - the distal end of the autograft 2; 4 - ulnar bone; 5 - lavsan ribbon; 6 - lunate bone of the wrist; 7 - transossal nylon seam; 8 - reconstructive plate with angular stability.

The method of plastic surgery of the distal end of the radius is as follows.

After removal of the pathologically altered distal end of the radius 1, an autograft 2 is taken from the middle third of the fibula, together with a portion of the flexor muscle of the thumb and a portion of the fibula. The distal end 3 of the autograft 2 is simulated to ensure its congruency with the lunate bone 6. A vascular anastomosis is applied, stitching the portion of the fibular artery of the autograft 2 to the radial artery, and the portion of the flexor muscle of the big toe is sutured to the muscle with the long flexor of the big toe. At the level of the dissected transverse ligament of the wrist, the autograft 2 and the ulna 4 are covered by the type of a clamp and fixed with mylar ribbon 5. The lunate bone 6 and the distal end 3 of the autograft 2 are fixed with a transossal nylon suture 7. The autograft 2 is fixed with screws to the radius 8 of the reconstructive bone 1 stability.

The method for plastic surgery of the distal end of the radius is illustrated by a clinical example.

Patient A., 32 years old, was admitted to GBUZ SOKOD with a diagnosis of Osteoblastoclastoma of the distal radius of the radial metaepiphysis. 02/13/2014, the patient underwent surgery according to the developed method. The figure 2 shows the x-ray of the wrist joint of the patient in direct projection before surgery (a) and after surgery (b). The operation proceeded without technical difficulties. In the postoperative period, complications in the form of autograft migration, wound infection and others were not observed. On control radiographs, an autograft fusion with a radius was noted. Gradually, the patient restored hand function, range of motion in the wrist joint. No instability in the joint was noted. The range of motion in the wrist joint after 6 months was flexion - 20 °, extension - 40 °, radiation abstraction - 10 °, elbow abduction - 20 °.

The proposed method can be successfully used in trauma, orthopedic, oncology hospitals for the surgical treatment of patients with neoplasms, post-traumatic defects, osteomyelitis, pseudoarthrosis and other pathologies of the distal end of the radius.

Information sources

1. Neustadt E.L., A.B. Markochev A.B. Tumors and tumor-like diseases of the bones. - St. Petersburg: Tome, 2007, 90-92 p.

2. Sargsyan A.G., Grishin I.G., Goncharenko I.V. et al. Free transplantation of vascularized tissues in reconstructive surgery of the upper limb. Problems of microsurgery. M., 1985, 21-22 s.

Claims (1)

A method for plastic surgery of the distal end of the radius, including the collection of an autograft in the form of the fibula with a portion of the fibular artery, fixation of the autograft, characterized in that the autograft from the fibula further includes a portion of the muscle of the flexor of the big toe, which is sutured to the muscle of the long flexor of the big toe , the distal end of the autograft is modeled with a rasp to ensure its congruency with the lunate wrist bone, which is transossally fixed to it m nylon suture at the level of a slit transverse carpal ligament graft and ulna by a collar type of cover and fixed Mylar tape, is fixed to the autograft bone reconstructive radiation plate with angular stability.

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