RU2614215C1 - Low-invasive method for elimination of isolated residual adduction of anterior part of foot in case of equino-varo-adduction deformation of feet in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes performance of longitudinally lateral cut in projection of 5 metatarsal bone, reaching tendon of peroneus brevis. Tendon is cut off with cortical plate. Bed is formed on the base of 5 metatarsal bone. Free end of tendon of peroneus brevis with cortical plate is placed into bed, and cortical plate is fixed to metatarsal bone in position of foot deformation correction. It is advisable to shape cortical plate in form of polygon, and to shape bed on the base of 5 metatarsal bone if form of the same polygon as cortical plate.

EFFECT: method prevents postoperative complications and fixes tendon to bone in more reliable way.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of congenital and acquired equino-varo-adduction deformation of the feet in children with residual isolated adduction of the anterior part of the feet.

A known method of treating congenital clubfoot in young children (application No. 94018128, 1994), including access to the ankle joint, dissection of the ligaments and tendons, arthrotomy of the hock joints and subsequent suturing of the wound, dissect the ligaments along the inner and outer surfaces of the ankle joint, mobilize the outer ankle, insert the talus bone into the fork of the joint, raise the talus and heel bones in the horizontal and sagittal planes to form a physiological angle between them, move the outer ankle forward and after suturing the wound, a tendon allograft is transplanted between the outer ankle and the diaphysis of the 5 metatarsal bone in the position of easy hypercorrection of the foot.

A known method of treating clubfoot with internal torsion of the leg bones in children from 3 years of age (RF patent No. 2346662, 2006), including dissection of the muscle abducting the first toe, plantar aponeurosis, lengthening of the Achilles tendon, common flexor of the fingers and long flexor of the first finger, the posterior tibial muscle, capsulotomy of the ankle, subtalar, talus-navicular, scaphoid-sphenoid and metatarsal-sphenoid joints, cut the tendon of the anterior tibial muscle at the transition to the plantar surface and move it to the second sphenoid bone, perform transverse osteotomy of the fibula and tibia in the distal metaphysis, rotate the distal leg with the foot to the anatomically correct ratio of the condyles of the thigh and ankles, push the talus into the ankle of the ankle joint, and fix the lower leg and foot with a compression-distraction apparatus.

The disadvantage of both of these methods is the low reliability of the attachment of the tendon to the bone with the help of threads and the possibility of repeated tearing of the tendon. In addition, the risk of infectious complications increases. In these methods, there is a high invasiveness, which leads to a low consolidation result. In the process of implementing the methods, a large number of accesses are made, which causes persistent pain syndrome and increases the rehabilitation time of patients. There is a high probability of obtaining excessive hypercorrection, which leads to flat-valgus deformity. Given the presence of an external fixation apparatus, the quality of life during osteosynthesis by the apparatus is deteriorating, since there is a need for dressings for the duration of use of the external fixation apparatus, which leads to prolonged immobilization.

The task (technical result) of the present invention is to prevent complications by more securely attaching the tendon to the bone.

The problem is solved in that a minimally invasive method of eliminating the isolated residual adduction of the forefoot during equino-varo-adduction deformation of the feet in children involves performing a longitudinal lateral incision in the projection of the 5 metatarsal bone, accessing the tendon of the short fibula and lengthening it by cutting off the tendon of the short fibula muscles at the attachment site in the region of tuberosity of the 5 metatarsal bone and attachment to the base of the 5 metatarsal bone, fixation in the correction position. According to the invention, the tendon is cut off with a cortical plate, a bed is formed on the base of the 5 metatarsal bone with an osteotome, the free end of the tendon of the short fibular muscle with a cortical plate is laid in the bed and the cortical plate is fixed to the metatarsal bone in the position of correction of foot deformation.

In children under 3 years of age, it is advisable to fix the cortical plate with a transossal surgical suture.

In children older than 3 years, it is advisable to fix the cortical plate with biodegradable fixatives.

For even more reliable attachment of the tendon to the bone, it is advisable to form a cortical plate in the form of a polygon, and to form a bed on the base of the 5 metatarsal bone in the form of the same polygon as the cortical plate.

The invention is illustrated by the following graphic materials, where in FIG. 1 shows a lateral projection of the foot, in FIG. 2 is a general view of the foot with residual reduction of the anterior section to surgical treatment, FIG. 3 - general view of the foot after surgical treatment.

The proposed method is as follows.

A longitudinal lateral incision is made in the projection of the 5 metatarsal bone. The skin, subcutaneous adipose tissue, retainer and tendon sheath are dissected in layers, and then the tendon (1) of the short fibular muscle is accessed. Next, the tendon (1) with the cortical plate is cut off at the attachment site (2) in the area of the tuberosity of the 5 metatarsal bone. A bed is formed on the basis of the 5 metatarsal bone with an osteotome, the free end of the tendon of the short fibular muscle with a cortical plate is laid in the bed, and the cortical plate is fixed to the base (3) of the 5 metatarsal bone in the position of correction of foot deformation. In children under 3 years of age, the cortical plate is fixed with a transossal surgical suture. In children older than 3 years, the fixation of the cortical plate is carried out with biodegradable fixatives. Get additional correction of the deformation of the foot (stop). The bed is washed with an antiseptic, for example, a solution of chlorhexidine. Check the hemostasis of the postoperative wound, layered stitches in the wound in the opposite direction. Next, an aseptic dressing and gypsum immobilization are applied from the fingertips to the inguinal-gluteal fold. Impose gypsum immobilization for up to 6 weeks from the time of surgery.

Example.

Patient N., 3 years old, was admitted to the pediatric orthopedic department of Novosibirsk NIIITO in 2011 with a diagnosis of congenital left-side clubfoot, typical form, severe degree. He underwent treatment at the place of residence without satisfactory results. The observation period at the place of residence was 6 months. He turned to NNIITO with a residual component of deformation. On examination, an isolated adduction of the forefoot of the left foot was revealed (Fig. 2). A minimally invasive method was performed to eliminate the isolated residual adduction of the forefoot. The observation period after the implementation of the claimed invention and gypsum immobilization was 7 months (Fig. 3). A follow-up examination revealed a complete clinical and radiological correction of the deformity.

The advantage of the proposed method over existing ones is the reliable attachment of the tendon to the bone by maintaining the connection of the tendon with the cortical plate and placing the cortical plate in a specially prepared bed on the basis of the 5 metatarsal bone. In this case, there is a reliable fixation of the cortical plate in the bed and faster tissue fusion, since the bone tissue is adjacent to the same bone tissue, the likelihood of a tendon detachment is reduced. In the case of the formation of the cortical plate and the bed in the form of identical polygons, an even more reliable fixation is provided, since the sides of the polygon of the cortical plate and the bed prevent the possibility of displacement of the cortical plate.

This method does not require additional metal structures. There is a minimal risk of trauma and infectious complications. Provides a complete correction of foot deformation taking into account the biomechanics of the foot. It allows you to maintain the correct shape of the foot, congruence of the joints in the area of the back, middle and front sections of the feet, to form the most physiological foot in the process of child growth while maintaining the full biomechanics of the joints.

A minimally invasive method of eliminating the isolated residual adduction of the forefoot during equino-varo-adduction deformation of the feet in children is implemented using modern equipment using modern technologies and materials.

Claims (4)

1. A minimally invasive method for eliminating the isolated residual adduction of the forefoot during equino-varo-adduction deformation of the feet in children, including performing a longitudinal lateral incision in the projection of the 5 metatarsal bone, accessing the tendon of the short fibular muscle and extending it by cutting off the tendon of the short fibular muscle at the site attachment in the area of tuberosity of the 5 metatarsal bone and attachment to the base of the 5 metatarsal bone, fixation in the correction position, characterized in that the tendon is cut off from the cortex cial plate 5 based on the metatarsal bone box osteotome form, laid in a bed of free end the tendon peroneus brevis from the cortical plate and the fixed plate to the cortical bone in the metatarsal foot deformation correcting position. 2. The method according to p. 1, characterized in that the fixation of the cortical plate is carried out by a transossal surgical suture. 3. The method according to p. 1, characterized in that the fixation of the cortical plate is carried out with biodegradable fixatives. 4. The method according to any one of paragraphs. 1, or 2, or 3, characterized in that the cortical plate is formed in the form of a polygon, and the bed on the base of the 5 metatarsal bone is formed in the form of the same polygon as the cortical plate.

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