RU2616181C1 - Method of transposition of a derivative vessel - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: perform an osteotomy of the ilium anterior semicircular lower spine to the lower edge of the large sciatic notch, osteotomy of the ischial and pubic bones perform Periacetabular semicircular, anterior acetabular fragment is rotating in the sagittal plane.

EFFECT: method can prevent caudal displacement of the femoral head.

1 dwg

Description

The present invention relates to medicine, in particular to traumatology and orthopedics, and can be used for reconstruction of the hip joint with underdevelopment of the acetabulum.

A known method for the transposition of the acetabulum, including osteotomy of the sciatic and pubic bones and angular osteotomy of the ilium from a single access without changing the patient’s position during surgery and introducing a shaped allograft into the cleavage (see MM Kamosko, A.G. Baindurashvili “Dysplastic coxarthrosis in children and adolescents ”(clinic, pathogenesis, surgical treatment. St. Petersburg, SpecLit, 2010, p. 14).

However, the need for the use of an allograft and its long-term reconstruction significantly lengthens the period until the patients are upright.

As a prototype, a method for transposition of the acetabulum was selected, including oblique osteotomy of the sciatic bone in the immediate vicinity of the acetabulum, osteotomy of the pubic and sciatic bones, and subsequent rotation of the acetabular fragment outward (see I. Akhtyamov, O. Sokolovsky "Surgical treatment of hip dysplasia," Kazan, 2008, p. 56-57).

However, the rotation of the acetabular fragment outward does not prevent the possibility of caudal displacement of the femoral head. In addition, the method leads to deformation of the entrance to the small pelvis, which makes it impossible for obstetric use in the natural ways, as well as to deformation of intrathoracic vascular and nerve formations.

The task of the invention is to improve the method.

EFFECT: prevention of the possibility of caudal displacement of the femoral head.

The technical result is achieved due to the fact that in the method, including osteotomy of the ilium, pubic and sciatic bones and rotation of the acetabular fragment, osteotomy of the ilium is performed from the anteroposterior spine semicircularly to the lower edge of the large sciatic notch, osteotomy of the sciatic and lobular isabular and the acetabular fragment rotate anteriorly in the sagittal plane.

The method of transposition of the acetabulum is illustrated in the drawing, where in FIG. 1 shows a diagram of the operation.

The method is as follows. An approach is made to the anterior surface of the ilium 1. With chisels, an oscillating saw or a Dzhigli saw with a saw slightly lower than the anteroposterior iliac spine 1, a semicircular osteotomy of the ilium is performed with a cut at the lower edge of the 3 major sciatic notch. Then, a semicircular periacetabular osteotomy 6 of the sciatic bone is performed by an angle-shaped chisel inserted along the inner surface of the femur to the obturator opening 4 from its posterior-upper edge 5 until it is connected to the lower edge 3 of the previously performed osteotomy 2 of the ilium. Then, with chisels or a Jigley saw, drawn into the locking hole 4 from its front-upper edge 7, perform a periacetabular semicircular osteotomy of the 8 pubic bone to the lower edge of the iliac-crest elevation 9. The resulting fragment 10, containing the acetabulum, rotate anteriorly in the sagittal plane to the full overlapping the femoral head with the posterior edge of the cavity. The achieved position is fixed by transossal insertion of spokes or screws.

Clinical example. Patient A., 15 years old, was treated at the institute in September 2015 due to a subluxation of the head of the right femur. September 28, 2015 the operation was performed: a triple pelvic osteotomy on the right with a semicircular osteotomy of the ilium, sciatic and pubic bones and subsequent rotation of the formed fragment anteriorly at least 50 degrees. The achieved position is fixed by two transossally held rods. The postoperative period is smooth. At the control examination after 4 months, the overlap of the head of the right thigh is complete. The range of motion in the joint is complete, the patient has no complaints.

The method allows you to create a complete overlap for the femoral head, which prevents its caudal dislocation, eliminates the need for transplants, eliminates deformation of the entrance to the small pelvis and pelvic formation.

Claims (1)

A method for the transposition of the acetabulum, including osteotomy of the ilium, pubic and sciatic bones and rotation of the acetabular fragment, characterized in that the osteotomy of the ilium is performed from the anteroposterior iliac semicircular to the lower edge of the large sciatic notch, osteotomy of the sciatic and lobular acetabular, fragment rotate anteriorly in the sagittal plane.

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