RU2743971C1 - Davirov's method for replacing the humerus diaphysis defect - Google Patents

Abstract

FIELD: medicine, traumatology and orthopedics.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Tubular bone diaphysis defect is replaced with an autograft obtained from a fragment of the patient’s fibular bone diaphysis. The autograft is removed, processed from the outside, giving it a cylindrical shape. Then the transverse channels are drilled; the chips formed during processing are placed in the autograft bone marrow canal. Incisions are made in the area of the tubular bone diaphysis defect. The proximal end of the autograft is immersed in the medullary canal of the proximal tubular bone fragment and fixed. Then the distal end of the autograft is immersed in the medullary canal of the distal fragment and the tubular bone is fixed in the anatomically correct position with an external fixation device. Osteotomy of a longer tubular bone fragment is performed; the isolated fragment is fixed in the apparatus and displaced in dosage along the autograft with the formation of a distraction graft until it comes into contact with the opposite fragment.

EFFECT: method enables replacing tubular bone diaphysis defect with its own tissues and providing mechanical strength of full value while reducing the time of fixation of the limb with an external fixation device due to the combination of techniques of the claimed invention.

6 cl, 13 dwg

Description

The field of technology.

The invention relates to medicine, namely to traumatology-orthopedics, and is intended to restore the integrity of the humerus.

State of the art.

Defects of tubular (humerus, tibia) bones are the result of severe mechanical trauma, various pathological processes, such as osteomyelitis or tumors. As a result, the tubular bone, which has lost a significant part of the diaphysis, is divided into two fragments: proximal and distal, and is unable to perform its supporting function. To restore the integrity of the tubular bone and the function of the upper limb, it is required to compensate for the defect, to connect the proximal and distal fragments of the tubular bone while maintaining the anatomical length of the bone and restoring mechanical strength to its original state (before the appearance of the defect). At the same time, it is important to preserve the blood supply, the bone marrow inside the bone as factors providing osteogenesis.

Various methods are used to restore the integrity of the tubular bone. When replacing extensive defects of the diaphysis of the long bones of the extremities, the Ilizarov method is widely used, which involves lengthening a proximal fragment, a distal fragment, or two bone fragments at once (source [1]: Ilizarov G. A., Shved S. I., Martel I. I. Chreskostny osteosynthesis of severe open fractures of the shoulder bones: methodical recommendations / Ministry of Health of the RSFSR; VKNC "VТО". Kurgan, 1990. 29 p.). Replacement of the bone diaphysis defect is performed by regenerating new bone tissue when a distraction regenerate is formed. To form the regenerate, a dosed movement of the selected bone fragment in the defect is carried out until the latter is completely replaced, followed by fixation using a compression-distraction apparatus (external fixation apparatus). For the period of distraction, at a rate of 1 mm per day, the bone fragments are stabilized by the apparatus, as a rule, it takes several months. After the regenerate completely fills the defect, it is necessary to fix the limb in the apparatus, for about 1 month more, in order for the regenerate to "mature" and become sufficiently mechanically strong.

This method [1] is favorable for the patient in terms of maintaining the natural anatomical integrity of the bone. The Ilizarov method allows you to restore the integrity of the humerus or tibia, completely restore the mechanical strength and support function of the limb. However, its use presupposes long-term treatment of the patient in a hospital, it takes time for the formation of the regenerate, the period of distraction lasts from 1 to 6 months, and the maturation of the regenerate, up to 1 month. Long-term treatment is often unacceptable for both the patient and the health care system and the economy, since significant financial resources are required for long-term treatment.

The possibility of shortening the period of treatment and at the same time obtaining a result in quality comparable to the result obtained by the Ilizarov method is an object of the present invention.

There is a known method of transplanting a blood-supplied graft of the third rib to replace defects of the humerus (source [2]: patent RU 2 563 957), for which a longitudinal access of 12-15 cm is performed in the projection of the III rib, the costal artery with the costal nerve is separated from the rib for 7 -9 cm in the axillary region, ligate the costal artery and cross the costal nerve at the site of the proposed osteotomy, cross the costal muscle, separate the pleura from the rib along the inner surface, perform an osteotomy, thus obtaining a bone graft on a vascular pedicle with a length of 7.5-9 cm, consisting of a costal artery and associated veins of the same name, a site of intercostal muscles and an intercostal membrane, a graft is carried out in the subcutaneous tunnel of the chest posterior to the pectoralis major muscle and the neurovascular bundle on the shoulder, the graft is inserted into the bone marrow canals of fragments of the humerus, fragments the humerus is fixed with a plate.

However, the method [2] does not allow to restore the bone to its original state (before the appearance of the defect). The rib graft does not have sufficient mechanical strength. The cross section of the graft is less than the cross section of the humerus and the supporting function of the limb is not fully restored, the patient is forced to limit the load on the limb, otherwise the risk of bone fracture in the graft area increases. The constant sparing attitude to the limb leads to muscle degeneration.

A known method of replacing a defect in a long tubular bone (source [3]: patent RU 2 376 951). The BIOS of a bone with a segmental defect is performed with bilateral blocking of the nail according to a static scheme. After this, an osteotomy of the longer bone fragment is performed. The next step is to mount the external support of the apparatus. After that, the flexible rods (wire, cables) are fixed to the intermediate bone fragment, they are passed through the holes made in the cortical layers of the short bone fragment (or through the blocks fixed to the short fragment), and the flexible rods are fixed with traction clamps to the external support. After replacing the defect by gradually bringing the intermediate fragment into the defect area and forming a distraction regenerate between the proximal and intermediate fragments, the intermediate fragment is blocked, and the transosseous apparatus is dismantled.

This method [3] uses a metal implant that remains after treatment, which does not allow the method to be considered biologically pure. For the formation of a distraction regenerate, it is necessary to have a blood supply, free circulation of biological fluids, growth factors; a metal implant does not contribute to the formation and maturation of the regenerate. On the contrary, the presence of a metal implant in the medullary canal prevents the circulation of biological fluids, the transfer of cells and growth factors.

Known technology for replacing the defect of the diaphysis of the tibia (source [4]: patent RU 2701312). The defect of the tibial diaphysis is replaced with an autograft obtained from the fibula. A sleeve is placed on the autograft, equipped with longitudinal through channels, made of porous polytetrafluoroethylene, the length of which is 5% greater than the length of the defect and less than the length of the autograft. The transverse dimension of the sleeve corresponds to the cross-sectional dimension of the tibial shaft. The proximal end of the autograft is fixed in the medullary canal of the proximal tibia fragment. The distal end of the autograft is placed in the medullary canal of the distal fragment of the tibia. The tibia is fixed in the anatomically correct position with an external fixation apparatus (AVF). The proximal and distal fibula fragments are connected with a combined implant. Compression of tibial fragments is performed with the help of AVF. The sleeve is compressed on the autograft. The position of the autograft relative to the distal fragment of the tibia is fixed. The tibia and fibula are fixed in the achieved position of the AVF until the tibia consolidates. EFFECT: replacement of a defect of the tibial diaphysis while ensuring the integrity of the tibial bones and full support function of the tibia.

Method [4] makes it possible to replace the defect in the diaphysis of the tubular bone, while providing full mechanical strength, but requires the use of a foreign body, a fluoroplastic sleeve, which is not always possible. In addition, the autograft from the fibula does not allow the circulation of biological fluids from the bone marrow cavity of the autograft into the surrounding space, at the place of installation.

The essence of the technical solution.

The invention is aimed at improving the methods of replacing the diaphysis defect of the humerus or tibia using one's own tissues, allows to expand the arsenal of means for full biological replacement of the tubular bone defect.

The technical result consists in replacing the defect of the diaphysis of the tubular bone with its own tissues and providing full mechanical strength while reducing the time of fixation of the limb with an external fixation device.

The technical result is achieved by the fact that in the method of replacing the defect of the diaphysis of the tubular bone, the defect of the diaphysis of the tubular bone is replaced with an autograft obtained from a fragment of the diaphysis of the fibular bone of the patient. The autograft is removed, processed from the outside, giving it a cylindrical shape, transverse channels are drilled in the autograft, the chips formed during processing are placed in the bone marrow canal of the autograft, incisions are made in the zone of the defect of the diaphysis of the tubular bone, the proximal end of the autograft is immersed in the proximal bone marrow and the proximal end of the autograft is immersed in the bone marrow the end of the autograft is immersed in the medullary canal of the distal fragment of the tubular bone and fixed, the tubular bone is fixed in the anatomically correct position with an external fixation device, an osteotomy of a longer bone fragment of the tubular bone is performed in the area where the autograft is immersed, the isolated fragment is fixed in the external fixation device and the autologous graft is displaced along the graft with the formation of a distraction regenerate, before contact with the opposite fragment of the tubular bone, an external fixation device provides compression of the fragment tubular bone, remove the external fixation device.

It is assumed that before installing the autograft, the bone marrow canal in the fragments of the tubular bone is reamed and cleaned. The autograft is isolated using minimally invasive osteotomy with a drill, sequentially drilling the transverse canals in the bone along the osteotomy line. The chips formed during processing are mixed with platelet-rich plasma and placed in the bone marrow canal of the autograft.

The above essence ensures the achievement of the technical result. Replacement of the defect in the diaphysis of the tubular bone is carried out by the patient's own tissues from the patient's fibula and by distraction regenerate, which together form a single bone block of equal strength to the normal bone. Thus, due to the regenerate, the lack of safety margin of the autograft from the fibula is compensated, and due to the use of the autograft, the period of fixation of the regenerate to its maturity is reduced. After the formation of the regenerate, the limb is loaded in a gentle mode for a month, and then it can be used in full measure as before the formation of a defect. The growth of newly formed bone tissue (regenerate) is also supported by vascularization and circulation of biological fluids, cells through an autograft, which saturates the regeneration zone with growth factors, supplies nutrients and at the same time carries a mechanical support function, stabilizes bone fragments of the tubular bone.

Thus, the integrity of the tubular bone, full support function of the shoulder or lower leg is ensured.

Before installing the autograft, the medullary canal is drilled and cleaned in the fragments of the humerus. The autograft is mechanically processed (a cylindrical geometric shape of the autograft is formed), giving it a shape that ensures placement of tubular bone fragments in the medullary canal. This allows the autograft to be freely positioned in the medullary canal, to create compression of the AVF, and to move the selected fragment along the autograft. Transverse channels in the autograft allow biological fluids to circulate freely, feeding the reparative (restorative) regeneration zone.

The method is illustrated by graphic materials:

Figure 1 - Figure, shows the autograft installed in the defect of the diaphysis of the humerus and the regenerate covering the autograft;

Fig. 2 is a diagram showing the defect of the humerus;

Fig. 3 is a diagram showing an autograft installed in the defect of the humerus;

Fig. 4 is a schematic diagram showing the osteotomy of the proximal humerus fragment to the level of the autograft;

Fig. 5 is a diagram showing the distraction of the isolated fragment of the humerus with the formation of a regenerate on an autograft;

Fig. 6 is a diagram showing the closure of the selected fragment of the humerus with the opposite fragment of the humerus;

Fig. 7 is a diagram showing the restoration of the integrity of the humerus due to autograft and regenerate;

Fig. 8 is a diagram showing an osteotomy of a distal fragment of the humerus to the level of an autograft;

Fig.9 - Scheme, shows the distraction of the isolated fragment of the humerus with the formation of a regenerate on an autograft;

Fig.10 is a diagram showing an autograft installed in the defect of the tibia;

Fig. 11 is a schematic diagram showing osteotomy of a proximal tibia fragment with the fragment being isolated;

Fig. 12 is a diagram showing the distraction of an isolated fragment of the tibia with the formation of a regenerate on an autograft;

Fig. 13 is a diagram showing the closure of the selected fragment of the tibia with the opposite fragment of the humerus.

The graphic materials indicate:

1- defect of the diaphysis of the humerus;

2 - a proximal fragment of the humerus;

3- distal fragment of the humerus;

4- autograft ;,

5- selected fragment of the humerus;

6- place of osteotomy;

7- chisel;

8- transverse through channels;

9- bone clamps of the external fixation device;

10- regenerate (newly formed bone tissue);

11- fibula.

Implementation of the method.

Replacement of the defect of the diaphysis of the humerus with a length of 3 cm (Fig. 1-7).

Defect 1 (figure 2) of the diaphysis of the humerus is replaced with an autograft 4 (figure 1) obtained from a fragment of the diaphysis of the fibula of the patient. The patient is put into a state of anesthesia, anesthetized. The operating field is treated with antiseptics. Form an autograft 4 (figure 2; 6; 7), for this, a fragment of the diaphysis of the fibula of the patient is isolated. The fragment is isolated using minimally invasive osteotomy with a drill, sequentially drilling the transverse canals in the fibula along the osteotomy line. The length of the autograft 4 is determined depending on the longitudinal size (length) of the defect 1 of the diaphysis of the humerus, with the expectation that the autograft 4 should exceed the longitudinal size of the defect by 50 mm. Mechanical processing of a fragment of the diaphysis of the fibula is carried out with a mill. The autograft 4 is processed outside, giving it a cylindrical shape. Form in the autograft 4 with a drill or needle, transverse canals from the lateral surface inward, into the medullary canal, with a diameter ranging from 1.8 to 3 mm. The shavings formed during processing are placed in the bone marrow canal of the autograft 4. Mechanical processing of the seat for the autograft is carried out 4. Soft tissue incisions are made on the shoulder in the projection of the defect 1 of the diaphysis of the humerus. At the same time, the adjacent nerves and arteries are protected. Process the ends of the proximal 2 (figure 1; 9) and distal 3 (figure 1; 9) fragments of the humerus. The medullary canal is drilled and cleaned in the proximal 2 and distal 3 fragments of the humerus. When drilling the bone marrow canal, take into account the transverse size and length of the autograft 4. The bone marrow canal in the proximal fragment 2 and in the distal fragment 3 of the humerus is drilled so that, after mechanical processing, the autograft 4 is immersed so that further immersion of the autograft 4 into the bone marrow canal is limited, i.e. so that it sinks all the way. The proximal end of the autograft 4 is immersed (figure 3) into the medullary canal of the proximal fragment 2 of the humerus and fixed with wires or bone screws. The distal end of the autograft 4 is immersed in the medullary canal of the distal fragment 3 of the humerus and fixed with wires or bone screws. The humerus is fixed in the anatomically correct position with an external fixation device (not shown in the diagrams). Retaining pins are passed crosswise and crosswise through the proximal and distal thirds of the shoulder. In the taut state, the spokes are attached to the apparatus supports, which are connected to each other by threaded rods with the possibility of longitudinal dosed movement. Perform osteotomy (figure 4), chisel 7, proximal bone fragment 2 of the humerus in the area where the autograft 4 is immersed in it (the end of the autograft 4 goes beyond the osteotomy zone). They penetrate to the level of the autograft 4, but do not injure it, leaving it intact. The selected fragment 5 is fixed in the external fixation apparatus with bone fixators 9 and displaced in dosage (Fig. 5), in the postoperative period, starting from 2-4 days, at a rate of 1 mm per day, along the autograft 4 with the formation of a distraction regenerate, until contact with the opposite distal fragment 3 of the humerus (Fig. 6). The isolated fragment 5 at the same time covers the autograft 4, the regeneration zone is located around the autograft 4. During the distraction period, reparative bone regeneration is supported by the cells of the bone marrow stroma, stem cells, osteogenic cells differentiating from the autograft 4. After the formation of the regenerate in the defect, the external fixation device provides compression fragments of the humerus, and remove the apparatus. The regenerate is supported by the autograft 4, and the maturation of the regenerate is carried out on the autograft 4 (Fig. 7), which makes it possible to exclude the period of fixation by the apparatus. Autograft 4 is biologically active, the chips contained in it, bone marrow, are a source of biological substances, cells, proteins that stimulate osteogenesis in the regeneration zone. Channels 8 allow biological fluids to circulate freely, cells move, mineral and organic substances, protein molecules that regulate cell division and survival, thereby supporting the formation of new bone tissue. Autograft 4 increases the efficiency of distraction osteogenesis. Autograft 4 provides reliable immobilization of fragments, which contributes to stable regeneration. Replacement of the defect 1 of the diaphysis of the humerus is carried out by the patient's own tissues from the fibula and the regenerate. In this case, the lack of safety margin of the autograft 4 is compensated by the regenerate, the regenerate completes ossification on the autograft 4 without the apparatus.

Replacement of a defect in the diaphysis of the humerus 4 cm long (Fig. 1; 7; 8).

Defect 1 (figure 2) of the diaphysis of the humerus is replaced with an autograft 4 (figure 1) obtained from a fragment of the diaphysis of the fibula of the patient. The patient is injected with anesthesia, anesthetized. The operating field is treated with antiseptics. An autograft 4 is formed (Fig. 8), for this a fragment of the diaphysis of the fibula of the patient is isolated. The length of the autograft 4 is determined depending on the longitudinal size (length) of the defect 1 of the diaphysis of the humerus, with the expectation that the autograft 4 should exceed the longitudinal size of the defect by 80 mm. Mechanical processing of a fragment of the diaphysis of the fibula is carried out with a mill. The autograft 4 is processed from the outside, given a cylindrical shape. Form in the autograft 4 with a drill or knitting needle, transverse channels from the lateral surface inward, with a diameter of 2 mm. The chips formed during processing are mixed with platelet-rich plasma and placed in the bone marrow canal of the autograft 4. The seat for the autograft is machined 4. Incisions are made on the shoulder in the projection of the defect 1 of the diaphysis of the humerus. At the same time, the adjacent nerves and arteries are protected. The ends of the proximal 2 (Fig. 8) and distal 3 fragments of the humerus are processed. The medullary canal is drilled and cleaned in the proximal 2 and distal 3 fragments of the humerus. The proximal end of the autograft 4 is immersed (Fig. 8) into the medullary canal of the proximal fragment 2 of the humerus and fixed with wires or bone screws. The distal end of the autograft 4 is immersed in the medullary canal of the distal fragment 3 of the humerus and fixed with wires or bone screws. The humerus is fixed in the anatomically correct position with an external fixation device (not shown in the diagrams). Perform osteotomy (Fig. 8) of the proximal bone fragment 2 of the humerus in the area where the autograft 4 is immersed in it. They penetrate to the level of the autograft 4, but do not injure it, leaving it intact. The selected fragment 5 (the selected fragment covers the autograft 4) is fixed in the external fixation apparatus with bone fixators 9 and is displaced in a dosage (by 1 mm per day) (Fig. 9) along the autograft 4 with the formation of a distraction regenerate, until contact with the opposite distal fragment 3 of the humerus ... After the formation of the regenerate in the defect, the external fixation device provides compression of the fragments of the humerus, and the device is removed. The maturation of the regenerate is carried out on an autograft 4, which makes it possible to exclude the period of fixation with the apparatus. Autograft 4 is biologically active, the chips contained in it, bone marrow, platelet-rich plasma are a source of biological substances that stimulate osteogenesis in the regeneration zone. Channels 8 allow biological fluids to circulate freely, cells move, mineral and organic substances, protein molecules that regulate cell division and survival, thereby supporting the formation of new bone tissue. Autograft 4 increases the efficiency of distraction osteogenesis. Autograft 4 provides reliable immobilization of fragments, which contributes to stable regeneration. Replacement of the defect 1 of the diaphysis of the humerus is carried out by the patient's own tissues from the fibula and the regenerate. In this case, the lack of safety margin of the autograft 4 is compensated by the regenerate, the regenerate completes ossification on the autograft 4 without the apparatus.

Replacement of the defect of the tibial diaphysis with a length of 5 cm (Fig. 10-13).

Defect 1 (Fig. 10) of the diaphysis of the humerus is replaced with an autograft 4 (Fig. 10) obtained from a fragment of the diaphysis of the fibula 11 of the patient. The patient is put into a state of anesthesia, anesthetized. The operating field is treated with antiseptics. Form an autograft 4 (figure 2; 6; 7), for this, a fragment of the diaphysis of the fibula 11 of the patient is isolated. The fragment is isolated using an osteotomy with a chisel. The length of the autograft 4 is determined depending on the longitudinal size (length) of the defect 1 of the tibial diaphysis, with the expectation that the autograft 4 must exceed the longitudinal size of the defect by at least 80 mm. Mechanical processing of a fragment of the diaphysis of the fibula is carried out with a mill. The autograft 4 is processed from the outside, giving it a cylindrical shape. Form in the autograft 4 with a drill, transverse canals from the lateral surface inward, into the medullary canal, with a diameter in the range of 2 mm. The shavings formed during processing are placed in the bone marrow canal of the autograft 4. Mechanical processing of the seat for the autograft is carried out 4. Soft tissue incisions are made on the lower leg in the projection of defect 1 of the tibial diaphysis. At the same time, the adjacent nerves and arteries are protected. The ends of the proximal 2 (Fig. 10) and distal 3 (Fig. 10) fragments of the tibia are processed. The medullary canal is drilled and cleaned in the proximal 2 and distal 3 fragments of the tibia. When drilling the bone marrow canal, take into account the transverse size and length of the autograft 4. The bone marrow canal in the proximal fragment 2 and in the distal fragment 3 of the tibia is drilled so that, after mechanical processing, the autograft 4 is immersed, so that further immersion of the autograft 4 into the bone marrow canal is limited, i.e. so that it sinks all the way. Perform osteotomy (figure 4), chisel 7, proximal bone fragment 2 of the tibia. The selected fragment 5 is fixed in the external fixation apparatus with bone fixators 9 The proximal end of the autograft 4 is immersed (Fig. 3) into the medullary canal of the proximal fragment 2 of the tibia and fixed with wires 9 (Fig. 10) or bone screws (not shown). The distal end of the autograft 4 is immersed in the medullary canal of the distal fragment 3 of the tibia and fixed with 9 wires or bone screws. The tibia is fixed in the anatomically correct position with an external fixation device (not shown in the diagrams). Intermittently, crosswise, the fixing wires are passed through the proximal and distal thirds of the lower leg. In the taut state, the spokes are attached to the apparatus supports, which are connected to each other by threaded rods with the possibility of longitudinal dosed movement. The selected fragment 5, the device of external fixation is dosed displaced (Fig. 5), in the postoperative period, starting from 2-4 days, at a rate of 1 mm per day, along the autograft 4 with the formation of a distraction regenerate (Fig. 12-13), before contact with the opposite distal fragment 3 of the humerus (Fig. 13). The isolated fragment 5 at the same time covers the autograft 4, the regeneration zone is located around the autograft 4. During the distraction period, the reparative bone regeneration is supported by the cells of the bone marrow stroma, stem cells, osteogenic cells differentiating from the autograft 4 through channels 8. After the formation of the regenerate in the defect 1 by the apparatus external fixation provides compression of the tibial fragments, and the apparatus is removed. The mechanically fragile, immature regenerate is supported by the autograft 4, and the maturation of the regenerate is carried out on the autograft 4 (Fig. 7), which makes it possible to exclude the fixation period with the apparatus (about 1 month). Autograft 4 is biologically active, the chips contained in it, bone marrow, are a source of biological substances, cells, proteins that stimulate osteogenesis in the regeneration zone. Channels 8 allow biological fluids to circulate freely, cells move, mineral and organic substances, protein molecules that regulate cell division and survival, thereby supporting the formation of new bone tissue. Autograft 4 increases the efficiency of distraction osteogenesis. Autograft 4 provides reliable immobilization of fragments, which contributes to stable regeneration. Replacement of the defect 1 of the tibial diaphysis is carried out by the patient's own tissues from the fibula and the regenerate. In this case, the lack of safety margin of the autograft 4 is compensated by the regenerate, the regenerate completes ossification on the autograft 4 without the apparatus. The restored tibia in terms of mechanical strength is not inferior to the normal tibia, while the period of fixation of the limb by the apparatus for maturation of the regenerate is excluded.

The method can be implemented in medical clinics equipped with surgical equipment and instruments. The method makes it possible to replace the defect in the diaphysis of the tubular bone with its own tissues and to provide full mechanical strength of the bone, while the time for fixing the limb with an external fixation device is reduced.

Claims (7)

1. A method of replacing the defect of the diaphysis of the tubular bone, in which the defect of the diaphysis of the tubular bone is replaced with an autograft obtained from a fragment of the diaphysis of the fibular bone of the patient, characterized in that the autograft is removed, processed from the outside, giving a cylindrical shape, the transverse canals are drilled in the autotransplant, shavings formed during processing, the autotransplant is placed in the medullary canal, cuts are made in the defect zone of the tubular bone diaphysis, the proximal end of the autograft is immersed in the medullary canal of the proximal tubular bone fragment and fixed, the distal end of the autograft is immersed in the medullary canal of the distal tubular fragment, the tubular bone is fixed and fixed anatomically correct position with an external fixation device, an osteotomy of a longer bone fragment of the tubular bone is performed, the selected fragment is fixed in an external fixation device and displaced along the autotransplus in dosage NTA with the formation of a distraction regenerate before contact with the opposite fragment of the tubular bone, the external fixation device provides compression of the fragments of the tubular bone, the external fixation device is removed. 2. The method according to claim 1, characterized in that before installing the autograft, the bone marrow canal in the fragments of the tubular bone is reamed and cleaned. 3. The method according to claim 1, characterized in that the autograft is isolated using minimally invasive osteotomy with a drill, sequentially drilling the transverse canals in the bone along the osteotomy line. 4. The method according to claim 1, characterized in that the chips formed during processing are mixed with platelet-rich plasma and placed in the bone marrow canal of the autotransplant. 5. The method according to claim 1, characterized in that the osteotomy of the proximal fragment of the tubular bone is performed. 6. The method according to claim 1, characterized in that the osteotomy of the distal fragment of the tubular bone is performed. 7. The method according to claim 1, characterized in that the defect of the humerus or tibia is replaced.

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