RU2760992C1 - Arthrodesis method of anterior talocacaneal articulation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used to perform arthrodesis of the talonavicular joint. Access to the joint area is performed. Under the control of an image intensifier, a one-stage osteotomy of the articular surfaces is performed. Through the body of the scaphoid bone, outside the scaphoid-wedge joint, two Kirschner wires are passed. Channels are drilled along the needles, cannulated screws are installed and compression is expelled in the area of the talo-navicular joint.EFFECT: method provides increased efficiency of treatment, avoids progressive avascular necrosis and persistent pain syndrome due to minimally invasive access and simultaneous osteotomy of articular surfaces.1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, can be used in the treatment of chronic subluxations, the consequences of fracture dislocations and arthrosis of the joints of the foot and joints formed by the talus.

Fractures and dislocations of the bones of the foot and talus are rare and complex pathologies. As a result of high-energy impacts, they are often found in polytrauma. Due to the unique anatomy, the peculiarities of the blood supply, and numerous complex joints, the treatment of injuries to the talus of the bones of the foot presents significant difficulties. Their course is often accompanied by the development of infectious complications, degenerative arthrosis, deformities of the middle and hindfoot, avascular necrosis, unsatisfactory treatment outcomes and a high level of disability.

Due to the peculiarities of the anatomy and blood supply of the talus and the bones of the middle and hind foot, when choosing wide approaches for the purpose of surgical treatment, trophic disorders of local tissues, the appearance of epidermal blisters, fibrous restructuring of soft tissues, which, in the future, provoke development of avascular necrosis.

Despite the variety of methods of conservative and surgical treatment of victims, a stable and adequate fixation of bone fragments for early loading is not always achieved. This often leads to unsatisfactory treatment outcomes: contractures, chronic pain in the subtalar joint, which significantly reduce the patient's quality of life and walking function.

A known method of treating injuries and diseases of the talus (USSR AS No. 1146024), including resection of pathological altered tissues of the talus, the formation of a groove along the load axis in the talus, placing an autograft in the formed groove. This method, in view of the trauma of soft and bone tissues, as well as the expected wide access, worsens the vascularization of the above tissues, thereby provoking the development of aseptic necrosis of the talus, and can also lead to a valgus position of the foot. At the same time, this operation is traumatic due to the need to take a graft from the fibula of the intact lower leg, the development of neurological disorders and fractures of the weakened portion of the bone of the intact limb is not excluded. The above osteoplastic method is quite traumatic, does not allow additional compression, which can lead to failure of arthrodesis.

The closest to the achieved technical result (prototype) is a method for minimally invasive arthrodesis of the subtalar joint (RF Patent No. RU2549297C1), which consists in the fact that the operation is performed by puncturing the skin along the back surface of the leg proximal to the calcaneal tubercle 1-1.5 cm along the outer edge Achilles tendon. A boron is introduced into the cavity of the subtalar joint and the articular surface of the posterior part of the calcaneal-talar joint is treated. For the treatment of the articular surfaces of the anterior part of the talocalcaneal joint, an additional approach is performed by incision of the skin, not exceeding 0.5-0.8 cm, along the dorsal-outer edge of the foot in the projection of the tarsal sinus. A cavity is formed between the calcaneus and talus with the subsequent installation of an autograft into it from the outer condyle of the femur. The method eliminates deformation and pain by reducing the trauma of the operation and improving the vascularization of the talus

The disadvantages of this method are: the need for multiple approaches for resection of the articular surface of the talus and calcaneus, which creates the risk of avascular necrosis of bone fragments and suppuration of wounds. Also, this method does not allow visualizing the quality of processing of articular surfaces, and there is also a high risk of damage to blood vessels and nerves located in the subtalar joint. Long-term exposure to excessive amounts of boron on local tissues, due to toxicity, can lead to impairment of postoperative wound healing.

The authors propose a highly effective method for arthrodesis of the subtalar joint and joints of the foot.

The technical result of the proposed method is a minimally invasive osteotomy of the articular surfaces of the calcaneus, talus and foot bones from a mini-access with a special osteotome with two blades, followed by fixation of the joint with two screws with a channel of 7.3 mm or 4.0 mm.

The method is carried out as follows:

The essence of the method is illustrated by Figures 1-5:

The figure 1 shows an X-ray of a patient with aseptic necrosis of the scaphoid.

Figure 2 shows an X-ray after the implementation of a mini-access to the talo-navicular joint and the installation of an osteotome with two blades.

Figure 3 shows a radiograph and an image after osteotomy of the articular surfaces of the talonavicular joint.

Figure 4 shows an X-ray after passing the wires through the talonavicular joint.

Figure 5 shows the radiograph after placement of cannulated screws with compression of the talonavicular joint.

Under aseptic conditions, after two times treatment of the operating field with antiseptic solutions under anesthesia, or with one of the types of regional anesthesia, a linear incision up to 4 cm is made on the orthopedic operating table along the anteromedial surface of the dorsum of the foot in the projection of the talonavicular joint. Stupidly and sharply with the help of a raspator, the talo-navicular joint is isolated, soft tissues are pushed back. Under the control of an electro-optical converter (EOC), an osteotome with two blades is installed perpendicular to the joint. Osteotomy of the articular surfaces is performed under the control of the image intensifier. The resulting fragments are removed from the wound, the formed osteotomized surfaces are carefully processed with a bone spoon. The joint area is treated with antiseptic solutions. Then, through the body of the scaphoid bone, outside the navicular-wedge-shaped joint, 2 Kirschner wires are passed, under the screw diameter of 4.0 mm, from front to back parallel to each other. Channels for 4.0 mm screws are drilled along the needles using a cannulated drill. Cannulated screws 4.0 mm with washers are installed along the spoke with further compression in the area of the talo-navicular joint. The surgical wound is treated with antiseptic solutions with layer-by-layer suturing.

Clinical example:

Patient V., 35 years old., Was admitted to the clinic with pain in the foot (denies the fact of injury) with a diagnosis of aseptic necrosis of the scaphoid bone of the right foot. On admission, radiographs of the right foot and ankle joint were performed (Fig. 1). After 3 days, the osteotomy of the articular surfaces of the talonavicular joint was performed in a planned manner through a mini-access to the talonavicular joint with the installation of an osteotome with two blades (Fig. 2) (Fig. 3). Then, through the osteotomy zone, 2 Kirschner wires were passed (Fig. 3), along which, after the cannulation of the canals with a cannulated drill, cannulated screws 4.0 mm with washers with further compression were installed. On the control radiograph of the right foot, reliable fixation in the osteotomy area with screws with a channel was determined (Fig. 5). The patient moves with additional support, without external immobilization, with a load of 1/7 of the body weight on the right lower limb.

Thus, the claimed method has shown high efficiency in the treatment of chronic intra-articular injuries and arthrosis of the talus and foot bones. This method is technically simple, does not require expensive equipment, avoids progressive avascular necrosis and persistent pain syndrome, and can be used in any trauma department.

Claims (1)

The method of arthrodesis of the talonavicular joint, including the implementation of minimally invasive access to the joint area, while under the control of an image converter, a one-stage osteotomy of the articular surfaces is performed, then two Kirschner wires are inserted through the body of the scaphoid, outside the scaphoid joint, under the screw diameter 4 , 0 mm, from front to back, parallel to each other, along the needles using a cannulated drill, channels are drilled for screws 4.0 mm and cannulated screws 4.0 mm with washers are installed with further compression in the area of the talo-navicular joint.

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