RU2795396C1 - Method for restoring congruence in the hip joint with open reduction of the hip in children - Google Patents

Abstract

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: invention relates to and can be used to restore congruence in the hip joint during open reduction of the hip in children. The joint capsule is dissected, the fat pad, the round ligament of the femoral head and the transverse connection of the acetabulum are removed, followed by the reduction of the head into the cavity. Before reduction of the head, resection of hypertrophied sections of the lower osteochondral parts of the acetabulum in the area of its notch is performed.

EFFECT: method provides prevention of lateroposition, decentration and mechanical trauma of the femoral head, improves the functions of the hip joint and provides prevention of early coxarthrosis due to resection of hypertrophied areas of the lower osteochondral parts of the acetabulum in the region of its notch.

1 cl, 6 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of children with congenital or pathological dislocation, as well as hip subluxation and the consequences of aseptic necrosis, accompanied by lateroposition of the femoral head.

The displacement of the femoral head from the acetabulum in diseases of the hip joint of congenital or acquired origin is accompanied by both hypertrophy of soft tissue formations in the joint cavity and secondary deformations of its bone parts. Soft tissue formations include duplication of the joint capsule, fat pad, round and transverse ligament of the thigh. These pathological formations are removed during the operation of open hip reduction. Underdevelopment of the arch of the acetabulum is eliminated, if necessary, by one or another type of pelvic osteotomy or acetabuloplasty.

A known method of surgical treatment of children with hip dislocation (open reduction of the hip), which consists in dissection of the joint capsule, removal of the fat pad, round ligament of the femoral head and transverse connection of the acetabulum, followed by reduction of the head into the cavity. (Herring JA. Tachdjian's pediatric orthopaedics: From the Texas Scottish Rite Hospital for Children. Saunders; 2013. 1696 p.).

However, with a long-term dislocation and subluxation of the hip, the consequences of aseptic necrosis, in addition to hypertrophy of the transverse ligament of the acetabulum, hypertrophy and deformation of the lower osteochondral sections of the acetabulum in the region of its notch are observed. These changes in the lower parts of the cavity violate the congruence of the articular surfaces and are the cause of both lateroposition and decentration of the femoral head, and its mechanical trauma after reduction, followed by early development of arthrosis of the hip joint.

The disadvantage of the known method of surgical treatment of children with hip dislocation is that it does not solve the problem of lateroposition and decentration of the femoral head, as well as its mechanical trauma after reduction.

The objective of the invention is to increase the effectiveness of surgical treatment of children with subluxation and dislocation of the hip by preventing decentration and mechanical trauma to the femoral head to improve the function of the hip joint and prevent early coxarthrosis.

The method can be used in children from 1 to 17 years of age.

The technical result of the task is achieved by the fact that in the method of surgical treatment of children with hip dislocation (open reduction of the hip), which consists in dissection of the joint capsule, removal of the fat pad, round ligament of the femoral head and transverse connection of the acetabulum with subsequent reduction of the head into the cavity, it is proposed before by repositioning the femoral head into the cavity, perform resection of hypertrophied areas of the lower osteochondral sections of the acetabulum in the area of its notch.

In FIG. 1 shows a diagram of the pelvic bone with hypertrophy and deformation of the lower osteochondral sections of the acetabulum in the region of its notch.

Pos. 1 - ilium.

Pos. 2 - pubic bone.

Pos. 3 - ischium.

Pos. 4 - hypertrophy and deformation of the lower osteochondral sections of the acetabulum in the region of its notch.

In FIG. Figure 2 shows a model of a reconstructed hip joint of a patient with hip dislocation, hypertrophy and deformity of the lower osteochondral parts of the acetabulum in the region of its notch.

Pos. 5 - femur.

In FIG. Figure 3 shows a model of the reconstructed hip joint of a patient after open reduction of the femur and resection of the lower osteochondral parts of the acetabulum in the region of its notch.

Pos. 6 - resected sections of the lower osteochondral sections of the acetabulum in the area of its notch.

In FIG. Figure 4 shows a radiograph of the hip joint of a patient with hip dislocation before surgery according to the proposed method.

In FIG. 5 shows a radiograph of the hip joint of a patient with hip dislocation immediately after surgical intervention according to the proposed method. The application of the method for restoring congruence in the hip joint provided a concentric reduction of the femoral head into the cavity.

In FIG. 6 shows a radiograph of the hip joint of a patient with hip dislocation 3 years after surgery according to the proposed method. The application of the method for restoring congruence in the hip joint ensured the full development of the hip joint with the growth of the child.

The method for restoring congruence in the hip joint with open reduction of the hip in children is as follows:

The position of the patient on the operating table on the "healthy" side. An angular incision of the skin and subcutaneous tissue in the upper third of the thigh along the outer surface. After a cruciform dissection of the wide fascia of the thigh, the gap between m. gluteus media and m. tensor fascia lata. Mobilize the anterior and posterior edges of m. gluteus media.

At the place of attachment to the lesser trochanter, the m.iliopsoas tendon is highlighted and crossed. The joint capsule is accessed.

Produce anterior-upper arthrotomy. The duplication of the capsule is excised. The round ligament is cut off from the head of the femur; the fat pad and transverse ligament are removed from the cavity of the acetabulum. A visual and palpatory assessment of the lower osteochondral sections of the acetabulum in the area of its notch is performed. With their hypertrophy and deformation with Luer or Liston forceps, pathologically altered areas are resected until the smooth surface and congruence of the femoral head and acetabulum are restored. The reduction is performed, the centering of the head in the cavity is assessed and the exclusion of its trauma during movements in the hip joint.

The joint capsule is sutured. If necessary, an external fixing needle is carried out. The wound is sutured tightly in layers. Aseptic bandage. A control radiography of the hip joints is performed in the anterior-posterior projection and the operated limb is immobilized with a coxite plaster cast.

The positive effect of the invention is as follows: resection of hypertrophied and deformed bone and cartilage sections of the lower parts of the acetabulum in the region of its cutting allows solving the problem of lateroposition and decentration of the femoral head, as well as its mechanical trauma after reduction. This will improve the function of the hip joint and ensure the prevention of early coxarthrosis.

Claims (1)

A method for restoring congruence in the hip joint with open reduction of the hip in children, which consists in dissection of the joint capsule, removal of the fat pad, round ligament of the femoral head and transverse connection of the acetabulum, followed by reduction of the head into the cavity, characterized in that before reduction of the head, resection of hypertrophied areas is performed lower osteochondral sections of the acetabulum in the region of its notch.

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