RU2820506C1 - Method for femoral corticotomy in distal one-third - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for femoral corticotomy in a distal one-third. Consecutive counter perforation of cortical plates is performed along the planned fracture line. For this purpose, osteoperforations are drilled with drill bit or wire from two opposite sides of the femoral bone to the depth of the cortical layer. Osteotome equipped with a spike on the cutting edge is used for dissection of the cortical layer of the bone. Spike of the osteotome is placed in the perforated holes, and sections of the cortical plasty are sequentially dissected between the holes by striking the handle of the osteotome.

EFFECT: method enables femoral corticotomy in a distal one-third with a predictable fracture line while maintaining the integrity of the bone marrow and other structures of the medullary canal by using an osteotome with a spike, which sequentially dissects sections of cortical plasty between holes.

1 cl, 5 dwg, 1 ex

Description

Field of technology.

The invention relates to the field of medicine, in particular to orthopedics, and can be used in the treatment of patients with shortenings and deformities of the lower extremities.

State of the art.

There is a known method of osteotomy of the femur in the distal third, “corticotomy according to Ilizarov” (Bloodless lengthening of the tibia using the method of distraction epiphysiolysis: Methodological recommendations / KNIIEKOT; Comp.: G.A. Ilizarov, V.I. Gracheva, V.K. Kamerin. - Kurgan , 1976. - 24 p.). The supports of the external fixation device are installed on the femur. Access is performed along the anterior outer surface of the thigh, in the distal third of the femur. Using an instrument (surgical chisel or osteotome), the cortical plate is crossed along the anterior outer and partially along the posterior outer surface of the femur. The anterior-internal and posterior-internal parts of the cortical plate of the surface of the femur remain intact. Next, the remaining uncrossed portion of the bone is fractured (osteoclasia) by rotating the supports of the external fixation apparatus in opposite directions.

Corticotomy using this method allows you to preserve the bone marrow intact, but does not always lead to a predictable fracture line of the femur; there is a risk of fracture of the uncrossed part of the bone along a line different from the planned one.

There is a known method of osteotomy of the femur in the distal third (Lengthening the femur after partial corticotomy according to Ilizarov in children and adolescents: Methodological recommendations / Ministry of Health of the RSFSR, All-Russian Scientific Center "VTO"; Compiled by: G.A. Ilizarov, A.A. Chipizubov, S. G. Lavrentyeva-Ilizarova. - Kurgan, 1987. – 32 p.). Access to the femur is performed. Using an instrument (chisel, osteotome), the cortical plate is crossed along the anterior-outer, posterior-outer, anterior-inner and posterior-inner surfaces of the femur.

A complete osteotomy of the femur using this method inevitably leads to damage to the structures inside the medullary canal, the bone marrow.

Thus, the problem with the known methods is that in the course of violating the integrity of the bone, while ensuring the integrity of the bone marrow and other structures of the bone marrow canal, there is a risk of obtaining a fracture line that differs from the expected one, and when obtaining the expected fracture line by completely intersecting the cortical plastic, it is not ensured preservation of the bone marrow and other structures of the bone marrow canal.

The objective of the present invention is to develop a method of corticotomy that ensures the preservation of bone marrow and other structures of the medullary canal, while obtaining a predictable fracture line of the femur.

The essence of the technical solution.

The technical result consists in obtaining a corticotomy of the femur in the distal third with a predictable fracture line while maintaining the integrity of the bone marrow and other structures of the medullary canal.

The technical result is achieved by the fact that in the method of performing corticotomy of the femur in the distal third, which includes making two opposite approaches to the bone, dissecting the cortical layer of the bone with an osteotome, sequential counter perforation of the cortical plates is performed along the planned fracture line, for this purpose the surface of the femur is drilled with a drill from two opposite sides or osteoperforation wire to the depth of the cortical layer; To dissect the cortical layer of the bone, an osteotome equipped with a spike on the cutting edge is used, the osteotome spike is placed in the perforation holes, and the sections of cortical plastic between the holes are sequentially dissected by striking the handle of the osteotome.

The invention is illustrated by diagrams:

Figure 1 is a diagram showing a cross section of a bone, a drill forming a perforation hole in the cortical layer of the bone, on one side of the bone surface;

Figure 2 is a diagram showing a cross section of the bone, the sequential position of the drill that forms perforations in the cortical layer of the bone, on one side;

Figure 3 is a diagram showing a cross section of a bone, an osteotome with a spike entering a perforation hole in the cortical layer of the bone;

Figure 4 is a diagram showing a cross-section of the bone, the sequential position of the osteotome with a spike entering the perforation hole in the cortical layer of the bone;

Figure 5 is a diagram showing a cross section of the bone, the sequential position of the drill that forms perforations in the cortical layer of the bone, on the opposite side of the bone surface.

Specification:

1- drill;

2- osteotome;

3- cutting edge;

4- spike;

5- perforation hole;

6- cortical bone

7- bone marrow.

Implementation of the invention (see Fig. 1 to 5, designations according to the specification).

The method is used to perform an operation to dissect the femur in the distal third. The method uses a drill 1 and an osteotome 2, which has a handle (not shown in the diagrams) for striking it, and a working part containing a cutting edge 3. The cutting edge 3 is equipped with a tenon 4, the tip of the tenon is intended for installation in perforation holes 5 made to cortical layer 6 of the bone, in order to fix the position. Osteotome 2 allows you to cross the cortical layer 6 to the depth of the cortical layer 6.

In the hip method, two opposite approaches are performed to the distal third of the femur. Using a tool (drill or wires and osteotome), the cortical plate is crossed along the perimeter of the surface of the femur. To do this, along the planned bone fracture line, perforation of the cortical plate is performed, holes are drilled with knitting needles (or a drill), sequentially located along the corticotomy line (but not connected to each other, the holes are made in increments of 3 to 8 mm), on two opposite sides of the femoral surface bones, to the depth of the cortical layer. Then, using an osteotome, the holes are connected to each other, cutting the cortical layer along the perimeter of the bone. The osteotome spike is sequentially placed in the holes made in the cortical layer of the bone, thereby fixing its position, hitting the osteotome handle, sequentially cutting the bone sections between the holes. A counter corticotomy is performed from two opposite approaches, which ensures contact of the working instrument with the cortical plate along its entire perimeter without penetration into the medullary canal. Preliminary successive counter osteoperforations of the cortical plates followed by their connection with an osteotome equipped with a spike (spout) create the possibility of obtaining a predictably specified fracture line of the femur.

Since the wires and ostetomes do not penetrate the medullary canal, a given fracture line is obtained without the need to perform osteoclasia of the cortical plates by rotation, and without traumatizing the structures of the medullary canal. The fracture line can be made in a given shape, in a given location, and predictably dissect the cortical layer of the femur.

An example of using the method.

After anesthesia and treatment of the surgical field using known techniques, osteosynthesis of the femur is performed using an external fixation device for a shortened and deformed hip. In a tensioned state, the spokes are attached to the supports of the external fixation device installed at the appropriate level and in the required plane. The latter are connected to each other by threaded rods and hinge units, ensuring their multi-plane movement relative to each other. Along the anterior inner surface of the thigh in the distal third: after a skin incision (ranging from 10 to 15 mm), in the projection of the intended corticotomy line, access to the surface of the femur is bluntly formed, under the “protection” of a cannulated guide with a drill with a diameter of 3.0 to 3, 5 mm, using a drill, osteoperforations are sequentially performed (anterointernal, internal and posterior internal cortical plates). Then, using an orthopedic hammer and a narrow osteotome with a spike (which helps to easily find the osteoperforation hole), step-by-step connection of the perforated holes (“windows”) is performed without the osteotome penetrating into the medullary canal. To complete the counter corticotomy, a contralateral skin incision of 10 to 15 mm is made, access to the surface of the femur is formed, with the same drill with a diameter of 3.0 to 3.5 mm, under the “protection” of a cannulated guide, osteoperforations are sequentially performed using a drill ( anterior, external and posterior external cortical plates). Using an orthopedic hammer and an osteotome with a spike, a step-by-step connection of the perforated holes is performed; individual holes create a continuous line without the osteotome penetrating into the medullary canal.

Rotational osteoclasia, which must be performed with one external approach, is usually not required. If rotational osteoclasia is required, it is easily performed, and the fracture line runs along the line of the holes.

The operation is completed by performing a control x-ray, stabilizing the apparatus systems, suturing the wounds and applying aseptic dressings.

The practical implementation of the method is illustrated by the following clinical observation.

Patient Ya., 14 years old, was admitted to the clinic with a diagnosis of pseudoachondroplasia, short stature, varus deformity of both knee joints.

To correct the deformity of the left femur and its lengthening, a counter corticotomy of the femur in the distal third and osteosynthesis with an external fixation device according to Ilizarov were performed.

During the operation, according to the method described above, corticotomy of the femur was performed from two opposite approaches (anterointernal and anterior external), having previously performed osteoperforations of the femur and then combining the perforation windows with a chisel and a spike into a fracture line in a given direction.

The operation was completed by performing radiography, the supports of the external fixation apparatus were stabilized, the wounds were sutured, and aseptic dressings were applied.

As a result of treatment, correction of deformities and the planned lengthening of the femur were achieved. The patient walks with full weight bearing on the operated limb. Full range of joint movements.

The use of the counter corticotomy method provides a given, predictable corticotomy trajectory, which is achieved by delicate counter operation of the instruments (drill and osteotome) at the same level on opposite sides of the femur, while preventing the fracture line from “moving” in the proximal direction (into the middle third of the diaphysis) or into distal direction (to the metadiaphysis, to the location of the wire).

In addition, the proposed technique reduces the time required to perform corticotomy and, most importantly, leaves the structures of the medullary canal intact.

In general, this improves the anatomical and functional results of treatment of patients with shortening and deformities of limb segments.

The technical result consists in obtaining a corticotomy of the femur in the distal third with a predictable fracture line while maintaining the integrity of the bone marrow and other structures of the medullary canal.

Claims (1)

A method of performing corticotomy of the femur in the distal third, including making two opposite approaches to the bone, dissecting the cortical layer of the bone with an osteotome, characterized in that successive counter perforation of the cortical plates is performed along the planned fracture line; for this purpose, the surface of the femur is drilled from two opposite sides with a drill or using an osteoperforation wire to the depth of the cortical layer; To dissect the cortical layer of the bone, an osteotome equipped with a spike on the cutting edge is used; the osteotome spike is placed in the perforation holes and the sections of cortical plastic between the holes are sequentially dissected by striking the handle of the osteotome.