SU1199240A1 - Method of treatment of hypoplastic coxarthrosis of adults - Google Patents

Description

The invention relates to medicine, in particular to operative orthopedics, and can be used in the surgical treatment of diseases of the hip joint.

The purpose of the invention is to reduce the duration of treatment.

FIG. 1-3 shows the hip joint, the main stages of surgery.

The method is as follows.

With the access of Degas-Zavradnichek, the spitting area is exposed. The small elevator is driven by the femoral neck and the gluteal muscles are removed outwards, the second elevator is brought by the small skewer under the iliopsoas muscle, diverting the leading muscles inwards. These techniques open up the front surface of the intertrochanter area all the way from the small spit to the top of the large spit. Outwardly from the intercavity line on the limited width of the area, the subperiosteal expose the intercavity area from the small spit to the top of the greater spit.

Then, with a grooved chisel, an arcuate bone dissection is made from the upper edge of the lesser skewer to the tip of the greater skewer outwards from the intertrochanter line (Fig. 1), after which, from the lesser spit, a single-toothed hook is pulled over the femoral neck displacement of dissected osteotomized fragments relative to each other along the arc of osteotomized fragments relative to each other along the arc of osteotomies by the required amount of variation by the known method (Fig. 1 and 2). Fragments are temporarily fixed with an awl held outside the great skewer inward parallel to the upper edge of the femoral neck.

Subperiosteal expose the inner surface of the intertrochanteric region from the lower edge of the arcuate osteotomy perpendicular to the axis of the diaphysis of the femur. For the neck of the femur, the Gigley saw is turned on and from the inside outwards the transverse osteotomy of the femur is performed through the lower point of the arcuate osteotomy (Fig. 1). Moving the handle of the fixing awl anteriorly, rotate the bone fragments of the proximal end of the thigh posteriorly, which eliminates excessive anthetory. The distal fragment of the femur is displaced medially by 1.5 cm (Fig. 1 and 2) to relieve spasm of the adductor muscles of the thigh, reduce the lever arm of their action, and also to reduce the load on the internal division of the knee joint, according to the common biomechanical axis of the lower limb. The fragments are fixed with a metal device, after which the awl is removed (Fig. 3).

Example. Patient A.S.N., 26 years old, was admitted to the orthopedic department of the Sverdlovsk scientific research institute of traumatology and orthopedics with a diagnosis of bilateral hypoplastic coxarthrosis stage 1–2 and extensor-contraction-abduction-rotational contracture of the left hip joint.

On admission, the patient was worried about persistent pain in the left hip joint, which was aching at rest, and acute when walking. The length of the limbs was the same both relative and in segments. Walking the patient was accompanied by lameness on the left lower extremity, did not use additional support when walking.

On the radiograph of the left hip joint, the head of the left hip is displaced proximally, at the level of the base of the Ilium forms a non-arthrosis, the distal section of which is located at the level of the upper edge of the articular cavity. The cervical diaphragmatic angle of the left femur is 145 °, the angle of true anteversion is 25 °; during abduction and internal rotation of the left thigh, the head is centered in the cavity. The patient underwent an operation according to the proposed method on May 12, 1983. The Degas-Zahradnichek access revealed a spitting area on which 2 lines were subperiosteally with a chisel along the course of future osteotomies: the first is outward from the intertrochanter line in the direction of the small skewer to the vascularization proximal femur, and the second - from the small trochanter transverse to the axis of the diaphysis of the femur. The tendon of the iliopsoas muscle is cut off from the small skewer. For the neck of the thigh from the side of the small skewer, a saw saw was wound, with the help of which the femur was transversely cut 1/3 of the diameter over the top edge of the small skewer. From the same point as the transverse osteotomy, the arcuate osteotomy was made outwards from the intertrochanter line with a grooved chisel, after which the cross-sectioning of the bone was completed.

As a result of the osteotomies produced, a triangular spit fragment of the femur was formed, while the gluteal muscles (vascularized autograft) remained attached. The deformity of the proximal femur was corrected in two planes: with a single-toothed hook set around the femoral neck, the proximal fragment was displaced relative to the middle fragment upwards along the articulated osteotomy arch. The proximal and middle fragments of the upper end of the thigh are fastened about 1199240

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stitched from the outside to the inside, which was used as a lever for centering the femoral head.

As a result of these manipulations, valgus deformity and ₍ excessive antetration of the proximal femur, distal fragment of the femur is shifted inwards from the middle fragment by 1 cm and all fragments fixed by metal structures to their complete immobility are removed simultaneously. The awl was removed from the two upper fragments ¹⁾ .

The postoperative course is smooth, primary healing. On a radiograph, three weeks after surgery, the primary signs of fusion of bone fragments on two levels (blurring of the contours of the contact fragments, indicating the beginning of endosteal fusion), and after 2 months. endosteal fusion

is over. After 3 months after surgery, the patient is allowed to walk with a partial load of the operated limb, and after 6 months. after surgery - with full load. In the same period removed the lock. Pain in the left hip joint is absent, the length of the operated limb has not changed. Movement in the left hip joint restored to the level of preoperative. The patient walks with a cane, the operation is satisfied.

The invention provides a reduction in terms of treatment by optimizing the conditions of adhesion of bone fragments after correcting excessive values of the cervical-diaphysary angle and antatortion angle, since osteotomy does not damage the vascular-muscular gate in the region of the intertrochanteric lines and the femoral crest, which preserves the vascularization of the bone fragments and the length of the operated limb.

FIG. 2

FIG. 3

Claims (1)

METHOD OF TREATMENT OF HYPOPLASTIC COXARTHROSIS IN ADULTS by means of a double figured intertrochanteric osteotomy with the formation of autograft, characterized in that, in order to shorten the treatment time, osteotomy from the side of the skewtus is performed, with one cross section being arcuate to the top of the other, another person has to cross the other crosswise cross-section of the cross, another person has to cross the other skullcap. to the big spit. WITH WITH Yu FIG. / 1199240