SU1454422A1 - Method of treatment of contracture of knee joint in case of rheumatoid arthritis - Google Patents

Abstract

This invention relates to traumatology. The purpose of the invention is to prevent the development of ankylosis. After synovectomy, transverse osteotomy of the femur is performed at the level of the distal metadiaphisis. The end of the proximal fragment is inserted into the bone marrow canal of the distal fragment. The lateral ligaments of the knee joint are extended, the quadriceps of the femur is divided into two halves in the frontal plane and the posterior part of the tendons is held under the patella, and the front part is duplicated in the form of a duplicate to the upper pole of the patella. The method allows to prevent shortening of the leg. Q €

Description

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This invention relates to medicine, namely to traumatology and orthopedics.

The purpose of the invention is the prevention of ankylosis with the prevention of trauma to the neurovascular bundle.

The method is carried out as follows.

A semi-oval incision is made in the skin, subcutaneous tissue and fascia, which goes around the patella outside and continues along the front surface of the thigh to its middle third. The lateral spinal thigh muscle is cut from the tendon of the quadriceps thigh muscle within the tendon stretch. The patella is dislocated into the wound and is displaced inwards along with the skin-fascial flap. The affected synovial membrane, capsule, granulation tissues, cicatricial growths in the joint area are excised. The cross bridges are cut through Z-shaped, and when they change, they are cut off completely. Formation of the articular ends of the femoral region 15

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tibia and patella by excision of the intra- and periarticular Cicatricial and bone growths or by separating the ankylosis site along the line of the former joint space, giving them or retaining their natural shape. In the upper corner of the wound, the subperiosteal expose the femoral bone and cross transversely at the level of the distal metadiaphysis. The end of the proximal fragment is punctured and inserted into the medullary canal of the distal fragment, thus eliminating the flexion contracture in the knee joint. In the event of excessive tension of the lateral bonds, the Z-shaped elongation of the latter occurs. Fragments of the femur are fixed with a plate and screws, and the lateral ligaments of the knee joint are sutured with polyester seams. When the integumentary cartilage is destroyed, the articular ends of the femoral and tibial bones are overlapped with canned dura mater or fascia. Lavan grooves are applied to the cruciate ligaments, hollow 4;

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| kiva articular end of the tibial bone tH in the correct position relative to the articular end of the femur. The tendon of the quadriceps femoris is dissected into two halves in the frontal plane at the upper pole of the patella. The posterior portion of the quadriceps tendon is cut off from the site of attachment, held over the patella, and stitched to the edges of the patella and to the edges of the patella with mylar seams in the position of natural tension of the quadriceps femoris. The anterior portion of the tendon-PIA quadriceps is shortened as a duplicator and hemmed to the upper pole of the patella. The lateral broad muscle of the thigh is stitched in the same place. The wound is sutured in layers. Immobilization of the extremity of the posterior Gypsum Longuet is carried out for 7-8 days.

Example. Sick UD, 9 years old. He enrolled in the juvod of the articular form of rheumatoid arthritis. The patient himself did not move due to pronounced contractures in the root joints (90 ° to the right, 85 ° to the left). A semi-oval skin incision, subcutaneous tissue and fascia, rounding up, patella outside and an edge along the front surface up to its middle third was made. Outside The thigh muscle is temporarily cut off from the muscle of the quadriceps of the thigh, in tendons of the tendon. The suture is dislocated into the wound and mixed, en medially. The sclerotic capsule, adhesions, and granulation tissue were removed from all parts of the joint. In this case, the iZ-shaped dissected stretched posterior cruciate ligament. The anterior cruciate ligament and menisci were completely destroyed by the rheumatoid process. Economical | BUT, on a thickness of 5 mm, the deformed articular surface of the tibia is resected. Through the upper part of the wound, the subperiosteal femur is separated and crossed transversely at the level of the distal metadiaphysis. The distal end of the pro-: maximal fragment is sharpened and implanted into the bone marrow canal to a depth of 25 mm. The fragments of the femur are fixed to each other by a plate and four screws. At the same time, a decrease in flexion contracture in the knee joint was noted, and the tension of the flexor muscle tendons disappeared. To achieve full extension of the knee joint, Z-shaped dissected, lengthened by 5 mm and side ties sutured with polyester. The structure disappeared completely, movement in the joint - 50-185 °.

The joint surface of the tibia is wrapped with tinned dura mater. Restoration of the posterior cruciate ligament.

An overly extended tendon of the quadriceps femoris is dissected in the frontal plane 60 mm up from the level of the upper pole of the patella. The posterior portions of the tendons are cut off from the site of attachment and passed under the patella and hemmed to its edges and to the patellar own connection at the lower pole. The front portions of the tendons are laid in duplicate and hemmed to the upper pole of the patella. The wound is sutured in layers tightly. In the postoperative period, physiofunctional measures were performed. When viewed in the long term of treatment, satisfactory movements in the knee joint were noted, and the patient was able to move.

The proposed method allows restoring mobility in the knee joint, preventing trauma of the neurovascular bundle, and returning patients the opportunity to actively move.

Claims (1)

Invention Formula A method of treating a knee joint flexion contracture for rheumatoid arthritis by removing the synovial membrane, capsule, Cicatricial and bone growths, characterized in that, in order to prevent ankylosis with prevention of trauma to the neurovascular bundle, after the synovectomy, the femur bone was subjected to the heart of the heart, and it wasn’t possible to use the systolic bone tissue to prevent ankylosis with preventive treatment of the neurovascular bundle. its end is in the metaphysis, the lateral ligaments of the knee joint are extended, the tendon of the quadriceps muscle is cut in the frontal plane into two halves and the posterior sexes are held Inu tendons under the patella, and the front in the form of duplicatory stitched to the upper pole of the patella.