SU1489741A1 - Method of treating aseptic necrosis of head of the femur - Google Patents

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of aseptic necrosis of the femoral head. In order to restore movement in the joint in the early postoperative period, due to the restoration of the head shape, segmental excision of the altered tissues is performed and the defect is replaced with an autograft with a cortical layer of the greater trochanter.

The invention relates to medicine, namely to surgical orthopedics.

The purpose of the invention is the restoration of movements in the joint in the early postoperative period due to the restoration of the shape of the head.

. The proposed method is as follows.

On the front-side of the thigh from the front-upper spine through the middle of the greater trochanter down to the lower border produce an incision in the skin and underlying tissues. Artrotomy. The head of the femur is dislocated into the wound, providing access to its diseased segment. A segmental resection of a necrotic focus is performed together with peeled cartilage to healthy bone tissue. The boundary of healthy bone tissue is determined by its staining with a solution of ampullated methylene blue 10.0 pre-introduced into a large skewer.

The subperiosteal strip exposes the outer surface of the greater trochanter, from which a free cortical-spongy graft is dissected, in shape and size exactly corresponding to the defect of the head. A free graft is placed in a defect by adding crystalline chymotrypsin in an amount of 30-40 mg so that the cortical surface of it repeats the articular surface of the head.

After plastics, the head is reduced to the acetabulum, and the graft in the substituted part is retained due to the constant compression, which is formed by the natural intra-articular pressure.

The operation is completed by suturing the joint capsule and sutured the layers in layers. After surgery, the limb is placed on the Beler splint in the retracted position. After the sutures are removed, passive development of movements in the operated joint is performed according to the generally accepted method.

Example. Patient K. B., 37 years old, entered the orthopedic department with complaints of persistent severe pain in the right hip joint, the impossibility of loading the limb. Sick since 1978 was treated conservatively, but the condition worsened. Upon admission to the department walks on crutches, without loading the right leg. Flexion in the right hip joint to 110, the extension is complete, painful.

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1489741

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Lead, cast and rotational movements are practically absent. The relative shortening of the limb is 1 cm. On the radiograph of the right, hip joint in the position of abduction, necrosis 5 of the upper pole of the head is determined, its fragmentation and impression are disturbed by the continuity of the articular cartilage. Diagnosis: aseptic necrosis of the head of the right femur stage III. The patient under the general anesthetic | θ operation was performed - segmental resection of the upper pole of the head to healthy bone tissue together with delaminated cartilage. Subperiosteal naked outer surface of the greater trochanter. A trans-plantation free identical size was taken, which was placed in the resulting head defect along with 40 mg of crystalline chymotrypsin. After that, the head is set in the acetabulum. Superimposed hermetic seams on the joint capsule. Layer wound closure, stitches on the skin. On the postoperative radiograph of the right hip joint in the anteroposterior projection, the articular contour of the head and the congruence of the joint are fully restored. In the area of the large skewer 25 there is a cortical-spongy defect. On the control radiograph through

the year after the operation is determined by the complete fusion of the graft with the head bed, the restoration of the articular contour and the shape of the head. The joint gap is uniform. The ratio in the joint is correct. The defect of the big skewer decreased and acquired clear contours. The patient walks without additional support. The function of the operated joint in full.

The clinical efficacy of the proposed method consists in the restoration of the femoral head, the mobile and supporting joint function and the reduction of treatment time for aseptic necrosis of stage III compared with the known.

Claims (1)

Claim A method of treating aseptic necrosis of the femoral head by segmental excision of altered tissues and replacement of a defect with a bone graft, characterized in that, in order to restore movement in the joint in the early postoperative period due to restoration of the shape of the head, an autograft is formed with a cortical layer of a large trochanter.