SU1584921A1 - Method of plasty of injured proximal end of thigh bone - Google Patents

Abstract

The invention relates to medicine, namely to orthopedics and traumatology, and is used for defects of the proximal end of the thigh. In order to provide movements in the hip joint, the proximal end of the thigh is grafted with a free autograft of the first metatarsal bone on the vascular pedicle, ensuring continuous objective monitoring of the blood supply to the graft by incorporating a skin flap attached to the skin wound. Restoration of the function of the donor foot is ensured by moving the second metatarsal bone on the muscular pedicle to the position of the first and subsequent joining of the diaphysis of the main phalanges of the I-II-III toes by a bone graft.

Description

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

The aim of the invention is to provide movements in the hip joint in young children and to ensure the function of the donor foot.

The method is carried out as follows.

From the incision on the dorsum of the foot, the dorsal artery of the foot and the great saphenous vein are exposed, starting from the circular ligament to the head of the metatarsal bone. I metatarsal bone is dissected from metatarsophalangeal and metatarsal-spine-like joints, separated from surrounding tissues, maintaining communication with the vascular bundle, including the dorsal artery of the foot and the great saphenous vein. The artery and vein are cut off at the level of the circulatory ligament, with the skin containing 1.0 1.0 cm in size. The second metatarsal bone and the second metatarsophalangeal joint, the short muscles of the foot attached to the indicated skin are removed from the surrounding tissues. education m. The transverse osteotomy of the second metatarsal bone is performed at the level of the proximal metaphysis, the II stubbyalphalangeal joint is dissected and the second metatarsal bone on the muscular pedicle consisting of short muscles of the foot is replaced. The main phalanxes of I-II-III toes are exposed at the base and the bone graft is introduced through their diaphysis in the transverse direction to further stabilize the foot.

The proximal end of the femur is exposed, the hilus is removed from the scar tissue, the first metatarsal bone is connected to the proximal spine.

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hip using an Ori screw; anteversion angle 10 and a cervical – diaphyseal angle up to 115 °. Then the metatarsal bone is placed in the acetabulum. A superficial artery and a vein, enveloping the iliac bone, with which the artery and vein of the graft are anastomosed using microsurgical techniques, are separated from the incision in the pa-Khova region. The skin flap included in the {vascular pedicle is hemmed to the edges of the skin incision. The wound is sutured in layers tightly and the limbs are attached (position of slight bending for 3-4 weeks.

Example. Patient T., 6 years old, was hospitalized for a defect in the proximal end of the femur. In the history of acute hematogenous osteomyelitis of the left hip, complicated by pathological dislocation of the hip. Surgical treatment - the tilt of the greater skewer with the reduction of dislocation due to postoperative suppuration was ineffective, since the resorption of the proximal end of the thigh occurred. On admission the patient did not walk, an anatomical shortening of the left leg by 8 cm was noted / there were no active movements in the left hip joint. Attempts at passive movements caused pathological over-bending at the level of the proximal end of the thigh. Radiographically, there was a complete absence of the neck, head, and proximal end of the thigh. According to this method, an intervention was carried out to collect the first metatarsal bone in the left foot region, replacing donor defect II with the metatarsal bone. The defect of the proximal end of the femur is replaced by the I metatarsal bone with the imposition of microvascular anastomoses. On the left lower limb, a half-and-half coxit dressing is applied. The postoperative period proceeded smoothly, the wound healed by primary tension, the color of the skin flap, stitched to the edge of the wound, remained pink. After 4 weeks removed the front cover of the gypsum

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rehabilitation programs have been initiated. After 3.5 months, recovery of active and passive movements in the hip joint was noted. Radiological examination showed complete confluence of defects at the site of the transferred II metatarsal bone. “A comprehensive biomechanical study showed a complete restoration of the function of the left foot.

Thus, the proposed method of plastics the proximal end of the femur when it is defective by growing free autograft on the vascular pedicle has the following advantages: it restores movements in the hip joint, prevents postoperative complications due to the feeding vessels of the graft, provides graft growth during the growth of the child, preserves the function donor foot by replacing the donor I metatarsal bone by the second. The presence of a skin flap in the composition of the vascular pedicle and stitched to the skin wound provides continuous objective monitoring of the state of blood circulation in the transplanted graft.

Claims (2)

1. A plasty of the affected proximal femur by replacing it with an autograft on the vascular pedicle, characterized in that, in order to provide movements in the hip joint in young children, the first metatarsal with distal epiphysis is taken as a graft and the growth zone, and in the composition of the vascular pedicle of the graft include a skin flap and fix it above the vascular anastomosis. 2. The method of pop. 1, which differs from the fact that, in order to ensure the function of the donor foot, the second metatarsal on the muscle leg is moved to the position of the first metatarsal bone and the diaphysis of the main phalanges of the I-II-III toes. transplant