SU1600735A1 - Method and apparatus for treating deformation of knee joint - Google Patents

Abstract

The invention relates to medicine, namely to orthopedics and traumatology in the treatment of varus deformity of the knee joint with an external torsion of the tibia. In order to prevent arthrosis by providing congruence of the articular surfaces with the elimination of external rotation of the tibia, the periarticular hinge osteotomy of the tibial bone with correction of the limb axis is carried out, the place of attachment of the bone plate with its own ligament of the patella is additionally moved, the lateral ligaments supporting the patella are dissected medially. A device for implementing the method comprises a housing 1 in the form of a plate, having the shape of a semicircle with through holes 5, which play the role of guide sleeves. In the central part of the plate there are holes for fastening. 2 Il.

Description

1

The invention relates to medicine, namely to orthopedics and traumatology, and can be used to perform periarticular osteotomy in the area of the knee joint.

The purpose of the invention is the prevention of arthrosis by ensuring the congruence of the articular surfaces with the elimination of external rotation of the tibia.

: The method is carried out as follows. A section of the fibula bone is dissected according to a known cut, soft tissues in the area of the tibial tuberosity are dissected, a guide device is installed on the ijcocTH, drilled through his channels, crossed with a long The bone bridges remaining between the channels perform the deformity correction by moving the distal fragment outwards until the normal loading axis is restored and the bone fragments are fixed in this position.

: From the longitudinal section open (the tibial tuberosity region is knocked out and its proximal part is knocked over, which joins the patella, and together with the pole, -: it is retracted to the side. A guide device with the apex offset is installed on the front surface of the exposed tibial bone its pre-calculated level under the outer condyle of the tibia and fix it to the bone using the fastening and three set screws so that the osteotomy plane is located strictly in the anterior-posterior direction the hole was located prior to the drill coming out of the bone, the length of the channel from the outer surface of the device to the back surface of the bone was measured, the required length of the drill was set taking into account the distance between Figure 1 shows the chuck and the upper surface of the Teflon gasket device, which eliminates friction between these surfaces. Channels are drilled into the bone through the holes of the guide device. The transfer device is removed, the remaining bone bridges are crossed, deformation correction is performed by moving the distal fragment outwards until the normal axis of the limb loading is restored, the bone defect formed on the inner surface is filled with graft, the cut ribs are laid on the formed by removing the periosteum and applying small A bone bed located medially from the former place of attachment of tuberosity for a distance that provides a normal angle of bondage nick, and fixed with its Of additional skin incision 2-3 cm long located at the edge of the patella verhnenaruzhnogo, dissect

from 1: |

lateral ligaments supporting the patella, the wound is sutured in layers.

Example. Sick G., 37 years old, entered 10.11.87 with complaints of pain in the right knee joint, crunch during movement, limb deformity in the rut joint, frequent dislocations of the patella. Notes that these phenomena are worried for about 10 years, the onset of the disease for no apparent reason, was treated on an outpatient basis, with no effect. Objectively: varus deformity of the right lower extremity is noted at the level of the knee joint, atrophy of the limb muscles. Increased lateralization of the tibial tuberosity is determined. Symptom is positive on both sides.

the function of the right knee joint 180–80 ° When bending to an angle of 150 °, there is a periodical lateral subluxation of the patella, while palpable fibro-modified lateral ligament supports supporting the patella.

On roentgenograms of the limb in the position of one hundred, the deformity is 18 °, the narrowing of the articular in the internal part of the right knee joint, the pronounced signs of deforming arthrosis of the internal part of the joint.

Diagnosis: dysplasi of the knee joints, 30 varus deformity of the right knee joint, patellar instability syndrome, 2 gonarthrosis.

11/21/87 an operation was performed on the right knee and right shin. After treating the operative floor under a general 35th anesthesia, the first stage is performed subperiosteal resection of the fibular portion. The second stage, from the longitudinal cut along the front surface of the upper third of the leg, exposes the area of the tibial tuberosity, its proximal part is knocked down, the transition to the patellar fold and those with a tie are retracted to the side. A guiding device is installed on the anterior-surface of the exposed tibia under the external condyle and is fixed to the bone with the fastening and three setscrews so that the osteotomy plane is located strictly in the anterior-posterior direction and is higher than the dissected tuberosity, i.e. 50 patelum attachment points. Drilled a hole before the drill exited the bone, measured the length of the channel from the surface of the device to the back surface of the bone, set the required length of the drill, taking into account the location 55 on it between the cartridge and the front surface of the wall of the Teflon gasket that prevents friction between these surfaces through the holes of the device 40

the guide drilled the channels into the bones, the sending device was removed, the remaining bone bridges crossed with an ear chisel, the deformity was corrected by moving the distal fragment outwards until the normal axis of the limb was restored. The bone defect that formed along the inner surface was filled with a graft, osteotomized tibial fragments at the end of each of the set screws are provided with a slot 13 for a screwdriver, and the second one is pointed and has a bearing pad 14.

The device is applied as follows.

A section of the fibula is resected at the border of its upper third and middle third. A longitudinal skin incision is then performed on the front surface of the -, „„ „,. .xw, .iri ja- K - - - ™ About the front surface was fixed with a pivotal device of the external tenth of the upper third of the leg in the area of the bulge-shaped ticnology nTrClU aULJ 7V4 / xtrr nii TsA, - .. f u «

focal fixation, cut-off tuberosity was laid on a bone that was formed by removing the periosteum and applying small incisions located medially from the former place of attachment of tuberosity on

of tibia. With the help of the chisel, the proximal part of the tuberosity is knocked down and, together with the link, the patella is retracted. On the front surface of the tibia ustanavlig -. f - .. h .111 rid..vyv.iu v vyjiDUJcucpuut5un the leagues established a height that provides a normal device, so that its top .. .. beyond the fixed wall 3 is under the center of the external condyle. Through the hole 7, drill a hole in the bone tissue and with the help of

Do it with a screw washer. From an additional incision 3 cm long, located along the upper outer edge above the "," - "" "g --v fixing screw 11, reinforce the knee pusher, cut the lateral ligaments, jO into the bone. At the same time, the installation of the device is supported by the software, „. „„ J J f

thirty

supportive patella. Hemostasis during surgery. Extrafocal tubular drainage, layered crevices on the skin.

In the postoperative period: weekly bed rest, then gradually develop movements in the knee joint, walking with a foreign support and metered load on the operated limb. The postoperative period was uneventful. The wound healed by primary tension. The fixing rod apparatus was removed after 60 days, the screw fixing the tibial tuberosity was removed 5 months after the operation. Control examination 05/20/88 (6 months after surgery). No complaints. The contours of the knee of the usual form. There is no inflammatory effect. The axis of the limb is correct. Joint function in full. Symptom Zolen is negative. With active movements in the joint, the patella slip is normal.

FIG. 1 shows the device, top view; in fig. 2 is a section A-A of FIG. one.

The device for treating the knee joint decompression comprises a body 1 in the form of a plate in the shape of a semicircle with bottom 2 and wall 3, which on both sides has bends 4 and is provided along its entire length, including bends 4, through holes 5 that play the role of sleeves. Bottom 2 and him. the protrusion 6 is provided with four holes 7-10 for fastening. Hole 7 has a conical

in a predetermined position, they are made by means of set screws 12 located in the threaded holes 8-10. If necessary, the fixing screw I 1 can be loosened or tightened. Making the conical shape of the hole 7 with the presence of a spherical chamfer therein, as well as the lower part of the spherical fixing screw head 11, allows the guide device to be installed with the set screws 12 in a predetermined position regardless of the shape of the tibial front surface. The device is installed so that the holes 5 are located in the strictly anterior-posterior direction, and the osteotomy plane passes above the cut tuberosity, i.e. the attachment point of the patellar tendon.

Aside from the center of the tibia, a test hole was drilled above the external condyle. Using a depth gauge, the distance from the upper surface of the back wall device d6 to the tibia is measured and the length of the drill is determined, taking into account the thickness of the Teflon gasket, which eliminates trauma to the vascular bundle lying behind the tibial bone. Teflon gasket prevents contact of the drill chuck with the guide device.

Through the holes 5, made in the wall 3 and the limb 4, the channels are drilled in the bone

  . .vv .. ,, -, h, UI1 and t, drills channels in the bone

inner surface and spherical face- 50. Unscrew the locking screw 11

KV and R HPM VPTa unn rifiu gdyi / 1lp 71gm11g1Y nr.rt IIо

C and It has a locking screw 11 for fixing the device in the bone. In this case, the lower part of the screw head 11 has a spherical shape. The holes 8-10 are threaded and have set screws 12 for positioning the device in a predetermined position relative to the bone.

and the sending device is removed. The remaining bone plates are crossed with a thin chisel. The distal bone fragment is retracted until the normal loading axis of the limb is restored. The defect formed on the internal surface of the tibia is filled with either a fragment of the previously cutted fibular bone.

One end of each of the installation screws is provided with a slot 13 for a screwdriver, and the other is pointed and has a bearing pad 14.

The device is applied as follows.

A section of the fibula is resected at the border of its upper third and middle third. Then, a longitudinal skin incision is made on the front surface of K - - - ™ O on the front surface of the upper third of the tibia in the area of the rigidity of the upper third of the tibia in the area of the bugs.

of tibia. With the help of the chisel, the proximal part of the tuberosity is knocked down and, together with the link, the patella is retracted. On the anterior surface of the tibia, a lisgy device is installed ..vyv.iu v vyjiDUJcucpuut5un, so that the top of its wall 3 is under the center of the external condyle. Through the hole 7, drill a hole in the bone tissue and with the help of

jO in on the bone. In this installation device. „„ J J f

thirty

25

in a predetermined position, they are made by means of set screws 12 located in the threaded holes 8-10. If necessary, the fixing screw I 1 can be loosened or tightened. Making the conical shape of the hole 7 with the presence of a spherical chamfer therein, as well as the lower part of the spherical fixing screw head 11, allows the guide device to be installed with the set screws 12 in a predetermined position regardless of the shape of the tibial front surface. The device is installed so that the holes 5 are located in the strictly anterior-posterior direction, and the osteotomy plane passes above the cut tuberosity, i.e. the attachment point of the patellar tendon.

25

Aside from the center of the tibia, a 40 test hole was drilled above the external condyle. Using a depth gauge, the distance from the upper surface of the back wall device d6 to the tibia is measured and the length of the drill is determined, taking into account the thickness of the Teflon gasket, which eliminates trauma to the vascular bundle lying behind the tibial bone. Teflon gasket prevents contact of the drill chuck with the guide device.

Through the holes 5, made in the wall 3 and the limb 4, the channels are drilled in the bone

and UI1 and t, drills channels in the bone

50.canas. Unscrew the locking screw 11

 50.canas. Unscrew the locking screw 11

about

and the sending device is removed. The remaining bone plates are crossed with a thin chisel. The distal bone fragment is retracted until the normal loading axis of the limb is restored. The defect formed on the internal surface of the tibia is filled with either a fragment of the previously cutted fibular bone.

bones, or donor bone. The bone fragments of the tibia are fixed. On the anterior surface of the tibia at a distance (medialization, downgrading or ventralization), providing the normal angle of the patellar tendon, form the bone bed by removing the periosteum and applying small incisions. The previously cut tuberosity is placed on the formed bone bed and fixed to the bone with

Research Institute of canals in the tibia in the sagittal plane, the intersection of the bone between the canals, retraction of the distal fragment before restoring the limb axis with subsequent fixation, characterized in that, in order to prevent arthrosis by ensuring the congruence of the articular surfaces with the elimination of external rotation of the lower leg, an osteotomy of the proximal is additionally performed Depth W liV / V 1 L iJ ft It J / "iiiv iij j I Жь ji aiLi, -....

HELP screw and serrated plate. The wound of the 10th tibial tuberosity of the tibial bone is sutured in layers with its own layer. The connection of the patella is displaced,

medial to ensure the physiological angle of the patellar ligament, followed by fixation to the tibia.

From an additional incision 2–3 cm long, located along the upper-outer edge of the patella, the lateral ligaments are dissected, the supporting ligaments supporting the patella are dissected. ° patellae.

2. Device for treating varus deformity of the knee joint, comprising a body with holes for attachment, characterized in that, in order to prevent arthrosis by ensuring the congruence of the articular surfaces, the body is made in the form of a plate of a semicircular shape with limbs and through holes mi on its surface, with a protrusion located in the middle of the plate.

At the same time, the patella shifts medially and occupies a normal position in the block of the thigh, excluding its dislocations and the appearance of retroponella arthrosis in the postoperative period.

Claims (1)

Invention Formula . Method for treating knee joint varus deformity by resection MASCY KNEE cyuiaBa uyicm jjcocr.uMn -v-fy. .... 1j--. parts of the fibula, 2 ° outcrop, and the mounting holes are made in the center of the tibia, the forming part of the plate and the protrusion. Research Institute of canals in the tibia in the sagittal plane, the intersection of the bone between the canals, retraction of the distal fragment before restoring the limb axis with subsequent fixation, characterized in that, in order to prevent arthrosis by ensuring the congruence of the articular surfaces with the elimination of external rotation of the lower leg, an osteotomy of the proximal is additionally performed otde- ....  tibial tuberosity with personal connection of patella, move it medial to ensure the physiological angle of the patellar ligament, followed by fixation to the tibia.  dissect lateral ligaments supporting the patella. Aa