SU1637768A1 - Method for treatment of destruction of the femoral condyle accompanied by displacement of the growth area in the intact condyle and angular deformity of the knee joint in children - Google Patents

Abstract

The invention relates to medicine, namely to orthopedics and traumatology in the treatment of the destruction of one of the femoral condyles with a violation of the location of the germ zone of the other with angular deformity in the joint in children. To prevent deformity by changing the position of the germ zone, the femoral osteotomy is performed over the defect in the articular zone bone, then osteotomy over the preserved condyle slanting downward to the middle of the intermylkalkovoy bone, the middle fragment is reduced to the level of the lower pole of the saved mouse; Single with simultaneous angular correction in the joint pieces and set the sprout zone perpendicular to the axis of the femur to form a reclaim subsequent fixing and development movements. J

Description

The invention relates to medicine, namely to reconstructive interventions on the knee joint.

The purpose of the invention is to prevent deformation by changing the position of the germ zone.

The method is carried out as follows.

The position of the patient on the back. Make a parapatella skin incision from the lower pole of the patella upwards 8 - THEN see. Layers form an approach to the distal end of the femur. At the level immediately above the defect, the femoral condyle with a chisel produces transverse osteotomy of the femur. The second osteotomy is performed below the first one - approximately from the place of 1 cm above the intact condyle obliquely downwards to the middle of the inter-myeloidal microarray. During osteotomy, the periosteum and soft tissue from the femur do not exfoliate to maintain blood supply.

In parallel, 2 Kirschner needles, 2 mm in diameter, are introduced in an oblique direction from the bottom upwards from the side through the tibia into an osteo-tom fragment of the femur. The ends of the spokes are bent. A metal rod with an end screw thread in the frontal plane parallel to the growth zone of the condyle and the Kirschner needle in the sagittal plane of the condyle are inserted into the intact condyle of the femur. The surgical wound is sewn up in layers.

Next, rods and spokes are inserted to overlay the Kalnberz external fixation device: one rod with a screw end

ABOUT

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cross-cut and Kirschner knitting cross at the level of the middle third of the thigh; two pairs of Kirschnerz spokes cross to the level of the upper and middle third of the leg.

The layout of the external fixation device is carried out as follows: the proximally located rod and the needle above the transverse osteotomy line are fixed on the same ring; through the intact condyle, the stem and the spu are fixed on the half ring; cross-cutting the tibia with the spokes fastened to the rings at Each level; two in parallel, through the osteotomized fragment, the held spokes are fixed 15 on a ring located distal to the others. All rings are segmentedly connected by three to four rods.

After 7–10 days after surgery, a gradual 20 reduction of the middle / osteotomized fragment of the femur was performed by distraction of the distal ring at a rate of 1 mm per day. The middle osteotomized fragment of the femur is gradually reduced to 25 achievements of the lower pole level of the in- condial condyle. At the same time, aalgus or varus deformities of the distal end of the femur are corrected by compression between the proximal 30th ring and the semiring. After correction of the epiphysmal sprout zone, the intact condyle should be perpendicular to the axis of the thigh.

Periodic radiological monitoring of the movement of bone fragments was carried out. When the osgeohomized middle fragment is reduced to the articular / w joint, 2 additional Kirchier's spiases are cross-crossed through the reduced 40 fragment of the intact condyle and fixed to the ring. The knitting needles, previously passed through the octeoiotic fragment, are removed. The apparatus is removed from the lower leg and the knee is released for functional treatment.

During treatment in the apparatus, walking on crutches with a load on the back is permitted. congenital leg. The load is gradually increased. The device is completely removed 50 after restoration of the bone structure at the site of the distraction regenerate and osteo-Composer P. ip oa Tehred M. Morgenthal

Tommy. After removal of the apparatus, the load on the injured limb is terminated and active functional treatment of the knee joint is started. Depending on the wedge of the X-ray picture, the load is gradually increased.

Example. Sick V., born in 1983, was diagnosed with a destruction of the external condyle of the femoral bone of the epithelial osteomyelitis of the distal hip bone. Valgus curvature of the right knee joint.

On admission, a rhomotum, valgus deformity in the knee joint 80 °, movement in the knee joint 0/35/120, pathological lateral discomfort in the joint in a volume of 35 ° was observed. X-ray logically - a defect of the lateral condyles subluxation of the tibia outward and anteriorly, out of the patella.

At the age of 5 years, a correcting osteotomy and the distal end of the bone bone were produced according to the proposed procedure.

Elimination of the deformation by gradual correction in the external fixation device Kalnberz during the day. Fixation in the device for 5 months.

After the treatment with the proposed method, the correct anatomical relationship in the knee joint, the rules on the axis and the bearing of the lower flesh, the joint apparate of the knee joint is stabilized. No pain.

Claims (1)

The invention of the method of treating the destruction of the femoral condyles when the sprouts of the area of the conserved condyle are displaced with angular formation in the knee joint in children with the osteotomy of the condyle of the femoral bone of the dosed fractional contraction with the formation of regenerate to establish congruence and elimination of angular deformity development, distinguishing us m ft so that, with the aim of warning deforiutzmi due to the change put r..g: t / .ovogo zone, additionally deploy Fragment before the formation of the regenerator s bischelka install sprout zone condyle perpendicular thigh KOST1 Proofreader N. Revska Editor V.Kovtun Order 881 Circulation 426 Subscription VNIIPM State Committee for Inventions and Discoveries at the State Committee on Science and Technology of the USSR 113035, Moscow, Zh-35, -Raushska nab., 4/5 Tommy. After removal of the apparatus, the loads on the injured limb are stopped and active functional treatment is started in the knee joint. Depending on the clinical x-ray picture, the load is gradually increased. Example. Sick V., born in 1983, was diagnosed with destruction of the external condyle of the femur of the epiphysial osteomyelitis of the distal end of the femur. Valgus curvature in. areas of the right knee joint. On admission, lameness, valgus deformity in the knee joint 80 °, movement in the knee joint 0/35/120, pathological lateral laxity in the joint in a volume of 35 ° was observed. Radiographically - defect lateral condyle, subluxation of the tibia outward and anteriorly, dislocation of the patella. At the age of 5 years, a corrective osteotomy of the distal end of the femur was made according to the proposed technique. The elimination of the deformation was made by gradual correction in the external fixation device of Kalnberz for 45 days. Fixation in the device for 5 months. After the treatment with the proposed method, aostacioalene has the correct anatomical relationships in the knee joint, the axis and the support of the lower limb are correct, and the knee joint apparatus is stabilized. No pain. The invention The method of treating the destruction of the femoral condyle when the sprouting zone of the preserved condyle is displaced with angular deformity in the knee joint in children by osteotomy of the condylar part of the femur by metered reduction of the fragment with the formation of a regenerate until congruence is restored and the angular deformation of the joint is reconstructed to remove the angular deformity in order to restore the congruence and eliminate the angular deformity in the joint with the development of the regenerate until the congruence is restored and the angular deformity is removed in order to restore the congruence to recover the congruence and eliminate the angular deformity of the femoral bone. m ft so that, in order to prevent deforming due to a change in the position of the r ... r: t /. of the upper zone, the Fragment is further deployed to Vani reclaim forms bischelka install sprout condyle area perpendicular to the femur KOST1 Proofreader N. Revska