SU1745221A1 - Method for treatment of a defect of the femoral neck - Google Patents

Abstract

Use: in medicine, specifically in traumatology and orthopedics, for the treatment of fractures and patellas of the femoral neck. The purpose of the invention is to reduce the time of adhesion by improving blood circulation. SUMMARY OF THE INVENTION: The anterolateral access to the hip joint exposes the defect area, refreshes the ends of the bone fragments, produces intertrochanter osteotomy over the small skewer and under the small skewer; Positive effect: shortening the treatment time due to shortening the healing time.

Description

This invention relates to medicine, namely to traumatology and orthopedics for the treatment of patients with fractures and false joints of the femoral neck.

The purpose of the invention is to reduce the time of adhesion by improving blood supply in the proximal part of the thigh.

The method is carried out as follows.

The position of the patient on a healthy side. Anterolateral access to the joint (skin incision from the anteroposterior spine is directed forward and downward to the patient skewer and further down the longitudinal shaft of the thigh diaphysis). With such an access, it is possible to penetrate the gap between the medial annual muscle and the muscle that tensions the wide fascia of the thigh. The capsule of the joint is opened and the area of the cervical defect is exposed, the scar tissue between the head of the thigh and the remnants of the cervix is exposed, the ends of the bone fragments are refreshed. Further, the lateral approach exposes the proximal femur up to 10 cm long enough to pick up the bone fragment and apply a diaphragm overlay of the retainer in the subsequent diaphragm, with only the outer lateral femur exposed by the subperiosteal lateral portion of the rectus femoris muscle. The saw blade is made intertransfer osteotomis over a small spit. The large skewer, along with the remnants of the neck, is retracted upwards. The lesser skewer, along with m.lllapsoas attached to it, is brought into the wound. Subject to osteotomy under the base of the lesser skewer. A bone metadiaseous cylindrical autograft 1.5-2.0 cm long is obtained together with m.iliapsoas attached to a small skewer (which is supplied by a.lltolumbalis and a.clrcumflexa Ilium profunda). The resulting bone fragment of the thigh diaphysis on the musculoskeletal pedunus &

fc

2

next you

It is carried to the cervical defect area. Moreover, this is done without any effort, since the exit of the pelvic cavity m.lllapsoas passes through the muscle lacuna and goes down the front surface of the hip joint, attached to the small skewer. After replacement of the femoral neck defect with bone autograft on the musculoskeletal leg, the femoral head and the bone autograft are fixed with a compressive metaphysis screw. A four-blade nail with a diaphysis pad is attached to the distal end of the screw, firmly connected to each other. There is a screw hole in the four-bladed nail. Moreover, the diaphysis pad is connected to a four-blade nail at an angle of 120-135 °, i.e. a valgus is known to be created between the diaphysis of the femur and the neck.

Thus, the four-blade lock is additionally fastened to the metaphorical screw, thereby eliminating the rotation of fragments due to the blades that enter the bone tissue, and using a nut at the end of the screw, a compression is created between the fragments. Since the hip diphase fixation is known to have an angle of 120-135 °, fragments of the femoral neck are set in a valgus position relative to the diaphysis of the thigh, thereby compensating for the shortening of the limb, since the bony cylinder on the diaphysis with a length of 1.5-2.0 cm is not compensated by anything. The fragments of the femur are brought together to one another, a compression is created between them and the diaphysial lining is fixed to the bone with screws. Observations showed that if before the operation the shortening of the limb reached 3-4 cm due to the dislocation of the thigh upwards, then after the operation the shortening of the limb remains no more than 1 cm, which is achieved due to the valgus of the neck. This is a perfectly acceptable shortening, especially in such a severe pathology. Moreover, such shortenings are easily compensated by orthopedic shoes.

Example. Ill M., 57 years old. Diagnosis: defect of the femoral neck, Anterior-accessory surgery performed: double intertrochanteric osteotomy of the femur with a false joint of the cervical bone bone graft on the musculo-vascular pedicle.

Two months after the operation, she is walking on crutches. The joint is moderately swollen. No pain. Radiological signs of regeneration are determined; there is no destruction of the head. The axis of the cervix is correct

fragments are stable, valgus is saved. After 6 months there are no complaints. Walking with a stick, loading the leg. The limb is supporting. X-ray head structure is preserved, regeneration processes are expressed

between the head and autograft. After 10 months there are no complaints. He walks with a wand. The shortening of a limb is 1 cm. The function of the joint: the sagittal plane is 0/0/100, the frontal plane is 20/0/10, the rotation is 10/0/5.

Radiographically, the femoral head is preserved, the fixative is stable, the reparative processes are expressed. After 1 g 2 months after the operation (the fixator is removed 1 year after the operation) it goes on its own. Get sick

not. Sleeps on the operated side. The function of the joint is the same as in 10 months. The bone fusion between the neck and the femoral head is determined radiographically, bone tissue is traced between the bone fragments, the head structure is normal, and there is no sclerosis. At the site of osteotomy of the diaphysis of the hip - bone fusion.

Claims (1)

The invention of the method of treating a femoral neck defect by accessing the hip joint, forming a graft from the greater trochanter and moving it on the muscle leg to the defect site with subsequent fixation, characterized in that, in order to shorten the time of adhesion by improving blood supply in the proximal fragment , the graft formation is performed by excising a fragment of the diaphysis of the femur with a small skewer and muscles attached to it, and the osteotomy is performed in the intertrochanter and subjacent regions.