SU906538A1 - Method of artrodesis of hip joint - Google Patents

Description

(54) METHOD OF ARTHRODESIS OF THE HALF JOINT

one

The invention relates to medicine, namely to orthopedics and traumatology, and can be applied as an operative connection of the femur to the pelvic bones with false hip joints, coxarthrosis and complicated fractures.

There is a known method of hip arthrodesis, which is carried out by fixing the proximal konpa of the femur to the acetabulum with a fixator located on the pelvic bone and on the proximal end of the femur ti J.

However, the known method does not ensure the reliable fixation of the proximal horse bone in the acetabulum, which leads to the need for external immobilization, lengthening the duration of arthrodesis, reducing the effectiveness of treatment;

The purpose of the invention is to increase the reliability of fixation and shorten the time of arthrosis.

This goal is achieved by the method of arthrodesis of the hip joint by fixing the proximal end of the femur to the acetabulum with a fixator located on the pelvic bone and the proximal end of the femur, a bone wedge is placed in the cleft of the proximal bone of the femur femur and pelvic bone by shaped bone grafts.

The drawing shows a scheme for implementing the method of hip joint arthrodesis.

The method is carried out as follows.

. After anesthesia, the surgical field is treated and sterile sheets are applied. Soft tissues are excised and refresh the temporal end of the femoral bone. the remaining parts of the head refresh the acetabulum from the cartilage tissue. Two wedges of different sizes are cut from the remaining femoral head. One of the clicks is autoknost, i.e. The prepared hip head is positioned over the proximal end of the femur between the fixator and the body of the ilium. The second klkn, also made from the femoral head, is wedged into a wedge made of allotraio. T-shaped plantation in such a way that the contact area of the proximal end of the femur with the bone pelvis is only from autococci (maternal bone to the maternal bone). Tr & wedge is made of allograft (from the femoral or femoral condyles) in the desired size. Making a wedge of allograft is produced at the time of surgery. After wedging the proximal end of the trouble. of the renal bone and the insertion of the manufactured clicks (there are three of them), the proximal end of the femur is placed in the acetabulum. Compression arthrodesis is performed using a fixative that has the shape of the proximal femur, i.e. fits snugly to the ileal tepu, has a definite flexion (160-155 °), external rotation (10-20), retract (10-15), taking into account the neck-diaphysar angle. The fixator is fixed with screws to the iliac bone (3-7 holes) and along the femur (hole), where there is an eccentric with which the compression along the axis of the limb is given. In the middle of the plate, a screw is passed, which passes through the proximal end of the femur, through a set of two wedges in the cleft to the bottom of the acetabulum, giving compression in the medial direction. In this way, the proximal end of the femur is connected to the bone of the pelvic bone, making stable solidity. The wound is sutured in layers. Example. Performing arthrodesis with a false joint of the femur with bone resorption, such as the neck of the left femur. Give general anesthesia. The patient is placed on the left side. Treat the surgical field and cover the patient with sterile sheets. On the outer surface of the left hip joint, indentation 4–5 cm from the anterior superior axis of the dorsal bone, a slightly zigzagous skin incision is made through a large spit down along the femur 16–18 cm long; the wound is covered with sterile towels or large napkins. Cut through the soft tissues and widen the wound. The wound is dried and tied up small bleeding vessels. The bone knife is cut through the periosteum and freed from soft tissues. The processed proximal end of the femur is wrapped in sterile wet wipes moistened with saline. The head is removed from the acetabulum and freed from cartilage. Make two wedges 1 and 2 of different sizes from the remote head of the femur bone. Thereafter, the cartilage portion of the acetabulum is removed and refreshed. A wedge 3, 7-8 cm long, is made of the allograft and is treated so that the wedge 2 made of autocapacity (from the head) should be wedged into it. Thus, from two wedges 2 and 3 form one monolithic 1y klkn. The processed proximal end of the femur is split into two parts at a length of 8-10 cm, and a wedge consisting of wedges 2 and 3 is inserted into the splitting end of the femur. A split wedge is inserted into the acetabulum, creating a physiological position. After resetting the proximal end of the femur to the body and the diaphase of the femur, a fixator is installed and fastened to the body of the Ilium with screws (5-7 screws). KSP1 1 (made from the femoral head) is inserted into the formed slot under the plate above the proximal end of the anterior bone. As a result of installing this wedge, the contact area increases, i.e. build up the body: the ilium and create an artificial roof of the acetabulum. The distal end of the fixer is fastened with screws to the diaphase of the femur and, with the help of an eccentric, create a compression along the axis of the limb, i.e. distal proximal direction. After that, the bone channel is drilled through the plate and the proximal end of the femur, which passes through the wedges 2 and 3 to the bottom of the acetabulum. The screw is screwed into the formed bone canal, washers and nuts are installed, and the compression is carried out in the medial direction. Thus, they create solidity in the area of the hip joint and create compression in the distal (along the axis of the limb) and medial directions.

The wound is washed with a solution of hydrogen peroxide and dried. Layered nodular catgut sutures are laid on soft fabrics and silk sutures on the skin. The wound is treated with iodine and aseptic dressing is applied.

After complete splicing, i.e. arthrodesis in the hip joint, confirmed both clinically and radiographically, the fixator is removed as follows: the patient is placed on the operating table (position on the side). Under local infiltration anesthesia with a solution of 0.25-0.5% novocaine (50-1OO ml), a skin incision is made through the old postoperative scar. Cut through soft tissues to the bone and widen the wound with dilators. After detecting the metal structure with a screwdriver and a socket wrench, the screws, nut and screw are unscrewed and the plate is removed. The wound is sutured in layers. Treat the iodine with the operative field and impose an aseptic surface. As a result of the implementation of the proposed method, a physiologically favorable position of the limb is created after the operation; using the central compression screw, three points of support are reached: to the body of the Ilium, to the bottom of the heliport along the femur. This situation is the most stable.

As a result of the method, a method using a lock

impose an external plaster cast, exclude many complications, such as spontaneous arthrodesis, loosening of the fixator, complications associated with the imposition of external fixation, prolonged forced bed rest, which indicates an increase in therapeutic effect with a shortened operation time, the exception of external fixation, complications simplifying operational techniques, creating a functionally advantageous position.

The method is simple, not complicated. It can be widely used in many medical institutions, especially in hot climates, where an external fixation with a coking gypsum bandage leads to many complications. m

Claims (1)

Invention Formula The method of hip joint arthrodesis by attaching the proximal end of the femur to the acetabulum with a fixator located on the pelvic bone and the proximal end of the femur differs from the fact that A bone fix is made, then the space between the fixer, femur and pelvic bone is filled with shaped bone transplants. Sources of information accepted in the attention during the examination 1. USSR Copyright Certificate № 757157, cl. A 61 B 17/18, 1978.