UA14635U - Technique for replacing large defect of proximal division of tibia after tumor resection - Google Patents

Abstract

The technique for replacing the large defect of proximal division of tibia after resection of the tumor comprises the resection of the tumor, the electrocoagulation of the cavity, and the replacement of the defect with the grafts. Metal-acryloxyde prosthesis is used with the support metal constructions arranged in a fan-like mode. The prosthesis is attached to the tibia by the metal screws.

Description

Description of the invention

The claimed technical solution refers to medicine, namely, to traumatology, orthopedics and 2 oncology, and can be used in the replacement of large defects of the proximal part of the tibia, which will be formed after the removal of tumors localized in this area.

There are known methods of replacing defects of the proximal part of the tibia, in which auto- or allografts are used, which are inserted into the defect in various ways |11; 21; ISI; 141; I5I.

The disadvantages of the known methods are that there is a need to take and use an autograft to replace the 710 defect, which, in turn, leads to the formation of a tibial bone defect during, and the use of allografts prolongs the period of immobilization of the operated limb, the period of treatment and involves a number of complications, such as associated with incompatibility with the tissues of the operated patient, and quite often an accompanying infection, in turn, leads to the rejection of transplants and requires their removal.

In addition to the above, the disadvantages of known methods are that they do not allow the release of 72 spongy tissue to the subchondral plate, which violates the ablasticity of the operation, and insufficient strengthening of the subchondral plate can lead to a pathological fracture during loading of the operated limb.

There is a well-known method of strengthening the subchondral plate of the proximal part of the tibia |E), which we took as a prototype. The latter is carried out in the following way: the tumor is removed intracavitarily, the formed cavity is treated with an electrocoagulator, the defect is replaced with auto or allografts, which are placed in a triangle, with the widest transplant placed horizontally under the subchondral plate in the frontal plane, and the other two placed in an M-shape and supporting the horizontally placed transplant , so that the ends of the latter are wedged into the bone marrow canal.

The disadvantage of the known analogue method is the possibility of preserving spongy tissue under the subchondral plate, which contradicts the rules of ablastic; the transversally laid graft does not provide complete reliable support over the entire area of the subchondral plate, and the other two M-shaped transplants provide stable fixation.

The useful model is based on the task of creating a method of replacing a large defect of the proximal part of the tibia after tumor removal, which ensures reliable support of the subchondral plate of the tibia, early function in the knee joint and early load on the operated limb, which, in turn, reduces the percentage of complications, shortens the period of treatment and incapacity of patients. at

The task is solved by the fact that in the method of replacing a large defect of the proximal part of the tibia after tumor removal, which includes intracavity resection of the tumor, treatment of the formed cavity with an electrocoagulator, replacement of the defect with grafts, according to a useful model, the formed bone defect is replaced with metal acrylic oxide a prosthesis in which the supporting metal structures are arranged in a fan shape and the prosthesis is fixed to the tibia with metal screws.

The essence of the claimed method is explained by the drawings: "

Fig. 1 - a tumor of the proximal part of the tibia; From 50 Fig. 2 - a large defect of the tibia, formed after the removal of the tumor; c Fig. 3 - introduction of screws into the defect of the tibial bone to fix the metal acrylic oxide endoprosthesis;

From" Fig. 4 - replacement of a large defect of the proximal part of the tibial bone with a metal acrylic oxide endoprosthesis.

The method is carried out as follows: - dissect the skin and soft tissues with an anterior-external incision above the tumor (Fig. 1); - - expose the tumor; "Iz" - remove the tumor within healthy tissues, perform an intracavitary resection, preserving the subchondral plate of the tibia and the walls of the tibia b that are not visually affected by the tumor (Fig. 2);

Ge) 20 - the cavity formed after tumor removal is treated with an electrocoagulator; - screw the screws into the tibia so that their free ends are in the cavity that was formed after the tumor was removed (Fig. 3); - fill the cavity in the tibia with a liquid mass of acrylic oxide, while filling the cavity, insert metal screws in a fan-like manner into the acrylic with caps directed to the side 29 of the subchondral plate and the walls of the tibia and wait for the acrylic oxide to polymerize (Fig. 4); c - remove excess acrylic oxide formed in the polymerization process; - the postoperative wound is sutured in layers; - immobilize the operated limb from the fingertips to the upper third of the thigh. - After removing the immobilization, they begin to develop movements in the knee joint. 60 We give an example of clinical observation.

Patient A., 64 years old, medical history Mo5950. She was hospitalized in the Department of Bone Oncology of the National Institute of Clinical Oncology due to osteoclastoma of the proximal part of the tibial bone of the left lower leg. Examined. An intracavitary resection of the tumor was performed with replacement by a metal acrylic oxide prosthesis according to the proposed method. The postoperative course is smooth. The wound healed by primary tension. After 3 weeks, the immobilization was removed and movements in the knee joint began. Dosed loading with crutches on the left lower limb After 6 weeks.

Full recovery of movements in the left knee joint after 12 weeks. Walks with a cane.

The advantages of the proposed useful model are shortening the period of immobilization of the limb after surgery, early recovery of movements in the knee joint, improvement of the patient's quality of life in the postoperative period.

Sources of information: 1. Vynogradova T.P. Bone tumors - M.: Medicine, 1973. -336p. 2. Peterson B.E. Surgical treatment of malignant tumors. - M.: Medicine, 1976. -368p.

Z. Trapeznikov N.N. Sarcoma! bones (clinic, diagnostics, treatment). -Gashkent: Medicine Uz. SSR, 1983. -314p. 70 4. Chaklin V.D. Bone and joint tumors. - M.: Medicine, 1974. -287p. 5. Lanzman Yu.V. Bone tumors. -Tomsk: Publishing House of Tomsk University, 1990. -312p. b. Babosha V.A. and others. The method of strengthening the subchondral plate of the proximal part of the tibia (Ukraine. Declaratory patent Mo5976. M kl" AbЭ1817/56, 15.04.2005. Bull. Mo41. t

Claims (1)

The formula of the invention is a method of replacing a large defect of the proximal part of the tibia after tumor removal, which includes intracavitary removal of the tumor, treatment of the formed cavity with an electrocoagulator, replacement of the defect with transplants, which is characterized by the fact that the formed bone defect is replaced with a metal acrylic oxide prosthesis, in which supporting metal structures are placed fan-shaped and the prosthesis is fixed to the tibia with metal screws. - IS) so (Se) « h- - with . and? - sh" (22) o 50 sl s 60 b5