UA68570A - Method for making endoprosthesis of upper articular end of humerus - Google Patents

Abstract

The method for making endoprosthesis of the upper articular end of humerus comprises the removal of destruction focus within the limits of the normal tissues and the substitution of the bone defect by xenograft. Upon resection of the destruction focus, the spongy tissue of the head of humerus is removed. The cavity is filled with the liquid methyletacrilate and the upper xenograft end is finally immersed into the liquid.

Description

Description of the invention

The claimed technical solution relates to medicine, namely orthopedics, and can be used 2 for the treatment of malignant tumor lesions of the upper end of the humerus.

Known methods of treatment of malignant tumor lesions of the upper third of the humerus, including amputations and exarticulations of the shoulder (1), interscapular-thoracic amputations and resections (2), endoprosthesis using auto- and xenomaterials |Z| etc.

The disadvantages of known methods are that they are highly traumatic, worsen the patient's quality of life, and 70 organ-preserving operations lead to impaired function of the operated limb.

The known method, taken by us as a prototype |4). It is carried out in this way. Resection of the upper articular end of the humerus together with the head is performed. The level of osteotomy depends on the size and localization of the tumor. To replace the resulting defect, a two-component endoprosthesis is used, consisting of a plastic head (polyamide-12) and a metal leg, connected through a metal sleeve with a 72 internal thread. The remains of the capsule of the shoulder joint are strengthened around the head of the endoprosthesis with a mylar bag suture. One or two channels are drilled in the large tubercle of the endoprosthesis; mylar tapes are passed through them, to which the supraspinous and subspinous muscles are sewn. In the postoperative period, the hand is fixed in the abducted position for 1-1.5 months on an abducting splint or in a plaster cast.

The method has the following disadvantages.

There is a high risk of endoprosthesis dislocation due to destruction of the joint capsule and rotator cuff muscle tendons. For the same reason, the volume of active and passive movements in the shoulder joint suffers to a great extent.

Long periods of immobilization.

The invention is based on the task of improving the method of endoprosthesis of the upper articular end of the humerus, which ensures a reduction in the trauma of the operation, prevention of dislocations of 22 endoprostheses, preservation of the range of motion in the shoulder joint, and improvement of the patient's quality of life. "

The task is solved by the fact that in the method of endoprosthesis of the upper articular end of the humerus, which includes removal of the focus of destruction within healthy tissues, replacement of the resulting bone defect with a xenograft, in accordance with the invention, the replacement of the bone defect is performed without damage to the articular surface and the tuberous zone of the humeral head bones at

The essence of the claimed method is explained by an illustration: -

Fig. 1 - resection of the affected area of the humerus.

Fig. 2 - in the implementation of an endoprosthesis in the head of the humerus. at

Fig. C - fixation of the endoprosthesis to the distal fragment of the humerus. with

The method is carried out as follows: 3o - dissect the skin and subcutaneous adipose tissue with an incision along the deltoid-thoracic furrow, extended ee, downwards; - the tumor focus is isolated ablastically together with the adjacent muscle layer; - with the help of a Jigli saw, the humerus is crossed at the level of the surgical neck and 3-4 cm below the tumor (Fig. 1); C - with the help of Volkman's spoons, the spongy tissue of the head of the humerus is removed, and the resulting cup is filled with liquid ethacrylate prepared by ЕХ (ietroge;

From" - the upper end of the metal-polymer insert is inserted into the solidifying ethacrylate (Fig. 2); - after hardening of the ethacrylate, the lower end of the insert is compared with the distal fragment of the humerus and they are fixed side by side with the help of a metal plate AO (Fig. 3); - the wound is sutured in layers; b - the limb is fixed with Turner's plaster bandage for 2 weeks, after which reconstructive treatment is started. o We give a clinical example of the implementation of the method.

Example 1. 1st Patient P., 47 years old, medical history Mo4238, locksmith, was admitted to OKO DNDITO on 25.02.03. on the occasion of - I 50 hypernephroid cancer of the kidney, TUMOM'", a pathological fracture of the shoulder in the upper third. He considers himself sick for 6 months. He underwent a course of combined treatment in an oncological dispensary (removal of the kidney, chemoradiation therapy). According to the claimed method, it was done surgery Post-operative period was uneventful Started rehabilitation 2 weeks after surgery Returned to previous job 3 months after surgery.

The advantages of the claimed method are that it is easy to perform, prevents dislocations in v. shoulder joint, does not disrupt its function, significantly improves the patient's quality of life.

Sources of information taken into account. 1. Mahson A.N., Mahson N.E. Surgery for metastatic bone tumors. M., "Realnoe Vremya", 2002. p. 61. because 2. Makhson N.E., Makhson A.N. Adequate surgery for shoulder and pelvic girdle tumors. M. RPO "Hella-Print", 1998.

Z. Zatsepin ST, Makhson AN. Removal of the entire humerus bone with prosthetic replacement of the defect in oncological patients. Material! plenum of the All-Union Society of Traumatologists and Orthopedists. M., 1980. dB 4. Zatsepin S.T., Bone pathology of adults. M., "Medicine" 2002., p. 463.

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Claims (1)

The formula of the invention is a method of endoprosthesis of the upper articular end of the humerus, which includes removal of the focus of destruction within healthy tissues, replacement of the resulting bone defect with a xenograft, e) which differs in that after resection of the focus of destruction, the cancellous tissue of the head of the humerus 32 is removed and the resulting cavity is filled with liquid methyl acrylate, followed by immersing the upper end of the xenograft into it. Official bulletin "Industrial Property". Book 1 "Inventions, useful models, topographies of integrated "microcircuits", 2004, M 8, 15.08.2004. The State Department of Intellectual Property of the Ministry of Education and Science of Ukraine. with . and? (o) (ee) 1 - 50 (42) 60 b5