RU2200492C2 - Method for treating false articulations in tubular bones - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves longitudinally sawing the greater of two bone fragments on 4-7 cm long distance. The sawing process is carried out in two mutually perpendicular planes with four equal leaves being produced. Catgut ligature is spirally wrapped over sharp end of the other fragment as 0.5-1.0 cm wide belt and tied. The sharp end of the fragment wrapped with the ligature is tightly built in into the medullary canal of the sawn fragment. EFFECT: enhanced effectiveness of treatment; increased contact area; improved adaptation conditions. 4 dwg

Description

 The invention relates to medicine, namely to orthopedics and traumatology, i.e. to methods of treating false joints of tubular bones.

 One of the necessary conditions for the success of the treatment of false joints of the tubular bones is a dense mutual adaptation and stabilization of bone fragments. There are many ways to achieve adaptation of fragments / N.V. Sklifosovsky, 1876; B.E. Limberg, 1924; M.Yu. Epstein, 1926; B. Boychev, 1958; S.T. Zatsepin, 1960; A.A. Korzh, R.R. Talyshinsky, 1974; I.A. Movshovich, 1994 and others. However, it is far from always possible to create sufficient mutual adaptation and stabilization of fragments without various types of metallosynthesis, which in itself is often associated with weakening of already suppressed osteogenesis.

As a prototype, the method of telescopic introduction of the pointed end of one bone fragment into the bone marrow canal of another (Fig. 1) was taken in order to stabilize them and increase the area of contact surfaces / B. Boychev, 1958. The advantage of the prototype is the stabilization of fragments without implantation of the metal in the area of the false joint, which is very important in conditions of weakened osteogenesis. The disadvantage is the difficulty of achieving optimal mechanical and biological conditions at the junction of bone fragments due to the following circumstances:
1 / insufficient contact area of fragments;
2 / the inability to create between telescopically fixed bone fragments spontaneously supported prolonged compression having an osteoinductive effect;
3 / the possibility of wedging and cracking of bone fragments when a large force is applied to adapt them, which is due to insufficient elasticity of bone tissue, exacerbated by sclerotherapy in the area of the pseudarthrosis.

 The purpose of the invention is the optimization of mechanical and biological parameters at the junction of telescopically fixed bone fragments in the treatment of false joints of tubular bones.

 The goal is achieved by increasing the area of contacting surfaces, improving the mutual adaptation of bone fragments with the creation of spontaneously supported dynamic compression between them and the presence of a stimulator of inhibited osteogenesis in the area of the false joint.

 The invention is as follows.

 Surgical examination of the pseudoarthrosis is carried out with the release of its zone from cartilage and scar tissue. The ends of the mobilized bone fragments are “refreshed” with removal of the closure plates and restoration of the bone marrow canal. Then the end of the smaller of the fragments is sharpened, and the larger is cut longitudinally from the end for 4-7 cm in two mutually perpendicular planes / Fig. 2 /. In this case, four identical strips of the cortical plate are formed, intended to give the transverse contour of the bone fragment the necessary minimum of elasticity sufficient to create dynamic compression at the junction of telescopically fixed bone fragments. So, with the introduction of the pointed end of a smaller fragment into the bone marrow canal of a longitudinally sawn large fragment, a springy divergence of the strips of the cortical plate of the latter occurs. Moreover, in addition to creating a springy dynamic compression between bone fragments, the contact area between them increases. The degree of elasticity and the contact area between the fragments is greater, the longer the line of osteotomy. To exclude the likelihood of a cracking of the bone marrow canal and the line of longitudinal osteotomy going beyond the intended limits, small / 0.2-0.5 cm / holes / 3 / should be drilled at the ends of all four osteotomy lines. In addition to providing prolonged dynamic compression and an increase in the contact area, the longitudinal osteotomy of the larger of the bone fragments creates conditions for the more rapid formation of a stabilizing fragment of the bone “commissure” between them due to bone formation along the entire length of the osteotomy lines.

 To stimulate insufficient osteogenic potencies in the area of the pseudoarthrosis at the conical-pointed end of the smaller fragment, a transverse groove or notch is made with a rasp or chisel prior to its introduction into the medullary canal of the larger fragment, with a rasp or chisel / Fig. 4, a /. The latter prevents the catgut ligature tied to it from slipping, one end of which is pulled up and the other tightly wound in the proximal direction so that each previous loop prevents each subsequent loop from slipping down (Fig. 4, b /. Upon reaching the desired width of the "belt" - 0.5-1.0 cm, from the ligature rings located in one layer, the ends of the ligature are tied with a knot fixing it (Fig. 4, c, g). Then, the end of this fragment is tightly inserted into another / Fig. 4, g /. Catgut "belt" contributes to a stronger link between fragments due to the ability of catgut to colloidal swelling in a humid environment / blood, lymph /. The osteoinductive effect of the helically wound ligature is due to the fact that catgut, being a foreign protein and causing a weakened reaction at the junction of bone fragments, stimulates bone formation in the pseudoarthrosis, whose osteogenic potencies are significantly inhibited.

Features:
1 / Longitudinal osteotomy of the larger of the bone fragments in two mutually perpendicular planes for 4-7 cm.

 2 / Drilling holes at the ends of longitudinal osteotomy lines.

 3 / Tying at the pointed end of the smaller of the fragments of a spiral-wound catgut ligature.

 4 / Relatively large contact area between telescopically fixed bone fragments.

 5 / Providing spontaneous prolonged dynamic compression at the junction of bone fragments.

 6 / Revitalization of inhibited osteogenic potencies in the area of the false joint by the presence of catgut / foreign protein /.

 As an example of the clinical application of the proposed method for the treatment of false joints, the following observation.

 Patient V., 38 years old, was admitted to the orthopedic department of the RTC on 09/19/96 with a diagnosis of pseudarthrosis of the middle third of the left humerus. From the anamnesis: on April 5, 1995, he received a through gunshot bullet wound in the middle third of the shoulder with a comminuted fracture of the humerus, about which he spent three days in the Gudermes Central District Hospital, where he underwent primary surgical treatment of the gunshot wound and stabilized the fracture with a plaster cast from a healthy shoulder to shoulder fingers of the left hand. From April 8, 1995 to May 29, 95, he was at the station. treatment in the Central District Hospital of Khasavyurt, where after secondary healing of a gunshot wound on 04/25/95, bone-wise osteosynthesis with a plate was performed. Discharged on May 14, 1995 in a plaster cast. Subsequently, due to the development of osteomyelitis of bone fragments and the failure of bone osteosynthesis, an operation was performed on July 4, 1995 in the Khasavyurt CRH: removal of the metal structure, fistulosecvestrnecrectomy.

 On radiographs of the left humerus from 09/14/96, an atrophic pseudoarthrosis with ocularisation of the ends of bone fragments and formed closure plates is noted.

 On September 24, 1996, an operation was performed: telescopic fixation of bone fragments according to our technique with extra-focal compression-distraction osteosynthesis by Ilizarov’s apparatus. Under endotracheal anesthesia, a linear longitudinal incision was made to the skin of the external surface of the shoulder, 9 cm long. In a sharp and blunt way, the bone fragments were skeletonized and mobilized for a short distance. Interfragmental scar tissue excised. The ends of the mobilized bone fragments are refreshed: the bone marrow channels partially obliterated at the ends of the fragments are restored. A more massive proximal bone fragment is osteotomized longitudinally in two mutually perpendicular planes for 4 cm. 0.4 cm holes are drilled at the ends of the osteotomy lines. The end of the distal bone fragment is pointed; at a distance of 1.2 cm from the top with a chisel, notches were made with a catgut ligature / 2 /. One end of the last is stretched distally along the axis of the fragment, and the second end is helically wound in the distal direction into one layer by 0.5 cm, after which both ends of the ligature are interconnected, thus fixing the catgut "girdle". Then a dense telescopic penetration of the pointed end of the distal fragment into the longitudinally sawn end of the proximal was carried out. In this case, four equal “petals” of the latter elastically diverged, increasing the internal diameter of the bone marrow canal by approximately 0.3 cm and creating dynamic compression forces at the junction of bone marrow fragments. After this, without suturing the wound and visually monitoring the degree of mutual adaptation of the fragments, a typical extra focal osteosynthesis was performed using the Ilizarov apparatus of two parafracture rings and paraarticular semirings. After making sure of the correct position and stable fixation of bone fragments, the wound was sutured in layers. The postoperative period was uneventful.

 The Ilizarov apparatus was dismantled on 11/21/96 in the presence of a stable consolidation of fragments. The result of treatment is regarded as satisfactory.

 Thus, the proposed invention "A method of treating false joints of tubular bones" by the method of telescopic fixation of bone fragments allows you to create more optimal mechanical and biological conditions in the area of the false joint in comparison with the prototype, which allows to reduce the time and improve the treatment results of patients with this pathology.

Claims (1)

 A method of treating false joints of tubular bones, which consists in introducing the pointed end of one fragment into the bone marrow canal of another, characterized in that the larger of the fragments is longitudinally sawn from the end for 4-7 cm in two mutually perpendicular planes with the formation of four equal "petals" elastically diverging with a dense telescopic implantation in its bone marrow canal of another fragment, at the pointed end of which they spirally wind and tie a catgut ligature, creating with it a "belt" Rina 0.5-1.0 cm.

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