RU2236189C2 - Method for treating phalangeal enchondromas and those of wrist's metacarpal bones - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should fill defect of bony tissue with cortico-spongy allotransplant, moreover, transplant should be oriented to rear and rear-lateral phalangeal surfaces or metacarpal bone with its smooth cortical side. The method enables to restore normal anatomical ratios of osseous structures, optimize conditions for functioning in finger's flexor apparatus after operative interference.

EFFECT: higher efficiency of therapy.

9 dwg, 2 ex

Description

The present invention relates to medicine (traumatology and orthopedics) and is intended for the treatment of bone tumors (enchondroma) of the phalanges of the fingers and metacarpal bones of the hand.

Known and used in the clinic methods of surgical treatment of enchondroma of the phalanges of the fingers and metacarpal bones of the hand consist in curettage (excochleation) of a bone tumor with bone grafting [1] or replacing the resulting bone defect with an implant made of carbon syntactic foam [2].

The disadvantages of these methods is that after such interventions relapse of the tumor occurs due to the difficulty of radical curettage of the tumor cavity. In the postoperative period, pronounced stiffness and contracture in the joints of the fingers of the hand occur due to prolonged immobilization in the postoperative period.

A known method of treating enchondroma of the main phalanx of the finger of the hand, taken as a prototype. This method includes segmental resection of the pathologically changed part of the tubular bone of the hand within the epiphyseal zones, and the defect formed is replaced by two semi-cylindrical cortical allografts with their introduction into the distal and proximal epiphyses of the bone fragment, and the graft is covered with two or three thick catgut ligatures [3].

The disadvantage of this method is the great trauma of the surgical intervention itself, the need for prolonged postoperative immobilization before implantation and rearrangement of semicylindrical cortical allografts, which leads to severe stiffness and contracture in the joints of the fingers.

The invention consists in a combination of distinctive features sufficient to achieve the desired technical result, namely improving the functional results of treatment. This essence consists in the fact that a bone defect is densely filled with a cortical-spongy allograft, and the graft is oriented with the smooth cortical side to the back and back-side surfaces of the phalanx (metacarpal bone).

Orientation of bone grafts in the proposed manner is carried out both to restore normal anatomical ratios of bone structures, and to optimize the functioning conditions of the extensor apparatus of the finger after surgery. Using the proposed method prevents the formation of coarse adhesions between the smooth cortical surface of the graft and the extensor tendon.

To confirm the above, we carried out experiments on rabbits, consisting in the fact that after the surgical creation of an edge defect, the bone graft was placed in the formed bone bed with its location in relation to the surrounding tissues or the cortical plate, or the endosteal side of the graft.

When the graft is placed with a smooth cortical plate to the surrounding soft tissues, the graft is implanted into the mother’s bed primarily from the endosteum. The entire cortical plate of the graft remains not fused with the surrounding tissues, even for a period of 1-1.5 months from the day of surgery.

In FIG. 1 shows a microphotograph of a slice where the graft is oriented by a smooth cortical plate to surrounding soft tissues. Microphoto. ICBM-6, approx. 7, about 8, where:

a) the cortical plate of the graft.

b) soft tissue around the cortical plate of the graft.

c) the border between the soft tissues and the cortical plate of the graft — there is no adhesion cicatricial process.

Whereas when the graft was positioned with respect to the surrounding tissues with the endosteal side at the same time, the graft merged with these tissues due to the development of adhesive scar tissue throughout. Figure 2 presents the microphotograph of the slice, where the graft is oriented with the endosteal side to the surrounding soft tissues. Microphoto. ICBM-6, approx. 7, about 8, where:

a) soft tissue around the endosteal part of the graft.

b) the endosteal side of the graft is soldered to the surrounding soft tissues throughout.

- The technique of surgical intervention with resection of a part of the phalanx (metacarpal bone) opens up wide surgical access for the possibility of thorough removal of tumor tissue within a healthy bone under the control of the eye.

- The left portion of the palmar cortical plate of the phalanx (metacarpal bone) serves as a source of regeneration and is a kind of splint fixing the allograft for the period of its implantation.

- The preserved articular surfaces of the phalanx (metacarpal bone) with the palm of the hand cortical plate make it possible to densely fill the bone defect with an allograft and restore early active function in the joints of the finger.

The method is as follows.

Under intravenous anesthesia with a rear semi-oval skin incision on the finger or on the hand, the extensor apparatus is exposed. After longitudinal dissection of the extensor tendon or leading it to the side, the back and side surfaces of the affected phalanx (metacarpal bone) are isolated. In areas of bone lesions, the back cortical plate is resected to healthy areas and lateral surfaces of the cortical plate with careful curettage of the tumor cavity and rinsing with antiseptic solutions. At the same time, the integrity of the palmar cortical plate of the phalanx (metacarpal bone) and articular surfaces are maintained. Bone grafting is performed by tightly laying the graft, and on the back and back-lateral surfaces the graft is laid with a smooth cortical plate outside. Restore the integrity of the longitudinally dissected extensor over the graft and suture the skin wound. Immobilization is carried out by the palmar gypsum splint for two weeks (before removal of skin sutures).

After removal of skin sutures and splices, the patient undergoes active therapeutic exercises in the interphalangeal joints of the finger.

Clinical examples.

Patient V-va, 32 years old. Diagnosis: enchondroma of the 5 metacarpal bone of the right hand.

Figure 3 - photo from an x-ray of the right hand of B. B. - before surgery.

Figure 4 - photo from an x-ray of the right hand of B. B. - after the operation performed by the proposed method.

Figure 5 - photo from an x-ray of the right hand of B. B. - after surgery after 3 months.

6 is a photo from an x-ray of the right hand of B. B. - 1 year after the operation.

Patient D., 12 years old. Diagnosis: enchondroma of the main phalanx of 2 fingers of the left hand.

Fig.7 is a photo from an x-ray of the left hand of D. D. - before surgery.

Fig. 8 is a photo from an x-ray of the left hand of D. D. - after the operation performed by the proposed method.

Fig.9 is a photo from an x-ray of the left hand of D. D. - after surgery after 7 months.

Sources of information

1. Usoltseva E.V., Mashkara K.I. Surgery of diseases and injuries of the hand. L .: Medicine, 1978, pp. 177-179.

2. A method for the treatment of enchondromal phalanx of the fingers. AC No. 1377065, 1988.

3. A method of treating the enchondroma of the main phalanx of the finger of the hand. AC 1641309, 1991.

Claims (1)

A method of treating phalanx and metacarpal bones enchondrom by resecting part of the affected phalanx or metacarpal bone with removal of tumor masses and replacing the defect with a bone allograft, characterized in that the bone defect is filled with a cortical-spongy allograft, with the back and back-side surfaces of the phalanx The metacarpal bone graft is oriented with the smooth cortical side.

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