RU2257170C2 - Method for treating false articulation in long tubular bone - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should osteotomize the end of distal osseous fragment along the line coming oblique-cross-sectionally through its sclerosed and healthy sections, center at reposition opposite ends of the main fragments by keeping the isolated fragment as intact one, perform stable fixation till restoring osseous integrity with the help of compression-distraction apparatus. The method enables to stimulate osteogenesis in area of healing.

EFFECT: shortened period for therapy.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with false joints of limb bones of various etiologies.

There is a method of treating a false joint of a long tubular bone [1], which involves applying a compression-distraction apparatus to a damaged segment of a limb, closed reposition (dosed distraction) of bone fragments until the biomechanical axis of the segment is restored, and subsequent stable fixation until bone consolidation is complete. However, this method is associated with long periods of treatment of patients, which is due to the reduced regenerative ability of inert tissue in the area of the pseudoarthrosis and the need, therefore, to prolong the period of stable fixation in the apparatus.

There is a method of treating a false joint of a long tubular bone [2], in which, initially, using the external fixation apparatus, a duplicate of the ends of the fragments is metered, after which the end of one of them is osteotomized, the ends of the fragments are inserted into each other and the joint area is sealed with a selected bone fragment with subsequent stable fixation to fusion. The named method also provides for a long period of fixation, which is predetermined by the sclerosis of the fused sections of the opposing ends of bone fragments.

The objective of the invention is to develop a method of treating a false joint of a long tubular bone, which reduces the time of medical rehabilitation by stimulating the process of reparative osteogenesis in the fusion zone and thereby reducing the necessary length of the period of stable fixation in the apparatus after restoration of biomechanical parameters and anatomical dimensions of the affected segment.

This problem is solved by the fact that in a method including reposition of bone fragments and performing an osteotomy of the end of one of them with subsequent stable fixation to restore bone integrity using a compression-distraction apparatus, the end of the distal bone fragment is osteotomized along a line running obliquely through its sclerotized and healthy sections, and during reposition, the opposing ends of the main fragments are centered, leaving the selected fragment intact.

The method is illustrated by a detailed description and an example of its practical use.

The method is as follows.

After anesthesia and treatment of the surgical field with known techniques, osteosynthesis of the affected limb segment is performed. When performing it, transosseously, crosswise, fixing knitting needles, taking into account the existing deformation of the segment, are carried out through healthy areas of bone fragments above and below the zone of the pseudarthrosis. Depending on the level of its localization, in addition, fixation of the bones of the adjacent bone segment can also be carried out. In a tense state, transversely held knitting needles are mounted on apparatus supports installed at an appropriate level, which are connected to each other by threaded rods and articulated units with the possibility of dosed multi-plane movement. At the same time, the apparatus systems fixing the adjacent limb segments are connected in such a way as to ensure the possibility of maintaining active-passive movements in the corresponding joint. Through a soft tissue incision in the projection of the pseudoarthrosis, access to the surface of the distal bone fragment and perform oblique osteotomy of its end along the line passing through the sclerosed and healthy areas of bone tissue. Moreover, in the presence of an angular deformation of a segment, it is usually produced starting from that side of the end of the fragment, which corresponds to the convexity of the bone, and then from top to bottom with the exit on the opposite side of the bone. Following this, reposition of the main fragments is carried out, centering them relative to each other, and thereby restore the axis of the segment. The osteotomized end fragment is left intact, and it occupies a free position between the opposing ends of the main fragments, partially compensating for the thinning of the affected area of the bone. Reposition, depending on the magnitude of the deformation, can be performed both directly during the operation and dosed, with simultaneous lengthening of the segment during postoperative management. And in fact, and in another case, the operation is completed by suturing the wound, performing control radiography and stabilization of the apparatus.

In the postoperative period, if dosed reposition of fragments and segment elongation is not performed - a pace of a turn of 2-4 degrees, a longitudinal movement of 1-1.5 mm per day - the bone fragments are stably fixed by the apparatus. During this period, due to the fact that the osteotomy of the end of the distal fragment is also performed through its healthy area, due to the reaction of the osteogenic tissues of the latter, the diastasis formed between the osteotomized fragment and the maternal fragment is filled with bone regenerate during reposition. At the same time, a violation of the integrity of the bone causes a natural intensification of the blood supply to the damage zone. And since it is located distal to the pseudoarthrosis, its constituent, altered fibro-sclerotic areas of bone fragments are also intensely supplied with blood, which causes organotypic restructuring in them, accompanied by bone tissue regeneration. Together, this stimulates reparative osteogenesis, provides a closed transformation of the entire affected area of the bone with the restoration of its integrity and thickness. Upon receipt of a reliable picture of organotypic bone remodeling, the apparatus is dismantled; additional immobilization of the limb, as a rule, is not required; prescribe a course of exercise therapy with a gradually increasing load on the operated limb.

Example. Dog, age at the time of surgery 2 years; diagnosis: stiff false joint of the tibia in the middle third, atecurative deformation of the right lower leg 30 degrees (figure 1). To restore the integrity and axis of the bone, an operation was performed: osteosynthesis by the Ilizarov apparatus; oblique osteotomy of the end of the distal fragment of the tibia adjacent to the zone of the pseudarthrosis. During osteosynthesis, through the tibia of the right tibia, taking into account the existing deformation, proximal and distal to the zone of the pseudoarthrosis, two pairs of fixing knitting needles were transosseously, cross-linked, which were mounted on the external supports that make up the two subsystems in tension. Using threaded rods with hinges, the latter were connected to each other taking into account angular deformation. Through an incision of soft tissues, an oblique osteotomy of the end of the distal tibial fragment was performed along a line passing through its sclerotic and healthy areas. Following this, leaving the osteotomy end fragment intact, an instantaneous reposition of the main bone fragments was performed. The operation was completed by suturing the wound, applying aseptic dressings and stabilizing the systems of the device (figure 2).

In the postoperative period, stable limb fixation was performed for 60 days. 30 days after the operation, intense regeneration in the pseudoarthrosis was noted, and by 60 days of fixation, there was a restructuring of the bone structures throughout the affected area of the bone with the disappearance of fibrosclerotic fields (Fig. 3). Compared with the traditional periods of osteosynthesis with similar false joints, which are on average 110-130 days, with the proposed method of treatment, the terms are reduced by a minimum of 1.5-2 times. From the moment the apparatus is removed, the animal fully loads the operated limb, whose axis is correct; the thickness of the right tibia throughout corresponds and somewhat exceeds that of the intact limb (figure 4).

Thus, the use of the proposed method reduces the time of medical rehabilitation by stimulating the process of reparative osteogenesis in the fusion zone and thereby reducing the necessary length of the period of stable fixation in the apparatus after restoration of biomechanical parameters and anatomical dimensions of the affected segment.

Sources of information

1. V.I. Shevtsov, V.D. Makushin, L.M. Kuftyrev. Treatment of congenital pseudarthrosis of the lower leg bones. - Mound. 1997. S. 130-137.

2. A.S. USSR N 835421, published 07.06.81. Bull. 21.

Claims (1)

A method for treating a false joint of a long tubular bone, including reposition of bone fragments and performing an osteotomy of the end of one of them with subsequent stable fixation until bone integrity is restored using a compression-distraction apparatus, characterized in that the end of the distal bone fragment is osteotomized along a line passing obliquely across it sclerotic and healthy areas, and during reposition, the opposing ends of the main fragments are centered, leaving the selected fragment intact.

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