RU2349277C2 - Method of pelvis reconstruction after stable malunion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly traumatology and orthopedics, and can be applied in surgical interventions preventing post-operation complications in treatment of stable pelvic bone malunions. Method involves transverse osteotomy of iliac bone body at top pelvis half and gradual descent of its distal segment by compression distraction method to restore anatomic contours of front pelvis part. During pelvis segment descent the hip at reconstructed side is fixated in functionally beneficial position.

EFFECT: reduced traumatic rate of surgical intervention, prevention of post-operation complications for the indicated pathology.

2 cl, 1 ex, 5 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with consequences of pelvic fractures.

There is a method of treating chronic pelvic fractures (Cherkesszade DI, Kamenev Yu.F., Ulashev U. U. Treatment of pelvic bone fractures in polytrauma. - Tbilisi, 1990. S.99-105), including sequential osteoplastic stabilization of the pubic and sacroiliac joints.

However, this technique does not provide for the restoration of the anatomical contours of the pelvic ring with a significant vertical displacement of its halves.

A known method for the treatment of chronic pelvic injuries with its stable vertical deformation (Shlykov I.L. Surgical treatment of patients with the consequences of pelvic ring injuries: Author. Diss. Candidate of Medical Sciences. - Yekaterinburg, 2004, 28 s). The method involves fixing the pelvis using a compression-distraction apparatus, performing an osteotomy of the pubic, sciatic bones and lateral mass of the sacrum, reposition of the halves of the pelvis and their subsequent stabilization until consolidation.

The technique provides the complete elimination of the components of the pelvic deformity. At the same time, performing a triple pelvic osteotomy is very traumatic and involves significant blood loss. In addition, in the absence of pain in the lumbosacral region, a repeated change in the stable relationship of the anatomical formations that had developed at the time of the operation may lead to their recurrence.

The objective of the invention is to develop a method for reconstruction of the pelvis with a stable incorrectly fused fracture, which reduces the morbidity of surgical intervention and the prevention of postoperative complications.

This problem is solved by the fact that in the method of reconstruction of the pelvis with a stable abnormally fractured fracture, including violation of the integrity of the pelvic bone, reposition and fixation of the pelvis using a compression-distraction apparatus, transverse osteotomy of the ilium body on the superior half of the pelvis and its distal segment are dosed down to restoration of the anatomical contours of the anterior pelvis.

At the same time, it is envisaged that to prevent subluxation in the hip joint during the reduction of the pelvic segment, the hip on the reconstruction side is fixed in a functionally advantageous position.

The method is illustrated by a description, an example of its practical use and drawings, which depict:

Figure 1 - radiograph of the pelvis of the patient before treatment;

Figure 2 (a, b) - radiographs of the pelvis of the patient during treatment;

Figure 3 (a, b) - photo of the patient during treatment;

Figure 4 - radiograph of the pelvis of the patient after treatment;

Figure 5 (a, b, c, d) - photo of the patient 1 year after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, osteosynthesis of the pelvic bones is performed. When it is performed, the rods are cantilevered into the wings of both iliac bones, into the body of the ilium on the superior half of the pelvis and, on the same side, the fixation knitting needles are transversely carried through the femur at the level of its proximal and middle third. The free ends of the rods and spokes are mounted on external supports - arcs, rings, strips - which are connected to each other by threaded rods and hinged nodes with the possibility of multi-plane dosed movement.

Through an incision of the soft tissues, an access to the surface of the ileal body on the superior half of the pelvis is performed and its transverse osteotomy is performed somewhat proximal to the fixing rods cantilevered into this area. The fixed hip is given a functionally advantageous position. To prevent subluxation in the hip joint, it is advisable to additionally stabilize it with 4-5 spokes, carried out transarticularly along the axis of the femoral neck from the undervert region.

The operation is completed by performing control radiography, the wound is sutured with an aseptic dressing.

In the postoperative period, starting from 3-5 days, a metered reduction of the osteotomized distal segment of the pelvis in its superior half is performed. Lowering (traction) of the segment is carried out as a single unit with a fixed hip at a rate of 1.0-1.5 mm per day until the anatomically correct contours of the anterior part of the pelvis are restored and, thereby, eliminating functional shortening of the limb.

Following this, the system of the apparatus is transferred to a stable fixation mode while maintaining a compressive force at the junction of the associated pubic bones. If additional stabilization of the hip joint was performed, transarticularly held knitting needles at this stage should be removed, at the same time dismantling of the hip fixing system is also possible. Hardware fixation of the pelvis is supported until the reconstruction of the site of the generated regenerate of the ilium and the consolidation of bones in the symphysis zone.

After dismantling the device, the patient is prescribed a course of exercise therapy.

The practical implementation of the method is illustrated by the following clinical observation.

Patient T., 21 years old, was admitted to the hospital with a diagnosis of stable, improperly fused multiple pelvic fractures, severe deformation of the pelvic ring.

She was injured as a result of a fall from a height of 3.5 years ago. Complaints about the functional failure of the left lower limb, cosmetic defect, inconvenience when sitting.

Radiological: gross deformation of the pelvic ring with the displacement of the left half of the pelvis up 4 cm (Figure 1).

To restore the anatomical contours of the anterior pelvic region and equalize the length of the lower extremities, the patient underwent surgery: osteotomy of the ilium on the left, osteosynthesis of the pelvis and left thigh with an external fixation device.

During the operation, after anesthesia and treatment of the surgical field, the rods were cantilevered into the wings of both iliac bones, into the body of the right (left) ilium, and transdermally held the knitting needles through the left femur at the level of its proximal and middle third. The free ends of the rods and spokes are fixed on external supports, which are connected to each other with the possibility of metered movement.

A transverse osteotomy of the body of the left iliac bone was performed through a soft tissue incision somewhat proximal to the fixing rods cantilevered into this region. The fixed hip was given a functionally advantageous position, the hip joint was additionally stabilized by 5 needles, carried out transarticularly (Fig. 2, a).

In the postoperative period, starting from 3 days, dosed reduction (traction) of the osteotomized distal segment of the left side of the pelvis was performed in a single unit with a fixed hip (Figure 2, b). The rate of traction ranged from 1.0-1.5 mm per day. After obtaining an X-ray picture of the restoration of the anatomically correct contours of the anterior part of the pelvis on day 52, the reduction of the pelvic segment was stopped. The system of the apparatus was transferred into a stable fixation mode while maintaining a compressive force at the junction of the matched pubic bones, the transarticularly held needles were removed (Fig. 3, a, b). Subsequent hardware fixation was carried out for 45 days. After dismantling the apparatus, the patient underwent a course of rehabilitation therapy.

As a result of treatment, the total duration of which was 180 days, the anatomically correct shape and continuity of the anterior part of the pelvis were restored, functional shortening of the limb was eliminated (Figure 4).

At the control examination after one year, the achieved treatment result is saved. The patient does not show complaints: the length of the limbs is the same, the movement of the hip joints is within normal limits, she does not walk lame, does not experience inconvenience when sitting, and there is no pain syndrome (Figure 5, a, b, c, d).

Using the method in the RRC "WTO" them. Acad. G.A. Ilizarova showed that its use provides a reduction in the morbidity of surgical intervention and the prevention of postoperative complications in the treatment of patients with stable incorrectly fused pelvic fractures.

Claims (2)

1. A method for reconstructing the pelvis with a stable, incorrectly fused fracture, including a violation of the integrity of the pelvic bone, reposition and fixation of the pelvis using a compression-distraction apparatus, characterized in that the transverse osteotomy of the ilium body on the superior half of the pelvis and its distal segment are dosed down to restoration of the anatomical contours of the anterior pelvis. 2. The method according to claim 1, characterized in that in the process of lowering the pelvic segment, the hip on the side of the reconstruction is fixed in a functionally advantageous position.

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