RU2388423C2 - Method of replacing bone tissue defects in operational treatments of cysts and neoplasms of metaepiphyseal zone in long tubular bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and ortopedics. Resection of neoplasm within healthy tissues with further processing of cavity is performed. One of allotransplant plates with dimensions 8-12 cm × 2 cm × 0.4-0.6 cm is introduced into subcondylar area horizontally, parallel to joint surface of knee joint. Second plate with dimensions 12-15 cm × 2 cm × 0.4-0.6 cm is installed vertically, resting with one edge on tibia diaphysis, with the other - on horizontal plate, creating support for it. Remaining defect is filled with allotransplant obtained from spongy bone.

EFFECT: method ensures even distribution of loading on joint surfaces, increase of mechanical strength of bone and preservation of support ability of extremity.

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Description

The invention relates to medicine, namely to methods for surgical treatment of diseases of the musculoskeletal system, leading to impaired limb function.

A known method of surgical treatment of cysts and neoplasms, which consists in resection of a fragment of the tubular bone in the metaepiphyseal zone. For plastics of the resulting bone defect, Volkov's operation is performed. Technique of operation: in accordance with the size and shape of the bone defect, several (5-8) allo-bone plates are harvested so that after insertion into the medullary canal, these plates deepen by 3-6 cm beyond the bone cavity. You need to enter them tightly to achieve good contact between them. Similar plates are laid extramedullary and firmly tied with catgut yarns. The plates should fit snugly together. Then surrounding tissues are tightly sutured around the grafts. The operation is completed by applying a plaster cast [1].

The disadvantage of this method is the increased trauma and high complexity of surgical intervention, violation of the supporting function of the limb and the inability to evenly distribute the load on the articular surface in the case of a metaepiphyseal location of the bone defect.

There is a method of surgical treatment of cysts and neoplasms of the metaepiphyseal area of the tubular bones, which consists in resection of the neoplasm within healthy tissues, followed by treatment of the cavity with subsequent random filling of the defect with an allograft of the cancellous bone [2].

The disadvantage of this method is the low effectiveness of the treatment, namely: a decrease in the support ability of the limb due to a decrease in the mechanical strength of the bone, subsidence of the tibial condyles and, as a consequence, deformation of the limb, which further violates the function of the limb. This method is taken as a prototype.

The aim of the invention is to increase the efficiency of treatment of patients with cysts and neoplasms of the metaepiphyseal area of the tubular bones.

This goal is achieved by the fact that one of the allograft plates with a size of 8-12 cm × 2 cm × 0.4-0.6 cm is injected horizontally parallel to the articular surface of the knee joint in the submaxillary region, the second plate is 12-15 cm × 2 cm × 0 , 4-0.6 cm are installed vertically, abutting against the diaphysis of the tibia with one edge and the horizontal plate with the other, creating support for it.

Comparison of the proposed method with other known in the field of medicine showed its compliance with the criteria of the invention.

The invention is illustrated by graphic material.

The drawing shows the creation of a reference plane by the proposed method.

1 - horizontal plate measuring 8-12 cm × 2 cm × 0.4-0.6 cm;

2 - a vertical plate measuring 12-15 cm × 2 cm × 0.4-0.6 cm;

3 - bone defect;

4 - replacement of the residual defect volume with a trabecular bone allograft.

The method is as follows.

Two plates of cortical bone layer 8-12 cm × 2 cm × 0.4-0.6 cm in size and 12-15 cm × 2 cm × 0.4-0.6 cm are pre-harvested based on the individual characteristics of the patient. Access - from the incision along the front-inner surface of the lower leg in the projection of the pathological formation. Stupidly and acutely from the soft tissues, a pathological formation stands out, they produce its resection. The walls of the resulting cavity are treated. One of the allograft plates is inserted into the submaxillary region horizontally parallel to the articular surface of the knee joint. The second plate is installed vertically, abutting against the tibia diaphysis with one edge and the horizontal plate with the other, creating support for it. The remaining defect is filled with spongy allocost. Hemostasis during the operation. Layer wound closure. Stitches to the skin.

The fundamental difference between the proposed method and the generally accepted method is the use of an allograft of the cortical plate instead of the cancellous bone and its fundamentally different styling. The advantage of the proposed method over the prototype is to create greater mechanical strength of the tibia, due to which there is no deformation of the axillary region in the postoperative period due to a more optimal load distribution on this region.

Clinical example

Patient Sh., 48 years old, was admitted to the clinic of traumatology and orthopedics GOU VPO SamGMU September 3, 2006 with a diagnosis of enchondroma of the upper third of the right tibia. Medical history No. 00000/000. From the anamnesis it is known that for 2 years I was disturbed by pain in the inner condyle of the right tibia. In January 2006, an osteoblastoclastoma of the upper third of the right tibia was diagnosed, about which it was observed in the OKOD of Samara. September 6, 2006 operation was performed: resection of education. The resulting bone defect was replaced by the developed method. At the control examination on 09.10.2007 revealed:

The technical result. The use of this method of laying an allograft in order to evenly distribute the load on the articular surfaces, increase the mechanical strength of the bone and maintain supportability of the limb creates optimal conditions for the operation, which reduces the risk of limb deformation in the postoperative period, reduces the time of immobilization, shortens the hospital bed, and facilitates postoperative rehabilitation.

Used Books

1. Movshovich I.A. Operative orthopedics. M .: "Medicine", 1994, p. 455.

2. Traumatology and orthopedics. / Ed. G.S. Yumasheva, H.A. Musalatova. Ed. 4th. M .: "Medicine", 1995, p. 532.

Claims (1)

A method for replacing bone defects in surgical treatment of cysts and neoplasms of the metaepiphyseal zone in long tubular bones by resection of the neoplasm within healthy tissues, followed by cavity filling, followed by filling of the defect with a spongy bone allograft, placed randomly, characterized in that one of the 8 allograft plates -12 cm × 2 cm × 0.4-0.6 cm is injected horizontally, parallel to the articular surface of the knee joint, into the submaxillary region, the second plate Dimensions 12-15 cm × 2 cm × 0,4-0,6 cm is placed vertically, one end abutting against the diaphysis of the tibia, the other - a horizontal plate, creating a support for it.

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