RU2479272C1 - Method for autoosteoplastic replacement of postresection defect of long bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to orthopaedics, and may be used in the treating the patients with post-resection defects of long bones of hand. After resection of a lytic lesion, an external fixation mini-apparatus is applied on a long bone. A cortical bone graft is sampled from the tibial bone. It is followed by corticotomy of the affected long bone through the lytic lesion. The sampled autograft is immersed into the defect cavity. Compression thrusts are created at the junction of the bone fragments and the graft by crumpling the cortical layer of the long bone of hand within the corticotomy area by graduated advance of assemblies of the mini-apparatus towards each other.

EFFECT: method ensures eliminating the bone defect, provides faster osteogenesis within the abnormality, prevented postoperative complications.

1 ex, 4 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with post-resection defects of tubular bones of the hand.

A known method of replacing bone defects after resection of tumors of small tubular bones, including surgical access, resection of the tumor and replacement of a bone defect. The cavity of the bone defect after treatment with antiseptic solutions is filled with granules of porous titanium nickelide through a funnel that ensures accurate distribution of granules in the cavity (RU 2003109960 A).

However, the proposed method does not envisage autologous replacement of a bone defect, which can lead to the development of rejection reactions of implanted particles of a bone substitute, a decrease in bone strength, prolonged external immobilization of a limb and, as a result, to an unsuccessful attempt to replace a post-resection defect of a tubular bone, the development of persistent contractures and deformities of the hand.

There is a method of treating phalanx and metacarpal bones of the hand, where a bone defect is 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 or metacarpal bone (RU 2236189 C2).

However, this method is not without drawbacks due to the use of allogy (not antigenically inert, sometimes not always accessible) as the graft by the authors, placing it freely in the area of the bone defect, which often leads to graft lysis or to prolonged organotypic reconstruction and, as a result, to long-term patient rehabilitation .

The objective of the invention is to develop a method for autocostoplastic replacement of a post-resection defect in the tubular bone of the hand, which activates the consolidation processes and fills the bone defect with newly formed bone tissue and prevents complications associated with bone allotransplantation and cutaneous fixation of the limb.

This task is achieved by the fact that after resection of the destruction site, an external fixation mini-apparatus is applied to the tubular bone, a cortical autograft is taken from the tibia, a corticotomy of the affected tubular bone is performed through the destruction focus, the taken autograft is immersed in the defect cavity, and compressive forces are applied to the joint bone fragments and graft, crushing the cortical layer of the tubular bone of the hand in the corticotomy zone by the metered movement of the nodes mini-appar ata towards each other.

The invention is illustrated by a detailed description, an example of the practical use of the method, as well as illustrative material, which shows:

Figure 1 - scheme of the method;

Figure 2 - photo radiographs of the brush of the patient P. before treatment;

Figure 3 - photo radiographs of the brush of the patient P. during the creation and maintenance of metered compressive efforts at the joints of bone fragments;

Figure 4 - photo radiographs of the brush of patient P. after dismantling the Ilizarov mini-apparatus, removing the needles (1.5 months after the operation).

The method is as follows.

In the operating room, after anesthesia, bleeding of the extremities and treatment of the surgical field, the affected tubular bone of the hand in the area of interest is exposed subperiostally from the economical skin incision using blunt and sharp methods. An intraosseous resection of the tumor focus is performed within the limits of healthy tissues using osteotomes, acute Volkman spoons, bone cutters. The formed post-resection cavity is treated with an electrocoagulator and 96% ethanol for three minutes. After the cavity is washed with antiseptic solutions, it is treated with sharp bone spoons and its linear dimensions are measured.

After repeated treatment of the skin of the hand with an antiseptic solution using an electric drill, 2-3 Kirschner spokes (depending on the size of the bone fragment) are cantilevered into the tubular bone proximal and distal to the formed bone cavity, bent and attached to the nodes of the Ilizarov mini-apparatus, which is mounted on threaded rod. At this stage, osteosynthesis of compressive forces in the apparatus is not created.

After anesthesia, a cortical bone autograft from the tibia is taken.

A sharp chisel in the transverse length of the bone in the direction in the middle of the bone cavity and through it a corticotomy of the tubular bone of the hand is performed. The validity of a corticotomy is tested by determining the pathological mobility of bone fragments. The bone cavity is washed with an antiseptic solution. The taken autograft is coapted (immersed) in the post-resection cavity in close contact with the walls of the cavity, and by moving the nodes of the mini-apparatus towards each other with the help of nuts and subsequent fixation. As a result, compressive forces are created at the joints of the distal and proximal ends of the graft and the tubular bone of the hand, and its cortical layer is crushed in the corticotomy zone, which leads to stimulation of osteoregenerative processes (Figure 1). The wound of the brush is sutured in layers, drained by a rubber graduate, aseptic dressings are applied.

The stress conditions created in the bone segment during compression at the junction of the fragments, along with the consolidation of the fracture, have a stimulating effect on the normalization of bone structure in the area of the pathological focus (crushing increases the mechanical strength of the joint, which prevents the development of relapse of the disease).

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

Patient P., 20 years old, was admitted to the clinic of the Center with a diagnosis of enchondroma of the proximal phalanx of the second finger of the right hand (Figure 2).

The patient underwent surgery - intraosseous resection of the tumor, transosseous osteosynthesis of the phalanx with an Ilizarov mini-apparatus, corticotomy of the proximal phalanx at the level of the thinned cortical layer (Fig. 3), sampling of a cortical bone autograft from the tibia of the left leg.

The patient was prescribed physiotherapy exercises for the hand on the third day after the operation (after the pain subsided). The consistency of compression at the joints of bone fragments was monitored every seven to ten days by rotating the nuts of the mini-apparatus. Additional immobilization of the hand until the onset of consolidation was not required.

Fixation in support compression mode - 45 days. The apparatus was dismantled, bone integrity was restored (Figure 4).

At the follow-up examination, after one year, the achieved treatment result is preserved, there are no signs of relapse of the disease.

Using the proposed method in the clinic FSBI "RRC" WTO "them. Acad. G.A. Ilizarova »The Ministry of Health and Social Development has shown that its use ensures the activation of the processes of consolidation and filling of the bone defect with newly formed bone tissue and prevents complications associated with bone allotransplantation and cutaneous fixation of the limb.

Claims (1)

A method for autocostnoplastic replacement of a post-resection defect in the tubular bone of a hand, including performing intraosseous resection of the destruction site, corticotomy of the affected tubular bone, characterized in that after resection of the destruction site, an external fixation mini-apparatus is applied to the tubular bone, a cortical autotransplant from the tibia is taken from the tibia the affected tubular bone through the destruction site, the taken autograft is immersed in the defect cavity, a lump is created pressing forces at the junction of the bone fragments and the graft, crushing the cortical layer of the tubular bone of the hand in the corticotomy zone by the metered movement of the nodes of the mini-apparatus towards each other.

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