RU2489106C2 - Method of osteosynthesis by ortho-suv apparatus in case of deformations of midfoot - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field o medicine, namely to traumatology and orthopedics, and can be applied for correction of midfoot deformations. Transosseous supports are applied on shin, calcaneous bone and instep bones. Two consol attachments are fixed to support, fixing calcaneous bone, at the top in frontal plane, half-ring being fixed in the same plane at the bottom. Additional bearing is fixed to support, which fixes instep bones more distally from it. Strata No1 and No5 are fastened to consol attachments of support, fixed on calcaneous bone. Stratum No3 is fastened in the center of additional half-ring of calcaneous support. Strata No2 and No4 are fastened to edges of remote support fixed on instep bones. Stratum No6 is fastened in the center of the same support, No 2, No 4 and No 6 being fixed with Z-shaped pads.

EFFECT: method ensures restoration of support ability of extremity, achievement of maximal reposition possibilities of apparatus with minimal dimensions of construction during fixation period.

1 ex, 16 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to correct deformations of the middle part of the foot.

There is a method of osteosynthesis by the Ilizarov apparatus for correction of deformations of the middle foot (Shevtsov VI, Ismaylov GR // Transosseous osteosynthesis in surgery of the foot. // A guide for doctors. - Publishing House "Medicine", 2008. - 360 S.) (figure 1).

According to this method, the Ilizarov apparatus, consisting of external supports connected by unified nodes to eliminate deformation, is applied to the damaged segment of the limb (foot bone) and the distal part of the lower leg.

Unified nodes for eliminating deformation of any degree of complexity are developed in detail at the Acad. G.A. Ilizarova. However, their use is a rather complex and time-consuming process, requiring the skills and extensive experience of the surgeon. Therefore, the disadvantages of using this device are:

1. The need for partial remounting of the apparatus to eliminate multi-plane multicomponent deformations, which is associated with the need to replace unified nodes (V. Vilensky. Development of the fundamentals of a new technology for treating patients with diaphyseal injuries of long bones based on transosseous apparatus with the properties of passive computer navigation: dis. ... cand Medical Science / Victor A. Vilensky. - St. Petersburg, 2009. - 284 p .; Paley D. Principles of deformity correction. / D. Paley. - New York: Springer-Verlag, 2005. - 806 p.). This increases labor costs, increases the patient's hospital stay or the number of outpatient visits.

2. When eliminating each component of the deformation, x-ray control is necessary, which increases the radiation dose to the patient and medical personnel.

Closest to the proposed device is Ortho-SUV, operating on the basis of computer navigation (Solomin L.N., Vilensky V.A., Utekhin A.I. Ortho-SUV - a new transosseous device based on computer navigation. // ASAMI Russian Congress . - Kurgan, 2009. - P.129-130) (figure 2).

According to the method of using this apparatus for correction of deformations of long tubular bones, the proximal and distal transosseous modules (which fix the proximal and distal bone fragments, respectively) are connected by six telescopic rods of the original design - strata. Changing the lengths of each of the strata provides the movement of one support relative to another (and, accordingly, the distal fragment relative to the proximal) in six degrees of freedom. The change in the length of each stratum necessary for the correction of deformation is determined by a special computer program. However, it is impossible to use a similar arrangement of the Ortho-SUV apparatus (osteosynthesis method) for foot deformation:

1. The basic support on the lower legs and the basic support at the metatarsal level with the correction of deformity of the feet are located almost perpendicular to each other. This makes it impossible to fix the strata only to the basic supports: part of the stratum would have to pass “through” the distal part of the leg and foot.

2. When correcting the deformation of the foot, it is impractical to use all the basic supports closed (circular): this increases the bulkiness of the apparatus, excludes the function of the support after correction of the deformation, and is often simply impossible for anatomical reasons.

The technical result of the invention is to ensure the maximum repositioning capabilities of the Ortho-SUV apparatus (correction of deformation of any degree of difficulty in one step along the “integral” path) while maintaining the minimum dimensions of the structure during the fixation period.

The result of the invention is achieved in that the proximal base module consists of two supports: annular at the level of the distal metadiaphysis of the lower leg and support, component 2 / 3-3 / 4 of the ring, fixed to the calcaneus. In addition to the “heel” support, two cantilever consoles are fixed from above in the frontal plane, and a half-ring is attached from below in the same plane. The distal base support constituting 2 / 3-3 / 4 rings is fixed to the metatarsal bones and to it and distal from it with the help of threaded rods, the support constituting 2 / 3-3 / 4 rings is fixed. In this case, strata No. 1 and No. 5 are attached to cantilever consoles of the support fixed on the calcaneus, stratum No. 3 is fixed in the center of the additional half-ring of the “calcaneal” support. Strata No. 2 and No. 4 are attached to the edges of the "outrigger" support, fixed on the metatarsal bones. Stratum number 6 is fixed in the center of the same support. In this case, strata No. 2, No. 4 and No. 6 are fixed to the supports using Z-shaped platiks (Figs. 3 and 4). After correction of the deformation, a modular transformation of the apparatus is performed: the proximal module, consisting of a support fixing the lower leg and a support fixing the calcaneus, is connected with rods or hinges to the support fixing the metatarsal bones. Cantilever consoles and a half-ring fixed to the “heel” support, and a “remote” support connected to the support fixing the metatarsal bones, are dismantled. This allows you to reduce the bulkiness of the structure and provide the possibility of support on the foot (Figure 5).

To substantiate the method, 30 bench studies were carried out (5 models for each tested layout option). We studied various options for attaching striations and mounting supports for the possibility of directional movement of the distal (distal osteotomy) of the foot in the directions:

- back flexion

- plantar flexion

- supination

- pronation

- abduction

- cast.

The research results allow us to establish that the proposed layout (figure 3 and 4) has the ability to produce the greatest amplitude of displacements in most of the tests used. Use for mounting strips No. 2, No. 4 and No. 6 of Z-shaped plates excludes the possibility of contact of the striations with the skin (and the pressure of the striations on the skin) at the maximum possible amplitude of the deformation correction.

The figures depict:

Figure 1 - Ilizarov apparatus for correction of deformities at the level of the middle section of the foot.

Figure 2 - apparatus Ortho-SUV.

Figure 3 - the optimal layout of the apparatus Ortho-SUV for correction of deformities at the level of the middle part of the foot, front view.

Figure 4 - the optimal layout of the apparatus Ortho-SUV for the correction of deformities at the level of the middle part of the foot, side view.

5 is a view of the apparatus after modular transformation.

6 is a photograph of a patient before correction of deformation.

Fig. 7 is a patient x-ray before correction of deformation in a direct projection and a lateral projection.

Fig. 8 is a photograph of the foot in the Ortho-SUV apparatus before correction, front and side views.

Fig.9 is a photograph of a lateral radiograph with the determination of the angle of correction.

Figure 10 - designation of striations on the direct and lateral radiographs in the navigation program.

11 is a photograph of the patient in the process of correction, front view and side view.

12 is a patient fluoroscopic image during correction of deformation in a lateral projection.

Fig. 13 is a photograph of the patient at the end of the correction, modular transformation of the apparatus — the striations are replaced by hinges, front and side views.

Fig - photograph of the foot in the apparatus of Ilizarov after correction close-up, side view.

Fig - photograph of the patient after correction, front view and side view.

Fig - foot radiographs of the foot after correction.

The method is as follows. At the level of the distal metadiaphysis of the lower leg, transosseous elements (knitting needles, screw rods) are carried out and an annular support is fixed to them. Transosseous elements are passed through the calcaneus and a support is fixed to them, which is 2 / 3-3 / 4 of the ring. Two cantilever consoles are fixed to the proximal surface of the support fixing the calcaneus in the frontal plane; a half ring is fixed to the lower surface of the same support. Transosseous elements are passed through the metatarsal bones and the support constituting 2/3 to 3/4 of the ring is fixed to them and a support constituting 2/3-3/4 of the ring is attached to it and distal from it using threaded rods. In this case, transosseous elements are carried out only in the projection of the "Recommended Positions" (L. Solomin. Fundamentals of transosseous osteosynthesis using the apparatus of G. A. Ilizarov. / L. N. Solomin. - St. Petersburg: Morsar AV, 2005. - 544 p. ; Solomm LN, Fomin NF, Toropov SS, Maikov SV The atlas of "Foot Reference Positions" for transosseous element insertion // 5th Meeting of the ASAMI International. Program and Abstract Book. - St. Petersburg, 2008. - P.154) . This reduces the risk of transfixation contractures and avoids damage to the great vessels or nerves. Strata No. 1 and No. 5 are attached to the console prefixes of the support fixed on the calcaneus, stratum No. 3 is fixed in the center of the additional half ring of the calcaneal support. Strata No. 2 and No. 4 are attached to the edges of the "outrigger" support, fixed on the metatarsal bones. Stratum number 6 is fixed in the center of the same support. In this case, strata No. 2, No. 4 and No. 6 are fixed to the supports with the help of Z-shaped plates. After correction of the deformation, a modular transformation of the apparatus is performed: the proximal module, consisting of a support fixing the lower leg and a support fixing the calcaneus, is connected with rods or hinges to the support fixing the metatarsal bones. Cantilever consoles and a half-ring fixed to the “heel” support, and a “remote” support connected to the support fixing the metatarsal bones, are dismantled.

Clinical example

Patient P., 24 years old was hospitalized 02/13/2010 in the clinic RNIITO them. P.P. Harmful with a diagnosis of Neuropathy of the left fibular nerve, neuropathic equinus deformity of the middle foot. In 2008, he suffered an accident as a result of an accident - an open fracture of the bones of the left leg in the n / 3 region, damage to the peroneal nerve. He was treated promptly: AVF, plastic defect with a non-free musculocutaneous flap (10.2009 g). 02/20/2010 the operation was performed: installation of the Ortho-SUV apparatus on the shin and foot (Fig. 8). The correction of the equinus deformation of the foot in the apparatus of Ortho-SUV for 28 days (Fig.9-12). After correction of the deformation, the strata of the Ortho-SUV apparatus were replaced by swivel joints (Figs. 13-14). After 1.5 months, the apparatus was dismantled (Fig.15-16).

Claims (1)

The method of osteosynthesis with the Ortho-SUV apparatus for the correction of deformities of the middle part of the foot by applying transosseous supports to the shin, calcaneus and metatarsal bones, characterized in that two cantilever consoles are fixed on the calcaneus support from the top in the frontal plane, and from the bottom in the same planes attach a half ring; additional support is fixed to the support fixing the metatarsal bones and distal from it, strata No. 1 and No. 5 are attached to the console consoles of the support fixed on the calcaneus, stratum No. 3 is fixed in the center of the additional half ring of the calcaneal support, strata No. 2 and No. 4 are fixed to the edges of the outrigger, fixed on the metatarsal bones, stratum No. 6 is fixed in the center of the same support, while strata No. 2, No. 4 and No. 6 are fixed with Z-shaped plates.

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