RU2547798C1 - Method of osteosynthesis by ortho-suv apparatus for elimination of ankle dislocations - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopaedics, and is intended for application in elimination of ankle dislocations. Additional ring support is fixed to base support, fixed to distal part of shin at level VII on rods in proximal direction. Distance between basic and remote support is determined from 5 to 8 cm. Diameter of remote support is selected to be 2-3 standard sizes larger than of the basic one. Distal support, which consists of two semi-rings, connected by bars, is fixed to foot bones in a single block. Additional support, fixed to basic support, and mobile support are connected by six strata. Fastening of strata to supports is realised in the following order: strata No 1, No 3 and No 5 are fixed to additional support at level IV of shin. Stratum No 1 is fixed in position 12, strata No 3 and No 5 in position 4 and 8, strata No 2, No 4 and No 6 are fixed to mobile support. Strata No 2 and No 6 are fixed to support at level of metatarsophalangeal joints, and stratum No 6 is fixed in position 6.

EFFECT: due to application of Ortho-SUV apparatus, working on the basis of computer navigation method makes it possible to set dislocations in ankle joint by apparatus in one stage for short period of time, with construction having minimal possible dimensions during fixation period.

46 dwg, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to eliminate dislocation in the ankle joint.

A known method of osteosynthesis by the Ilizarov apparatus in the treatment of chronic injuries of the ankle joint, including subluxations and dislocations in the ankle joint [1]. According to this method, the foot and lower leg are fixed in the Ilizarov apparatus (Fig. 1), consisting of external supports interconnected by hinges. Elimination of dislocation is carried out in several stages:

- distraction,

- elimination of displacement in width, at an angle in two planes, rotation,

- compression (restoration of the normal size of the joint gap). For example, a method for eliminating the anterior dislocation of the foot in the Ilizarov apparatus (Fig.2-5).

At each stage, the unified reposition nodes are remounted, accompanied by x-ray control. Thus, the disadvantages of this method can be considered:

- the labor required for the frequent change of unified reposition nodes,

- the associated long stay of the patient in the hospital,

- increased radiation exposure to the patient and medical personnel.

Known apparatus Ortho-SUV (Fig.6), operating on the basis of computer navigation, allowing reposition of bone fragments and correction of deformations of varying degrees of complexity [2, 3]. But to correct dislocations in the ankle joint, this device has not been used to date.

The technical result of the invention is the ability to reduce dislocations in the ankle joint by the Ortho-SUV apparatus in one step, along an “integral” path in a short period of time, while the structure has the smallest possible dimensions during the fixation period.

To indicate the positions of fixation of supports to the bones of the lower leg and foot, as well as to indicate the positions of attachment of the strata to the supports, the coordinate system “Methods for the unified designation of transosseous osteosynthesis” is used [4].

The result of the invention is achieved in that an additional (remote) annular support is fixed to the base support fixed to the distal part of the lower leg at level VII on the rods in the proximal direction. The distance between the base and the outrigger is 5 to 8 cm, and the diameter of the outrigger is selected 2-3 sizes larger than the base (Fig. 7-8). Fulfillment of this condition in this arrangement gives maximum mobility to the distal (movable) support without collision of striations with soft tissues and parts of the apparatus. The specific distance between the supports and the diameter of the extension ring is determined clinically, depending on the thickness of the soft tissues and the position of the transosseous elements.

The distal (movable) support, consisting of two half rings connected by trims, is fixed to the bones of the foot in a single block: the calcaneus, ram, metatarsal bones (according to the classical fixation in the AFF when the dislocations are corrected [1]). An additional support fixed to the base support and a movable support are connected by six striations.

The strata are fixed to the supports in the following order:

- strata No. 1, No. 3 and No. 5 are attached to an additional support at level IV of the lower leg. Stratum No. 1 is fixed at position 12, strata No. 3 and No. 5 at positions 4 and 8.

- strata No. 2, No. 4 and No. 6 are fixed to the movable support. In this case, strata No. 2 and No. 6 are fixed to the support at the level of the metatarsophalangeal joints, and stratum No. 4 is fixed in position 6.

The figures depict:

figure 1: the layout of the apparatus Ilizarov for reposition of dislocations in the ankle joint.

Figure 2: Anterior dislocation of the foot, fixation in the Ilizarov apparatus, the beginning of distraction, side view.

Figure 3: Elimination of posterior displacement of the foot, side view.

Figure 4: Compression to align the articular surfaces of the ankle joint, side view.

Figure 5: Eliminated dislocation of the ankle joint in the Ilizarov apparatus, side view.

6: Ortho-SUV apparatus.

Figure 7: Optimal arrangement of the Ortho-SUV apparatus for repositioning dislocations in the ankle joint, front view.

Fig: The optimal layout of the apparatus Ortho-SUV for reposition of dislocations in the ankle joint, side view.

Fig.9: Front dislocation of the foot, front view.

Figure 10: Front dislocation of the foot, side view.

11: Back dislocation of the foot, front view.

12: Back dislocation of the foot, side view.

Fig: Medial dislocation of the foot, front view.

Fig: Medial dislocation of the foot, side view.

Fig. 15: Lateral dislocation of the foot, front view.

Fig. 16: Lateral dislocation of the foot, side view.

Fig: Layout after modular transformation into fixation hinges, front view.

Fig. 18: Layout after modular transformation into fixation hinges, side view.

Fig: Close-up dislocation photograph, front view.

Fig. 20: Close-up photograph of a dislocation, inside view.

Fig.21: X-ray before the dislocation in a direct projection.

Fig.22: X-ray before the dislocation in the lateral projection.

Fig.23: Photo in the apparatus of external fixation, side view.

Fig.24: X-ray diffraction pattern in the apparatus of Ortho-SUV until the dislocation is repositioned, direct projection.

Fig.25: X-ray diffraction pattern in the apparatus of Ortho-SUV until the dislocation is repositioned, side view.

Fig. 26: Photograph after reduction of dislocation, front view.

Fig. 27: Photograph of the ankle joint after repositioning a dislocation in close-up, side view.

Fig. 28: Photograph of the ankle joint after repositioning a dislocation in close-up, inside view.

Fig.29: X-ray after reduction of dislocation and arthrodesis, lateral projection.

Fig. 30: X-ray diffraction pattern after dislocation and arthrodesis reduction, direct projection.

Fig: Layout No. 1, front dislocation - the maximum possible displacement of 8.5 cm, front view.

Fig: Layout No. 1, front dislocation - the maximum possible displacement of 8.5 cm, side view.

Fig: Layout No. 2, front dislocation - the maximum possible displacement of 7.5 cm, front view.

Fig. 34: Layout No. 2, front dislocation - the maximum possible displacement of 7.5 cm, side view.

Fig. 35: Layout No. 1, rear dislocation - the maximum possible displacement of 9 cm, front view.

Fig. 36: Layout No. 1, posterior dislocation - maximum possible displacement of 9 cm, side view.

Fig.37: Layout No. 2, rear dislocation - the maximum possible displacement of 7.5 cm, front view.

Fig. 38: Layout No. 2, posterior dislocation - the maximum possible displacement of 7.5 cm, side view.

Fig. 39: Layout No. 1, medial dislocation - the maximum possible displacement of 8 cm, front view.

Fig: Layout No. 1, medial dislocation - the maximum possible displacement of 8 cm, side view.

Fig: Layout No. 2, medial dislocation - the maximum possible displacement of 8 cm, front view.

Fig. 42: Layout No. 2, medial dislocation - the maximum possible displacement of 8 cm, side view.

Fig. 43: Layout No. 1, lateral dislocation - the maximum possible displacement of 6 cm, front view.

Fig. 44: Layout No. 1, lateral dislocation - the maximum possible displacement of 6 cm, side view.

Fig. 45: Layout No. 2, lateral dislocation - the maximum possible displacement of 6.5 cm, front view.

Fig. 46: Layout No. 2, lateral dislocation - the maximum possible displacement of 6.5 cm, side view.

To substantiate the method conducted 8 bench studies. During the study, two layouts were compared: No. 1 and No. 2 (Table 1). Both layouts had the same fixation to the base and movable supports, but layout No. 1 had an additional support, to which striations 1, 3, 5 were fixed, in accordance with the claimed method, and layout No. 2 had no additional support and strata 1, 3, 5 were fixed directly to the base support. We also investigated various options for attaching striations for the possibility of directional movement of the foot component in directions when eliminated:

- front dislocation (Fig.9-10)

- posterior dislocation (11-12)

- medial dislocation (Fig.13-14)

- lateral dislocation (Fig.15-16)

- angular and rotational displacement along the axis of the limb.

The results of the study are given in table 1. The analysis of the results confirms that the recommended layout No. 1, exceeds the layout No. 2 as far as possible the movement of the articular surfaces (Table 1).

The method is as follows. An annular support is fixed to the lower leg bones at level VII, which is the base. An additional annular support 2-3 sizes larger is fixed to the base support in the proximal direction by 5-8 cm. The movable support, having an oval shape and consisting of two half rings connected by trims, is fixed to the skeleton of the foot. An additional proximal support and a movable support are interconnected by six striations. In this case, strata No. 1, No. 3 and No. 5 are attached to the additional support at positions 12, 4 and 8, respectively, and strata No. 2, No. 4 and No. 6 are fixed to the movable support in the following order: strata No. 2 and No. 6 are fixed to support strips at the level of the heads of the metatarsal bones, and stratum No. 4 is fixed to the top of the posterior half ring in position 6.

In the passive computer navigation program Ortho-SUV [3], the motion parameters of the movable support are calculated, according to which the dislocation is metered in time. After eliminating all components of the dislocation, the base and movable supports are fixed to each other motionlessly, and the striations and additional support are dismantled. The apparatus, thus, in the period of fixation takes the minimum size (Fig.17-18).

This arrangement allows the reduction of dislocations in the ankle joint without additional remounts in one stage in a short period of time with a maximum displacement of articular surfaces up to 6 cm, the angular displacement of the foot along the sagittal axis (supination / pronation) to 80 ° and the rotational component of deformation along the vertical axis ( foot rotation in / out) up to 65 ° in both directions (table 1)

Clinical example

Patient I., 62 years old, was hospitalized in the clinic RNIITO them. P.P. Harmful with a diagnosis of a chronic dislocation of the left foot outward and backward, an external ankle fracture fused with angular deformation, a false joint of the internal ankle (Fig. 19-22).

05.03.11 operation was performed: installation of the Ortho-SUV apparatus on the shin and foot, osteotomy of an incorrectly fused external ankle. On the second day after the operation, the parameters of the stratum change were calculated. Made metered in time reduction of dislocation within 16 days (Fig.23-25). After the reduction, the strata of the Ortho-SUV apparatus were replaced by swivel joints. 05/05/11, the second stage of surgical treatment was performed - an ankle joint arthrodesis was performed with an intramedullary retrograde lockable rod (Figs. 26-30). As a result of the treatment, the left lower limb became fully supportive, which allowed it to move without the use of additional support (crutches, canes).

Bibliography

1. Solomin L.N. The basics of transosseous osteosynthesis by G.A. Ilizarova, 2005, pp. 263-267.

2. Solomin L.N., Vilensky V.A., Utekhin A.I. Ortho-SUV apparatus: transosseous apparatus, the work of which is based on computer navigation // Genius Orthopedics. - 2011. - No. 2. - S.161-169.

3. Vilensky V.A. “Development of the fundamentals of a new technology for the treatment of patients with diaphyseal injuries of long tubular bones on the basis of the transosseous apparatus with the properties of passive computer navigation: abstract, dis. for candidates. honey. Sciences / Vilensky Victor Aleksandrovich. - SPb., 2009. - 31 p.

4. The method for the uniform designation of transosseous osteosynthesis of long bones: method, recommendations 2002/134 / comp .: L.N. Solomin [et al.]. - St. Petersburg, 2004 .-- 21 p.

Table 1 Offset Type Layout number 1 Layout number 2

Front dislocation 85 ± 1.5 mm 74.1 ± 0.8 mm Posterior dislocation 89.9 ± 1.8 mm 76.1 ± 1.1 mm Medial dislocation 80.8 ± 1.2 mm 81.5 ± 1.1 mm Lateral dislocation 57.8 ± 1.0 mm 63.4 ± 1.0 mm Vertical axis rotation 66.9 ± 1.4 ° 68.3 ± 1.1 ° Sagittal axis rotation 80.7 ± 1.3 ° 81.6 ± 1.2 °

Claims (1)

The method of osteosynthesis with the Ortho-SUV apparatus to eliminate dislocations in the ankle joint with fixation of the base support to the bones of the lower leg at level VII and fixation of the movable support to the bones of the foot, characterized in that an additional outrigger is fixed proximal to the base support 5-8 cm with a diameter 2-3 sizes larger than the base; additional and movable supports are connected by striations, so that strata No. 1, No. 3 and No. 5 are fixed to the additional support at positions 12, 4 and 8, respectively, and strata No. 2, No. 4 and No. 6 are attached to the movable support so that strata No. 2 and No. 6 are fixed at the level of the metatarsophalangeal joints, and stratum No. 4 is fixed at position 6.

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