RU2629038C1 - Method for surgical treatment of valgus deformation of first metatarsophalangeal joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: tenolysis of the tendon muscle of the first toe muscle is carried out through projection access, only from the distal end of the metatarsal bone, in the region of the first metatarsal-phalanx with excision of the altered part of the bursa, to the proximal end of the main phalanx. After tenolysis, tendon tenoraphy is performed from the distal end of the metatarsal bone to the proximal end of the main phalanx, fixing it to the main phalanx, to capsule 1 of the metatarsophalangeal joint, to the diaphysis of the metacarpal bone. At each stage of fixation, the needle and thread are injected from the inside of the tendon, directed through its thickness, removed to its outer side, then brought from the outside of the tendon through its thickness to the inside, after which it is directed through the periosteum. The knots are tied between the bone and the tendon.

EFFECT: method prevents disease relapse within three years.

1 ex, 1 dwg

Description

The present invention relates to medicine, namely to traumatology and surgery, and can be used to eliminate hallux valgus deformity of the first metatarsophalangeal joint (Hallux valgus).

Various methods of treating Hallux valgus are known. So, more than 400 types of operations and their modifications are known for correction of deformations of the forefoot. All the proposed methods did not find wide application due to unsatisfactory results, were ineffective and traumatic.

So, there is a known method of treating Hallux valgus with the method of modified minimally invasive chevron osteotomy (Kardanov Α.Α., Zagorodni NV, Lukin MP, Makinyan L.G .: Modified minimally invasive chevron osteotomy in the treatment of Hallux valgus in young patients: Ж -l “Traumatology and Orthopedics of Russia” No. 4 (46), 2007, p. 9-14).

The known method includes subarachnoid anesthesia. A semi-oval skin incision, 2.5-3 cm long, is performed medioplantally, starting just below the middle of the head of the first metatarsal bone. With the displacement of the sesamoid hammock in the first intertarsal space, an additional incision of 0.5-1.0 cm is made through the capsule of the metatarsamal joint, and at angles between the axes of the first metatarsal bone and the proximal phalanx of the first finger more than 30 °, the tendon m is cut off. adductor halluces from the base of the proximal phalanx. An osteotomy is performed with an oscillating saw, positioning the osteotomy planes of the head so that they intersect 3-4 mm proximal to its anatomical center and converge at an angle of 40-45 °. With a finger, the head is laterally displaced to the required distance, after which it is fixed with the cannulated Baruk screw from the back surface of the metatarsal head. The protruding medial edge of the proximal diaphysis fragment is resected with an oscillating saw. The excess capsule is excised and sutured without tension in the middle position of the first finger.

The range of motion in the metatarsophalangeal joint and the absence of a tendency to varus or valgus displacement of the first finger are controlled intraoperatively by placing the foot on the table.

From the second day of the postoperative period, limited walking is allowed, in Baruk’s shoes, without external immobilization. They recommend the use of an interdigital insert from the time of surgery to one and a half months.

The main disadvantages of this method are trauma to the bone structure, damage to the integrity of the metatarsophalangeal joint, a long rehabilitation period and the possibility of relapse due to the failure to eliminate the cause of the disease.

The closest in technical essence to the claimed and adopted as a prototype is a method of eliminating the hallux valgus deformity of the first metatarsophalangeal joint according to His (Hiss, J.M. Hallux valgus, its cause and simplified treatment / J.M. Hiss // Am J Surg 11: 51, 1931).

With this method, access is carried out in the metatarsophalangeal joint and metatarsal bone. At the first stage, a tendon is isolated, tenolysis is performed, followed by tenotomy m. abductor hallucis. Next, an ellipsoid resection of the capsule of the metatarsophalangeal joint is performed, after which the tendon m. abductor hallucis is fixed dorsally to the periosteum of the first metatarsal bone. According to the author of this method, cicatricial degeneration of soft tissues in the region of the first metatarsophalangeal joint will allow holding the first finger in the correct position.

The operation due to mixed results was not widespread. The main disadvantages of this method are damage to the integrity of the metatarsophalangeal joint, tenotomy of the abductor of the first finger, which subsequently is a relapse factor of up to 80% in connection with the elimination of the cause of the disease.

The technical result of the proposed method is to increase the effectiveness of treatment by correcting deformation and bringing the first toe to a constant physiological position, minimally invasive intervention and reducing the time of surgery, as well as eliminating the recurrence of the disease by eliminating its cause.

The technical result is achieved by the fact that the method of surgical treatment of valgus deformity of the first metatarsophalangeal joint includes projection access, tenolysis of the tendon of the abducting muscle of the first toe, changing the attachment point and fixing to the first metatarsal bone.

Distinctive techniques of the proposed method are that through the projection access, the altered part of the bursa of the joint is excised and after tenolysis a tendon is performed from the distal end of the metatarsal bone to the proximal end of the main phalanx, fixing it to the main phalanx, to the capsule 1 of the metatarsophalangeal joint, to the diaphysis metacarpal bones.

The difference of the proposed method is also the fact that at each stage of fixation, a needle with a thread is injected from the inside of the tendon, carried through its thickness, brought to its outside, then from the outside of the tendon through its thickness brought to the inside, and then passed through periosteum, and the nodes are tied between the bone and tendon.

A comparative analysis of the proposed technical solution with the prototype allows us to conclude that the claimed technical solution meets the criteria of the invention of "novelty."

The analysis of patent and medical literature has shown that the proposed method contains features that distinguish it not only from the prototype, but also from other methods of eliminating the hallux valgus deformity of the first metatarsophalangeal joint.

Tenolysis of the tendon of the muscle leading to the first toe (m. Abductor hallucis), from the distal end of the metatarsal bone, then in the region of the first metatarsal joint, with excision of the altered part of the bursa of the joint, and to the proximal end of the main phalanx, eliminates the excessive tension of this tendon (proximal places of its pathological fixation) and to spontaneous reduction of dislocation of the first metatarsophalangeal joint, and thereby deformation of hallux valgus is eliminated.

The exception of disease recurrence is achieved by fixing a given position of the tendon m. abductor halluces with interrupted sutures to the main phalanx, to the capsule 1 of the metatarsophalangeal joint, to the diaphysis of the metacarpal bone. This technique allows you to get a reliable fixation of the tendon along its entire length and in a given position.

Holding a needle with a thread according to the claimed method provides reliable fixation with the possibility of tying knots between the tendon and bone. This placement of nodes reduces the risk of ligature fistula, and the concealment of nodes provides the best cosmetic effect.

The advantages of the proposed method over the known are as follows:

- increasing the effectiveness of treatment by correcting deformation and bringing the first toe to a constant physiological position;

- elimination of disease recurrence due to elimination of its cause - elimination of the etiological factor;

- less traumatic, minimally invasive intervention;

- a small amount of tissue involved;

- reduction of operation time (no more than 30 minutes);

- reduction of the rehabilitation period to 2 weeks;

- fast and complete recovery;

- simple to execute.

The above allows us to conclude that the claimed technical solution meets the criterion of "inventive step".

The method comprising the claimed invention is intended for use in healthcare. This method can be applied in surgery and traumatology to eliminate Hallux valgus. The possibility of its implementation is confirmed by the methods and means described in the application, therefore, the proposed solution meets the criteria of the invention "industrial applicability".

The essence of the proposed method is illustrated in figure 1, which schematically shows the region of fixation of the tendon of the muscle, abducting the first toe (m. Abductor hallucis) in norm and pathology: 1 - anatomical region of fixation, 2 - region of fixation with Hallux valgus; 3 - "excess" tendon with Hallux valgus; 4 - muscle-tendon complex, leading the first toe; 5 - muscle leading the first toe to its original position.

It is known that the main factors leading to the formation of Hallux valgus are a change in the anatomical region of fixation 1 to “pathological” 2 and the formation of an excess of tendon behind it 3. The “pathological” region of fixation occurs as a result of mechanical stress (narrow shoes, especially with high heels) on the metatarsophalangeal joint, which contributes to the formation of an adhesion process in this area. As a result, the place of fixation of the tendon is displaced with the formation of its excess 3. The changed lever of muscular action leads to subluxation in the metatarsophalangeal joint and the development of transverse flatfoot. This flatfoot is enhanced with a decrease in the length of the muscle-tendon complex 4 with Hallux valgus.

Eliminating the pathological region of fixation and excessive tension of the tendon, the authors of the proposed method restore the balance between the abducting and adducing 5 muscles of the first toe.

The proposed method is as follows. Tenolysis of the tendon of the muscle of the big toe - m. abductor hallucis, is carried out from the distal end of the metatarsal bone to the proximal end of the main phalanx. When performing tenolysis in the metatarsophalangeal joint, an inflammatory-altered bursa of the joint is excised with thorough hemostasis. After tenolysis is complete, normal recovery occurs, i.e. physiological relative position of the bones of the metatarsophalangeal joint. With an atraumatic needle and thread, the released tendon is fixed to the main phalanx, to the capsule of the first metatarsophalangeal joint, to the diaphysis of the metacarpal bone. In this case, the thread is carried out as follows. A needle with a thread is injected from the inside of the tendon, carried through its thickness, brought to its outside, then from the outside of the tendon through its thickness brought to the inside, and then passed through the periosteum. Then knotted sutures between the bone and tendon

The essence of the proposed method for surgical treatment of hallux valgus of the first metatarsophalangeal joint is illustrated by an example of a specific implementation.

Patient A.A. V., 30 years old, was admitted to the department of microsurgery in a planned manner with complaints of hallux valgus deformity of the second degree of the first toe of the left foot. Anamnesis of the disease 3 years. The patient performed the removal of Hallux valgus by the proposed method.

On day 2, the patient is allowed to walk with a full effect on the operated lower limb. On the 7th day, the patient was discharged with recommendations to limit physical activity on the operated lower limb, wearing comfortable shoes for 1 month.

Control examination after 3 months - no complaints, there are no restrictions on normal physical activity.

Currently, the authors of the proposed method in the Department of Plastic and Reconstructive Surgery OKB No. 1 "Badge of Honor" in Irkutsk, 22 patients were operated on - 10 men and 12 women. The age category of patients was 20-45 years. All patients were admitted to outpatient medical facilities and were operated on as planned. All 22 patients did not have concomitant severe systemic pathology.

Among them: 3 patients with I degree and 19 patients with II degree of hallux valgus deformity of the first metatarsophalangeal joint.

On the 2nd day after the operation, the patients operated on by the proposed method were allowed a normal regimen with limited involvement of the operated limb.

Patient disability time was 2 weeks.

A month after the operation, the function of the operated foot was restored in full, in all patients the transverse flatfoot and discrepancy of the metatarsal bones decreased.

Thus, the claimed method provides the complete elimination of hallux valgus deformity of the first metatarsophalangeal joint and restoration of finger function. Patient disability time was reduced from 1.5 months (by known methods) to 2 weeks.

Three-year follow-up of 12 operated patients showed no recurrence of the disease.

The method is simple to implement and can be performed by a surgeon or traumatologist.

Claims (1)

A method of surgical treatment of hallux valgus deformity of the first metatarsophalangeal joint, including projective access, tenolysis of the tendon of the abducting muscle of the first toe, changing the place of attachment and fixation of the tendon to the first metatarsal bone, characterized in that only the tendon of the abducting muscle of the first toe is carried out through projection access from the distal end of the metatarsal bone, in the region of the first metatarsophalangeal joint with excision of the changed part of the bursa, to the proximal end of the main phalanx, Tenolysis of the tendon is carried out from the distal end of the metatarsal bone to the proximal end of the main phalanx, fixing it to the main phalanx, to the capsule of the 1 metatarsophalangeal joint, to the diaphysis of the metacarpal bone, and at each stage of fixation, a needle with a thread is injected from the inside of the tendon, lead through its thickness, lead to its outer side, then from the outside of the tendon through its thickness lead to the inner side, and then pass through the periosteum, and the nodes are tied between the bone and the tendon.

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