RU2782124C1 - Method for eliminating the post-resection defect of ankylosis of the knee joint in conditions of purulent infection by the regenerative-tibial-femoral block - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, purulent surgery and can be used to eliminate the post-resection defect of ankylosis of the knee joint in conditions of purulent infection. Resection of the bones forming the ankylosed knee joint is performed. From the tenth day after the removal of the sutures, post-resection diastasis is eliminated by bringing its end walls closer together by 0.5-1.0 mm per day before their contact over the entire area and fixed until the formation of bone adhesions. Then, longitudinal traction of the fragments is performed in the 0.25 mm mode twice a day until the formation of a regenerate of two centimeters, followed by a two-week fixation period. Longitudinal traction is resumed in the 0.25 mm mode twice a day, increasing the regenerate between fragments to four centimeters, followed by a two-week fixation period. Longitudinal traction is resumed in the 0.25 mm mode twice a day until the limb length is restored.

EFFECT: method provides an increase in the mechanical strength of newly formed bone tissue, restoration of limb length, reduction of treatment time due to the dosed elimination of shortening, by which the regenerative-tibial-femoral block is formed.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics, purulent surgery.

The problem of surgical treatment of patients with a post-resection defect of ankylosis of the knee joint is relevant, since the severity of injuries in anthropogenic, man-made and natural disasters is currently significantly increasing.

A known method of fusion of the bones of the knee joint with osteomyelitis lesions. (Patent RU No. 2257173 dated 27.07.2005). Removal of non-viable tissues, compression of fragments and fixation to fusion using a compression-distraction apparatus are performed, while the end of the femur is immersed in the ends of both opposite bones of the lower leg. At the same time, the proximal end of the fibula is cut off and preserved, the contact area of the opposing ends of the femur and tibia is blocked by the latter and the patella. The method is highly traumatic, accompanied by a violation of the blood circulation of bone fragments, which leads to delayed fusion, the task of restoring the length of the limb in one stage is excluded.

A known method (Shevtsov V.I. Rehabilitation of patients with chronic osteomyelitis and bone cysts / V.I. Shevtsov, A.I. Lapynin, A.V. Zlobin. - Kurgan, 2003. - 263 S. (see page 47) when, after sequestrectomy, osteotomy is performed through the osteomyelitic cavity, dosed distraction of bone fragments until it is replaced by bone regenerate and restoration of the segment length, followed by fixation with a compression-distraction apparatus. segment and compaction by dosed compression in order to stimulate osteogenesis and increase the volume of the emerging regenerate.However, to achieve bone regeneration and eliminate the post-traumatic defect, bone areas involved in the osteomyelitic process are used, which significantly reduces the effectiveness of the method.

The prototype of the proposed method can be a technique for compensating for a post-traumatic or post-resection defect of the tibia (Patent RU No. 2626146 dated 21.07.2017). Perform osteotomy of the tibia at the same level or osteotomy of the fibula at the level of the fracture of the tibia. When the bone fragments are stretched by three to five centimeters, dosed distraction is carried out along the internal rods of the apparatus until a valgus deformity of the resulting regenerate occurs by 25-30 degrees. Perform subsequent distraction on all rods. The pressure is applied by an external pressure element of the compression-distraction apparatus, applied to the surface of the lower leg in the projection of the bone regenerates. Considering that this technique requires complex implementation and is carried out in several stages, it is advisable to carry it out when eliminating a defect in the tibia with a concomitant distal fracture of this bone.

The novelty of the proposed invention lies in the fact that the technique is performed in one step. The intersection of the bones that form ankylosis of the knee joint is performed taking into account its deformation. After metered compression to the end stop and the formation of a bone adhesion, the device is switched to a distraction mode of 0.25 mm twice a day until a regenerate of two centimeters is formed. Then a two-week period of fixation and resumption of distraction in the mode of 0.25 mm twice a day, increasing the regenerate up to four centimeters, with repeated two-week fixation and resumption of the period of distraction in a given mode, during which, simultaneously with the dosed elimination of shortening, a regenerative-tibiofemoral block. From above, below and vertically, like a spacer, the regenerate is surrounded by bone tissue, enhancing the mechanical strength of the block. Due to the blood supply to the femur and tibia, stimulation of osteogenesis is enhanced, a single bone regenerate is formed between the femur and tibia.

Significant differences: The method is carried out in one stage. Resection of the bones forming ankylosis of the knee joint is performed taking into account its deformation. After the formation of a bone commissure between the tibia and femur, the apparatus is transferred to the distraction mode by 0.25 mm twice a day until a regenerate of two centimeters is formed. Then a two-week period of fixation and the resumption of distraction in a given mode, increasing the regenerate up to four centimeters, with a second two-week fixation and the resumption of distraction. In this case, simultaneously with the dosed elimination of the shortening, a regenerative-tibia-femoral block is formed. From above, below and vertically, like a spacer, the regenerate is surrounded by bone tissue, enhancing its mechanical strength. Due to the blood supply to the femur and tibia, stimulation of osteogenesis improves, a single bone regenerate is formed between the femur and tibia.

The method is performed as follows [Fig. one]. In FIG. 1a - ankylosis of the right knee joint in a vicious position with the presence of an osteomyelitic cavity 5×5 cm before surgical treatment. After anesthesia and treatment of the surgical field, osteosynthesis is carried out with a compression-distraction apparatus. When it is performed, the fixing needles are carried out outside the zone of the focus of osteomyelitic lesions and taking into account the deformation. In the tensioned state, the spokes are fixed on the supports of the apparatus installed at the appropriate level, which are interconnected by threaded rods. Produce access to the lesion and carry out the removal of non-viable tissues. The intersection of the bones forming ankylosis of the knee joint is performed taking into account the deformation [Fig. 1b]. On the tenth day after the removal of the sutures, a dosed compression is carried out between the bone fragments to their end stop at 0.5-1.0 mm per day [Fig. 1c]. After the formation of a bone adhesion, the device is switched to the distraction mode of 0.25 mm twice a day until a regenerate of two centimeters is formed. Then a two-week period of fixation and resumption of distraction in the previous mode, increasing the regenerate up to four centimeters, with repeated two-week fixation and resumption of the period of distraction in the mode of 0.25 mm twice a day, during which, simultaneously with the dosed elimination of shortening, a regenerative-tibiofemoral block [Fig. 1d]. The final fixation mode depends on the strength of the fusion. It is controlled by performing a clinical test and radiographically.

Usage example

The practical use of the method is illustrated by a clinical example [Fig. 2]. Patient S., 42 years old, was admitted with ankylosis of the right knee joint in a vicious position with the presence of an osteomyelitic cavity 5×5 cm [Fig. 2a]. Under spinal anesthesia and treatment of the surgical field, osteosynthesis of the femur and lower leg was performed using a compression-distraction apparatus. During its execution, fixing spokes were carried out in the lower third of the femur, middle and lower thirds of the tibia. In the taut state, the spokes were fixed on the supports of the apparatus installed at the appropriate level, which were connected to each other by threaded rods.

A Texter incision made access to the lesion and removed non-viable tissue. The intersection of the bones forming the ankylosed knee joint was performed taking into account the deformity. From the tenth day after the removal of postoperative sutures, dosed compression between bone fragments to their end stop at 0.5-1.0 mm per day was carried out for 27 days [Fig. 2b]. Before the formation of bone adhesions, the fixation regimen is for 12 days. After that, the device was transferred to the mode of distraction by 0.25 mm twice a day, until the formation of regenerate two centimeters. Then a two-week fixation period and resumed the distraction period in the previous mode until the regenerate increased to four centimeters, followed by a two-week fixation period and resumed the distraction period in the same mode, 0.25 mm twice a day. Its duration was 85 days, which corresponded to the formation of the regenerative-tibiofemoral block and the elimination of shortening [Fig. 2c]. Fixation mode 141 days, It was controlled by the execution of a clinical trial. On radiographs after removal of the apparatus, an organotypically rebuilt regenerative-tibia-femoral block [Fig. 2d].

EFFECT: achieved by fixing the femur and lower leg using a compression-distraction apparatus, in the projection of ankylosis of the right knee joint in a vicious position with the presence of an osteomyelitic cavity, Texter access is performed in the area of the ankylosed knee joint. Taking into account the deformation, its resection is performed. The wound is sutured in layers. From the tenth day after the removal of the sutures, dosed compression between the bone fragments is started up to their end stop at 0.5-1.0 mm per day and 27 days are carried out. Before the formation of bone adhesions, the fixation regimen is for 12 days. After that, the device is transferred to the mode of distraction by 0.25 mm twice a day until the formation of a regenerate of two centimeters. Then a two-week period of fixation and resume distraction in the same mode until the regenerate increases to four centimeters, followed by a two-week period of fixation and resumption of distraction in the same mode of 0.25 mm twice a day. Its subsequent exposure corresponds to the formation of the regenerative-tibia-femoral block and the restoration of the length of the limb. Fixation mode 141 days, The strength of the fusion is controlled by a clinical test. Radiographically, after removal of the apparatus, an organotypically rebuilt regenerative-tibia-femoral block is revealed.

Each of the essential differences is necessary and, in combination, is aimed at achieving the goal and high quality of rehabilitation of patients.

The method allows to perform the operation in one stage, to increase the mechanical strength of the newly formed bone tissue, to restore the length of the limb, to reduce the treatment time.

Sources of information

1. Patent of the Russian Federation No. 2257173 dated July 27, 2005. The method of fusion of the bones of the knee joint with osteomyelitis lesions / N.M. Klyushin, V.E. Degtyarev, A.I. Lapynin, Yeltsov E.A.; publ. 07/27/2005. Bull. No. 21.

2. Shevtsov V.I. Rehabilitation of patients with chronic osteomyelitis and bone cysts / V.I. Shevtsov, A.I. Lapynin, A.V. Zlobin. - Kurgan, 2003. - 263 p. (see page 47).

3. Patent of the Russian Federation No. 2626146 dated July 21, 2017. A method for replacing a post-traumatic tibial defect Bull. No. 21. A.I. Lapynin, A.A. Safronov, V.I. Kim, Al.A. Safronov, A.M. Guryanov, V.V. Zakharov.

Claims (1)

A method for eliminating a post-resection defect of ankylosis of the knee joint under conditions of a purulent infection by forming a regenerative-tibiofemoral block, including the removal of non-viable bone fragments, fixation using a compression-distraction apparatus, characterized in that resection of the bones forming an ankylosed knee joint is carried out; from the tenth day after the removal of the sutures, post-resection diastasis is eliminated by bringing its end walls closer together by 0.5-1.0 mm per day until they come into contact over the entire area and fixed until a bone commissure is formed; then, longitudinal traction of fragments is performed in the mode of 0.25 mm twice a day until the formation of a regenerate of two centimeters, followed by a two-week period of fixation; then, longitudinal traction is resumed in the mode of 0.25 mm twice a day, increasing the regenerate between fragments up to four centimeters, followed by a two-week period of fixation; then, longitudinal traction is resumed in the mode of 0.25 mm twice a day until the limb length is restored.

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