SU982673A1 - Method of replacing flaws in articular ends of knee joint - Google Patents

Description

(54) METHOD FOR FILLING DEFECTS AT THE JOINT END OF THE KNEE JOINT

one

The invention relates to medicine and can be used to restore the health and mobility of the knee joint in the bogus having destructive lesions in the two femoral condyles and in the condyle of the tibia.

There is a known method of replacing defects in the articular ends of the bones of the knee joint with a bone-stalk graft, using fibular bone 1.

The closest in technical essence to the present invention is a method of replacing defects in the articular ends of the knee joint with bone-cartilage autografts followed by replacing postoperative defects at the site of autograft bone marrow allografts 2.

However, the known method does not provide a complete restoration of the shape of the articular surfaces of the femoral condyles, and also does not provide for the restoration of the anatomical structure of the ruscular end of the bone from which the bone-cartilage autograft was taken.

The aim of the invention is the restoration of support and mobility in the knee joint.

The goal is achieved by the fact that according to the method of replacing defects in the articular ends of the knee joint with bone marrow autografts followed by replacement of postoperative defects, bone marrow allografts are taken at the site of bone marrow allografts, bone marrow grafts are excised from

10 anterior part of the lower epiphysis of the femur, then replace with autotransplants defects of the articular articular surfaces of the femoral condyles and condyle of the tibial bone.

The method is carried out as follows.

The operation is performed under endotracheal anesthesia using muscle relaxants. An underlay is placed under the knee to give a limb a semi-bent posture. Incision of the skin and pozhikozhny fatty tissue semi-oval. It begins 1 cm above the top turning, runs 3 cm inwards from the inner edge of the patella and ends at

tibial tuberosity. In the course of the skin incision, cut through the fibrous leaf of the joint capsule and its synovial membrane. If there are fibrous adhesions between the patella and the femur, they are dissected, and then the kneecap is moved to the outer surface of the joint. Then cut through the intra-articular commissures and bend the limb at the knee joint as much as possible. After clarifying the nature of the pathological changes, the affected areas of the synovial membrane and foci of destruction in the articular ends of the bones are dissected, while paying attention to the careful removal of all non-viable tissues and at the same time maximizing the preservation of healthy parts of the joint. After this treatment, the postoperative defects in the articular bones of the bones repeat the shape of the pathological foci. Then, bone marrow autografts from the anterior lower end of the femur (facies patellarisfemoris) are excised according to the shape and size of the defects. At the same time, bone-cartilage autografts, designed to replace defects in the femoral condyles, which also have bulging articular surfaces, are cut out from the lateral portions of the specified femur, which have convex surfaces, and bone tissue - an arthritic autograft for the replacement of a defect in one of the condyles of the tibial bone, the articular surface of which is, as is known, concave.

The above autotransplants can simultaneously replace defects in the two, and sometimes in the three condyles of the knee joint, which depends on the extent of its damage. The size of the cartilage cover on the lateral parts of the facies patellaris femoris, used as autografts, largely replaces the most loaded parts of the articular surfaces of the two femoral condyles.

From the central section of the facies patellaris femoris, if necessary, a complete bone-cartilage autograft can be obtained, the size of the cartilage cover of which is sufficient to completely replace the entire cartilage covering the condyle of the tibia, and the spongy base is up to 3 cm. This allows you to fill rather deep bone defect condyle without additional bone autograft.

One of the principal features of the method is that the defects formed at the site of the excision of bone marrow autografts in the area of the facies patellaris femoris are completely restored by transplanting the bone and bone tissue of the allograft, preserved by the deep freezing method, taken from a similar section of the femur. The operating frame is protected with a polyethylene tube left in the joint cavity for 24. h.

After the end of the operation, the limb is placed on the functional splint in the flexion position at the knee and in the pelvic joints at an angle of 90 °. Subsequently, the flexion and extension of the limb alternate every 4–6 hours, 2 weeks after the operation, the patient is allowed to independently develop joint mobility in combination with local application of physical procedures on the joint. The patient is transferred to the walking mode with the help of crutches without loading the operated limb one month later after the operation. The load on the operated limb is allowed 2 months after surgery. Duration of antibacterial

therapy is 2-3 months.

Example}. Sick S., 35 years old, was admitted to the hospital with a diagnosis of tuberculosis of the right knee joint and ankylosis of the left knee joint. Disease duration is 11 years. The right lower limb is bent at the knee joint at an angle of 145 °, the joint is deformed, the movements in it are swinging. Foci of destruction, containing sequesters, are determined radiographically in all

condyle of the knee joint, the joint gap sharply narrowed.

An operation was performed during which, after excision of lesions, postoperative defects in all four condyles of the joint were replaced with bone-cartilage autografts, three of which were taken from the anterior distal end of the femur (facies patellaris femoris). These grafts are transplanted to defects in the two femoral condyles and in the inner condyle of the tibia.

Bone autograft transplanted from the anterior epimetaphysis of the femur, which filled the deep part of the defect and thin bone-cartilage autograft taken from the posterior patella, immersed in the superficial segment of the defect.

In the defect at the site of excision of osteochondral autografts in the anterior part of the distal end of the femur, the osteal cartilage allbtransplanted is completely replaced by facies patellaris

femoris).

Claims (2)

6 months after the operation, the general condition of the patient is good, walking with a load on the operated limb. Flexion in the joint is possible in the range of 180-80 °. Radiographically, osteochondral autografts transplanted into all four condyles of the knee joint, as well as osteal cartilage allograft, located in the anterior lower end of the femur, are rotated with the bony beds and largely rebuilt. The joint gap has become quite wide. Example 2. Ill for 45 years with a diagnosis of a right knee joint tubercle. Sick since childhood. The joint is deformed. Right lower limb bent at the knee at an angle of 150 °. Movement in the joint rocking. The extensive destruction of the external condyles of the femoral and tibial bones is determined radiographically. Joint gap sharply narrowed. Operation is performed, during .kotoroy posle.issecheni bone lesions formed are substituted defects osteo-cartilage schevymi autografts, one of which, when taken from the side, the convex portion faqies patellaris femoris, transplanted into the femoral condyle, while the other, excised from the central, concave parts of the fades patellaris femoris, immersed in a deep defect of the inner condyle of the tibia. The defect in the anterior part of the lower end of the femur at the site of excision of autografts is replaced by bone and cartilage allograft. After 7 months after the operation, the general condition of the patient is good. Goes with loading on the operated extremity. Flexion in the joint is possible in the range of 175-90 °. Radiological deformity of the knee joint is largely eliminated. Osteochondral autografts in the external condoms of the femoral and tibial bones, as well as the osteal and condyl allograft transplanted to the anterior lower end of the femur, are bonded to the bony beds and largely rebuilt. The joint gap is wider than before surgery. The proposed method of replacing defects in the articular ends of the knee joint makes it possible to replace bone and cartilage autografts with defects in the articular surfaces of the femoral bone lobes with full restoration of their shape, which is not possible to be carried out using known methods. This is largely provided by the rational choice of the location of bone and cartilage autografts - the anterior part of the distal end of the femur (facies patellaries femoris). At the same time, the aforementioned section of the knee joint is very convenient for excision of bone and cartilage autografts from it for the following reasons. First, it is rare; is affected by the pathological process and does not bear the main load, which is performed by the articulating surfaces of the condyle of the femur and the tibial bone. Secondly, the fac4es patellaris femoris is essentially a continuation of the condyle of the joint and has a shape as well as a structure substantially similar to those of the articular surfaces of the femoral condyles, which allows transplants taken from the specified joint section to be - to restore the most loaded parts of the articular end of the femur. In the implementation of the proposed method, postoperative defects formed at the site of excision of bone and cartilage autografts are completely restored by transplanting bone marrow allografts in them, that. As already noted, bone-cartilage autoplasty is not produced with the known methods, bone-cartilage allografts are immersed in a well-vascularized bone bed created in the unaffected bone section. This provides the best condition for the complete reorganization of seedlings, the replacement of their newly formed bone and cartilage tissues, and the transformation into structures controlled by the patient. If there are relatively small defects in the femoral condyles or in the absence of a defect in one of the indicated sections of the joint, the proposed method also makes it possible to replace an extensive defect up to 3 cm in depth in the articular end of the tibial condyle. In this case, a whole osseal cartilage autograft is used. The proposed method makes it possible to simultaneously replace defects in the two-three condyles of the knee joint, including to produce bone-cartilage autoplasty with complete restoration of the articular surfaces in the distal articular end of the femur, which is not possible in the known methods. The proposed method of replacing the defects in the articular ends of the knee joint restores the support ability of the limb and the mobility of the knee joint. The invention The method of replacing defects in the articular heel of the knee joint of the osteochondral cavity and autotransplants, with subsequent fixation of postoperative defects on the body, takes autografts by osteal allografts, characterized by the fact that, in order to restore ability and mobility in the knee wrist, you can also pick up the knee joint. from the anterior part of the lower femur epiosis, then substitute a78 totransilants loadable defects. Boychee B. et al. Operative orthopedic articulations of femoral-condyles and traumatologists. Sophie, 1961, M., p. 504, Noah bone and condyle boliebertstsovoy bone.668. Sources in (() ormatsi, -2. Chaklin VD Kostna plastic. M. 1 A1111 t | 1st in the examination "Medicine -, 1971, p. 119 (prototype). 982673