Method for treating post-traumatic talus diseases

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to medicine, namely to traumatology and orthopedics.

The known method of arthrodesis podernovo joint (see the Patent of Russia 21643989, A 61 B 17/56 Method of arthrodesis podernovo joint publ. 27.03.2001), which includes resection of the deformed surfaces of the calcaneus, nasienie cartilage podernovo joint, creating a gap between the talus and heel bone and the introduction autotransplant in the cavity podernovo joint when Ilizarov.

This method helps to prevent osteoporosis, but provides recovery only normal geometry of the lateral surface of the calcaneus, not allowing to treat pseudoarthrosis neck of the talus. In addition, it is traumatic, as it requires surgical intervention in two separated in time phase.

There is a method of treatment of injuries and diseases of the talus (see A.S. USSR №1146024, A 61 B 17/56 a Method of treating injury and disease talus, publ. 23.03.85), which includes resection of the pathological modified tissue talus, formation of the groove along the axis of the load in the talus, the location of the autograft in the formed groove.

This method does not prevent the development of deforming arthrosis of the ankle and ankle-heel joints, aseptic necrosis, can lead to valgus Polo the structure of the foot. Furthermore, the method traumatic because of the use of the graft, taken from the fibula other extremity, neurological disorders intact at the time of a limb.

Closest to the proposed method is a method of treatment of fractures of the talus with the complete destruction of the ankle-heel joint (see A.S. USSR 1754084, A 61 B17/56, a Method of treatment of fractures of the talus with the complete destruction of the ankle-heel joint, publ. 15.08.92), including the reposition of fragments of the talus bone, resection of the articular surfaces of the talus and the calcaneus, the formation of autograft from the iliac wing bone, the introduction of autograft, its fixation in srednetehnologichnym position.

The method can prevent the development of posttraumatic arthrosis deformans ankle-heel joint, aseptic necrosis of the block talus, creates a stable fusion and prevents valgus setting foot in the later stages after injury.

However, this method does not allow to treat avascular necrosis of the talus, the false joint (pseudoarthrosis) the neck of the talus, fixed types of deformity valgus in addition to the installation of the foot.

In addition, this method is traumatic, requires a long time due to the need Angop the astika.

The objective of this technical solution is the development of a treatment for post-traumatic disorders of the talus bone aseptic necrosis, pseudoarthrosis, elimination of pathological settings of the foot while reducing the time of surgery and anaesthesia, trauma, reducing the overall treatment time.

The technical result of the proposed method is an extension of the spectrum are fixed pathological conditions of the foot, including the effects of injuries of the foot in the form of avascular necrosis of the talus and pseudoarthrosis cervical bones.

This technical result is achieved by the fact that in the known method of treatment of fractures of the talus, including the reposition of fragments of the talus bone, resection of the articular surfaces of the talus and the calcaneus, the formation of autograft from the iliac wing bone, the introduction of autograft, it commits there are differences, namely resection of the articular surfaces of the talus and calcaneus produce the maximum restoring the anatomy of the tarsal part of a foot, without formation of the groove of the talus, namely, Resecure wedge-shaped fragments of the base of the wedge to the opposite deformation of the side, i.e. with valgus deformity of the base facing toward the medial surface of the foot, varus - lat the General, when the heel - torsiello, when eqwinus - ventral form of autograft with regard to the form of modeling resection length from the posterior edge of the talus to Saparova joint without vascular pedicles, autograft fixation is carried out with use of the Ilizarov frame.

The use of autograft without vascular pedicles allows to reduce the time of surgery and anesthesia time. Its length from the rear edge of the talus to Saparova joint allows you to treat pseudoarthrosis, and/or aseptic necrosis that developed as a result of the injury. Modeling resection without rationing groove also reduces the time of surgery, promotes better tradevest bone and fixation using the Ilizarov frame is an additional factor improving tradevest bone tissue.

The method is as follows.

Sickle cut a length of 12-15 cm prednamerennoe surface of the foot naked podjarny joint, produce modeling resection of the articular surfaces of the talus and heel bone podernovo joint taking into account detected after reposition or original installation of the foot (varus, valgus, eqwinus, heel).

For taking the graft from the section 7 cm from predavanja barb dorsale wing mobilizes odvzdusneni subperiosteal bone and excised fragment sizes 7× 2.5-4 cm, depending on the area of resection podernovo joint.

Transplant after giving him the necessary configuration puts between the talus and heel bone so that as much as possible to restore the anatomy of the tarsal part of a foot and to eliminate the existing deformation, as in the case of pseudoarthrosis block line necromania. The wound is sewn together in layers. Spend 1-2 spokes through the heel and ankle bone in the tibia bone along the axis of the tibia with a view to their temporary fixation.

Hold the spokes and put the supports of Ilizarov frame for a standard for the compression arthrodesis podernovo joint scheme and layout. Create compression in the area of surgical intervention, with doustraat residual components available strain.

This method allows to reduce the time of surgical intervention and the total duration of treatment of patients in 1.5.

EXAMPLE.

Patient K., aged 26 in autotrawl got closed, Pereloma-dislocation of the right talus. Conservative treatment in plaster has resulted in the formation of cervical pseudoarthrosis of the talus with the development of aseptic necrosis of the body of the bone. When admitted to hospital, the patient walked with a cane, was worried about the pain in the root region of the foot, difficulties with the selection of shoes due to the reduction in the height of the middle section (lift) one hundred is s.

Processed according to the described method, after 2 months of fixation in the Ilizarov, 1 month in a plaster of Paris splint is placed, and three weeks of rehabilitation, the patient returned to work (maintenance technician), the resulting reduction of pseudoarthrosis of the talus, restored her anatomy and spatial orientation of the departments of the feet, improved the structure of the affected sections of bone. The total period of treatment was 109 days.

A method of treating post-traumatic disorders of the talus, including the reposition of fragments of the talus bone, resection of the articular surfaces of the talus and the calcaneus, the formation of autograft from the iliac wing bone, the introduction of autograft, its fixation, characterized in that the resection of the articular surfaces of the talus and calcaneus produce the maximum restoring the anatomy of the tarsal part of a foot without the formation of the groove of the talus, namely Resecure wedge-shaped fragments of the base of the wedge to the opposite deformation of the side, that is, when hallux valgus base facing the medial surface of the foot, varus - lateral, with the heel - torsiello, when eqwinus - ventral form autograft with regard to the form of modeling resection length from the posterior edge of the talus to Saparova joint without vascular pedicles, is icatio autograft is manufactured using Ilizarov.



 

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