Method of single-step transiliac elongation of lower extremity

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the single-step transiliac elongation of a lower extremity. The lower edge of the semiluna notch is osteotomated with the formation of an insection to the base of the anterior-lower spine. Rearward from the sciatic notch the ischium is sawed to the arc-like line with the formation of a saw cut. An external cortical plate is sawn on the external surface of the iliac bone from the insection to the saw cut, with the formation of a line of transverse osteotomy. The insection and the saw cut are connected on the internal surface of the ilium by a line of arc-like osteotomy of the internal cortical plate, passing in front of the semilunar notch upwards - on the internal edge of the ilium wing, then down its crest and downwards - on the posterior part of the iliac bone, with an indent from the arc-like line with the formation of a tongue-shaped bone flap. The external and internal cortical plates are moved with respect to each other in the saggital plane for distant, equal shortening of the extremity.

EFFECT: method makes it possible to reduce a risk of recurrence, and reduce the term of rehabilitation.

4 dwg

 

The present invention relates to medicine, in particular to orthopedics, and can be used in the surgical lengthening of the lower limb.

As a prototype the selected method of cross-sectional elongation of the lower limb, including osteotomy of the Ilium by a nameless line, displacement of the distal and proximal fragments of the Ilium by the amount needed for correction of shortening, introducing into the resulting diastasis autograft, formed from the iliac wing, and fixation of the fragments of the Ilium and autograft three thick spokes Kirchner (see Morissy, R. T. and Lovele Winter s: atlas of Pediatric Orthopaedic Surgeri / R. T. Morissy, S. L. Weinstein / - VI Ed. - Iowa, 2006. - P. 289-291).

However, the known method when the transplant additionally injure the iliac bone. The use of autograft it involves a prolonged adjustment, which often occurs with loss of bone substance, which can lead to partial loss of correction of the velocity reached during the operation. Remodeling of the graft lengthens the recovery period and postpones the time of full load on the operated limb. In addition, harvesting of autograft, installing it increase the time of surgical intervention.

The object of the present invention is an improvement �of the manual.

The technical result is the prevention of relapse of shortening and accelerating the rehabilitation of patients after surgery.

The technical result is achieved due to the fact that in the method comprising osteotomy of the Ilium and the offset distal and proximal fragments, osteotomies the bottom edge of the semilunar notch, forming a notch to the base of the lower front spine, back from the sciatic notch nadpilivayut seat bone to the arcuate line, forming a slit on the outer surface of the Ilium saw through the outer cortical plate from cut to cut, forming a line transverse osteotomy, on the inner surface of the Ilium perform arcuate osteotomy connecting notch and propyl and passing forward of the semilunar notch up - on the inner edge of the iliac wing, then along the ridge and down on the back part of the Ilium, some distance from the arcuate line with the formation of the tongue-shaped bone flap, and slip the outer and inner cortical plates relative to each other in the sagittal plane at a distance equal to the shortening of the limb.

The essence of the proposed technical solution is illustrated by drawings, where Fig. 1 shows the iliac bone on the outside line and osteotomies; �IG. 2 - the iliac bone on the inside line and osteotomies; Fig. 3 - the iliac bone on the outside after its reconstruction; Fig. 4 - the iliac bone from the inside after its reconstruction.

The method is carried out as follows. Typical access produce approach to the wing of the Ilium 1, produce stellerovaya on the outer and inner surfaces to sciatic notch 2. Cut off the tendons of the muscles that attach to the front top spine 3. The bottom edge of the semilunar notch 4 osteotomies the front with a drill bit, forming a notch 5, reaching to the base of the lower front spine 6. Back from the sciatic notch 2 saw Gigli nadpilivayut seat bone to the arcuate line 7, forming propyl 8. On the outer surface of the Ilium 1 saw through the outer cortical plate from the notch 5 to cut 8, forming a line 9 to the transverse osteotomy. Then on the inner surface of the Ilium perform arcuate osteotomy of the internal cortical bone that connects the notch 5 and 8 and propyl passing forward of the semilunar notch up - on the inner edge of the iliac wing, then along its crest 10 and down - on the back part of the Ilium, some distance from the arcuate line 7 with the formation of the tongue-shaped bone flap 11.An arcuate osteotomy is performed in the cortical layer.�, that spongy substance leave mainly on the inner cortical plate. The outer and inner cortical bone of the iliac bones are displaced relative to each other in the sagittal plane at a distance equal to the shortening of the limb. The achieved position is fixed by screws 12, held transoxania from the crest of the Ilium 10.

Clinical example: B-th TS, 17 years, East. b-no No. 268971, admitted to the Department of pediatric orthopedics NIETO 12.03.2013 G. for idiopathic shortening of right lower limb 2 cm B-Aya complained of a limp on his right leg. 14.03.13 g. surgery performed on the proposed method. Immobilization was carried out koksetau a plaster bed for 2 weeks. The postoperative course was smooth. The wound healed by primary intention. After 2 weeks achieved complete preoperative range of motion in the hip joint, it is permitted to walk on crutches with no load on right n/a limb. Full consolidation of fragments observed 4 months after the intervention. It is permitted to walk with a full load on the leg, no lameness, the length of the lower limbs are the same on both sides.

Method cross-sectional transposase lengthening of the lower limbs reduces the trauma of surgery. The cutting out of the tongue-shaped flap and offset both�workers stable contact of the outer and inner cortical plates of the Ilium on a rather big stretch what contributes to the onset of full consolidation of bone fragments in the early stages. The method provides a very accurate intraoperative elongation of shortened limbs on the amount required, as it is only associated with the manipulation - offset - cortical plates after osteotomy of the Ilium, which is easily moved relative to each other. The method is simple in technical execution, poses additional difficulties for surgeons use the technique of surgical interventions on the bones of the pelvis.

Method cross-sectional transposase lengthening of the lower limb, including osteotomy of the Ilium and the offset distal and proximal bone fragments, characterized in that osteotomies the bottom edge of the semilunar notch, forming a notch to the base of the lower front spine, back from the sciatic notch nadpilivayut seat bone to the arcuate line, forming a slit on the outer surface of the Ilium saw through the outer cortical plate from cut to cut, forming a line transverse osteotomy, on the inner surface of the notch of the Ilium and propyl connect line arcuate osteotomy of the inner cortical bone, passing forward of the semilunar notch up - on the inner edge of the iliac wing �spine, then along the ridge and down on the back part of the Ilium, some distance from the arcuate line with the formation of the tongue-shaped bone flap, and slip the outer and inner cortical plates relative to each other in the sagittal plane at a distance equal to the shortening of the limb.



 

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