The method of surgical treatment of tuberculosis of the hip joint

 

(57) Abstract:

Usage: in tuberculosis in the surgical treatment of the hip joint. The inventive produce necrectomy articular ends of and in addition to the anterior surface of the cervical excised cortical T-shaped fragment, facing the foot proximally, through the educated defect is formed in the cancellous channel in the proximal direction and in the depth of the bone, and then excised autograft from the front to the top spine of the Ilium on the vascular and muscular leg, preserving the ascending branch of the lateral circumflex thigh artery and prevent it in the front part of the formed channel, and in the remaining part of introducing T-shaped fragment foot down, and the spongy substance in the direction of the greater trochanter. 7 Il.

The invention relates to medicine, namely to orthopedic surgery.

In the treatment of hip disease known way of accelerating revascularization of the femoral head in her treatment of avascular necrosis by implantation of free vascular bundle in the channel formed in the head of the femur (ed. St. N 1174012). However, it is not possible to sufficiently improve regime in vascular and muscular leg blood vessels have a greater degree while maintaining their connection with the periosteum. In this connection, when the surgical treatment of osteoarticular tuberculosis preferred method of bone transplantation on vascular muscle pedicle (E. N. Bellendir, I. U. Shalmagambetov, N. A. Sovetov, I. N. Plotnik, T. A. Lukashevich. The role of soft tissues in the healing of bone defects and reconstruction grafts // Orthopedist. injuries, and the prosthesis. 1972 No. 7, S. 42-48).

Closest to the proposed method is proprietary bone and cartilage autoplasty, which is an autograft, was hewed out of the internal division of the femoral head with the round ligament as vascular muscular legs [1] However, this method can only be performed in the absence of pathological changes in the ligament of the femoral head, when she is of normal length and elasticity. Tuberculosis of the hip joint is already in prakticheskoi phase reactive nonspecific inflammatory changes in the synovial membrane lead to cicatricial changes in circulatory disorders, including the round ligament. With the progression of the specific process with the localization of the contact degradation in mediacentral departments of the acetabulum and the femoral head above osposobljena in the specific process of the synovial sheath, covering a bunch of disturbed blood supply to the ligaments.

The aim of the invention is to increase the effectiveness of treatment of tuberculosis of the hip joint and its consequences.

This is achieved by the fact that is made of plastic replacement remote foci of altered bone articular ends of free grafts, and to improve the vascularization of the bed, bone regeneration and rebuilding these tranplantation is getting autograft taken from the crest of the wing of the Ilium on the vascular and muscular leg.

In Fig. 1 shows the General scheme of the method of Fig. 2 -7 stages of the method.

The following notation: 1 and 2 operational defects in the articular ends of the hip joint is replaced with an free auto-allografts; 3rd place taking proprietary autograft; 4 subcortical located on vascular autograft muscle pedicle; 5 formed vascular and muscular leg; 6 T-shaped channel formed to implement proprietary autograft on the vascular and muscular leg; 7 cortical autograft from the femoral neck, holding previously introduced proprietary.after skin incision, subcutaneous tissue and fascia autotransition allocate together with thin muscular flap of the ascending branch of the lateral circumflex thigh artery with accompanying veins, going under the muscle, tightening the broad fascia of the thigh and the middle gluteal muscle, and cut from the front to the top spine of the Ilium thin bone plate (POS. 3), where a leaf sprig artery is in the form of intraosseous artery. Harvested vascular muscle flap (POS. 5) cover with gauze soaked in saline solution, and perform radical or reconstructive surgery for intra-articular type of secretaiy lesions of bone tissue of the femoral head and body of the Ilium with subsequent auto-, ALLO - or multicomponent plastic formed defects (Ref. 1 and 2). Allografts are used after removal of the soft tissue elements of the trabecular bone. The autotransplants taken from the crest of the wing of the Ilium, or greater trochanter of the femur. Their sizes depend on the magnitude of postoperative defects in the articular ends. After graduating from plastics, for example, lesions of the femoral head within the area of load (Ref. 2) on the anterior surface of the femoral neck by a bit of what I bone plate (POS. 4) on vascular muscle flap, spongy bone surface facing the embedded grafts. Vascular and muscular leg when it is located in the upper part of the tunnel 5. Remote when the workpiece tunnel plate of the cortical layer of the femoral neck in the form of the letter T is rotated 90aboutin relation to harvested Lodge and implemented the narrow part perpendicular to the cortical layer of the cervix. Due to this embedded bone plate on the vascular and muscular leg jams in the depth of the bed and cannot fall out when the movements in the joint and the movement in the first days after surgery. Vascular and muscular leg passes freely through the remaining upper part of the bed in the cortical bone of the femoral neck without signs of external compression. Then vascular muscle flap is passed through the incision in the capsule of the joint, hemming the edges of the incision kemptville seams. After careful hemostasis, the wound was sutured in layers with bringing 24-48 hours of drainage through a separate skin incision. Postoperative limb strengthen on functional bus in the normal conduct of restorative treatment. The load of the joint gradually with 8-9 months, fully restoring apropos the TAVA, including secretaiy articular ends and plastic defects, characterized in that it further with the anterior surface of the cervical excised cortical T-shaped fragment, facing the foot proximally, through the educated defect is formed in the cancellous channel in the proximal direction and in the depth of the bone, and then excised autograft from the front to the top spine of the Ilium on the vascular and muscular leg, preserving the ascending branch of the lateral circumflex thigh artery and placed it in the front part of the formed channel, and in the remaining part of introducing T-shaped fragment foot down, and the spongy substance in the direction of a greater trochanter.

 

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