The method of determining indications for osteotomy of the medial wall of the femoral bed when hip arthroplasty

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology, and can be applied to determine the indications for osteotomy of the medial wall of the femoral bed with hip arthroplasty. Performed in the preoperative period analysis of radiographs of the operated hip. Perform the osteotomy of the medial wall of the femoral bed when the following radiometric performance: cervico-diaphyseal angle of more than 135othe angle of anteversion or retroversion 15othe entrance angle into the femoral bed formed by the intersection line of the calcar carried out from the level of the filing of the femoral neck bone on the inner edge of the compact zone of the medial wall of the femoral bed, with the longitudinal axis of the femur, less than the 20oand the line calcar crosses the lower boundary of the middle segment of the femoral bed between the inner edge of the compact zone and the longitudinal axis of the femur. The method allows to determine the indications for performing osteotomy of the medial wall of the femoral bed when hip arthroplasty through an analysis of radiometric indices. 5 Il.

The invention of ocnsideration hip joint is removed bone tissue in the zone of proximal femoral bed of the prosthesis, the testimony to which is the prevention division of the proximal femur (Vorontsov S. A., Epstein, G., Sobolev, I. P., kutiev Century A. , Yakovenko, E. I. Prevention of complications of hip arthroplasty// for elective surgery in traumatology and orthopedics. Collection of scientific. works. - S.-Petersburg. 1992. - S. 101-109; Kolesnik A. I. Kolesnik, M. A. Way to prevent split vertelney hip area in cementless hip arthroplasty. IV Congress of traumatologists and orthopedists Russia / Abstr. / N.-Novgorod. - 1997. - S. 566; Kolesnik A. I. Kolesnik, M. A., Andrianov Century A. Patent N 2134555 from 30.06.96, issued 20.08.99, "the Way to prevent split vertelney hip area in cementless hip arthroplasty".

Most fully indications for performing osteotomy of the medial wall of the femoral bed when hip arthroplasty described: Kolesnik A. I. Kolesnik, M. A. Way to prevent split vertelney hip area in cementless hip arthroplasty. IV Congress of traumatologists and orthopedists Russia / Abstr. / N.-Novgorod. - 1997. - S. 566.

The method is based on the measurement front-diaphyseal angle of more than 140owhich are the indications for osteotomy of the medial wall of the femoral bed.

However, the authors expose the indications for performing osteotomy of the medial wall of the femoral bed when hip arthroplasty only on the basis of one x-ray measure - value cervico-diaphyseal angle of the femur, holding in the preoperative period XRD analysis of the proximal femur of the operated hip.

Object of the invention is the determination of the indications for performing osteotomy of the medial wall of the femoral bed with hip arthroplasty.

The task is carried out by holding in the preoperative period analysis of radiographs of the operated hip joint, which consists in the measurement of some radiometric indices of the proximal femur, the magnitude of which will be an indication for osteotomy of the medial wall of the femoral bed: cervico-diaphyseal angle of the femur exceeds 135othe angle of the longitudinal rotation of the proximal femur (angle-anteversion or corner of retroversion) 15o, bedrennoi bone on the inner edge of the compact zone of the medial wall of the femoral bed, with the longitudinal axis of the femur), lower than the 20oand the line calcar crosses the lower boundary of the middle segment of the femoral bed between the inner edge of the compact zone of the middle segment and the longitudinal axis of the femur.

The invention is illustrated by figures.

In Fig. 1 presents photoroentgenograph of the proximal femur and the line forming the cervico-diaphyseal angle.

In Fig. 2 shows the segments of the femoral bed prosthesis.

In Fig. 3 presents photoroentgenograph of the proximal femur and the lines forming the angle - angle of entrance into the femoral bed.

In Fig. 4 presents photoroentgenograph hip and lines forming an angle to the longitudinal rotation of the proximal femur (angle-anteversion or corner of retroversion cervix).

In Fig. 5 radiographs of the hip joint of the patient C. before surgery (A) and after surgery (B, C).

The method is as follows.

In the process of the indications for prophylactic osteotomy was carried out by x ray diffraction of x-rays of patients and anatomic-x ray diffraction analysis of cadaveric bones. On the basics.

The top segment of the level of sawdust on the medial wall of the neck of the femur to the level of the upper edge of the lesser trochanter.

The middle segment from the level of the upper edge of the lesser trochanter to the level of the lower edge of the lesser trochanter.

The lower segment from the level of the lower edge of the lesser trochanter to the level of the bottom edge set of a leg prosthesis.

In the preoperative period, radiographs of the affected hip joint, in particular of the proximal femur in anterior-posterior projection in turn define the following quantities radiometric indices of the proximal femur:

1. Define cervico-diaphyseal angle (Fig. 1). The angle formed by the intersection of the axis of the neck of the femur with the longitudinal axis of the diaphysis of the femur.

2. Radiograph in axial projection determine the angle of the longitudinal rotation of the proximal femur (angle-anteversion or corner of retroversion cervix). The angle formed by the intersection of the longitudinal axis of the neck of the femur and transcondylar axis (Fig.4).

3. On radiographs in anteroposterior projection determine the angle of entrance into the femoral bed). The angle formed by the intersection line of the calcar, Provo bed before crossing with the longitudinal axis of the femur (Fig.3).

4. Determine the intersection of the line of calcar with the lower boundary of the middle segment of the femoral bed. Normal line of the calcar crosses the lower boundary of the middle segment of the femoral bed between the outer edge of the compact zone of the middle segment and the longitudinal axis of the femur (Fig. 2, 3).

Clinical example.

Patient S., 1972 R., was in the surgical Department of the MMU TMO hospital N 2, Kursk with 14.12.94, 10.02.95, Diagnosis: Left post-traumatic coxarthrosis 3rd stage. Aseptic necrosis of the femoral head of the 4th century Shebalino-causing contracture of the left hip joint with dysfunction of 4-th degree. The shortening of left leg up to 3 cm (Fig. 5A).

In the preoperative period produced x-ray study x-ray of the patient C. , where SDU 156o, WPRB 16oangle = 19oand the line calcar reaches the lower border of the middle segment of the femoral bed is not beyond the line of the longitudinal axis of the thigh. Exhibited indications for osteotomy (Fig. 5A).

17.01.95, the patient underwent surgery N12-13 - arthroplasty of the left hip joint prosthesis "Composed" HH+6, osteotomy of the medial wall of vernici durable. The postoperative period without complications. Metered load on the foot is allowed through the 3rd of the month. After 6 months of walking without crutches and sticks, pain when walking is not experiencing.

Thus, the task is to develop the indications for performing osteotomy of the medial wall of the femoral bed when hip arthroplasty solved by holding in the preoperative period analysis of radiographs of the operated hip joint, which consists in the measurement of some radiometric indices of the proximal femur, the magnitude of which will be an indication for osteotomy of the medial wall of the femoral bed: cervico-diaphyseal angle of the femur exceeds 135othe angle of the longitudinal rotation of the proximal femur (angle-anteversion or corner of retroversion) 15othe angle of entrance into the femoral bed formed by the intersection line of the calcar carried out from the level of the filing of the neck of the femur on the inner edge of the compact zone of the medial wall of the femoral bed with the longitudinal axis of the femur), lower than the 20oand the line calcar crosses the lower boundary of the middle segment of the femoral bed between the inner edge is Otomie the medial wall of the femoral bed with hip arthroplasty, including the definition of cervico-diaphyseal angle of the femur, wherein in the preoperative period spending analysis of radiographs of the operated hip joint, which consists in measuring the following radiometric indices, the magnitude of which will be an indication for osteotomy of the medial wall of the femoral bed: cervico-diaphyseal angle of the femur exceeds 135othe angle of anteversion or corner of retroversion 15othe entrance angle into the femoral bed formed by the intersection line of the calcar carried out from the level of the filing of the neck of the femur on the inner edge of the compact zone of the medial wall of the femoral bed, with the longitudinal axis of the femur, less than the 20oand the line calcar crosses the lower boundary of the middle segment of the femoral bed between the inner edge of the compact zone and the longitudinal axis of the femur.

 

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