The way osteoplastic amputation of the lower third of the leg

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and orthopedics with amputation of the leg. The inventive after the formation of Abilov tibial and calcaneal bones in them bore through one koronadalenos channel, which continue each other when comparing fragment heel bone to the Shin bone. Then cut the Achilles tendon at the insertion to the calcaneus and cut out the flap, which is carried out in the channel and fixed at the exit of the channel heel bone, which reduces postoperative complications. 3 Il.

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

Method osteoplastic amputation of limbs, first proposed by N. I. Pirogov /1853/, is of great scientific and practical importance. Amputation by Pirogov was the prototype of many ways osteoplastic amputation, which are analogs of the present invention. They differ from the traditionally accepted the fact that the stump has a higher functional qualities /Gritti, 1857; Y. K. Szymanowski, 1863; Stoks, 1875; N. A. Bogoraz, 1990; G. I. Turner, 1917; Yu Yu emergency medicine, 1943; M. I. of Kaslik, 19 is it the way mentioned in the N. And. Kondrashin and Century, Sanin /1984/, the essence of which consists in the following. Stremailbody incision from the tip of the external malleolus to the front surface of the inner ankle cut through the skin, subcutaneous tissue and fascia. The second rear section connecting the ends of the first incision, expose the ankle joint, cross lateral ligaments and produces dislocation in the ankle joint. Hold the foot in plantar flexion, perepilivat the calcaneus to the plantar plane of the section, remove the stop /Fig. 1/. 2-3 cm usepreview soft tissue from the tibia bone and above the ankle joint perepilivat Shin bones. Then the calcaneal bone remaining in the skin flap, is correlated with OPROM bones tibia and strengthen kemptville or silk sutures made through the periosteum calcaneal and tibial bones. Layers are sutured the wound and the resulting stump is fixed in the Antero-posterior plaster of Paris splint is placed.

The disadvantages of the prototype are the following:

1. On the one hand, it is difficult to achieve adequate adaptation of Abilov tibial and calcaneal brushes, and on the other, there is a possibility of increased intraosseous pressure of the tibia when dostizhene related to the primary illness or injury inflammation or transient reactive edema and lead to ischemia and secondary necrosis closed intraosseous structures. In addition, hypertension can result in "popping" tightly adapted fragment of a heel bone from the side end surface of the tibia and cause loss of contact between the fragments, and thus their necromania and insolvency stump.

2. The presence at the interface of Abilov tibial and calcaneal bone fixing their silk sutures may cause ligature fistula. Cathalogue same stitches may dissolve before the education between the fragments of bone spikes.

3. The prevailing tone rear muscle groups or retraction attached to the heel of the tuberosity of the Achilles tendon may cause displacement of the posterior fragment of the calcaneus and the loss of contact with OPROM tibia /Fig. 2/. To prevent this, some authors complement the operation of the fixation screw or wire, which subsequently requires additional intervention to remove them.

4. After fusion of the bone fragments greatest inconvenience for the patient is that it does not occur on the plantar portion of the heel bone, which in norm accounts for the load, and on the area where the Achilles tendon attaches. The consequence is chronic is so

The purpose of the invention to increase the quality of osteoplastic amputation with the exception of the possibility of insolvency stump and prevent the likelihood of trophic disorders of the bone tissue in the process of osteogenesis, and the Achilles tendon when the axial load on the stump.

This objective is achieved in that in both adaptable bone fragments formed manapany channel, through which is held and fixed on the exit flap is severed from the insertion of the Achilles tendon.

The invention is carried out as follows. After performing typical amputation of the prototype with the formation of lateral bone of Abilov tibial and calcaneal bones thick drill with a diameter of about 1 cm - drilled coonabarabran channels, continuing with each other with the adaptation of bone Abilov /Fig. 3,and/, then it will be cut off of the Achilles tendon at the place of attachment to the calcaneus. Then from the Achilles tendon is cut out uniform gotowizny flap, which is held in the previously generated channel both bone fragments and transoxania filed in moderate tension on the output of the th amputation are the following:

1. More secure, and better adaptation of Abilov tibial and calcaneal brushes;

2. To minimize the possibility of education ligature fistula;

3. Warning probability intraosseous hypertension;

4. Improved vascularization adaptable bones;

5. Eliminating the offset of the fragment of the calcaneus with the loss of its contact with the tibia due to the retraction of the Achilles tendon;

6. Warning microtraumatic and aseptic inflammation of the distal part of the Achilles tendon with the development of fileburst when the axial load on the stump.

As an example of clinical application of the proposed method osteoplastic amputation below the following observation.

Patient C. , 43 years old, delivered in the second of the mountains. the hospital Makhachkala from Khasavyurt CRH 14.08.95, on the third day after injury with a diagnosis of end-to-end gunshot gunshot wound of the left foot with comminuted fracture and partial defect of the talus, cuboid, navicular, and I-V metatarsal bones.

Due to the extensiveness of the damage to the foot and predictive futility of its control and motor functions 19.08.95, routinely produced by openestate under the harness, superimposed on the upper third of the tibia two skin incisions: front horizontal connecting both ankles on the anterior surface of the ankle joint, and the lower, perpendicular to the first, like the stirrup, passing through the plantar surface of the foot. Soft tissues were dissected to the bone with the opening of the ankle joint and the release of the talus and the greater part of the heel bone from the ligaments. After typically produced resection front-middle of the foot section and forming transverse bone of Abilov tibial and calcaneal bones thick drill /with a diameter of about 1 cm/ drilled coonabarabran channels, continuing each other when they are mapping. Then of a fragment of the calcaneus on the rear surface at a short distance of rasputia separated soft tissue and scalpel cut off at the place of attachment of the Achilles tendon. The latter split into three parts, two sides of which are resected, and the Central cut in the form of uniform throughout zgotowanego flap, of a width corresponding to the diameter of the formed bone channel. Flap conducted through the channel and fixed at the exit transoxanian Mylar seam in moderate tension. Tension is not the place. Layers superimposed seams on the wound with ostavleniem tubular drainage, remote on the third day. The postoperative period was without complications. The wound healed by first intention, the sutures were removed on the eleventh day. The patient was discharged 4.09.95,

At the control examination 21.03.97, the patient had no complaints, the supporting function of the stump is good. Postoperative scar soft, acpany with the underlying tissues, mobile. There amazonencore, rough skin support surface of the stump without violation of her skin. The result is interpreted by us as good.

Thus, the proposed method osteoplastic amputation of the foot are more optimal and reliable in comparison with the prototype, which allows to improve both the immediate and remote results of treatment of surgical, orthopedic and trauma patients requiring amputation of the lower extremities at the level of the lower third of the leg.

The way osteoplastic amputation of the lower third of the leg, consisting of resection of the medium of the forefoot with the formation of Abilov calcaneal and tibial bones, associated and mutually adapted, characterized in that in the fragment of the calcaneus and belostenniy of Abilov bones and which transoxania hold the flap, cut from the Achilles tendon and is fixed on the exit channel of the calcaneus.

 

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