Method of surgical treatment of the syndrome of lateral hyperplasia of the patella
(57) Abstract:The invention relates to medicine, namely to orthopedics, traumatology at eliminating lateral hyperplasia of the patella. Essence: the affected cartilage resetinput arthroscopy, cut through the fibrous capsule of the front outside access from the tibial tuberosity to the tendon of the quadriceps muscle without opening the cavity of the joint, which prevents postoperative complications. The invention relates to medicine, namely to traumatology and orthopedics, and can be used for normalization of biomechanical femoro-patello joint arthroplasty in the treatment of syndrome of lateral hyperplasia of the patella. Research Larson et al. (1978)  and Hille et al. (1985)  proved that the lateral splitting supporting the patella tendon apparatus over from the tibial tuberosity to straight hip muscles leads to the redistribution of loads acting on the femoral cartilage - nakolennikov joint.Performed according to indications (syndrome of excessive lateral pressure, pain and tightness retinaculum patellae laterale if it is accompanied by tilting of the patella or femoro-patello arthrosis) this Opera is the research Institute of the cartilage and the absence of signs of dysplasia, femoro-patello articulation results significantly worse (Metcalf, 1982 ; Papagelopoulos, Sim, 1997 ).The known method of lateral splitting the extensor apparatus by front-outer arthrotomy with the aim of resection of the diseased cartilage of the patella and subsequent dissection of the retinaculum patellae laterale (Osborne, Fulford, 1982 ). The disadvantages of this method are traumatic arthrotomy and frequent development of hemarthrosis in the postoperative period.The known method of Hempfling X. (1993) , which under arthroscopic control is performed dissection only fibrous capsule or fibrous and synovial membranes with the introduction of the scissors through the arthroscopic access to the joint. This method is technically difficult and also leads to frequent formation of hemarthrosis and subcutaneous hematoma, it is therefore necessary drainage of the joint in the postoperative period, which increases the risk of infectious complications.To avoid hemarthrosis in the postoperative period, as well as to simplify the operation method allows Ogilvie-Harris, Jackson (1984) , he is the prototype, namely, that the first stage arthroscopy is performed with resection of the damaged areas of cartilage, then special scissors through a small access from outside of the patella arthritis under control is subject to the technical complexity of the operation due to the need arthroscopic control dissection retinaculum patellae laterale; 2) frequent development of subcutaneous hematoma due to damage of collateral vessels and the inability to carry out a thorough hemostasis.The proposed method is as follows.Under regional anaesthesia or anaesthesia of the anterior-lateral and anterior-medial accesses performed arthroscopy of the knee joint. Under the control of the arthroscope was performed mechanical sawing affected cartilage, completing endoscopic phase of the operation lavage of the joint 2-3 liters of About 9% solution of sodium chloride. At a distance of 1 cm laterally of and parallel to the patella was performed skin incision length 3, see Selecting a fibrous capsule, cut her subcutaneously over from the tibial tuberosity to the tendon of the quadriceps femoris, the synovial membrane is not opened. Carried out a meticulous hemostasis, had stitches on the skin, a pressure bandage and rear plaster of Paris splint is placed on the upper third of the thigh to the lower third of the leg for 10 days. Functional treatment was started on the third day.On September 1, 1998, the proposed method of treatment used in 14 patients, in all cases obtained a good result.Clinical example.The patient Was, 19 years old, the story of b, onecause after exercise. In the clinical and radiological examination diagnosed the Syndrome lateral hyperplasia left patella. The patient performed arthroscopic resection of the affected area of the cartilage of the patella and lateral splitting the extensor apparatus according to the proposed method. Functional treatment is begun on the third day, immobilization back a plaster of Paris splint is placed 10 days. The patient is examined after 6 and 12 months after surgery, no complaints, on the control radiographs in axial projection of the lateral tilt of the patella is not defined.At the time of filing, we do not know this or identical to the claimed technical solution, which makes the proposed method meets the criterion of "novelty".Sources of information
1. Hempfling X. Arthroscopy. Diagnosis and therapy. Wiesbaden, Germany: ID of technoexport GmbH, 1993. - 92 S.2. Fulkerson J. P., Shea, K. R. Current concept review disorders of the patellofemoral alignment// J. Bone Jt. Surgery. - 1990. - V. 72-A, No. 9. - p. 1424-1429.3. Hille E. , Shulitz K.-P., C. Henrichs, T. Schneider Pressure and contact-surface measurements within the femoropatellar joint and their variations following lateral release// Acta Orthop. The Trauma. Surg. - 1985. - 104 N. - p. 275-282.4. Larson, R. L., Cabaud H. E., D. Slocum calf R. W. An arthroscopic method for lateral release of the subluxating or dislocating patella// Clin. Orthop. - 1982. - N 167. - p. 9-14.6. Ogilvie-Harris, D. J., Jackson R. W. The arthroscopic treatment of chondromalacia patellae// J. Bone Jt. Surgery. -1984. - V. 66-B, 5. - P. 660-665.7. Osborne A. H., Fulford P. C. Lateral Release for Chondromalacia Patella// J. Bone Joint Surg. - 1982. - V. 64-B - N-2. - p. 202-205 are.8. P. J. Papagelopoulos, Sim F. H - Patellofemoral pain syndrome: diagnosis and management// Orthopedics. - 1997. -V. 20, N 2. - p. 148-157. Method of surgical treatment of the syndrome of lateral hyperplasia of the patella, which consists in arthroscopic resection of lesion of cartilage and the dissection of the fibrous capsule of the knee joint, characterized in that the dissection is carried out from the front outside access over from the tibial tuberosity to the tendon of the quadriceps femoris without opening the cavity of the joint.
FIELD: medicine; medical engineering.
SUBSTANCE: device has handle having inlet and outlet canals. The canals communicate with opening in the handle. The opening is usable for positioning it on surface under treatment. Means for dosing abrasive agent supply in pneumatic carrier from container to opening in the handle. Selective and controllable liquid supply to the opening in the handle is carried out. The abrasive agent flow in pneumatic carrier takes place under excessive pressure action or under vacuum action, respectively. Abrasive agents and liquid are supplied to the opening in the handle under vacuum action or under excessive pressure action, respectively.
EFFECT: enhanced effectiveness of abrasive treatment.
31 cl, 2 dwg