A method of surgical treatment of injuries of the deltoid ligament of the foot

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology and can be applicable for the surgical treatment of rupture of the deltoid ligament of the foot. Form tunnels in vnutrenniy ankle, heel and scaphoid bones. Form two tunnels in soft tissues, one from the heel bone to the inner ankle, the second from the scaphoid to the inner ankle. Immerse the end of the allograft in the tunnel at the calcaneus, stuck his bone allograft and additionally fixed to the periosteum of the threads. Spend allograft sequentially from the calcaneus through the tunnel in the soft tissues, through the inner ankle, through the tunnel in the soft tissues, through the navicular bone on the inner edge of the plantar aponeurosis to the calcaneus. The method allows to restore the stability of the ankle joint, to strengthen the arch of the foot. 2 Il.

The invention relates to medicine and relates to methods of surgical treatment of diseases of musculoskeletal system, in particular patients with rupture of the deltoid ligament of the foot.

Known methods of surgical treatment of rupture of the deltoid ligament of the foot.

The disadvantage of this method is recovered only one of the three portions of the deltoid ligament, bolshevitsogo-RAM, whereas there are two portions - bolshevitsogo-scaphoid, bolshevitsogo-heel.

In addition, when taking autograft apply additional trauma to the patient in the knee.

2. The way the Institute. P. P. Yet.

The feature of the method of restoration of the deltoid ligament using allograft, fixed in the bone canal of the inner ankle, heel and scaphoid bones. This method is used for the prototype.

The purpose of the invention is to restore the stability of the ankle joint in the frontal plane by plastic anterior and posterior portions of the deltoid ligament allograft, fixed nutricote at three points, and strengthening the structures that support the arch of the foot.

The method is performed as follows.

The first skin incision semi-oval shaped bulge up produce in the region of the inner ankle of the foot. Skin flap usepreview down. Through the inner ankle is slightly above the joint space in Horiz is-sphenoid bone to the middle of the heel bone. Skin flap usepreview down and hold the hooks.

In the heel bone drill form the tunnel to a depth of 3 cm, the scaphoid through the entire thickness from the top to the bottom. The drill diameter and the allograft must be the same (Fig.1). The first and second operational wounds connect the two tunnels in the soft tissues, one goes from the heel, the second from the scaphoid to the inner ankle. The end of the graft is immersed in the heel bone tunnel at a depth of 3 cm and jam bone allograft wedge-shaped, and optionally locking the periosteum nonabsorbable sutures. The graft is sequentially carried out from the heel bone through the first tunnel, the ankle, the second tunnel, the scaphoid bone on the inner edge of the plantar aponeurosis to the calcaneus (Fig.2). Stop give moderate varus position to eliminate subluxation of the talus and create congruence of the articular surfaces. The graft is pulled so that the foot is held in a predetermined varus position.

Wounds sutured in layers. Conduct control x-rays of the bones of the foot. Put a plaster boot to the upper third of the leg for 6 weeks.

The principal difference predlagajemoj bones; form two soft tissue tunnel; end allograft immersed in the heel bone tunnel, fixed using bone allograft and threads to the periosteum, conduct allograft sequentially from the calcaneus through the inner ankle, through the tunnel in the soft tissues, through the navicular bone on the inner edge of the plantar aponeurosis to the calcaneus.

In Fig.1 shows the layout of the bone tunnels in the inner ankle, heel and scaphoid bones; Fig.2 - position allograft after the operation.

The advantage of the proposed method over the known is the following: allograft carried out so that there are formed two portions of the deltoid ligament, repeating the position of the natural ligament; intraosseous solid fixation of the graft in three points creates favorable conditions for its physiological adjustment, conducting graft on the inner edge of the plantar aponeurosis strengthens the arch of the foot.

The proposed method used in the clinic of traumatology and orthopedics of the Samara state medical University 4 patients with traumatic rupture of the deltoid ligament of the foot.

1. Patient K. , 4 March 16, 2000 with a diagnosis of chronic rupture of the deltoid ligament of the right foot. The injury was 6 months ago. Main complaint: the instability of the foot. When the support foot is shifted outwards. The last two months before admission was worried about the pain in the area of the inner ankle.

March 19, 2000 transaction on the proposed method. The postoperative course smooth. 1.5 months after surgery removed a plaster bandage. Conducted post-operative rehabilitation treatment. The result is positive. Viewed 29 June 2000. The operation the patient is satisfied, moves freely, not limping, pain is not worried.

2. Patient M 35 years old, he enrolled in the trauma Department of the clinic of traumatology and orthopedics of the Samara state medical University on March 30, 2000 with complaints of instability of the left foot and lameness.

Injured two weeks ago. When examination revealed excessive mobility of the foot in the frontal plane. On radiographs of the foot in the anteroposterior projection of the detected widening of the joint space of the ankle joint with the inner side of 5 mm With a diagnosis of traumatic rupture of the deltoid ligament of the patient operated on the proposed method 2 April 2000. Patient examined 3 months after surgery. No complaints, Hodge operated patient Including, 42 years of age, patient P., 29 years.

The method can be recommended in practical medicine.

The method of surgical treatment of rupture of the deltoid ligament of the foot, including the restoration of ligament using allograft and intraosseous fixation of the allograft to the inner ankle, characterized in that form tunnels in the inner ankle, heel and scaphoid bones, forming two tunnels in soft tissues, one from the heel bone to the inner ankle, the second from the scaphoid to the inner ankle, the end of allograft immersed in a tunnel in the calcaneus, stuck his bone allograft and additionally fixed to the periosteum of the threads, conduct allograft sequentially from the calcaneus through the tunnel in the soft tissues, through the inner ankle through the tunnel in the soft tissues, through the navicular bone on the inner edge of the plantar aponeurosis to the calcaneus.

 

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