The method of bone grafting by c. i. ezzor and a. matveyev,
(57) Abstract:The invention relates to medicine, namely to orthopedics and traumatology, and can be used for bone grafting. Remove the pathologic lesion within healthy tissue. Fill the cavity of cortical bone allografts in the form of plates on the type of "bundles of sticks" in a mixture with biomassto, which upon contact with a liquid medium bone wound swells, becomes plastic and completely fills the cavity of a bone, forming with allografts monolithic mass. The method allows to restore the integrity and uniformity of the bone, reduce recovery time, reduce the likelihood of complications. 5 Il. The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of patients with bone pathology.There is a method of bone grafting, which consists in the radical resection of the nidus when diaphyseal and periarticular locations with subsequent stress defect tubular graft connected to the type of "lock-plug" or "Russian castle" (see, for example, "Homoplastic in the treatment of bone tumors". Korzh A. A., Talshynskaya P. P. "Health". Ki is Yong with the possibility of damage to vessels and nerves, massive abscesses, recurrent illness, long term use of additional means of fixation duration and reconstruction allograft up to 2-3 years.There is also known a method of bone grafting, consisting in the removal of the nidus within healthy tissue and filling the resulting cavity with allograft type "bundles of sticks" (see, for example, "Disease of the bones in children M. C. Volkov, Moscow, "Medicine", 1974, page 72)
This method is adopted for the prototype.However, this known method has the same disadvantages, and its efficiency is greatly reduced because of the inability to compactly stow grafts in the parent's bed without the formation of free space (cavity) between the cortical plates and between them and the parent bed.The purpose of the invention is the shortening rehabilitation, reducing the likelihood of complications with the full restoration of the integrity of homogenous bone.This objective is achieved in that the bone cavity is filled with plates of bone graft (auto or ALLO) in a mixture with biomassto filler, which upon contact with a liquid medium bone wounds (hematoma) swells, the om monolithic plastic mass.The essence of the invention is that the filler is applied kollapen, granules which fill the gaps between the graft and between them and the parent bed.The method of bone grafting is as follows.Under General anesthesia a longitudinal cut through the skin and underlying soft tissue, exposing the cortical part of the bone over the tumor. Depending on the involvement in the pathological process of the walls of the affected segment produced either marginal or segmental resection within healthy tissue. Using previously harvested cortical plates carry plastic defect type "bundles of sticks" in the wound fall asleep biomassto (Callahan), which is in a liquid medium becomes plastic. Kollapen used in different condition (granules, plates, powder and so on). Thus kollapen mixed with hematoma or cavity is added to the liquid medium and swelling becomes plastic, turning into a gelatinous mass, completely filling the bone defect to the complete elimination of free space. After filling the bone defect impose nodal joints on the periosteum. Soft tissue tightly sutured in layers. Suture the skin and show the ode of the birth, did 01.09.98, 11 orthopedic Department CCH 59 with a diagnosis of Solitary cyst of the upper and middle third of the right humerus. From the anamnesis it is known that in 1995, the patient falls received a pathological fracture of the upper third of the right shoulder (Fig.1).Before joining CCH 59, Moscow children's hospital the patient was conducted functional treatment plaster immobilization with repeated puncture of the cyst and the introduction of bone cyst cavity solution of aminocaproic acid (Fig.2). In April 1998, has been re-pathological fracture in the middle third of the right shoulder. The patient in the children's clinical hospital n.a. Filatov was an intramedullary osteosynthesis of fracture two spokes (Fig.3), followed by the introduction into the cavity of the cyst solution of aminocaproic acid. In September 1998, the patient was admitted at 11 orthopedic Department CCH 59 with complaints of pain in the right shoulder during movement and exercise. 11.09.98, the patient removed the spokes of the right humerus and produced intranidus tumor resection with subsequent stress defect. When this linear cut length 14 cm were cut skin and underlying soft tissue. Subperiosteal bcii was fenestrated the corticotomy, the plate is removed and laid aside, and under it was revealed pathological focus, presents whitish cartilaginous consistency cloth, which is evacuated to a volume of 20 cubic see the cut tissue was sent for cytological examination. When this was opened, spokes, which through an incision in the lower third of the shoulder removed. Further milling was intranidus resection of the tumor to healthy bone tissue and the walls of cavity treated with antiseptic solutions and alcohol. Made of plastic defect shredded strips of allocate in combination with kalapana. After confirmation of defect filling the plastic mass (kollapen + allobone) previously taken cortical plate was machined on the inner surface to healthy bones, laid back in place and fixed the edges kemptville interrupted sutures. The wound was sutured tightly held the x-ray control (Fig.4,a and b) and imposed coracobrachialis cast for 8 weeks. After 6 months the x-ray control showed that the humerus in the upper and middle thirds evenly filled plastic bone in the stage of intensive restructuring allografts (Fig.5,a and b). The function of the shoulder joint is restored in poluchaetsya in a relatively small operating room trauma with a significant reduction in terms of restructuring of the plastic material with the restoration of the integrity of the bone. The method has been successfully used in orthopaedic clinic MMSI based CCH 59, Moscow in the treatment of patients with cystic lesions and primary benign tumors of the bones.The proposed method is ready for implementation in orthopedic and trauma clinics practical health and can be recommended for widespread use for the treatment of patients for appropriate indications. The method of bone grafting, including removal of the nidus within healthy tissue and filling the resulting cavity cortical bone allografts in the form of plates of the type "a faggot", characterized in that the fill cavity with allografts in a mixture with biomassto, which upon contact with a liquid medium bone wound swells, becomes plastic and completely fills the cavity of a bone, forming with allografts monolithic mass.
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.
EFFECT: higher efficiency of therapy.
5 dwg, 1 ex
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.
EFFECT: higher efficiency of therapy.
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.
EFFECT: increased accuracy of reposition, improved conditions for fusion.