The method of substitution of the skull defect
(57) Abstract:The invention relates to medicine, in particular to neurosurgery. Refresh in the bone defect region and fix them before a hard plate made in the form of the defect. Then attach the Dura mater of the threads of the long-absorbable material to the plate through drilled in her channels and at a distance from it equal to the thickness of the defect. In this first refreshed edge of the bone in the defect grease gel kalapana, then the bone defect is filled with granules of kalapana, covered it with gel, then the skull defect is closed with a plate made of kalapana containing the antibiotic gentamicin. The method can reduce complications and improve the reliability of bone regeneration. The invention relates to medicine, in particular to neurosurgery. Primarily the invention can be used to replace the defect of the skull vault bones.There is a method of replacement of a defect of the skull self-hardening plastic. It made of prosthetic skull is easily modeled during surgery and it can be any shape, it has sufficient strength, performing a protective function immediately pic is.R. Balabanov. Primary plastic defects of the skull. - M.: Medicine. 1966, S. 86-89).The disadvantage of this method is that under the prosthetic skull of self-hardening plastic material is stored defect of the skull bones. This method does not have characteristics that reduce complications by reducing operating injuries of bones and increase the reliability of subsequent bone regeneration and repair of the skull.Known invented us how cranioplastic along. C. 942708 (MKI And 61 in 17/00. Authors: C. C. Old and Y. N. Cherenkov), including exposure of the skull, Reshetilovka bone edges of the wound, the formation of the prosthesis of self-hardening plastic material and fixing it seams to the skull. Thus for the regeneration of bone tissue under the denture, the bone defect before closing fill with a mixture consisting of bone chips and blood of the patient.The disadvantage of this method is the lack of signs, providing immobilization of the mixture of biomass in a predetermined position and increase the reliability of the subsequent regeneration of bone in the skull defect. This method requires the fence to the patient a sufficient quantity of bone tissue from the bones of the skull, resulting in additional injury and UV (MKI And 61 In 17/56. Authors C. S. Old Century and I. Tarabrin), including exposure of the skull, Reshetilovka bone edges of the wound, the formation of the prosthesis of self-hardening plastic material and fixing it seams to the skull. With the aim of creating the optimum thickness of the regenerate Dura is fixed to the graft ligatures through the perforations at a distance of the thickness of the bone.The disadvantage of this method of cranioplastic is lack of evidence of a decline in complications by reducing operating injuries of bones, increase the reliability of subsequent bone regeneration and repair of the skull.The closest in technical essence and the achieved result for the proposed method is a method of cranioplastic the patent of the Russian Federation 1660244, which we take as a prototype, and the drawbacks outlined above.The technical result of the invention is to empower selection method cranioplastic and reduce complications by reducing the operative trauma and increase the reliability of subsequent bone regeneration and repair of the skull.The technical result is achieved by way of substitution of the skull defect includes refreshment in the Def is the Dura mater threads from long-absorbable material to the plate through drilled in her channels and at a distance from it, equal to the thickness of the defect. In this first refreshed edge of the bone in the defect grease gel kalapana, then the bone defect is filled with granules of kalapana, covered it with gel, then the skull defect is closed with a plate of kalapana containing the antibiotic gentamicin.A specific example of the method. In a patient with a depressed comminuted fracture of vault of skull in the parietal region was produced resection trepanation of the skull. Formed a bony defect in the skull. Due to cerebral oedema primary replacement of the defect of the skull bones are not made. On the disappearance of brain edema and wound healing was cranioplastic. After the surgical incision with an exposure of the skull defect and marrow of his bone edge in three-point drill holes in the bone. From kalapana-G containing the antibiotic gentamicin, cut the plate in the form of the skull defect and the size of a few more. On the edge of the plate in the projection of the holes in the skull and in its form at least two channels for threads. Dura in the center of the skull defect take a ligature of long-absorbable material - Polisorb. The ends of its link to node n is delny channel in the center of the plate. Through regional channels in bone and the plate hold the threads. Refreshed edge of the bone in the defect grease gel kalapana, and the bone defect is filled with granules of kalapana, covered it with gel. After placing the plates in the skull defect overlapping boundary ligatures attach the plate to the bones of the skull. Then ligatures conducted through the Dura and bred through the Central channels in the plate outwards, tighten Dura to the plate to another, formed from the ends of the threads of the hub, the inner surface of the plate. The ends of these threads link on the plate. The soft tissue in the operating wound sutured in layers.The significance of differences between the claimed process from the chosen prototype is the following. For replacement of bone defect in the skull provided by the joint application of all known forms of kalapana: gel, granules and plates. Lubrication gel refreshed the edges of the bone in the defect according to the claimed method creates a more complete contact of the granules kalapana. Filling of bone defects granules coated with gel kalapana provides a more complete contact between the granules. Closure of the defect of the skull before Korepanova plate, SOPs, providing the best conditions for their implantation. The use of a plate of kalapana containing the antibiotic gentamicin, due to the broader antimicrobial action of this drug and its harmlessness to the Central nervous system. It is known that in traumatology and dentistry to replace bone defects of the skeleton found the use of the drug kollapen, produced by the domestic firm "Intermediate", Calapan - bioactive osteoplastic material on the basis of homogeneous composition especially pure hydroxyapatite, collagen special treatment and antibiotics. Thus Callahan-L contains lincomycin hydrochloride and Callahan-G - gentamicin sulfate. As the material of high-purity hydroxyapatite and collagen, according to the structure closest to the biological tissue, this leads to a high biocompatibility of this material, the absence of a allergic reactions and rejection (Y. C., Vaschenko, 1996; Century, Germanov. 1999). Kollapen, because of the incoming of him hydroxyapatite, osteoinductive and matrix properties for the newly formed young bone tissue, improving the reparative processes in the contact of the bone (C. N. Buldygin, 1997, G. A., Kesan, 1997; C. I. Macon settled between him and the bone is not formed connective tissue layer (O. M. Bushuev, 1999). This material is almost identical to human bone, able to firmly contact with the bone structures in the implantation site and, over time, to replace bone defects, bone tissue. Callahan has the ability to biological degradation, over time, undergoing biodegradation. Kollapen, including collagen, is an active medium, the protector and the prolongator of medicines, in particular antibiotics. Collagen is also a stimulant of reparative processes (G. N. Berchenko, 1997). Antimicrobial activity of kalapana saved 16-20 days (O. M. Bushuev. 1999). Kollapen non-toxic, has no Carcinogenicity and forms strong complexes with antibiotics (Century. Century. Bachenko, S. M. Barinov, G. N. Berchenko, 1992). Kollapen release in the form of a 2% gel in granular form or in the form of plates. Apply Callahan and osteomyelitis after resection of large sections of tubular bones, loosely putting it in the interosseous space. Even in these cases, directly on the surface gradually resorbable hydroxyapatite formed newly formed bone trabeculae (O. M. Bushuev,1999), used for attaching the plate and Dura n is the time after the operation, when their fastening function will spontaneously replace connective tissue of the body. It is known that Polisorb has biocompatibility - no toxic, allergic and teratogenic effects on the body. Thread from Polisorb able to degradation in the body. Due to biodegradation abilities of such suture material to be broken down and excreted from the body, Polisorb absorbed into the tissues of the body to 56-70-th day (Kronstadt Beams and other New synthetic suture materials in surgery. Ryazan. 1994, 42 S.).Thus, the claimed method in all of its signs provides empowering method to select cranioplastic, reduces complications by reducing operating injuries of bones and increase the reliability of subsequent bone regeneration in the defect of the skull, which increases the quality of treatment and improves long-term outcomes, leading to economic benefits.The application of the invention is possible in children and military surgery, as well as in veterinary medicine. The way to replace the defect of the skull, including refreshment in the bone defect edges and fixing them before the hard plate made in the form of the defect, prikrasnie it channels and at a distance from it, equal to the thickness of the defect, wherein the first refreshed edge of the bone in the defect grease gel kalapana, then the bone defect is filled with granules of kalapana, covered it with gel, then the skull defect is closed with a plate made of kalapana containing the antibiotic gentamicin.
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.
SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.
EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.
SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.
EFFECT: complete repair of mobility in articulation.
SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.
EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.
3 cl, 3 dwg