The way to restore a damaged cruciate ligament of the knee joint

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and orthopedics, division of injuries and diseases of the knee joint. Essence: use proprietary synovial fibrosis flap of mediareleases folds, with arthroscopy stitch mediolaterally crease with the underlying fibers of the fibrous capsule, the outer border of the seam cut out a triangular fibrous synovial flap with the base to the front lower section of the joint, the top of which transcanadienne hem proximal refreshed or stitched cruciate ligament rupture, and the middle part of the flap to the distal section of the ligament fibrous side to it, which allows for the regeneration of damaged ligaments.

The invention relates to medicine, namely to traumatology and orthopedics, division of injuries and diseases of the knee joint, and can be used for the treatment of injuries and diseases of the knee.

The problem of reconstruction of the cruciate ligaments of the knee joint is not solved (D. E. Toutoungi et al., 2000). The most optimal is known today autoplastics methods in the treatment of injuries of ligaments in ICCE surgery cruciate ligament - their seam, based on the effect of spontaneous healing with preservation of proprioception and dynamic stabilization of the knee (D. Trager et al., 1995; R. L. Morgan-Jones, M. J. Cross, 1999). In this way the main difficulties are the autolysis and dinnerware when degeneration and rebuilding of the damaged portion of the ligament (A. Lavender et al., 1999), lack of blood flow and low regeneration potential of fibroblasts cruciate ligament (A. lllli, 1998; L. Yang et al., 1999; M. Yoshida, K. Fujii, 1999).

The prototype of this method is described in S. Badylak et al. (experimental work S. Badylak, S. Arnoczky, P. Plouhar, R. Haut, V. Mendenhall, R. Clarke, C. Horvath Naturally occurring increasing interest among matrix as a scaffold for musculoskeletal repair. Michigan State University, East Lansing, USA. Clin Orthop 1999 Oct; (367 Suppl): s. 333-43) way to repair a damaged cruciate ligament of the knee joint by transplantation of autologous extracellular matrix derived from the high regeneration potential of intestinal submucosal basis. However, the imposition of cartilage extracellular matrix via intraoperative created femoral and tibial bone channels with subsequent graft tension and anchoring in channels with screws. The graft is used to increase the mechanical strength crosswise OI the basics (effect LAD - ligament augmentation device; experimental design J. C. Kennedy: the Application of prosthetics to anterior cruciate ligament reconstruction and repair. Clin Orthop 1983 Jan-Feb; (172): 125-8; analysis of clinical material H. Kiefer, M. Richter, G. Hehl Augmentation techniques: are they out? Klinik für Unfall - und Wiederherstellungschirurgie, Lukas-Krankenhaus Bunde. Zentralbl Chir 1998; 123(9): 1002-13), but more is needed to stimulate cytogenesis and regeneration of ligament fibroblasts. It is assumed that extra-articular graft type LAD, for example, from the broad fascia of the thigh (D. Saragaglia et al., 1995), not having a similar stimulant effect, causes an inflammatory reaction in the knee than delay the regeneration of ligament (K. Kumar, N. Maffulli, 1999). However, extracellular matrix, as LAD, is a cartilage graft. Therefore, its use in operations stitching cruciate ligament is much more difficult, especially in the case of partial breaks. Additionally, extracellular matrix, and LAD, as a free graft, devoid of blood supply and pirovolakis that does not exclude the possibility of avascular necrosis and resorption, therefore, will reduce the effectiveness of the method when applied in the clinic.

The novelty of the proposed method of recovery of damaged cruciate ligament proprietary synovial-fibreboard is antata, use the protective properties of the synovial membrane and collagen fibers of the medial division of the fibrous joint capsule. The presence in this fibrous synovial graft cells of the medial collateral ligament with a very high regenerative activity (M. Yoshida, K. Fujii, 1999) provides improved regenerative capabilities of the damaged fragments of the anterior or posterior cruciate ligaments.

The essential fact is that the way to restore a damaged cruciate ligament of the knee joint by applying a transplant from autochina with fibrous basis differs for protection and regeneration of ligaments using proprietary synovial fibrosis flap of mediareleases folds, with arthroscopy stitch mediolaterally crease with the underlying fibers of the fibrous capsule, the outer border of the seam cut out a triangular fibrous synovial flap with the base to the front lower section of the joint, the top of which transcanadienne hem proximal refreshed or stitched cruciate ligament rupture, and the middle part of the flap to the distal section of the ligament fibrous party to it. Mediaterra scornage channel, located in the anterior-medial area of the knee joint (C. N. Merkulov et al., 1997). This synovial structure folds has the ability to withstand the corrosive properties of synovial fluid. To mediareleases the crease is subject to the medial part of the fibrous capsule with the same direction of the folds of the progress of the arterioles. The formation of non-free graft from the folds together with the collagen fibers of the medial fibrous capsule (and, therefore, collateral ligament) assumes its high regenerative activity. And standard arthroscopic instrumentary technically allows you to perform such an operation.

The technique of surgery is arthroscopic transposition formed proprietary transplant. First stage of mobilization fibrous synovial flap. This is a preliminary flashing mediareleases folds absorbable thread with capture fibers to be fibrous capsule, which begins with the farthest back part folds (arthroscopy is performed from the standard front access) blanket stitch through a separate anterior-medial access to the cavity of the knee joint with the implementation of the live from the joint out. Then arthroscopic scissors (or wire cutters) from stitched mediareleases folds with capture part of the fibers to be fibrous joint capsule along the outer border of the seam is cut out triangular synovial fibrosis flap. The broad base of the flap is formed in the anteromedial region closer to the transverse fold in the projection of the tibial mimedecode field and the corresponding femoral cut. In this case, its length will be sufficient to free the subsequent fixation and movement in the joint. In the second stage mobilized so fibrous synovial flap is held in place ligament. Stitched the top of the triangular flap sutured proximally refreshed or stitched cruciate ligament rupture transcanadienne without damaging the collagen tissue, and the middle portion is distal to the rupture in the same way. This mediolaterally synovial fibrosis flap is placed on the ligament fibrous (collagen) party. Then, under the control of the arthroscope is an extension of the joint to verify the functionality of the seam and the length of the flap by the lack of tension during movement.

It is essential that when the rupture front crestors the second folds of the posterior cruciate ligament to restore their morphological relationships. For the case of gap back cristalrosey ligament operation is performed similarly under the additional control of the arthroscope from the back-side arthroscopic access.

Similar to arthroscopic intervention can be made with partial rupture of cruciate ligament as a separate operation, the complete rupture of the ligament after the standard seam damage is found or perform a standard arthroscopic autoscoring plastics (F. H. Fu et al. , 1999; P. Lobenhoffer, 1999) as a landmark surgery to improve their results.

In the postoperative period, the extremity is fixed plaster pollution for 6-8 days - term restoration of the synovial membrane and the beginning of the formation of scar tissue in the area of ligament rupture. In the future, after the complete reduction of synovitis limitation of rotation and the maximum movement in the knee joint should not be less than 4 weeks - the time of formation of the receptor field autotransplants (T. Shimizu et al., 1999).

To improve the efficiency of the regeneration process is shown a standard conservative therapy with exposure to exudative manifestations on the part of the synovial membranes of the microcirculatory bed, and p is d regeneration cruciate ligament from the concentration of sex hormones (E. M. Wojtys et al., 1998).

Clinical example

Patient Y. , 20 years, history N 915. Operated arthroscopy 17.03.2000 about damage to the inner and outer meniscus and anterior cruciate ligament of the left knee. Produced under spinal anesthesia resection of the inner and outer meniscus and synovial fibrosis strengthening of partial rupture of the anterior cruciate ligament mediareleases fold by the proposed method. In the postoperative period 20.03.00 - puncture of the knee joint with the removal of 35 ml of synovial fluid mixed with blood. From the first day of the postoperative period was used antibiotic therapy with penicillin, with 4 days - held UHF, 7 - were prescribed exercise therapy without aggressive. To 27.03.2000 there was a shortage of extension, spontaneously cropped 28.03.2000 with the beginning of the walk. Free walk in the absence of pain syndrome with the restriction of the rotational load and deep flexion is permitted from 29.03.2000.

14.04.2000, a survey of the static stabilizers of the knee. When examining symptom "anterior drawer" not found. Anthropometry and range of motion in the joints of the lower extremities changes the Ohm, the proposed method is effective, simple, available, can improve the results of treatment can be used in General practice and serve as a basis for developing a treatment strategy.

The way to restore a damaged cruciate ligament of the knee joint through the application of the graft from autochina with fibrous base, wherein for the protection and regeneration of ligaments using proprietary synovial fibrosis flap of mediareleases folds, with arthroscopy stitch mediolaterally crease with the underlying fibers of the fibrous capsule, the outer border of the seam cut out a triangular fibrous synovial flap with the base to the front lower section of the joint, the top of which transcanadienne hem proximal refreshed or stitched cruciate ligament rupture, and the middle part of the flap to the distal section of the ligament fibrous party to it.

 

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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

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