A method of treating enchondroma phalanges and metacarpal bones brushes

 

The invention relates to medicine, namely to traumatology and orthopedics. Technical result: restoration of normal anatomic correlations of bone structures, optimization of conditions for the functioning of the extensor apparatus of the finger after surgery. Essence: make the filling of the defect with bone cortical-cancellous allograft, and to the rear and rear-side surfaces of the phalanx or metacarpal bone graft Orient smooth cortical party. 9 Il.

The present invention relates to medicine (trauma and Orthopaedics) and is intended for the treatment of bone tumors (enchondroma) phalanges and metacarpal bones of the hand.

Known and used in the clinic methods of surgical treatment of enchondroma phalanges and metacarpal bones brushes are scraping (excelasia) bone tumors with bone grafting [1] or by substitution of the resulting bone defect, the implant of carbon syntactic foam [2].

The disadvantages of these methods is the fact that after such interventions, relapse of the tumor because of the difficulty radical curettage of the cavity tumors. In poslove the Noah immobilization in the postoperative period.

There is a method of treatment of enchondroma main phalanx of the finger, brush, taken as a prototype. This method includes segmental resection of pathologically changed Department of the tubular bones of the brush within the epiphyseal zones, and the resulting defect replace two semi-cylindrical cortical allografts with their implementation in the distal and proximal epiphysis of the bone fragment, and the graft cover two or three ligatures thick catgut [3].

The disadvantage of this method is the most invasiveness of the surgery, the need for prolonged postoperative immobilization prior to implantation and adjustment of the semi-cylindrical cortical allografts, which leads to severe stiffness and contractures in joints of fingers.

The invention consists in the combination of distinctive features is sufficient to achieve the desired technical result, namely improved functional outcomes. This entity is that produce a dense filling of the defect with bone cortical-cancellous allograft, and to the rear and rear-side surfaces of bone (metacarpal bones) transplant orie is designed as to restore the normal anatomic relationships of bone structures, and for optimization of the operating conditions of the extensor apparatus of the finger after surgery. The use of the proposed method prevents the formation of coarse adhesions between the smooth cortical surface of the graft and tendon of extensor.

To confirm the above, we have conducted experiments on rabbits, which consists in the fact that the bone graft after surgical creation of a regional defect was formed within bone cavity with its location in relation to surrounding tissues or cortical, or endosteal side of the graft.

When the location of the transplant smooth cortical plate to the surrounding soft tissue, implantation of graft in the mother's bed in the first place by encosta. All cortical plate of the graft over the remains tied with surrounding tissues even in the period of 1-1 .5 months from the date of the operation.

In Fig. 1 shows microphoto slice, where the graft is oriented smooth cortical plate to the surrounding soft tissues. Microphoto. MBR-6, about 7, about. 8 where:

(a) cortical lamina transplant.

b) soft tissue around the cortical plate of transpla is missing.

While the location of the graft relative to the surrounding tissues endosteal side at the same time was the fusion of the graft with these tissues due to the development of adhesive scar tissue all over. In Fig.2 presents microphoto slice, where the graft is oriented endosteal side to the surrounding soft tissues. Microphoto. MBR-6, about 7, about. 8 where:

a) soft tissue around the endosteal side of the graft.

b) endothelina party transplant throughout brazed with the surrounding soft tissues.

Technique of surgical intervention with resection of part of the bone (metacarpal bones) opens wide online access for thorough removal of tumor tissue within healthy bones under the control eyes.

- Left plot Palmar cortical plate of bone (metacarpal bones) is a source of regeneration and is a kind of tire, fixing the allograft at the time of its implantation.

- Preserved articular surface of the phalanx (metacarpal bones) with Palmar cortical allow dense filling of the defect with bone allograft and restore early active function in the joints of the finger is expected on the finger or brush expose the extensor apparatus. After longitudinal dissection of the tendon of extensor or diverting it to the side distinguish the dorsal and lateral surface of the affected bone (metacarpal bones). In areas of bone lesions produce resection of the dorsal cortical plate to the healthy part and the side surfaces of the cortical plate with a thorough curettage of the cavity tumors and rinsing with antiseptic solutions. This maintains the integrity of the Palmar cortical plate of bone (metacarpal bone and articular surfaces. Bone plastic spend, firmly putting the graft, and at the rear and rear-side surface of the graft is laid smooth cortical outwards. Restore the integrity of the longitudinally cut extensor above the graft and sutured skin wound. Immobilization exercise Palmar plaster Longuet within two weeks (before the removal of skin sutures ).

After removal of cutaneous sutures and splint the patient have active physiotherapy in the interphalangeal joints of the fingers.

Clinical examples.

The patient In the society, 32 years. Diagnosis: enchondroma 5 metacarpal bones of the right hand.

Fig.3 - photo with radiographs of the right hand b-th Century - before the operation.

Fig.4 - photo with x-rays right keys the Century - after surgery after 3 months.

Fig.6 - photo with radiographs of the right hand b-th Century - after 1 year after surgery.

Patient D-VA, age 12. Diagnosis: enchondroma main phalanx 2 fingers of the left hand.

Fig.7 - photo with radiographs of the left hand b-th Days - before the operation.

Fig.8 - photo with radiographs of the left hand b-th Days after the operation, performed by the proposed method.

Fig.9 - photo with radiographs of the left hand b-th Days after surgery 7 months.

Sources of information

1. 'tseva E. C., Mascara K. I. Surgery of diseases and injuries of the hand. HP: Medicine, 1978, pp. 177-179.

2. A method of treating enchondroma phalanges. AC No. 1377065, 1988.

3. The treatment method enchondroma main phalanx of the finger brush. AC 1641309, 1991.

Claims

A method of treating enchondroma phalanges and metacarpal bones of the brush by resection of the diseased part of the phalanx or metacarpal bones with removal of tumor masses and replacement of the defect with bone allograft, wherein producing the filling of the defect with bone cortical-cancellous allograft, and to the rear and rear-side surfaces of the phalanx or metacarpal bone graft Orient smooth cortical party.

 

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