A method for the treatment of avascular necrosis of the internal condyle of the femur

 

The invention relates to medicine, namely to orthopedics and traumatology. Essence: resetinput internal condyle of the femur at the level of the bottom of the defect, mounted on bone cement implant, consisting of the femoral and tibial components and rolling meniscus liner that provides the possibility of an early load on the operated limb and rapid recovery of movement in the joint. 3 Il.

The invention relates to medicine, namely to orthopedics and traumatology.

There is a way plastics knee replacement, which removes only the changed portion of the articular end of the femur with the preservation of the cortical plate, and for replacement of defects using bone and cartilage allograft with demineralized base and nudemaniladating chondrules and subchondral part /the Copyright certificate №1736455, And 61 In 17/56/.

However, the proposed method, on the one hand, provides the plasticity of the entire articular surface, not allowing the correction of the deformity of the limb in the frontal plane, requires prolonged immobilization of the limb for the entire period of perestroika allotransplantation cartilage and bone tissues.

There is a method of knee replacement (aka prototype), which is a total replacement of the articular ends of the femoral and tibial bone with fixation of the endoprosthesis components on bone cement that allows you to restore the support function of the extremities and function of the knee joint /the Copyright certificate №1813426, And 61 F 2/38/.

However, the proposed method involves the total replacement of the articular surfaces of the artificial, resulting in the need to remove and minimally affected by the disease process articular surface of the outer femoral condyles and belieberboy bones, with an extensive arthrotomy and dislocation of the patella, leading to injuries of the extensor apparatus of the knee joint and significant blood loss, slowing the restoration of joint function and rehabilitation of the patient.

To address these shortcomings in degenerative-dystrophic lesions of the knee joint, in particular for aseptic necrosis of the internal condyle of the femur, the authors propose to perform arthroplasty only internal Department of the knee joint, providing relief of pain, rapid recovery of function castigada by performing arthroplasty internal Department of the knee joint meniscus of the endoprosthesis, consisting of a metal femoral and tibial components to be secured to the bone cement, and rolling meniscus liner from vysokomolekulyarnogo polyethylene, using the internal parapatellar access without dislocation of the patella, Resecure internal condyle of the femur at the level of the bottom of the defect, which makes it possible to keep the outer division of the knee and less traumatic surgical intervention to ensure the possibility of an early load on the operated limb (1st day after surgery and quick recovery of movement in the joint.

The method is as follows.

Internal parapatellar access (10-12 cm long) that extends from the upper edge of the patella to 3 cm below the joint line, and breaks up the knee joint. Condition of the articular surfaces of the femoral condyles and tibial bones, anterior cruciate ligament, deleted marginal osteophytes. The sender, using oscillatory and reciprocal saws, medially from the tibial attachment of the anterior cruciate ligament is resected articular surface of the internal condyle of the tibia and, using sh is the fact that using resettare blocks, napraviti, the guide sleeve and the spherical cutter, is resection of the internal condyle of the femur with osteonecrosis center on the bottom level of the defect. Align the gaps between the inner mewelcome femoral and belieberboy bones at 90 and 160 degrees of flexion in the knee joint ("flexion" and "extension periods) by milling the internal condyle of the femur with a step of 1 mm After a trial Assembly of the endoprosthesis using the fitting templates and selection of the thickness of the meniscus insert the installation of the femoral and tibial components of the endoprosthesis with fixation at the bone cement. Upon completion of the polymerization of the bone cement is implanted meniscus liner.

The joint cavity drained through contrapartida, and the wound is sutured in layers. Immobilization is not used.

From the next day after surgery, the patient begins to walk with the additional help of the crutches, with metered load on the operated limb, physical therapy without limiting the amplitude of passive and active movements in the knee joint. 5-7 days after surgery, the patient goes to dopolnitelnye B., 70 years old (case history No. 7336/2001), was hospitalized about deforming arthrosis of the II century, varus deformity of the right knee, with aseptic necrosis of the internal condyle of the right femur IV Art. Pain in the knee joint bothering about 3 years. Periodically passed a course of conservative treatment with a positive effect. After the course of intra-articular injections of corticosteroids in 2001 noted a sharp worsening of the pain syndrome and the occurrence of deformation of the lower limb. Subsequent conservative treatment (non-steroidal anti-inflammatory drugs, physiotherapy, physiotherapy) have not been expressed clinical effect. Produced arthroplasty internal division of the right knee joint meniscus with implants with cement fixation components. The wound healed by first intention. Immobilization was not used. After 3 weeks allowed full weight-bearing on the operated limb. To 6 months after surgery, the patient goes without additional support, no pain, the axis of the limb is correct, the range of motion in the knee joint 180-50 degrees (Fig.1, 2, 3).

Claims

Sgtrane condyle of the femur at the level of the bottom of the defect, set on the bone cement implant, consisting of the femoral and tibial components and moving meniscus of the liner.

 

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