Method for treating patients for false joints of long tubular bones having tectorial tissue defects

FIELD: medicine.

SUBSTANCE: method involves excising cicatricially transformed periosteum areas on the side of tectorial tissue defect under substitution. Intact periosteum areas above sclerose bone areas are cut and rolled aside as flaps on broad base. Exposed sclerose bone fragment surface is longitudinally resected on the soft tissue defect side with exposed bone wound being formed. Muscle part of free revascularized transplant is separated from fascia in conformity with bone wound surface area with muscle tissue being exposed. The autograft is laid over the prepared bone wound and fixed.

EFFECT: improved graft blood supply conditions; accelerated treatment course.

4 dwg

 

The invention relates to the field of reconstructive surgery and traumatology, i.e. to methods of treatment of false joints of long bones with a defect in epithelial tissues. Can be used in the specialized field of reconstructive microsurgery.

In reconstructive surgery and traumatology known method of treatment of false joints of long bones with a defect in epithelial tissues, when in conditions of immobilization or fixation perform the substitution of the defect krovosnabjaemah tissues (Nikitin GD, Cancer V. Linnik, S.A. et al. Surgical treatment of osteomyelitis. Russian graphics. - Saint-Petersburg. - 2000. - S.).

However, the known method has significant drawbacks:

It is known that the blood supply to the bone fragments of false joint pathologically changed. Also known dependence of the blood supply to the bone fragments of false joint blood from surrounding tissues. The closure of the bone medullary canal, and fibrotic changes of the periosteum significantly reduce the role of the medullary and periosteal blood supply sources of the ends of the bone fragments. However, edge defect, over the false joints, surrounding tissues, roscovitine after trauma, and sometimes after surgery, have depleted the vasculature and, therefore, dostatochnymi revascularization abilities which in turn affects reparative processes.

Replacement of defective epithelial tissue over the false joint krovosnabjaemah tissues can improve the blood supply to tissues recipients region, and the effect of improving the blood supply depends on the quality of the blood supply used for replacement of a tissue defect. However, the ends of the bone fragments false joint in particular from the defect integumentary tissues often sclerotic (fibrous), which is an obstacle to the unification of the vasculature of the bone tissue with vascular bed even well krovosnabjaemah fabrics used for defect closure over the false joint. As a result of improved blood supply to the bone fragments, and hence the impact on osteoreparative processes either not happening or is not fully manifested, which affects the timing of treatment, rehabilitation and augmentation of anatomical and functional changes of the affected limb.

The objective of the proposed method for the treatment of false joints of long bones with a defect of epithelial tissue is to increase the efficiency of surgical treatment, reducing treatment time and improve functional results.

The task in the treatment of false joints of long bones with a defect in epithelial tissues, including the pressure of pathologically changed tissues and replacement of defective epithelial tissue over the false joint svobodnim revascularizing the autograft with muscle part, is achieved by the fact that the replaced defective epithelial tissues excised areas of scar modified periosteum and intact areas of the periosteum over the areas sclerotioides bone cut, prepare the chin and turn in hand in the form of patches on a broad basis, then Nude from the side of the soft tissue defect sclerotherapy the surface of the bone fragments longitudinally resetinput with the formation of a naked bone wounds and surface muscle parts free revascularizing autograft released from fascia, respectively, of the surface area of bone wounds with exposed muscle tissue, after which the autograft impose on the prepared bone wound and fixed.

The proposed method and the features that distinguish it from known in the medical and patent literature is not found, which allows to make a conclusion on compliance with a criterion of "novelty".

The essence of the invention is that by replacing the defective epithelial tissues excised areas of scar modified periosteum and intact areas of the periosteum over the areas sclerotioides bone cut, prepare the chin and turn in hand in the form of patches on a broad basis, then Nude from the side of the soft tissue defect sclerotherapy the surface of the bone fragmentable resetinput with the formation of a naked bone wounds, and the surface of the muscle parts free revascularizing autograft released from fascia, respectively, of the surface area of bone wounds with exposed muscle tissue, after which the autograft impose on the prepared bone wound and fixed.

It is the excision of the scar plots the modified periosteum and dissection, peeling and loosening in hand in the form of patches on a broad base intact areas of the periosteum over the areas sclerotioides bone exposure from the side of the soft tissue defect sclerotioides the surface of the bone fragments with subsequent longitudinal resection and formation of naked bone wounds allows you to prepare a surface suitable for Association vasculature, bone and krovosnabjaemah fabrics that are used for defect replacement.

At the same time pick by size of epithelial defect free tissue revascularizing autograft, including muscle part, has good axial blood supply.

The release of muscular part of autograft from the fascia accordingly, the surface area of bone wounds with exposed muscle tissue can form an exposed surface of the autograft with well-developed vascular network.

It is a special preparation of surfaces autotransplantation bone fragments and ensures good contact krovosnabjaemah tissue and bone with pathologically altered blood flow. In this situation, applying and fixing autograft on the prepared bone wound can be regarded as a substitution of the periosteum, i.e. the formation of periosteal new source of blood supply to the bone fragments of a false joint.

The combination of these factors not only increases the effectiveness of surgical treatment with a reducing treatment time, but in doing so reduces the anatomical and functional changes in the affected limb and promotes earlier rehabilitation.

Thus, the combination of all the hallmarks allows to achieve the goal and to get a positive result.

The execute method is illustrated in figure 1-4.

Figure 1 - In the field of false joint, from the defect of epithelial tissue formed bone wound.

Figure 2 - Skin-muscle free revascularizing autograft raised on the vascular pedicle. The surface of the muscle parts free revascularizing autograft exempt from fascia, respectively, of the surface area of bone wounds with exposed muscle tissue.

Figure 3 - Completed replacement of defective epithelial tissues in the region of false joint free revascularizing an autograft.

Figure 4 - Result of treatment.

The method is as follows: the patient with false joints of long bones and Def the drive integumentary tissue over it to remove diseased epithelial tissue, exposing the ends of the bone fragments of a false joint. Areas of scar modified periosteum excised. Intact areas of the periosteum on bone sclerosal from defect in epithelial tissues dissected, prepare the chin and turn in hand in the form of patches on a broad basis. Then Nude from the side of the defect sclerotherapy the surface of the bone fragments longitudinally resetinput with the formation of a naked bone wounds. Free revascularizing autograft with muscle take part in size, the corresponding defect in epithelial tissues. The surface of the muscular part of the autograft released from the covering fascia by excision, respectively, of the surface area of bone wounds with exposed muscle tissue. Free revascularizing autograft impose on the prepared bone wound and fixed.

Clinical example:

Patient Y., 31, and/b No. 458856. Clinical diagnosis: false joint of the middle third of the right tibia. Scar-ulcerative defect integumentary tissue on the anterior surface of the tibia. Chronic osteomyelitis.

From the anamnesis: about two years ago was hit by a car. One of the components of polytrauma was an open fracture of the right tibia. In further formed a false joint of the tibial diaphysis with rubtsovoizmenenne defect in epithelial tissues.

The patient underwent reconstruction of the right tibia, including the replacement of defective epithelial tissue over the false joint, i.e. our proposed method, removed diseased epithelial tissue, the exposed ends of the bone fragments of a false joint. Areas of scar modified periosteum excised. Intact areas of the periosteum on bone sclerosal from defect in epithelial tissues dissected, debonded and turned to the side in the form of patches on a broad basis. Then Nude from the side of the defect sklerozirovana the surface of the bone fragments longitudinally resected with the formation of a naked bone wounds. Selected posterior tibial vessels at the level of the upper third of the leg. Made osteosynthesis segment in the Ilizarov frame. Free revascularizing autograft, including muscle part, taken up in size, the corresponding defect in epithelial tissues. The surface of the muscular part of the autograft exempt from covering fascia by excision, respectively, of the surface area of bone wounds with exposed muscle tissue. Free revascularizing autograft imposed on the prepared bone wound and fixed. Imposed microanastomosis between vessels autograft and posterior tibial vessels. Circulation in Autotrans is antati restored.

The resulting fusion. A good functional result. The patient is qualified.

The proposed method is implemented in the Department of reconstructive microsurgery scientific centre of surgery, RAMS, and will find wide application in clinical practice.

The use of the proposed method of reconstruction of the distal shoulder when correctly fused and non-consolidation of intra-articular fractures allows you to:

1. To improve the efficiency of surgical treatment.

2. To improve functional results.

3. To reduce the treatment time.

A method for the treatment of false joints of long bones with a defect in epithelial tissues, including the removal of pathologically changed tissues and replacement of defective epithelial tissue over the false joint free revascularizing the autograft with muscle part, characterized in that the part replaced defective epithelial tissues excised areas of scar modified periosteum and intact areas of the periosteum over the areas sclerotioides bone cut, prepare the chin and turn in hand in the form of patches on a broad basis, then Nude from the side of the soft tissue defect sclerotherapy the surface of the bone fragments longitudinally resetinput with the formation of a naked bone wounds and surface muscle parts free revascularizing and is of cotransplanted exempt from fascia accordingly, the surface area of bone wounds with exposed muscle tissue, then autograft impose on the prepared bone wound and fixed.



 

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