Method of surgical treatment of knee joint osteoarthrosis

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics, and can be used for surgical treatment of knee joint osteoarthrosis. For this purpose subchondral spongiosotomy is carried out. After that, channel is formed in zone of its performance to internal cortical layer. After that, biocomposite glass crystalline material "Biosit Sr-Elkor" is introduced into formed channel in form of granules.

EFFECT: method ensures elongation of remission terms due to elimination of venous congestion of subchondral zone and normalisation of intraosseous pressure, as well as reduction of surgery traumare.

2 dwg, 1 ex

 

The invention relates to medicine, namely to orthopedics, and can be used in the surgical treatment of osteoarthritis of the knee.

Closest to the claimed solution is a Method for surgical treatment of gonarthrosis deformans" (Dubrovin G.M., Tikhonenkov S.N. RF patent №2201721, register. 10.04.03,), where extending the period of remission and reduction of postoperative complications produce spongy bone osteotomy (spongiosum) from trepanation holes of the tibia, without destroying the cortical layer of the latter introduce cortical autograft in the area of spongiosum through trepanation hole. The clinical effect of this operation is associated with a decrease in intraosseous pressure and revascularization of the subchondral zone.

However, this method of treatment is associated with more trauma to the tibia and the need for immobilization of the limb in contrast to this proposed methodology. As bone autograft is resorbed faster than biocomposite glass-ceramic material "Bioset CF-Alkor", which in turn leads to shorter time to remission.

The technical result - the prolongation of remission and reduction

trauma intervention by introducing in the subchondral area of the tibial condyles the spine of the biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules.

The technical result is achieved by conducting subchondral spongiosum and the introduction of radiopaque glass bioitalia "Bioset CF-Alkor" in the form of granules in the subchondral area.

The INVENTION is ILLUSTRATED by FIGURES

Figure 1 shows the final circuit operation after the introduction of the biocomposite steklokeramicheskaja material "Bioset CF-Alkor" in the form of granules in the area of spongiosum.

Figure 2 shows a radiograph of the right knee joint after injection of a biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules in the area of spongiosum.

The METHOD IS AS follows

Subperiosteal expose a part of the internal condyle of the tibia 1.5-2 cm below the level of the joint space and form a transversely located trepanation hole of the cortical layer of the bone (1) rectangular shape of 0.5×1.5 cm Through the hole with a narrow osteotome transversely parallel to the articular surface cut spongy bone of the metaphysis (2) on the entire surface, reaching the inner surface of the cortical layer. Drill form a channel to the inner cortical layer. Biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules (3) introducing into the zone of spongiosum (2) through trepanation hole (1) (1).

SPECIFIC EXAMPLE

Patient F., born in 1947, was admitted to the orthopedic and trauma Department of the city clinical hospital №4 gburski 8.08.2011,

When the flow was dominated by complaints of pain in both knee joints, more to the right. The pain gradually increased after daily exercise, wore whining, pulling the nature, slightly decreased after the long rest, disturbed at night.

After clinical and radiological examination diagnosed with Primary osteoarthritis in both knees, decompensated form, Art. III

Due to the fact that the patient was dominated by the clinic endosteal hypertensive pain syndrome associated with venous stasis in the subchondral area and increased intraosseous pressure, and the patient refuses the replacement, operation was performed - the subchondral spongiosum with stress subchondral space biocomposite glass-ceramic material "Bioset CF-Alkor" (g.).

The progress of the operation. Under aseptic conditions made the cut on prednimustine surface of the tibia from the joint cavity length 2.5 see Subperiosteal naked area of the tibia. With the help of the apparatus of IInd 500/75 (meter low pressure "Triton") made the measurement of intraosseous pressure in subchondral the th area of the tibia, which amounted to 460 mm Vogt (4508 PA). At a distance of 2 cm from the articular fissure produced trepanation hole of 0.5×1.5 cm From the hole narrow osteotome parallel to the articular surface made dissection of the spongy bone (spongiosum) to the inner cortical layer. Drill a 6.5 mm formed channel to the inner cortical layer. Biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules through the opening is introduced into the channel (figure 2). The wound is drained and sutured in layers tightly.

The postoperative period without features. Movement in the knee joint is allowed 2 days after surgery. The load on the leg is allowed 2 weeks after the operation.

Monitoring the patient has shown a good result: the disappearance of pain syndrome immediately after surgery, increase range of motion in the joint 2 times.

Thus, the task is achieved by introducing a biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules in the area of spongiosum. Thereby eliminated venous congestion subchondral zone and normalized intraosseous pressure, thereby prolonged periods of remission.

A method of surgical treatment of osteoarthritis of the knee joint, including subchondral spongiosum, otlichalis the same time, then in the area of its conducting form a channel to the inner cortical layer, which is injected biocomposite glass-ceramic material "Bioset CF-Alkor" in the form of granules.



 

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