RU2392887C2 - Surgery technique for flexion contracture of knee joint in infantile cerebral paralysis patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics. There are performed two posterolateral incisions - internal and lateral in a distal thigh. Tendons of the biceps, semitendinous, semimembranosus mucles are separated and cut off from the attachment point. A lateral canal is created in a supracondylar region of the thigh. Therethrough, the separated tendons are approaching each other to be fixed to the periosteum. A third skin incision is performed along the anterior thigh in a projection of a tendon of the rectus muscle. The tendon is separated and shortened by a corrugation suture after extension of knee.

EFFECT: method eliminates injures of soft tissue structures of the popliteal space, improves extension function of the joint.

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Description

The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable for the treatment of flexion contracture of the knee joint due to spastic paralysis of the muscles of the lower limb.

Known methods for surgical treatment of flexion contracture of the knee in patients with cerebral palsy

1. Egers method in the modification of Movshovich. A feature of the method is the transplantation of tendons of the biceps, semi-tendons, semi-membranous muscles from the lower leg into the canals of the condyles of the femur and their fixation with the help of mylar fine-mesh tape 7 mm wide (1).

The disadvantage of this method is the fixation of tendons in the canals on the posterior surface of the femoral condyles, the formation of which is inconvenient for the surgeon and can cause damage to the soft tissue structures of the popliteal fossa. Straightening the lower leg in the knee joint brings the fixation points of the quadriceps femoris closer together, sharply decreases its tone, and, consequently, worsens the function of the extension of the lower leg. Lavsan ribbons are a foreign body, can cause an individual rejection reaction.

2. The way of Egers. A feature of the method is the transplantation of tendons of the biceps, semi-tendon, semi-membranous muscles from the lower leg to the condyles of the thigh (2).

The disadvantage of this method is the fixation of tendons in the canals on the posterior surface of the femoral condyles. Their formation is inconvenient for the surgeon and can cause damage to the soft tissue structures of the popliteal fossa. The second drawback is the straightening of the tibia in the knee joint leads to a rapprochement of the fixation points of the quadriceps femoris muscle, a sharp decrease in its tone, and, consequently, to a deterioration of the extension function of the tibia.

Egers method is taken as a prototype.

The aim of the invention is to restore the function of the knee joint in cerebral palsy, increasing the effectiveness of treatment, reducing the number of complications.

This goal is achieved by the fact that two posterolateral incisions are made, internal and external in the distal femur. Then secrete and cut off from the place of attachment of the tendon of the biceps, semi-tendon, semi-membranous muscles. Form a transverse channel in the supracondylar region of the thigh. Through it towards each other spend the selected tendons and fix. A third skin incision is made along the anterior surface of the thigh in the projection of the tendon of the rectus femoris muscle. The tendon is secreted and shortened by a corrugating suture after straightening the lower leg in the knee joint.

Comparison of the proposed method with others known in the field of medicine, showed its compliance with the criteria of the invention.

The method is illustrated in graphic material. Figure 1 - allocation of the distal tendon of the biceps femoris muscle 1, tendons of the semi-tendon muscle 2, tendons of the semi-membranous muscle 3. Figure 2 - the formation of the transverse tunnel in the supracondylar region 4. Figure 3 - passing through the tunnel 4 to meet each other tendons of the selected muscles 1, 2, 3. Figure 4 - the application of the corrugating suture Kuneo on the tendon of the rectus femoris 5, fixation of the ends of the threads in the channel of the patella 6.

The method is as follows. The first skin incision is made along the posterior surface of the lower third of the thigh. Distal tendon of the biceps femoris is isolated. A second skin incision is made along the posteriorly inner thigh in the lower third. Tendons of the semi-tendon and semi-membranous muscles are isolated. Marks are sutured at the same level on the skin and tendons of the selected muscles. Then, the distal tendons of the biceps, semi-tendon and semi-membranous muscles are cut off from the place of their attachment to the lower leg (Figure 1). In the supracondylar region, a transverse tunnel is formed with a drill (Figure 2). Through the formed tunnel towards each other, the selected tendons of the biceps, semi-tendons and semi-membranous muscles are carried out (figure 3). These tendons are pulled to match the marks on the skin and muscle abdomen and fixed to the periosteum. Wounds are sutured in layers tightly. A third skin incision is made along the anterior surface of the thigh in the projection of the rectus femoris muscle. The tendon is secreted. The lower leg in the knee joint is straightened, which becomes possible after cutting off the main flexors of the lower leg from the place of their attachment and moving them to the thigh. Kuneo's corrugating suture is applied to the tendon of the rectus femoris muscle, the tendon is shortened, the ends of the threads are fixed into the patella canal (figure 4). Layer wound closure tightly. A plaster cast is applied in the physiological position from the fingertips to the gluteal fold for 6 weeks.

The fundamental difference between the proposed method and the known ones consists in conducting the selected tendons through one transverse channel in the supracondylar region of the femur and increasing the tone of the quadriceps femoris muscle by shortening the tendon with a corrugating suture.

The advantage of the proposed method over the known is that the formation of a single channel in the supracondylar region for conducting and fixing the selected tendons is more convenient for the surgeon and eliminates damage to the soft tissue structures of the popliteal fossa; Toning the quadriceps femoris improves extensor function of the knee joint.

Clinical examples

1. A patient, a boy of M. 10 years old, was admitted to the children's orthopedic department of Clinics SamGMU January 10, 2007 with a diagnosis of cerebral palsy, early residual stage, spastic diplegia, flexion contracture of the knee joints. The child is sick from birth. Observed in the clinic at the place of residence. Periodically undergoes courses of inpatient, conservative treatment by a neurologist and orthopedist. Complaints about limiting range of motion in the knee joints, stiffness of gait. An objective examination revealed the following symptoms: hypertonicity of the tibia flexor; limitation of active extension in the knee joints on the right - 150 °, on the left - 145 °; tendon and periosteal reflexes on the legs are increased, are caused from the expanded reflexogenic zone; kneecap clonuses; positive pathological flexion reflexes of Rossolimo, Mendel-Ankylosing spondylitis, Zhukovsky and extensor Babinsky, Oppenheim. January 15, 2007 the operation was performed according to the described method. The plaster cast is removed after 6 weeks. Rehabilitation carried out within 3 weeks. The volume of active extension in the knee joints increased to 176 ° on the right and 172 ° on the left. The patient was discharged to continue treatment at home.

2. The patient, a girl of E. 8 years old, was admitted to the children's orthopedic department of the Clinics of SamSMU on February 15, 2007 with a diagnosis of cerebral palsy, early residual stage, spastic diplegia, flexion contracture of the knee joints. Sick from birth. Observed in the clinic at the place of residence. Three times passed courses of inpatient, conservative treatment by a neurologist and orthopedist. Complaints of limiting range of motion in the knee joints, stiffness, instability of the gait. An objective examination revealed the following symptoms: hypertonicity of the tibia flexor; limitation of active extension in the knee joints on the right 160 °, on the left 155 °; tendon and periosteal reflexes on the legs are increased, are caused from the expanded reflexogenic zone; kneecap clonuses; positive pathological flexion reflexes of Rossolimo, Mendel-Ankylosing spondylitis, Zhukovsky and extensor Babinsky, Oppenheim. February 19, 2007 the operation was performed according to the described method. The plaster cast is removed after 6 weeks. Rehabilitation carried out within 3 weeks. The volume of active extension in the knee joints increased to 178 ° on the right and 175 ° on the left. The patient was discharged to continue treatment at home.

The method is recommended for use in orthopedic departments for the treatment of flexion contractures of the knee joints in cerebral palsy.

Information sources

1. I.A. Movshovich. Operative orthopedics. M., 2006, p. 270-271.

2. I.A. Movshovich. Operative orthopedics. M., 2006, p.270.

Claims (1)

A method for surgical treatment of knee flexion contracture in cerebral palsy, including transplantation and fixation of the biceps, semi-tendons, semi-membranous muscles from the lower leg to the thigh into the bone canal, characterized in that the tendons are fixed in one transverse canal in the supracondylar region of the femur, rectus tendon hips tone with a shortening, corrugating seam.

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