Deformation of the neck of the femoral bone. Valgus deformation of the hips in the child's curvature of the hip

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An analysis of the treatment of 47 children withcongenital breast deformation (VDSHBK), which was treated in rhini them. G.I. Turner and RSDCRC from 1975 to 2005. The age of patients was from 1 month to 19 years, boys were 14, girls - 33. Right-sided localization was observed in 31, left-sided - in 14, two-sided was marked in 2 patients.

The pathological symptom complex included the shortening of the limb from 3 to 25 cm, the external rotational, leading or flexible contracture in the hip joint. The radiological manifestations of the congenital varetle deformation of the neck of the femoral bone were characterized by a violation of the spatial position and the pathological state of the structure of bone tissue of the proximal end of the femoral bone. The cervical deformation of the femur (SCBC) was from up to 30 °. The state of the bone structure was to delay the ossification of the neck and head of the femoral bone, the cervix dystrophy of varying degrees against the background of its dysplasia, intersective false joint, and alsofear cervical defect. Based on the studies, a classification of congenital breeding of the femur neck, taking into account the magnitude of the shode, the state of the bone structure and shortening value: 1st degree of gravity: shode 90-110 °, delay of osxification or cervical dystrophy 1-2 degrees, shortening thighs up to 30%; 2nd degree of gravity: the shine of less than 90 °, the cerviff dystrophy 2-3 degrees or a false joint in the frequency region, the shortening of the hip is 35-45%; 3rd degree: The shode is less than 70 °, the cervix defect of the femoral bone, the shortening of the thigh by more than 45%.

The above classification of the congenital varestic deformation of the neck of the femoral bone served as the basis for the development of indications, firstly, the method of treatment (conservative or operational), and secondly, to the choice of a particular method of surgical intervention.

An indication of the conservative treatment was the degree of severity of congenital varetle deformation of the neck of the femoral bone in children under 3 years of age. Conservative treatment was to create a favorable position of the head of the femoral bone in the hip joint with the help of a fary cushion, Mirzoyeva tires, and in children older than a year - in carrying an orthopedic apparatus with a landing for a sedlicated hill (like Thomasa). Massage was carried out and physical animation aimed at improving blood supply in the hip joint. The testimony for the surgical treatment method was II and III degree of gravity of congenital breeding cervical deformation of the femoral bone, as well as the degree in children over the age of 2-3 years old at the magnitude of the shield less than 110 °.

1 The degree of congenital varetle deformation of the neck of the femur with signs of the cervix dystrophy and the shode less than 110 ° was an indication for the operation on the method developed by us. The basis of the operation was the transposition of the fragment of the femoral bone of the trapezoidal form with a small spit under the dystrophy of the neck of the femoral bone and the simultaneous correction of the shield. II-III The severity of the congenital varetle deformation of the neck of the femoral bone was indicated to the early surgical treatment, which was aimed at eliminating the vicious installation of the thigh and was in operations on the soft tissues surrounding the hip joint. The second severity of the congenital breeding strain of the neck of the femoral bone in children over 2-3 years old was a testimony for the correction of the spatial position of the proximal femoral bone department for the methodology developed by us (patent for the invention No. 2183103). The basis of the operation was the interstate deictioning and valgizing osteotomy of the femoral bone, accompanied by the myotomy leading, lumbosy-iliac, straight and tailoring muscles, cutting off the fibrous tightness of the front portion of the middle jagged muscle and disseminate the wide fascia of the hip in the transverse direction. III The degree of severity of the lesion (cervical defect) in children over 6 years old was a testimony for osteosynthesis of the head and the proximal end of the femur using (for the cervical plastic) of the tissue musculoskeletal complex on the supply vascular leg with the fragments of the knitting or screws.

The absence of the head, a pronounced leading contracture in the hip joint in children over 12 years of age and adolescents, was the basis for the reconstructive operation at the proximal department of the femoral bone with the formation of an additional point of the thigh support in the pelvis.

According to the proposed surgical methods, 39 children were operated on, 8 patients received only conservative treatment. When applying the tactics developed by us, the treatment of children with congenital vius deformation of the femoral bone, good and satisfactory functional results were obtained in 93.6%.


Vorobev S.M., Pozdeev A.P., Tikhomirov S.L.
Republican specialized children's clinical orthopedo-neurological rehabilitation center, Vladimir, Rnidoi them. G. I. Turner, St. Petersburg

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Valgus and Varetle Deformation

The normal position of the leg corresponds to the conditional line, carried out through the first gap between the fingers of the foot, the middle of the knee and the hip joint. The deviation from this line is considered deformation (violation of a normal location, curvature), which can be a varestic and valgus.

In the varestic deformation (O-shaped), the middle part of the shin is visually deflected by the dust, valgus deformation (X-shaped) The skin shovels inside, legs resemble the letter H.

Neck hip.

Valgus deformation of the hip neck is characterized by a change in the cervic-diaphysic corner, its magnification. Most often combined with the Valgus deformation of the legs and the plane-valgus deformation of the stop. In most cases, this disease is a congenital pathology caused by the displasain of the hip joint, but may also develop as a result of injury or damage to the nervous system. It may lead to the development of cocarrosis (damage to the hip joint).

Legs

The deviation of the leg axis, in which the distance between the inner ankles is visually determined, the knees are tightly compressed.

Valgus deformation of the legs appears in childhood as a result of premature permission to stand, long stay in the standing position (in the Manege), violation of crawling. This is due to insufficient powers of muscles and ligaments, and an increased load on them. Rahit, dysplasia of hip joints, knee injuries can be attributed to significant reasons for this pathology. The main changes initially affect the knee joints, there are some of them to reject, the appearance of a plane-valgus flatfoot. The child complains about the fatigue of the legs, asks on his hands, notes pain in the legs with long walking. In the asymmetric curvature of the legs, there is a risk of scoliosis (spinal curvature).

Ankle joint

The Valgus deformation of the ankle joint is characterized by the displacement of the heel of the dust and the bumping of the feet itself inward. Often leads to the development of plane-valgus flatfoot.

Foot

Flat-Valgus deformation of the foot (flatfoot) is the most common type of foot valgus deformation. It is characterized by a change in the direction of the axis of the foot, and the decrease in its arches. Most often found in childhood.

Main reasons:

• congenital violation;
• traumatic flatfoot with a bone fracture, defeat of the ankle joint, breaking bundles;
• static flatfoot due to increased load on the joints due to excess weight et al.;
• rachitic flatfoot;
• paralytic flatfoot, as a complication of osteomyelitis.

Valgus deformation of the first finger of the foot (Hallux Valgus)

With the Valgus deformation of the thumb of the foot, a change in the advantage of the pelleflang should be changed, as a result of which the thumb is shifted inside. In this case, the position of the remaining fingers is also disturbed.

Possible causes of straightening of the foot

Among the causes of the Valgus deformation of the thumb:

• endocrine changes;
• genetic predisposition;

With this pathology, there is a weakness of the ligament and muscular foot apparatus. The deformation and arthrosis of the first finger joint causes an increased and uneven load on the front of the foot, which is exacerbated by the wearing shoe with a narrow nose and / or high heel.

Symptoms

The manifestations of this disease are the appearance of "bones" in the area of \u200b\u200bthe altered joint, changing the position and shape of the remaining fingers. It is accompanied by pain in the joint and foot, fast fatigue. In the area of \u200b\u200b"cones" there is redness, a small swelling.

The severity of the deformation:
1. Deviation of the thumb side to 15 o.
2. Deviation of thumb from 15 to 20 o.
3. Deviation of thumb from 20 to 30 o.
4. Deviation of thumb over 30 o.

At 3 and 4 degrees of deformation, the development of complications, such as:

• hammerous curvature of fingers;
• painful natopes and corn prone to inflammation;
• hide pain;

Finger's curvature is preceded by the inconvenience of shoes wearing and the appearance of pain when walking. Due to the deformation of the joint, the foot change occurs, the emergence of the elevation in the middle, where painful corns and natoptes are easily formed. The second finger of the foot also changes, takes the form of a hammer, a corn is also formed on it.

Such symptoms may occur in some other diseases: deforming osteoarthritis, arthritis, gout. To find out the reason for the appearance of "bumps" and pain, it is necessary to apply for advice to the orthopedic. After inspection, the doctor will appoint you a X-ray examination (a shot of the foot in three projections) and the planography.

As a result of the further development of the pathological process, during the untreated Valgus deformation, many patients develop chronic bursitis (inflammation of the near-handing bag) and the Diselener's disease (change in the structure of bones of plus).

Treatment

Flatfoot

Treatment of flatfoot is a long and labor-intensive process. At the same time, it is necessary to constantly carry orthopedic shoes with a hard backdrop, special orthopedic stelks (better custom), conducting regular courses of massage and therapeutic physical education.

Treatment of Valgus Stretching Foot

Conservative treatment
Non-surgical methods for the treatment of Valgus deformation include wearing orthopedic supinators and night tires, stelc, interfallated gaskets, physiotherapeutic treatment, therapeutic gymnastics for the fingers of the legs and feet. To reduce inflammation, intra-articular administration of diprospan, hydrocortisone (hormonal preparations) is used.

Conservative treatment does not lead to complete recovery, used only in the early stages, and as a preoperative preparation.

Surgery
There are a large amount (more than 100) methods of surgical treatment of Valgus deformation. The main of them are presented below:

• Excoctomy (excision of some part of the pink bone head).
• Osteotomy, or removal of a part of the phalange of the finger or a tie bone.
• Creating a state of motionlessness of the thumb of the foot (arthrodez).
• Restoration of ligaments around the high-fingela foot joint of the thumb, and their comparison.
• Arthroplasty resection, or resection (removal) of part of the tune-standing joint by a tie bone.
• Replacing the affected joint for implant.

However, it should be noted that the part of patients has a re-education of "bones". In the postoperative period, patients have for a long time to limit physical load on the foot. This creates some inconvenience.

Currently, less traumatic methods of surgical treatment of Valgus deformation are used, in which the postoperative rehabilitation period is significantly reduced.

Rehabilitation after surgery

On the second day after the operation, it is allowed only to move your fingers. Walking, not advancing the operated area, it is possible in 10 days. The load on the entire foot can only be given a month after treatment. Six months later, with a prosperous period of the postoperative period, it is allowed to play sports with the load on the legs, and wear shoes on heels.

An effective method for facilitating the rehabilitation after the operational treatment of Valgus deformation is the shock-wave therapy, which is aimed at improving blood circulation in tissues, as well as to reduce edema and pain at the operation site.

Footwear

With the Valgus deformation of the first finger of the foot, shoes should be soft, with a wide nose and low heels (up to 4 cm).

With a flat-rack deformation of the foot, it is necessary to wear new shoes with a high and rigid back, 3 cm above the heel, with a dense and high supinator.

Orthopedic insoles

To correct the deformation of the foot, various types of rake and semias are used. It is best for this that are suitable insoles made by individual order. With their help, the load on the joints of the legs is reduced, the blood circulation of the foot improves, the feeling of fatigue in the legs is reduced.

Sometimes insoles are hard to fit in shoes, especially standard. Therefore, in order to correct pathological disorders in the foot, you can use half-squints - a shortened option of ordinary insoles (without the front department).

In some unlawful cases, orthopedic can allow wearing orthopedic tunes.

Massage at the Walgus Stop Deformation

1. The massage course is from 10 to 20 procedures, with an interval of about 1 month. Massage affects not only the shin and feet, but also back and hips, because An important meaning is the condition of the entire muscular apparatus participating in motion.
2. Starting with the zone area. Movements - stroking and rubbing, from the center of the dudder.
3. Next, you should switch to the area of \u200b\u200bthe buttocks, where there are circular stroking, rubbing and kneading, tendering and stroking.
4. On the back surface of the thigh, intensive rubbing from the knee joint up the thigh, sampling and stroking.
5. Massage should be carried out in different ways, on the inner and outer surface. All techniques (rubbing, kneading) inside are carried out intensively, and outside - gently. This allows you to stimulate the internal muscles and relax external, which leads to the correct installation of the foot.

Valgus Stop deformation in children

Valgus deformation of the foot in children is represented mainly by flat-valleling flatfoot. In this case, there is a deviation of the heel of the dust, the appearance of pain during long walking and increased fatigue. With a timely manner, and regularly conducting treatment can be achieved to fully restore the state of the foot. To establish the degree of violations and the definition of treatment methods, an orthopedic consultation is necessary.

Treatment

For the treatment of Valgusal deformation of the feet in the child, attention should be paid to the pose of a small patient: in the standing position should be closed - it reduces the burden on the joints and stop. The duration of walks should be limited. Good affects the installation of the legs:

• swimming;
• bicycling;
• walking barefoot (especially in the sand, grass and pebbles);
• football game;
• classes in the Swedish wall;
• lazain on the stairs.

To adjust the foot installation, wearing orthopedic shoes with a high rigid back or insoles. The orthopedist will help you correctly pick up. Shoes should sit on the leg well. You can not wear shoes already used. At home you can walk without shoes.

Massage as it is impossible to better affect the recovery process. It takes it regular courses. Therapeutic physical culture is very important, exercises must be held daily. It is better to present this in the form of a game so that the child can with pleasure they perform. From the exercise, it should be noted the lifting of small items and cleaning the towel to the legs, rolling the sticks of the foot, upset from the Pose "in Turkish".

In case of ineffective treatment, they resort to surgical operation. For this purpose, the varizable osteotomy is carried out. In the course of the operation from the bone (with the Valgus deformation of the lower leg, the wedge is chipped). The bone is connected by screws. After the operation, apparatuses for external bone fixation are used, osteosynthesis using the Ilizarov method.

Before use, you must consult with a specialist.

The emergence of hip deformations is at the heart of various reasons. Part of the deformations comes from changes in the area of \u200b\u200bhip joint and hip neck. Deformation in the field of metaphysis and thigh diaphysis can be congenital, rachistic, inflammatory, can be associated with injury and various tumors.

Rachitic thigh deformations

A characteristic feature of the pathological process in the early period of Rakhit is the formation of osteoid tissue, which is not subjected to a timely permeatement.

At the end of the disease, when the process of ossification is not fully restored, the traction of the muscles, especially leading, and the premature load on the legs cause the thighs characteristic of Rakhita - O-shaped thigh (Femur Varum). More often there is a bilateral deformation of the thigh.

Symptoms. Usually the deformation captures all the thigh and the shin.

Due to the arcuate deformation of the hip and changes in the field of epiphyseal cartilage, the length of the limbs is reduced, the disproportion between the length of the body and limbs occurs. The physiological axis of the femoral bone is broken, and as a result of the irregular load near the ankle joint, the secondary deformation of the foot is often occurred.

Prevention and treatment. During the period of fresh Rahita, with a tendency to deformation of the limbs, it is necessary to fix their plaster bus and not resolve the loads on them until the bone structure is fully reduced, which is checked radiologically. Temporarily give an unloading orthopedic apparatus. At the same time, vitaminotherapy and ultraviolet irradiation of the patient are carried out.

Treatment of the formed deformation of the hip consists in osteotomy, correcting its axis or lengthening.

Osteotomy makes under local anesthesia. The outer cut dissect wide fascia, outdoor wide muscle, periost, carefully stop bleeding. At the height of the greatest deformation of the thigh make oblique osteotomy, they produce skeletal extracts or placing gypsum for 2 months, then therapeutic gymnastics, careful load in the tutor, are applied.

With a noticeable shortening of the limb, due to the deformation of the thigh, it is possible to lengthen the entire limb in two ways: on the thigh or the operation on the bones of the leg. For the elongation of the femoral bone, the method of segmental osteotomy on N. A. Bogray with the introduction of a font in the bone margin or Z-shaped osteotomy followed by skeletal extracts.

Z-shaped osteotomy is carried out as follows. After the Z-shaped dissection of the periosteum, the diaphysis is drilled by a narrow drill in the front seat in 3-4 places, and the drill follows and through the rear wall.

Then a narrow sharp bit split a femoral bone in length. The channels drilled in front of it allow you to produce osteotomy without any difficulty and such a value that is required to eliminate the shortening of the thigh.

Some after Z-shaped osteotomy drives in the bone marginal channel Autotransplant, which does not interfere with the stretching of fragments, prevents their offset and ensures consolidation.

Then, for 2 weeks, stretching the skin with sticky plaster, culb or zinczhelotine paste with side traction to prevent lateral curvature is used.

The following complications are possible when lengthening the limb:

• temporary weakness of muscles from elongation;
• fracture on the site produced earlier osteotomy;
• slow consolidation;
• vicious union;
• restriction of mobility in the knee after long-term fixation.

Patients should be withstanding for a long time, but with active movements in the joints and focusing legs. With proper postoperative jurisdiction, the patient complications can be avoided.

You can also reach the lengthening of the limb by osteotomy bones of the leg.

Recently, various screw devices are used to lengthen the hips, the legs with a good result, in particular the Gudyshauri apparatus.

Traumatic thigh deformations

There are traumatic deformation of the upper third of the thigh, diaphysis and distal end areas.

Symptoms. The deformation of the hip in the upper third occurs after damage to the epiphyse (epiphisheolysis), the cervical fracture (Coxa Vara Traumatica) or the meta-diaphysarity department of the femoral bone. In the latter case, the angular curvature of the hip with its shortening is developing. With a diaphyseal deformation of the hip, the displacement of fragments in length and width, violation of the physiological axis of the thigh and the shortening of the limb are the most important symptoms. The displacement of the distal fragment along the periphery and recombulation of the femoral bone, externally unobthered, significantly upset the function of the limb.

Treatment. In the cases shown, it produces an operational elimination of deformation by osteotomy and lengthening the femoral bone.

Deformation of the thigh of inflammatory origin

Inflammatory processes arising in the proximal or distal epiphysis of the femoral bone in childhood lead to shortening the limb and to change its shape and function.

The most significant deformations occur after the tuberculosis process in the field of head and neck or in distal epiphysis. Shortening in such cases sometimes reaches 8-10 cm or more. The shape and axis of the femur also change.

Similar deformations of the hip and shortening are also developing after septic (metastatic) osteomyelitis of the femoral bone, which arose in early childhood after the umbilical sepsis.

Symptoms. The main symptoms are shortening the thigh and chromota. With a more careful study, it is possible to detect the incorrect development of the medial or lateral removal of the distal epiphyse of the femoral bone, a violation of its growth, sometimes premature synostosis and as a result of this, the development of Genu varum or Genu Valgum.

On the radiograph, you can establish a violation of the structure of the meta-epiphyseal department and synostosis.

Treatment. Treatment of shortened thighs can be conservative or operational. The use of orthopedic devices or orthopedic shoes is shown in children. Operational lengthening of the femoral bone is made in shortening over 4 cm.

The article has prepared and edited: a surgeon doctor

The invention relates to medicine, namely to orthopedics, traumatology in the treatment of varetle deformation of the neck of the femoral bone. Essence: Conductions through the wing of the ileum, large spit, middle and lower thigh, the ends of the spokes are fixed on the supports of the compression-distraction apparatus, connect the support on the wing of the ileum and the proximal support on the thigh, and the middle support is connected to distal on the thigh, perform The integrity osteotomy of the femoral bone in the bottom upward, outside - knutrice, is corrected by the deformation of the proximal thigh department, in the lower third of the hip they perform transverse osteotomy, the intermediate fragment of the femur medially is shifted, fixed in the reached position, through a large spit and the hip neck, console knitters are carried out, Through the nadaacetabular region, they are adjusted, arcuately bend them, fixed and stretch to the arc of the device, 5-6 days after the operation, distraction between the middle and distal supports with a leading pace through the outer rods of the device, which allows the roof of the godpadin, the level of the length of the limb, but Ramalize the biomechanical axis. 5 yl.

The invention relates to medicine, in particular to orthopedics-traumatology, namely used in the treatment of the breeding of the neck of the femoral bone using the severity fixation apparatus. A method of reconstruction of the hip joint is known, which provides for a single-time recovery of the seed-diaphysicular angle (shode) and an increase in the hip head coating by the supervant osteotomy of the iliac bone and the slope of the distal fragment of the dudder pelvic (A.S. 757155, the USSR. The method of correction of the ceroid diaphysicular angle and the roof Paddins in the varestic deformation of the neck of the thigh. Publishing house. 28.04.80, Bul. 31). However, this method provides for the performance of tone wedge-shaped or interstitious coal-shaped osteotomy, with a supervalled osteotomy, followed by the fixation of the gypsum bandage, which does not allow gentle-to-form the roof of the godded depression, eliminate the pathological restructuring of the hip neck, fully equalize the length of the limbs and normalize its biomechanical axis. The objective of the present invention is to develop a method for treating the breast bone cervical strain, allowing to increase the hip head coating without osteotomy of the iliac bone, eliminate the pathological restructuring of the hip neck, fully equalize the length of the limbs and normalize its biomechanical axis. The task is solved by the fact that in the method of treatment of the breeding of the neck of the femoral bone, which includes the implementation of interstate osteotomy and fixing fragments of femoral and iliac bones in the supports of the transducer, are additionally introduced through the region of the large spit, the hip neck of at least four console spokes, and through the nadacetabular region - At least two spokes, the ends of which are bended the duct, fixed in the support of the device and stretched, while in the lower third, the transverse osteotomy of the thigh is performed, and the interstitious osteotomy is carried out in the distance from the bottom up from the outside, after which the intermediate fragment is moving under the pathological rearrangement zone hips. The present invention is explained by a detailed description, a clinical example, a diagram and photographs in which: FIG. 1 depicts a femoral osteotomy scheme with fixation of its fragments and hip joints in the supports of the transducer; Figure 2 presents a photo of the patient E. before treatment; figure 3 shows a copy of the R-gram of the patient E. before treatment; Figure 4 illustrates the photo of the patient E. after treatment; Figure 5 presents a copy of the R-gram of the patient E. after treatment. The method is carried out as follows. In the operating room after the anesthesia of the processing of the operating field, the antiseptic solution are performed on four levels (FIG. 1): through the wing of the iliac bone, the region of the large spit, the middle and lower third of the hip. The ends of the spokes conducted through the bone are pairly fastened on the supports of the compression-distraction apparatus. Support on the wing of the ileum and the proximal support on the thigh connect with each other with the help of hinges; The middle support and distal on the thigh connect with each other with the help of threaded rods. The connected supports have the ability to move relative to each other. Then the interstate osteotomy of the femoral bone in the distance is from the bottom up the outside - knutrice. Correction of deformation of the proximal thigh department. In the lower third of the hip they perform transverse osteotomy and shifting the intermediate fragment of the femur medial. After that, fragments of the femoral bone are fixed with the help of supports in the situation achieved. Through a large spit and the neck of the hips, console knitters conduct console knitting needles, and through the nadaacetable region - the knitting needles, which are arcuately bend, are fixed and stretched to the arc of transparent fixation, which contributes to the stimulation of the reparative processes in the hip neck and the roof of the godpad. At 5-6 days after surgery, distraction between the average and distal thigh supports with a leading pace along the outer rods of the device is formed, while the regenerate of a trapezoidal form is formed before equalizing the length of the limbs with the restoration of its biomechanical axis. After reaching full consolidation in the areas of osteotomy, the device is dismantled. An example of a method. E. Patient (East. Bol 30556) entered the treatment with a diagnosis: the consequences of hematogenous osteomyelitis, the cervical deformation of the neck of the right thigh - 90 o, shortening the right lower limb 4 cm, combined contracture of the right hip joint (extension - 160 o, assignment - 100 o), Valgus deformation of the knee joint - 165 o. The result of the disease is 5 years (figure 2). Upon admission, complaints with fatigue, periodic pain in the field of the right hip joint, chromotype, shortening the right lower limb, restriction of movements in the right hip joint and deformation of the right lower limb. The symptom of Trendelenburg is sharply positive. On the radiograph of the pelvis - the deformation of the proximal department of the thigh, the shode is 90 o. The destruction of the neck of the femur with its fragmentation is noted throughout. Merilic wpadina dyslastic: acetabular index (AI) is 32 o, the thickness index of the gummy depression (TD) - 1.75, the depth index is 0.3. In the operating room after the anesthesia of the processing of the operating field, the antiseptic solution was performed on four levels: through the wing of the iliac, the region of the large spit, the middle and lower third of the hip. The ends spent through the bone of the spokes are fixed on the supports of the compression-distraction apparatus. Support on the wing of the iliac bone and the proximal support on the thigh are connected to each other with hinges; The average support and distal on the thigh are connected to each other with the help of threaded rods. Then the intersecting osteotomy of the femoral bone in the direction of the outside - knutri is below up and transverse osteotomy in the lower third of the thigh. The correction of deformation of the proximal thigh department and shift the intermediate fragment of the femur medially. After that, fragments of the femoral bone are fixed using the supports in the situation achieved. Through a large spit and the neck of the thigh, cantilever needles were carried out, and through the nadaacetable region - the knitting needles, which are arcuctantly are curved, fixed and stretched to the arc of the transcidate fixation apparatus. On 5-6 days after the operation, distraction was distraction between the average and distal supports of the hip with a leading pace along the outer rods of the device until the length of the limbs and the restoration of its biomechanical axis was formed, while the regenerate of the trapezoidal form was formed. Distraction was 27 days. The device is removed after 76 days. After treatment, there is no complaints, the gait is correct, the length of the legs is the same, the symptom of trendelenburg is negative, the volume of movements in the hip and knee joints is complete (figure 4). On the radiograph of the pelvis, the centration of the femoral head in the master's depression is satisfactory, the shode is 125 o, AI-21 O, etc. - 2.3, the depth index of the godded depression - 0.4 (figure 5). The proposed treatment method is used in the RNC clinic "WTO" them. Academician G.A. Ilizarova in the treatment of patients with the cervical deformation of the neck of the femoral bone. The execution of this method allows to achieve good anatomical functional results by eliminating the deformation of the proximal femur department, restoring the integrity of the hip neck, gentle the formation of the roof of the godded depression due to the stimulation of the reparative processes by additionally entered in the thigh and the roof of the gloomy depression, the restoration of the biomechanical axis of the limb Simultaneous unloading of the hip joint by the device of transkomatic fixation. The proposed method provides for the use of a well-known toolkit produced by the medical industry, does not require additional accessories, devices, expensive materials and relatively small-scale. Allows the functional load on the operated limb and the FFC in the early postoperative period, which warns the development of persistent contractions of adjacent joints.

Claim

The method of treating the pellets cervical strain, which includes the implementation of the interstate osteotomy and fixing the fragments, characterized in that they are performed through the wing of the ileum, large spit, the middle and lower third of the thigh, the ends of the spokes are fixed on the supports of the compression-distraction apparatus, connect the support on the wing The ileal bone and the proximal hip support, the average hip support with distal, perform the interstitious osteotomy of the femoral bone in the direction of the bottom up, outside - knutrice, the deformation of the proximal department of the thigh is corrected, in the lower third of the thigh perform transverse osteotomy, shifted the intermediate fragment of the femur medially, fixate In achieved, console knitters are carried out through a large skewer and neck of the thigh, they carry out knitting needles through the nadacetabular region, their arcuate is bent, fixed and stretched to the arc of the device, 5-6 days after surgery, distraction between medium and distal supports with advanced m tempo on the outer rods of the device.

The main manifestation of the disease is the decrease in the shode less than 120 °. Two forms of the disease are isolated: congenital varetle deformation and varetle deformation of development. Congenital deformation is found in a newborn. As the cause of the disease, the pressure of the walls of the uterus, the aseptic necrosis of physical and hip necks, the delay of osxification due to the failure of the supply vessels. Varus is accompanied by signs of dysplasia in the form of a compassion of the masterpiece, congenital dislocation or congenital underdevelopment of the thigh, as well as different lengths of the legs. Vius developmental deformation or secondary deformation is diagnosed over the age of 4. It is associated with metabolic disorders and takes place with diseases such as rickets, epiphisseols of the hip head, morkio disease, imperfect osteogenesis, mucopolysaccharideosis, metaphizar xondromblasis, infection. VDB wears both one-sided and double-sided. One-sided curvature was observed in 60-75% of cases. A two-way process, which takes place in 25-40% of cases, is more connected with general metabolic violations - Rahit, osteomalacia, imperfect osteogenesis.

When VBB in the proximal thigh department, several processes occur simultaneously, which determine the nature of the disease. The effect of etiological factors leads to a violation of the ossification of the cartilage matrix of the hip metaphy, which is called local fatigue dystrophy. The durability of the bone is not enough for resistance to the action of weight strength. There is a slow bending of the hip neck together with the head and the development of the varestic deformation of the proximal thigh department. The flexio moment of force acting on the proximal thigh department increases. In the neck of the thigh there is a decrease in the compression component of the strength and increasing its displacement component. The pathological bending of the neck and the thigh head is developing simultaneously with the physiological growth of a large spit in the cranial direction, as a result of which the vertex of the spit is set above than the center of rotation of the hip joint, and the attachment points of the disintegration muscles come together. There is a weakening of the discharge muscles, muscle imbalance occurs, the dominance of the resulting muscles, a decrease in the hip disharge. The vius deformation of the thigh is accompanied by a decrease in the anthemery of the thigh up to its retrovert, resulting in a decrease in the inner rotation of the thigh. The breaker and version reduces the space for the dishonor of the hip that when the assignment causes the emphasis of a large spit and the hip neck to the edge of the godded depression and in the iliac bone. There is a convergence of the fixation points of the discharge muscles and their weakening. While walking the power of the discharge muscles is not enough to raise the pelvis up on the side of the portable leg. Instead of lifting, the pelvis on the side of the portable legs occurs. On the side of Varus, the hips arises with the symptom of Trendelenburg with the deviation of the body toward the support leg to reduce the load on the discharge muscles.

A child with VDB has a sentence began to start self-walking. From 2 years it becomes a notable disturbance of standing. The symptoms of the violation is associated with the symmetry of the damage to the hips. With one-sided vapor deformation, there is a seeming increase in the size of a large spit and its speech in the cranial direction. In shortening the leg in the range of 1-1.5 cm there is a chromotype of a sore leg. With a significant weakness of the disgusting muscles, the child is diagnosed with a symptom of Trendelenburg. With a bilateral process there is a making gait with a large amplitude of the deviation of the body in the frontal plane. The difference in the length of the legs increases with age, which leads to the weighting of symptoms.

VDB is diagnosed with radiography. On the thigh radiograph, there is fragmentation of metaphysis and epiphyse, expanding the epiphysear plate, as well as a triangular bone fragment at the junction of the neck with epiphysis, more often along its bottom surface. In 3/4 cases, a compassion of the masterpiece was observed. On the radiograph in the front-rear projection, the Hilghezzerier is carried out through the Y-shaped cartilage of the godflower and the second line along the edge of the hip epiphyse. An intersero-epiphylastic angle is formed, which in a child of 7 years ranges from 4 to 35 °, on average by 9 °. In an adult, an angle is less than 20-25 °. With Varus the proximal thigh, the angle "reaches 60 °. For VDD, the progressive nature of the flow is characterized. The increase in deformation is accompanied by a worsening of walk without pain. The spontaneous stop of the development of the thigh curvature occurs during an inter-screw-epiphyzar coal less than 45 °.

Treatment

Conservative methods of treating the varestic deformation of the thigh in the form of traction or immobilization are considered ineffective. Preventive shoes are used to prevent the development of secondary deformation in the distal departments of the lower limb. Using the contribution, the length of the lower limbs and compensation for the progressive shortening of the sore feet is equalized.

Indications for surgical treatment depend on the magnitude of the deformation, the flow of the disease and age of the patient, of which the priority parameter is the angle of curvature of the thigh. With MEA from 45 to 60 °, they perform observation and perform a radiographic study 1 time in six months. The radical methods of treatment are resorted in the case of deformation progression. The testimony to the operation is an increase in MEU more than 60 °, a decrease in the shode is less than 100-110 °, a positive symptom of Trendelenburg, as well as a visible worsening of walking. Contraindication to the operation is the absence of clinical symptoms with MAEU less than 45 °, as well as the absence of the progression of curvature at MEA less than 60 °. Compared with the validity of the deformation age, age is less important to test. Each age period has its advantages for surgical intervention. Early operations under the age of 2 years are rarely carried out due to the low severity of the deformation of the bone. The positive side of the intervention at an early age is the possibility of full remodeling of the deformed bone. It describes the restoration of bone structures after the operation in children aged 18 months. Children over 2 years old have more grounds for the use of surgical treatment methods due to greater degrees of deformation. A big child is relatively easier to fix the bone. The operation is made with the following objectives:

• correction of the vius curvature and animality of the thigh to reduce the strength of the shift and increase the strength of the compression in the neck of the thigh;
• alignment of the length of the lower extremities;
• reconstruction of a large spit in order to create conditions for the work of the discharge muscles.

Operation: exposed osteotomy

Indications: Varetle deformation of the proximal department of the thigh, MEU is more than 60 °, the shode is less than 100-110 °.

Lateral skin incision over a large spit length 10-12 cm. In the hip neck parallel to the upper edge, the needle is administered under the control of the ESA. With the help of a drill or oscillatory saw in the hip neck parallel to the spin form a slot for the plate. Used the plate, bent at an angle of 140 °. The horizontal branch of the plate is clogged into the bone gap. Osteotomy is made in the exposure area at a distance of the disinfect of the femoral dice below the corner of the plate. Under the control of the ESA with the help of an oscillatory saw or osteotoma make the transverse intersection of the thigh diaphysis. They produce bringing the proximal fragment of the thigh and the diversion of the distal fragment. The proximal fragment is installed on a distal in such a way that the lateral cortical of the proximal fragment is in contact with the dice of the distal fragment. Screw to the diaphysia of the femur vertical branch of the plate. Perform a reposition of a triangular bone fragment to the neck of the thigh. Remove the needles. Apply a cocus gypsum bandage for a sore feet for a period of 8 to 10 weeks.

Treatment results

On average, the planting osteotomy allows you to reduce MAU5DO 35-40 °, and the shode to increase to 130-135 °. Sub-faithful and interstate osteotomy give approximately a similar correction result. In the postoperative period there is a loss of correction. 9-10 years after the intervention, the shode decreases from 137 to 125 °, and the MEU increases almost half. In the postoperative period for 3 years, almost all patients have a closure of the growth zone of the proximal physical of the femoral bone, after which the backlog in the growth of the thighs is noted. Shortening legs compensate for orthopedic shoes. A significant decrease in the thigh length is an indication for operational intervention. More often make the elongation of the bones of the short leg, less often produce shortening bones of the counterconduration limb. In half of the patients after the intervention, there is a weakness of the disgusting muscles of the thigh. In 60% of cases there is an excess increase in a large spit, which is eliminated by the operation of apophisodesis. In 87% of cases there is a decrease in the sizes of the thigh head, in 43% of cases - its compaction, as well as the compassion of the godded depression.