Congenital curvature of the thigh. Causes, types and treatment of congenital thigh curvature Varetle deformation of femur in children Treatment

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.

Cervical deformation of the neck of the femoral bone (youthful epiphisheolysis) is a disease of youth and quite rare.

Risk factors include, including long-term microtraums, an increased burden on the bone, suffered by Rahit, disruption of metabolism and hormonal status.

In the pathogenesis of this state: dystrophy in the spongy part of the paratypepinizar cervical zone, destructive changes, the formation of cyst and fibrosis.

• small soreness in the groin or popliteal area;
• light chromota;
• restriction of movements in the hip joint (restriction of the internal and increasing outdoor rotation);
• often symptoms are provoked by injury.

Diagnostics

At the beginning of the disease on the radiograph, an inhomogeneous bone structure in the para -pinizar zone of the femur neck, disruption of the beam longitudinal hip cervical structure along the axial load line is detected.

Against the background of osteoporosis, the neck of the epiphyse contours are highlighted as converted by a pencil, and the epiphyseal cartilaginous plate seems extended. The articular gap is often narrowed, and the height of the epiphyse, with a significant displacement of its for the stop, can decrease. Reducing the epiphyseal diaphyseal and increasing ceroid-epiphyseal angle.

It is characterized by osteoporosis of tubular bones with thinning and decreasing density of the cortical layer. There may be scoliosis, kyphosis, paradist defects in the bodies of the vertebrae and their wedge-shaped deformation.

Treatment

1. Hospitalization.
2. Complete exception of the load on the limb: bedding, deaf gypsum bandage, skeletal extract.
3. Surgery. It is often used: tunneling of hip neck, osteotomy.

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Complex cases of primary arthroplasty of the hip joint: deformation of the proximal femoral department

The normal anatomy of the proximal femur department is quite variable, and in the overwhelming majority of cases it is possible to do with standard endoprosthesis when complying with ordinary operational intervention techniques. From a practical point of view, the thigh can be considered deformed if its form and sizes are so unusual that compensation for anatomical disorders is required by applying special surgical equipment or non-standard implants.

Deformation of the proximal femur It may be congenital (dysplasia), post-traumatic (incorrectly fragile fractures of the ortho region), nuclear (therapeutic corrective interstate or exposure osteotomy), as well as develop due to metabolic disorders in bone tissue (PEDGET disease).

Hip deformations are classified depending on the anatomical localization, which includes a large skewer, a neck of the femur, metaphy and diaphim. In turn, the deformations in each of the listed anatomical zones may be divided by the nature of the displacement: the angular (varestic, valgus, flexing, extensive), transverse, rotational (with an increase in or decrease in the anthemery of the hip neck). In addition, changes in normal bone sizes and a combination of listed features are possible. The greatest difficulties for treatment are deformations of the femoral bone at two levels and in several planes.

General principles of treatment.

In the presence of deformation of the femoral bone, careful preoperative planning should be carried out in order to determine the possibility of applying standard approaches and structures. In some deformations there are significant difficulties in the preparation of the bone marrow channel. For example, the displacement of the diaphysis in the width in the sagittal plane may, when introducing the legs of the endoprosthesis, lead to perforation of the front cortical wall. Intraoperative fluoroscopy or radiography allow you to control the progress of the channel preparation and significantly reduce the risk of perforation of the wall of the femoral bone. The surgeon must decide whether it can set the leg by deviation from a standard position, or it is impossible, and it is necessary to resort to the osteotomy of the femoral bone. The presence of deformation affects the choice of the geometry of the leg and the method of its fixation. There are species of deformations that require the use of femoral components of special design, and in some cases there are making them to order. In severe deformations, it is often necessary to osteotomy a femoral bone, and in some cases - in the execution of the operation in two stages.

Thus, unfavorable factors that create difficulties in carrying out the operation and affect the choice of the leg of the prosthesis are the following: osteoporosis, deformation of the bone marrow channel in the sagittal and frontal planes, medialation and rotation of the thigh, the presence of unreasonable metal structures. Before surgery, the surgeon must carefully plan and have several structures of the endoprostheses of various types of fixation at its disposal. The following questions stand in front of the surgeon:

• the possibility of a simultaneous or subsequent elimination of deformation and installation of the endoprosthesis;
• correction of the length of the limb;
• restoration of muscular tone;
• selection of endoprosthesis design;
• removing metal structures installed in previous operations.

We use the following working classification of deformations:

1. In terms of deformation: neck of the femoral bone; the ultimate area; exposure area (top third of the thigh); two-level.
2. By type of displacement: single-bed ( two perception; multi-glossy.

The choice of the method of surgical treatment depending on the level of deformation of the femoral bone

Deformation of a big spit.

There are two main varieties of the deformation of a large spit, which make it difficult to perform the execution of arthroplasty: hovering a large spit with the overlap of the entrance to the bone marrow channel and its high location. When the large spit is hung, the preparation of the channel is significantly hampered, the preparation of the channel is created, a real threat to its chipping and the varetle installation of the endoprosthesis legs is created. The problem of endoprosthetation at a high arrangement of a large spit is the potential way of stopping a spit in the pelvis ("Impending" syndrome) with the development of the rear of the hip instability during bending and internal rotation of the hip, the appearance of chromotype due to the insufficiency of the disadvantage of the thigh muscles. For the prevention of these complications, it is advisable initially during the access to perform osteotomy of a large spit, which facilitates the preparation of the channel and allows you to compensate for the power of the muscles by reducing a large spit.

Fearless cervical deformation.

There are three variants of deformation: Valgus (excess cervic-diaphysarine angle), vius (reduced cervic angle) and torsion (excessive annersion or retrusive). Often, the specified types of deformation are combined with each other. The choice of treatment method in the varestic deformation depends on the presence of bilateral or one-sided lesion, as well as from the need to change the length of the leg. With one-sided deformation, as a rule, the sore leg is shorter, and standard structures can be used. If the surgeon wants to preserve the length of the leg during bilateral deformation, it is necessary to provide the use of legs with a smaller ceroid diaphysic angle (for example, the Alloclassic leg has an angle of 131 °) or with an increased "offset" and an extended neck head. In this case, it will be possible to restore the anatomy of the joint without lengthening the leg.

The Valgus deformation of the neck of the femur, as a rule, is combined with a nice metaepiffism and involves the use of legs with a narrow proximal part. In addition, it is desirable to use implants with a cervical diaphysic angle of 135 ° and more.

Small torsion deformations of the neck of the femoral bone can be compensated by the corresponding position of the feet of the endoprosthesis. Problems arise at the anterexia coal more than 30 °.

If you set the leg in this position, this will limit the outdoor rotation and may be accompanied by dislocation of the thigh. You can set the leg in the correct position by installing it on bone cement, or use the cinder-shaped prostheses (such as Wagner). Another output from this position may be the use of modular design legs (such as S-ROM, ZMR). With severe rotary deformations, when other methods of operations cannot be applied, performed the turbulent osteotomy of the femoral bone.

The deformations of the faithful bone area are extremely variable and polyethological. It is fundamentally possible to use both types of legs. In the preoperative period, it is necessary to carry out thorough planning in order to determine the optimal position of the leg, the size of the cement mantle. The legs of cement fixation are most often used in senior patients with signs of osteoporosis. In addition, this version of the endoprosthetics is used in difficulty with the installation of the leggall-free fixation.

Radiographs of bones pelvis patient V., 53 years old, with left-sided dysplastic coxarthrosis: And - 6 years after therapeutic interstitial osteotomy, there is a progression of coxarrosis; B - Endoprosthetics of the left hip joint with standard hybrid endoprosthesis (Cup Trilogy, Zimmer, Leb Lubinus Classic Plus, W.Link from Scion 126 °). The choice of leg is due to its greatest correspondence to the geometry of the bone of the thigh bone.

Radiographs of the right hip joint of the patient M., 70 years old, with the breeding of the neck of the femoral bone: A - 12 years after therapeutic interstate osteotomy; B - Osteoporosis of the femur, wide bone marrow channel predetermined the installation of the wedge-shaped feet of cement fixation (CPT, Zimmer) after removing the plate.

Radiographs of the patient S., 54 years old, with left-sided dysplastic coxarthrosis: a - deformation of the metaeplefify of the femur after the dernotation and valgizing interruption osteotomy (8 years after the operation); b - small media enabled to use the standard leg of the AML (DEPUY) fixing The choice of legs with a sufficiently extended coating with balls (5/8 of the length) is due to the need to distal endoprosthesis due to the pronounced bone seal at the place of the MVO; in, g - 6 years after surgery.

Radiographs of the right hip joint of the patient F., 51 years:a - aseptic necrosis of the head of the femur, who has grown out the fracture of the hip after the Valgizing VIVO, completed 11 years ago; B, B - the leg of the cementless fixation of Versys Et (Zimmer) is installed with a hughus slope in accordance with the geometry of the femur metaeplefif, the beak plate canal is filled with spongy autocurity.

Single-glossary deformation of the incense region with a large media media of the distal fragment and the cone-shaped shaped channel of the femoral bone: and - before the operation; B - 2 years after installing the Wagner's conical leg (Zimmer).

Radiographs of the right hip joint sick B., 53 years old: a - false joint of the neck of the right femur, who has grown in the fracture of the femur after the medical native healing interstate osteotomy; B, B - Considering the excess media of the femur diaphysis, the leg with Calcary (Solution, Dopuy) is selected for endoprosthetics, which has a porous coating on the entire length, which ensures distal fixation of the endoprosthesis.

Radiographs of the right hip joint of the patient G., 52 years: a - aseptic necrosis of the head of the femur, who has grown out a fracture after the MBO mediating; b - perforation of the outer wall of the femur with the leg of the endoprosthesis of the place of osteotomy (intraoperative radiograph); B - reinstalling the legs into the correct position with the fixation of a large spiner by the screen (1 year after the operation).

Radiographs of the patient K., 53 years old, with the deformation of the hip in the exposure region congenital dislocation of the thigh (degree s): and - before the operation; B - Cup Trilogy (Zimmer) is installed in an anatomical position, taking into account the deformation of the femoral bone in the middle third implanted the short conical legner of Wagner (Zimmer), plastic of the inner thigh level at the cervical level of the protester autocoupled transplant.

• osteotomy at the level of deformation; installation of the commodity component in an anatomical position;
• correction of the length of the leg of the endoprosthesis leg;
• restoration of the muscular "lever" due to the tension and fixation of the large spit or the proximal department of the thigh;
• ensuring stable fixation of bone fragments after osteotomy.

With severe deformations, a fundamentally different surgical technique is necessary, including the implementation of the osteotomy of the femoral bone.

Radiographs Patient T., 62 years: a, b - congenital dislocation of the thigh (degree d), deformation of the area after osteotomy with the purpose of creating the support hip; The trilogy gum component (Zimmer) is installed in an anatomical position, the wedge-shaped osteotomy of the femoral bone at the height of deformation with the implantation of the conical audit leg of Wagner (Zimmer), the refixation of a large spit with screws; G is the position of the implant and a large spit 15 months after surgery.

• sufficient tension of soft tissues at the osteotomy level with the possible free ignition of the head of the endoprosthesis;
• rotary stability of the distal fragment and its correct orientation;
• dense "landing" legs of the endoprosthesis both in distal and proximal fragments;
• sufficient contact of the legs with a distal fragment (at least 6-8 cm);
• creating a stable fixation of fragments due to their fixation by the type of "Russian Castle".

As an illustration, we give an extract from the history of the disease patient with the defect of bone tissue of the godded depression and the deformation of the diaphyse of the femur.

Patient X., 23 years old, entered the clinic in January 2001. Regarding the left-sided dysplastic coxarrosis, proper acetabloplastics with titanium endoprosthesis, a fragments of a fracture after a flexion-derrotective reflective osteotomy, the defect of the head of the femur, the rear subsoil in the hip joint and shortening the legs, on 7 See In one of the medical institutions, the patient consistently, since 1999, the following operations were performed: over governor acetabloplasty, expusted flexible-turbulent osteotomy of femoral bone. As a result of contacting the head of the femur with the metal endoprosthesis of the roof of the godfather, the destruction of the head of the femoral bone was destroyed, its rear sublifiers developed. In the clinic 01/15/0101, an operation was performed in the following volume: the left hip joint is based on the outer transglutteal access, the endoprosthesis of the sleeve roof is removed, the head of the femoral bone is restere. In revision, it was revealed that the godded wardin is flattened, the rear wall is smoothed, there is a cross-cutting defect at the location of the metal plate. The femoral bone is rotated by Knutri (at the place of osteotomy) and has an angular deformation (the angle is open for the post and equal to 35 °). The bone plastic of the defect is performed by the brandy depression, implanted and fixed with 4 spongy screws MULLER Ring Ring Polyethylene liner installed in a conventional anatomical position to bone cement with gentamicin. The wedge-shaped osteotomy of the femur at the height of the deformation, the reposition of the femoral bone (extension, twist). After processing the bone marrow channel, the drills and raspiles are installed a full-fledged leg of the cemental fixation (AML, Depuy). The osteotomy line is blocked by cortical aluminal grafts, which are fixed with the serchandic seams. In the postoperative period, the patient went with the help of crutches with a dosed load on the leg for 4 months with the subsequent transition to the cane. The lack of foot length was 2 cm and compensated by shoes.

X-ray diffuses of the left hip joint and computer tomograms of the patient X., 28 years (explanations in the text).

Radiographs Patient T., 56 years old: a - left-sided dysilastic coxarthrosis with dislocation of the hip head (degree d), deformation of the femur in the upper tert and after a corrective osteotomy; b - an attempt to get into the channel without osteotomy at the height of the deformation turned out to be unsuccessful (intraoperative radiographs); AML leg (depeu) is installed, after the z-shaped osteotomy of the femoral bone at the deformation height, additional fixation of the osteotomy line of the bone autotransplant from the femoral head; D - radiographs after 18 months: consolidation in the osteotomy zone, good osteo integration of both components, the tip of the prosthesis rests on the front wall of the femur (indicated by the arrow), which causes pain syndrome at large physical exertion

Radiographs of the patient K., 42 years old, with right-sided dysplastic coxarthrosis (degree d), double deformation of the proximal bone department: and - before the operation; b - the trilogy cup (Zimmer) is installed in an anatomical position, Z-forming the osteotomy of the femoral bone at the height of deformation with fixation of fragments by the type of "Russian Castle", the revision leg of Wagner (Zimmer); B is a stable fixation of both components of the endoprosthesis, the consolidation of the osteotomy zone after 9 months.

• I - the anatomy of the sleeveless depression is violated insignificant, the sphericality is preserved, the hip head is in the usual position;
• II - the presence of a segmental or strip defect of the godded depression with a dislocation / fodder of the hip head;
• III - the consequences of a complex fracture with a complete impaired of the anatomy of the godded depression and the combined defect (segmental and strip) bone tissue with a complete dislocation of the thigh head.

R.M. Tichelov, V.M. Shapovalov
RNIIITE them. R.R. Harmful, spb

Ticket 36:

1 ) Fractures of the fractures of hips and tibia: classification, diagnosis, treatment. There are fractures of one of the summers and both of the femoral bone syslots (intermatic Y- and T - shaped). Isolated fractures of the mysteries usually occur with a sharp deviation of the shin knutrice (fracture of the inner satellite) or the dust (fracture of the outdoor math). Fractures of both mysteries often occur as a result of falling from a high height on the straightened leg. Clinic. With an isolated FRONE Outdoor Matcher with a displacement of fragments, a valgus deviation of the leg (Genu Valgum) occurs, with a fracture of an internal displacement with a displacement - the genu varum). When fractures of both mysteries with displacement, anatomical shortening of the limb may be detected. In addition, the joint is sharply increased in the amount due to hemarrosis, the limb occupies a forced position: the foot is slightly bent in the knee and hip joints. Active and passive movements in the knee joint are sharply painful. When palpation is an increase in pain and a symptom of a patella. For fractures of this localization, the following clinical symptoms are characteristic: Knee pain and the lower part of the hip, increasing when feeling and pressure on the sideways. Vius or valgus deformation knee joint. Hip circity in the field of Myshlekov enharged.Contours Knee Sustava smoothed.Fluctuation In the knee joint ( gemarthrosis).Charlotting of the patella.Passive movement In the knee joint possible but painful.Sometimes You can determine bone crunch. Diagnosis is specified by radiographs produced in two projections. Treatment. Fractures of the distal femoral bone without displacement of fragments are treated by immobilization with a gypsum bandage (3-5 weeks) or by I. R. Voronovich: Apply side compression osteosynthesis with knitting vessels with stubborn sites. This method allows you to fulfill all 4 principle treatment of intra-articular damage: Perfect reposit The fracture (with accuracy to 2 mm., Since only with such a shift of the joint surfaces is possible to regenerate the hyaline cartilage). Reliable fixation Frances for the entire consolidation period. Early function (For the full function of cartilage and its metabolic processes). on damaged joints. Fixations are carried out puncture of the knee joint In order to evacuate the blood and administration to the joint of 20-30 ml, 1% of the novocaine solution. During the first 7-10 days after the injury, the need for repeated punctures of the joint and evacuation of blood often arises, which is one of the ways of preventing post-traumatic arthrosis. The local infiltration anesthesia is carried out by the Kirschner's knocker through the tibia jergis, the superior area or through the heel bone and impose pullout.Cargo at a fracture without a displacement of 2-4 kg, with a displacement - 4-8 kg. The term of stretching b weeks, the head of the head is fixed Circular gypsum bandageup to groin for a period of 6 weeks. After removing the dressing, proceeding with restorative treatment: baths, paraffin, massage, leafc, mehanotherapy. Restorationdisability during fractures without displacement of fragments after 3-3.5 months; When bothering fragments - in 5-6 months. Operational treatment:showing when closed by bone fragments are not compared. Bone fragments are exposed, they will repure and fix them either with a plate or 1-2 metal rods. The operated leg is fixed with a gypsum bandage before the formation of bone corn. Then proceed to restorative treatment. Operational intervention allows you to more accurately repure fragments, to carry out their solid fixation and, thanks to this, before starting functional treatment (2-3 weeks from the date of operation). The full load on the damaged limb is allowed not earlier than after 3.5-4.5 months. Fractures of the main bone syslots. The fractures of the TBLICE mysteries are intra-articular damage and occur most often when falling on straight legs or when the shin is deviated to the dust or knutrice. There are fractures of the outdoor mystery, internal mumout, as well as T- and U-shaped fractures of both mysteries. Fractures of the mysteries can be impressive and by type of twisting. They may be accompanied by damage to the meniscoves, the ligament apparatus of the knee joint, the interomal interim elevation of the tibia, fractures of the head of the mulberry bone, etc. Clinical picture Under the fractures of the tibia mysteries corresponds to intra-articular damage: the joint is increased in the volume, the leg is slightly bent, hemarthrosis is detected along the symptoms of the patella. The shin is deflected by the dudder during the fracture of the outer math or knutrice at the fracture of the inner satellite. The transverse size of the tibia in the field of the sumpers is increased in comparison with a healthy foot, especially with T- and U-shaped fractures. When palpation of the fracture region is sharply painful. Characteristic side mobility in the knee joint with a dispersed leg. Active movements in the joint are absent, passive movements cause sharp pain. You can't raise the straightened foot. Sometimes damage to the outdoor math is accompanied by a fracture of the head or cervical cervix. At the same time, a small-terror nerve may be damaged, which is recognized on the impaired sensitivity, as well as motor disorders of the foot. Radiographic research allows you to clarify the diagnosis and identify the features of the fracture. Treatment. In the fractures of the tights of the tibia, without displacement, the joint is produced to aspirate the blood and the introduction of 20-40 ml of 1% of the novel solution. The damaged limb is fixed with circular gypsum bandage. From the 2nd day, exercises are recommended for the four-headed muscles of the thigh. Walking with the help of crutches without load on the sore leg is allowed in a week. Gypsum bandage is removed after 6 weeks. To load the leg is allowed 4-4.5 months after the fracture. With an early load, impression of a damaged math can occur. With a fracture, the displacement is used both conservative and operational treatment. In some cases, permanent skeletal extract can be used for fractures with displacement, especially in case of condiscular, T and V-shaped fractures. At the same time, the finiteness of the patient is laid on the Beller tire, the needle is carried out through the heel bone, the cargo along the tibony axis is 4-5 kg. The duration of treatment with this method is 4-5 weeks, after which the limb is fixed with a passive gypsum bandage. Further treatment is the same as when the fracture of the mysteries without displacement of fragments. The physiological method with good results of treatment suggested I. R. Voronovich. Operational treatment is shown in unsuccessful conservative treatment. The operation is produced on 4-5 days after injury: open reposition of fracture and osteosynthesis with metal structures. The seams are removed by 12-14 days, and further maintaining a patient, as in the fractures of the sumpers without displacement.

2) Conservative treatment of osteoarthrosis of large joints. Methods of the department. Patients with deforming arthrosis It is necessary to observe a certain motor mode aimed at unloading the patient joint. They should avoid long walking, long standing on the legs or stay in one position should not be severity. With pronounced pain syndrome, during walking, you need to use the cane or walk with crutches. For the unloading of the sore joint, even at home, it is necessary to use bidding with a load on the axis of the foot 2-3kg. With sharp pains that are not passing from the above measures, it is possible to apply the fixation of the joint gypsum bandage for 2-4 weeks, but at the same time the movements are even more limited, and the contractures are exacerbated. The purpose of the conservative treatment of arthrosis - Restoration of blood circulation in the tissues of the sore joint. Therapy should be complex and include not only medication treatment, but also physiotherapeutic, sanatorium-resort. The described conservative treatment should be comprehensive and comply with the stage of development of the disease. Means of microcircular exposure Used to restore the microcirculation system. For this purpose, various funds are used, the pharmachenise of which is not They are appointed in the first stage of the disease in patients without sinovitia phenomena within 3 weeks. In the development of inflammation in the tissues of the joint, it is better to use funds that inactivate the kinine system - conflict, zalvan, trasilol, etc.

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.