СПОСОБ КОМПРЕССИОННОГО АРТРОДЕЗА ПОДТАРАННОГО СУСТАВА С ОДНОМОМЕНТНОЙ КОРРЕКЦИЕЙ ДЕФОРМАЦИИ

Аннотация

For correction of deformities and stabilization of the hindfoot in conditions where the latter is combined with a violation of the axis and shortening of the tibia, especially with extensive scar changes with concave side of the curvature, a new technique for compression arthrodesis of the subtalar joint is proposed. Key words: foot, subtalar joint, deformity, compression arthrodesis, Ilizarov apparatus. СПОСОБ КОМПРЕССИОННОГО АРТРОДЕЗА ПОДТАРАННОГО СУСТАВА С ОДНОМОМЕНТНОЙ КОРРЕКЦИЕЙ ДЕФОРМАЦИИ Аннотация. Для коррекции деформаций и стабилизации заднего отдела стопы в условиях, когда последнее сочетается с нарушением оси и укорочением большеберцовой кости, особенно при обширных рубцовых изменениях с вогнутой стороной искривления, разработана новая методика компрессионного артродеза голени. предлагается подтаранный сустав. Ключевые слова: стопа, подтаранный сустав, деформация, компрессионный артродез, аппарат Илизарова. The most common surgery used in adults to limit damage to the hindfoot is arthrodesis of the subtalar joint. This technique allows not only to correct the position of the heel, but also to fix it. As a rule, intra-articular intervention is associated with this meaning, which is supplemented by the introduction of autografts, allo- or xenografts [1, 2]. To fix a step with a plaster cast, various metal structures are used [3], as well as transosseous osteosynthesis, which not only creates, but also compression forces are maintained at a moderate level [4, 5]. With pronounced in deformities of the hindfoot, to prevent excision of the bone wedge, it is proposed technique of distraction arthrodesis of the subtalar joint [5]. Therefore, to correct incompatibilities combinations of deformities [6] of the distal metaphysis of the tibia with a vicious position of the foot caused by ankylosis of the ankle joint and deforming arthrosis subtalar joint, including in the presence of extensive, fused to the 260 underlying tissues, scars, we have proposed a technique compression arthrodesis of the subtalar joint with simultaneous correction of deformity shins and feet. After placing the needles on the lower leg, in the proximal metaphysis and diaphyseal part, they fixed in pairs in two external supports Ilizarov apparatus. Operative access is carried out through a longitudinal incision soft tissues posterior to the lateral malleolus, taking into account the direction of subsequent traction bones of the foot (rational proposal No. 42/96). Cartilage and fibrous tissue are then removed from articulating surfaces of the subtalar joint, correcting the position of the heel in the frontal plane. After this they carry out trans- or supramalleolar osteotomy of tibial bones. To prevent the eruption of soft tissues, knitting needles with thrust pads are used through the trochlea of the talus in a posterior direction anteriorly from top to bottom. Their proximal ends are bitten and immersed in soft tissues, the opposite ends are fixed with distraction rods to the support on the foot, to which the spokes are attached, passed through the heel and metatarsal bones. External supports on the lower leg and foot are connected to each other using rods and hinges. Distraction along the rods on the concave side of the curvature begins on the fourth day after operation. In this case, the resulting distraction forces create compression between talus and calcaneus bones. Additional an increase in compression forces, as well as maintaining them at the required level during the fixation period is possible through traction along distraction rods. An illustration of the above described technique is the following clinical observation. Patient B., 23 years old, was admitted to the clinic with post-traumatic anatomical shortening left leg by 3 cm, combined with bone ankylosis of the left ankle joint in vicious equinus position (155 degrees) and deforming arthrosis of the subtalar joint with pronounced pain. On the posterior surface in the lower third of the shin and ankle joint area there was a scar fused to the bone measuring 17x10 cm, in in the center of which there was previously a fistula. This orthopedic status was as a consequence of an open fracture received patient as a result of a car accident. Under epidural anesthesia, we performed the operation using the method described above. In this case, the needles through the scar-modified the site was not performed, and the transmalleolar osteotomy was performed distal to the postfistula parts of the scar. Corrective rotation of bone fragments began on the fourth day after surgery interventions at a rate of 0.5 mm three times a day. 261 The period of distraction and corrective reversal was 38 days, and subsequent fixation – 49 days. Moreover, at the beginning of this period wires passed transarticularly through phalanges of the toes of the left foot to eliminate the original hammertoe deformity of the latter were removed. After removal of the Ilizarov apparatus, no additional immobilizati