Our translation of
the patent for invention: NeverovVA,
ShilnikovVA. Method for plastic
surgery on the femoral head in applying hip joint endoprosthesis SU1743595 (1992). The original in Russian is
available at the link: 1992НеверовВА_ШильниковВА.
SU1743595A1 USSR
Inventors: Valentin Aleksandrovich Neverov, Viktor Aleksandrovich Shilnikov
Worldwide applications 1990 SU
Application SU904822620A events:
1990-05-03 Application filed by Ленинградский Государственный Институт Для Дальнейшего Усовершенствования Врачей
1990-05-03 Priority to SU904822620A
1992-06-30 Application granted
1992-06-30 Publication of SU1743595A
Status: Expired – Lifetime
Method
for plastic surgery on the femoral head in applying hip joint endoprosthesis
Valentin
Aleksandrovich Neverov , Viktor Aleksandrovich Shilnikov
Abstract
Use: in medicine, namely in orthopedics for hip joint
endoprosthetics. The purpose of the invention is to ensure the biomechanics of
the joint by preserving the fat pad of the acetabulum. The essence of the
invention: a channel is formed in the head, a tape is passed around the
transverse ligament of the acetabulum, then through the head channel, and its
ends are fixed in the natural attachment site by wedging using quick-hardening
plastic.
Description
The proposed method relates to medicine, namely to surgical methods of
treating the musculoskeletal system.
A known method of surgery on the femoral head ligament consists of
strengthening the cut end of the ligament to the iliac muscle through an
opening in the center of the bottom of the glenoid cavity. Another method consists
of cutting the ligament from the head and applying tendon sutures according to
Cuneo, then fixing the threads to the greater trochanter through a drilled
channel in the head.
The disadvantage of these methods is that they cannot be used for endoprosthetic
replacement of the femoral head. A method for forming a femoral head ligament
during endoprosthetics is known, which consists in that the endoprosthesis is
fixed in the acetabulum and in the femur with an artificial ligament, for
example, a lavsan tape, passed through a channel in the head, neck of the
endoprosthesis and in the proximal end of the femur and fixed on one side in
the acetabulum, and on the other side - in the subtrochanteric region. In this
case, one end of the ligament with a dumbbell-shaped stop is placed in the
cavity of the small pelvis through an opening made in the fossa of the glenoid
cavity.
The disadvantage of the known method is that it does not ensure the
restoration of the biomechanics of the joint, since one end of the artificial
ligament is attached to the bottom of the acetabulum, which does not correspond
to the normal anatomy of the hip joint, and the other - through the channel of
the endoprosthesis head, made in an arbitrarily chosen place, and not in
accordance with the place of attachment of the natural ligament to a specific
replaced femoral head. Thus, this method can only perform the fixing function
of the ligament, but is not capable of restoring the biomechanics of the joint.
In addition, when forming a hole in the glenoid fossa, the fat pad, which
contains a large number of vessels, is damaged, and the body itself, being
covered with a synovial membrane, under normal conditions helps supply the
joint with synovial fluid. Therefore, this method increases the trauma of the
operation, helps reduce the sliding of rubbing surfaces, disrupts the supply of
articular cartilage with a nutrient medium and creates conditions for the
penetration of infection into the pelvic cavity in the case of a purulent
complication.
The purpose of the invention is to restore the biomechanics of the joint by
preserving the fat pad of the acetabulum.
This goal is achieved by preserving the fat pad, and the connection of the
head and the acetabulum is made with an artificial ligament, passed around the
transverse natural ligament, which is then fixed to the head of the
endoprosthesis at the site of their natural connection, by wedging using a
quick-hardening polymer, from which the endoprosthesis is made. The proposed
attachment points of the artificial ligament, corresponding to their natural
attachment site, with preservation of the fat pad of the acetabulum, ensure
restoration of the biomechanics of the joint, a reduction in the trauma of the
operation and an increase in the reliability of the fixing function of the
artificial ligament of the hip and thereby achieving the purpose of the
invention.
Example. Patient N., 61 years old, was admitted on
2.2.90 with the diagnosis: pseudoarthrosis of the neck of the right femur. The
patient underwent endoprosthetic replacement of the right hip joint according
to Vorontsov with the formation of an artificial ligament of the femoral head,
which consisted of the following.
Using one of the known approaches to the hip joint, an incision was made in
the soft tissues, the joint capsule was opened. Using scissors, the ligament
was cut at the place of its attachment to the head of the femur. Then the head
was dislocated from the acetabulum, the femoral neck was resected at the level
of its base. A head made of quick-hardening plastic was welded onto a
titanium-acrylic blank (the stem of the endoprosthesis) made the day before. A
cast of the removed head of the femur was used as a mold. On the head of the
endoprosthesis made in this way, a fossa is clearly visible - the place of
attachment of the ligament of the head of the femur, through which a channel
with a diameter of 5 mm was made using an electric drill so that its external
opening came out on the upper surface of the neck of the endoprosthesis at the
place of its transition to the head. From the side of the external opening, the
channel is drilled in the form of a cone with the base outward. The stem of the
endoprosthesis is inserted into the medullary canal of the femur. In the lower
part of the acetabulum, through its notch under the transverse ligament, a
lavsan tape is passed using a clamp, the ends of which are brought together in
the form of a loop around the transverse ligament. The lavsan tape-ligament is
passed through the channel into the head of the endoprosthesis with a wire
guide. The head of the endoprosthesis is reduced to the acetabulum. In the
adducted position of the limb, the ends of the lavsan tape are stretched and
spread apart, and a plastic wedge is inserted between them; to the surface of which
a quick-hardening plastic of a doughy consistency (acryloxide) is preliminarily
applied. After polymerization of acryloxide and strong fixation of the femoral
head ligament in the tension position, the remaining ends of the lavsan tape
are excised, the joint capsule is sutured (Drainage). Layered wound suture,
aseptic dressing. Limb immobilization was not used. On the second day,
physiotherapy exercises were started, on the fourth day, sitting in bed with
lowered legs is allowed. The stitches were removed on the 12th day and from
this time on, walking with crutches with dosed support on the operated limb is
allowed. Two months after the operation, he walks with a cane, has practically
no complaints, and takes care of himself completely.
Claims
A method for plastic surgery of the femoral head ligament during joint
endoprosthetics by forming a channel in the head, passing a tape through the
head with fixation to the acetabulum, characterized in that, in order to ensure
the biomechanics of the joint by preserving the fat body of the acetabulum, the
tape is passed around the transverse ligament of the acetabulum, its ends are
fixed in the natural attachment site by wedging using quick-hardening plastic.
Non-Patent Citations
Ортопедия, травматология, протезирование,
1989, № 12, с. 57-58.
External links
Неверов ВА, Шильников
ВА. Способ пластики связки головки бедренной
кости при эндопротезировании тазобедренного сустава.
SU1743595, от 3 мая 1990.
Бюл. № 24, 30.06.1992. patents.su
Neverov VA, Shilnikov VA. Method for plastic surgery on the femoral head in applying hip joint endoprosthesis (Способ пластики связки головки бедренной кости
при эндопротезировании тазобедренного сустава) SU1743595А1 May 3, 1990. 1992. patents.google.comEN ,
patents.googleRU
Authors & Affiliations
Valentin Aleksandrovich
Neverov – traumatologist-orthopedist, PhD (1990), Saint Petersburg, Russia. rosturner.ru
Viktor Aleksandrovich
Shilnikov – traumatologist-orthopedist, PhD, Saint Petersburg, Russia. rniito.ru
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, endoprosthesis, prosthesis, invention, unipolar, subtotal
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
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