METHOD OF SINGLE-STEP BILATERAL HIP ARTHROPLASTY AT BILATERAL DYSPLASTIC COXARTHROSIS WITH FULLY DISLOCATION AND HIGH DISPLACEMENT OF WHIRLBONES Russian patent published in 2010 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly for traumatology and orthopedics. Intersecting spokes with tipping are passed over the upper front iliac spine, upper back iliac spine and intersecting spokes through the lower third of the femoral bones. Spokes passed through iliac bones are fixed in the arcs of the Ilizarov fixator. Spokes passed through the lower third of the femoral bones are fixed in the rings of the Ilizarov fixator. Rings and arcs of the Ilizarov fixator are connected with each other by threaded rods. On the second day after the operation began bringing down of the femoral bones is started by distraction until the reach of normal level of the location of round ligaments of femur towards the acetabulum. Then without taking off the apparatus of external fixation, skeletal traction system is mounted on each limb to one of the spokes passed in the bottom third of the femur. Dismantling of the apparatus of external fixation is carried out, leaving only the spoke on which the skeletal traction system is mounted. The achieved position is maintained by skeletal traction up to healing of spokes wounds. A one-stage bilateral hip replacement is carried out. The operation is performed in the patient's condition on his back on the operating table. The anterior-lateral approach to the hip joint is carried out. The proximal part of the femur is exposed. The head of the femur is resected. The acetabulum is handled with cutters. The fixing ring is installed. The endoprosthesis cup is installed on the bone cement. Sawdust femur is administered to the wound. The endoprosthesis femoral component is punched into the medullar canal. The hip reduction by traction on the extremity axis and rotation is carried out. After the control of amount of movements in the joint a joint capsule is formed of the soft tissue regenerate formed during the distraction of the femur. The wound is tamponed with napkins. 2-3 provisory sutures are put on the skin, then the same operation is made on the second hip joint. Then the provisory sutures and tampons are removed from the side of the first reconstructed joint. Control of hemostasis is carried out and the wound is sutured with leaving 2-3 drainages for 48-72 hours. Then on the second joint and provisory sutures and tampons are remove, too. Control of hemostasis is carried out and the wound is sutured with leaving 2-3 drainages for 48-72 hours. When installing the apparatus of external fixation each three intersecting spokes with tipping are passed through the upper front iliac spine, through the rear upper iliac spine and three intersecting spokes through the lower third of the femur. Bringing down the hips is carried out of 1 mm per day, in four installments of 0.25 mm each, while the movement of both hips at 0.25 mm is made synchronously. Moving both hips is carried out synchronously and with the same speed, until the moment when the head of the femur of one of the hip reaches the normal level position relative to the acetabulum. Then bringing down the first hip is stopped, and bringing down the second hip is continued until the normal level of the femoral head position relative to the acetabulum. Movement of both hips is conducted with a different speed, so as achievent the normal level of the femoral head position relative to the acetabulum occurres simultaneously. The bringing down of the hips is carried out within 6-8 weeks. When dismantling the apparatus of external fixation the apparatus symmetrically arranged elements on the iliac and femoral bones are dismantled simultaneously. The operation of single-step bilateral endoprosthesis replacement is carried out in 3 days after healing of wounds from spokes.

EFFECT: method provides surgical correction of severe congenital dislocations of both hips with formation of joint capsule made of soft tissue regenerate bone formed during distraction, complete recovery of the limb support ability, pain control and restriction of joint movement, elimination of possibility of traction injury of the sciatic nerve and vessels during the operation 4 dwg, 1 ex, 8 cl