METHOD OF SURGICAL TREATMENT OF FRESH RUPTURES OF ACHILLES TENDON WITH STEP-BY-STEP MONITORING OF TENDON SUTURE STABILITY IN CONDITIONS OF MOBILISATION IN POSTOPERATION AND REHABILITATION PERIODS Russian patent published in 2011 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Zigzag-shaped cut is made on posterior surface of shin in projection of Achill tendon rupture. Access to Achill tendon is realised. Stumps of ruptured tendon are exposed. Hematoma is evacuated. Degeneratively altered ends of tendon are excised until visible normal fibrous structure appears ion transverse cut. Proximal and distal stumps of tendon are mobilised along 5-6 cm and their suturing is performed. After that, at 3 centimetre distance from place of rupture on posterior surface of proximal stump of Achilles tendon 3 mm long and 5 mm deep puncture is made. Through puncture into tendon mass introduced is marker from biodegradable material. Onto place of tendon puncture one interrupted is applied with biodegradable thread. After that, paratenon, subcutaneous-adipose cellular tissue and skin are sewn. Aseptic bandage is applied. Extremity is immobilised with anterior shortened gypsum longuet in equinus position of foot. X-ray of shin and foot in lateral projection is performed in soft-tissue mode with matching on primary position of marker for distance-measurement from marker to arbitrarily selected control point on upper surface of heel bone in area of Achilles tendon attachment. Operated leg is placed into soft insert of brace with lateral stiffening ribs and brace foot. After that, step-by-step monitoring of tendon suture stability is carried out in mobilisation conditions by estimation of X-ray images of shin and foot in lateral projection in soft-tissue mode on 14-th, 20-th, 30-th and 40-th day after operation by program of postoperative control of marker position on its displacement relative said control point, which is determined in comparison with X-ray image, made on the first day after operation, by superposition of X-ray images and matching heel bone contours. On the 14-th day in case of uncomplicated course of postoperative period skin sutures are removed. Control X-ray and replacement of longuet for functional brace are performed. If on the 20-th - 21-st day after operation separation of tendon stumps does not exceed 2 mm, equinus is reduced by 20 degrees, providing possibility of active movements in ankle joint with limited amplitude. After that, next X-rays are carried out on the 30-th and 40-th day after operation. If old position of markers is preserved, volume of foot movements in brace is increased by 20 degrees after each radiography. By the end of 6-th week foot is brought into neutral position and full loading with body weight on operated extremity is allowed to patient. During 10 days back flexion of foot, which exceeds neutral position at 0 degrees continues to be limited by brace. Then limitation of volume of ankle joint movements is stopped.

EFFECT: method provides favourable conditions for Achill tendon union, prevention of tendon function disturbance, reduction of risk of tendon re-rupture at rehabilitation stages.

1 ex, 19 dwg