METHOD FOR SURGICAL CORRECTION OF THE ACETABULUM WITH HIP INSTABILITY COMPLICATED BY DEFORMATION OF THE ARTICULAR SURFACES Russian patent published in 2022 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics, and can be used for surgical correction of the acetabulum in case of instability of the hip joint, complicated by deformation of the articular surfaces. A transverse supraacetabular osteotomy is performed. The distal fragment is medialized and fixed with rods. After in the lateral section of the proximal fragment. At an angle to the osteotomy plane, a groove is formed into which a fragment of the cortical plate of the iliac wing is placed. A fragment of the cortical plate of the iliac wing is fixed using an autograft and pins. The achieved position is stabilized with an external fixation device. At the same time, the supports of the Ilizarov apparatus are installed on the distal metaphysis of the femur and the ilium, and the rod support of the external fixation apparatus is installed on the proximal femur. An incision is made along the bikini line. Access is made between the sartorius muscle and the tensor fascia lata. The head of the rectus femoris muscle is cut off, with a chisel in the direction from front to back. Outside medially under the anteroinferior spine above the attachment of the articular capsule, a transverse osteotomy is performed, at an angle of 15° to the horizontal, in the proximal and medial direction. By means of limb abduction and axial load in the proximal direction, the distal fragment of the ilium is medialized by 2/3 of the ilium diameter. Fragments of the ilium are fixed with a rod. Сontrol radiography of the hip joint in the anteroposterior projection is performed. The degree of lateral coverage of the femoral head by the cavity roof is determined. In the proximal fragment of the ilium from the lateral side at a distance of 0.5 cm from the zone of osteotomy, using a drill and a chisel parallel to the plane of the arch of the depression, a groove is formed with a depth of 1.5-2 cm, a length of 4-5 cm, a width of 0.4-0.5 cm. The direction of the groove is determined taking into account the remaining deficiency of the bone cover and deviates from the osteotomy plane by 10-20°, a fragment 4-5 cm long, 4-5 cm wide and 0.3 cm thick is formed from the outer cortical plate. The fragment is placed in the formed groove. An autograft taken from the iliac wing is placed over the fragment. The fragment and autograft are fixed with pins. Wounds are sutured in layers. Between the support of the external fixation apparatus fixed on the wing of the ilium and the support fixed on the femur. A maintenance distraction of 1.0 mm per week is carried out. The external fixation device is dismantled after 45-60 days.

EFFECT: method provides improvement of articular relations and increase in coverage of the femoral head by the cavity roof formed by moving bone fragments and changing the volume of the acetabulum.

2 cl, 1 ex, 6 dwg