METHOD FOR SURGICAL TREATMENT OF AGGRESSIVE BENIGN, BORDERLINE AND LOW-MALIGNANT NEOPLASMS OF THE METATARSAL BONES OF THE FOOT WITH PLASTY WITH AN AUTOGRAFT FROM THE ILIAC CREST Russian patent published in 2022 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of aggressive benign, borderline and low-malignant neoplasms of the metatarsal bones of the foot with plasty with an autograft from the iliac crest. Before performing surgical treatment, the spatial visualization of the affected foot bones with the location of an aggressively benign, borderline and low-malignant neoplasm is determined by the method for multilayer spiral computed tomography. The state of the surrounding soft tissues, vascular and nervous structures, which are not visualized when performing multilayer spiral computed tomography, is assessed using magnetic resonance imaging. In the position of the patient on the back, an S-shaped incision of the skin and subcutaneous fatty tissue in the affected metatarsal bone is performed along the dorsal surface of the foot from the projection of the metatarsophalangeal joint to the metatarsal joint. Obtuse and sharp way to access the neoplasm. The tendons of the extensor toes running in this zone are isolated and taken on the holders. An audit is performed with confirmation of the position of the neoplasm determined during multilayer spiral computed tomography and by the method for magnetic resonance imaging of the surrounding anatomical structures. The metatarsophalangeal joint is opened, the metatarsal-tarsal joint is opened, the affected metatarsal bone with the neoplasm is isolated within healthy tissues and, without opening it, the metatarsal bone is extirpated as a single block with the neoplasm. An incision is made in the projection of the iliac crest. Obtusely and sharply, the iliac crest is accessed and the iliac crest is isolated from the surrounding tissues. The size of the removed metatarsal bone is determined on the iliac crest for autograft sampling. Using an oscillator saw, a bicortically spongy autograft is isolated with a length corresponding to the removed metatarsal bone and a width of 3-4 cm. The autograft is cleaned using a rasp from soft tissue fragments, modeled using an oscillator saw, taking into account the parameters of the implantation zone. The autograft is placed in the area of the removed metatarsal bone, ensuring the maximum contact area of the autograft with the tarsal bones. The autograft is fixed with Kirschner wires, while the first wire is passed longitudinally through the corresponding finger, graft and tarsal bones. Then, the bone material remaining after modeling the main autograft is additionally placed between the main autograft, the tarsal bones and the nearest metatarsal bone to create a larger area of contact with the blood-supplying bones. The laid autograft is fixed with two Kirschner wires through the bone material, two metatarsal bones adjacent to it. In the distal section, fixation is carried out with two Kirschner wires through the graft and heads of adjacent metatarsal bones. The stability of the position of the autograft and the stability of its fixation are monitored, hemostasis during the operation, the wound is washed with an antiseptic solution and sutured in layers.

EFFECT: method ensures reliable restoration of the functional integrity and motor capabilities of the patient, conditions for preventing dislocations of the foot bones, as well as improving the patient's quality of life due to the techniques of the method.

1 cl, 3 ex