| 摘要 |
FIELD: medicine, traumatology, orthopedics. ^ SUBSTANCE: one should fulfill multi-plane osteotomy of proximal tibial end by starting transversely, then longitudinally up to subchondral layer of articular surface at forming extra-articularly mobile osseous-cartilaginous fragment. In subchondral area it is necessary to dip out trabecular bone, fulfill wedge osteotomy from posterior or anterior side of tibial metaepiphysis. One should form an osseous wedge at angle being equal to the angle of deformation in sagittal plane, apply needle-rod apparatus of external fixation, carry out transverse distraction an osseous-cartilaginous fragment in it due to moving at articular cartilage in direction and for the value of maximal deficiency of covering articular surfaces till forming functionally correct location of a limb's axis. Incase of knee joint recurvature and/or recurvature deformation of shin bones it is necessary to form an osseous wedge its bottom being towards posterior tibial surface and its angle being opened backwards and equal to recurvature angle. Osseous wedge should be resected at the angle being equal to that of defective anterior inclination but not less than 10 and not higher the level of tendinous fixation of shin flexors and extensors. In case of knee joint antecurvature and/or antecurvature deformation of shin bones it is necessary to form osseous wedge its bottom being towards anterior tibial surface at the angle being opened to the front and equal to antecurvature angle, and osseous-cartilaginous fragment in distal department should be resected for the value being equal to that of wedge foundation. The osseous wedge should be applied into longitudinal fissure between tibial fragments. Osteotomy should be carried out at the level of the middle fibular third out of additional incision along external surface in the middle third of a shin. Mobile osseous-cartilaginous fragment should be fixed in axial plane with P-shapely curved Kirschner's needle and a rod introduced in sagittal plane. This P-shapely curved needle and the rod should be introduced through the area of fixation of patellar ligament, transverse distraction should be carried out dynamically per 0.03 mm/1.5 h. Transverse distraction starts not later than the second d after correcting osteotomies. Multi-plane osteotomy starts with transverse incision being below tibial tuberosity, but above diaphysis. The innovation provides anatomical and functional reconstruction of knee joint, reconstruction of a limb's supporting ability, compensation in the deficiency of covering articular surfaces. ^ EFFECT: higher efficiency of correction. ^ 10 cl, 6 dwg, 1 ex |
