Postoperative treatment corrective osteotomy osteosynthesis of the shin bones. Indications and stages of corrective osteotomy

Corrective osteotomy knee joint- surgical intervention aimed at eliminating the deformation of the bone tissue. When planning such an operation, one should prepare for the artificial breaking of a small section of the bone in order to correct the malunion. There are different methods of osteotomy, differing in the level of complexity depending on the presence or absence of comorbidities and the general condition of the patient.

Indications and contraindications

Osteotomy of the knee is most often performed for degradation of cartilage and parts of the joints of the knee, when it is necessary to preserve healthy tissues.

Contraindications for surgery:

• rheumatoid arthritis;
• local and general infectious diseases;
• diseases of the veins and vessels of the legs;
• heart and lung diseases in the stage of decompensation;
• kidney and liver failure;
• obesity or dystrophy;
• diabetes;
• increased bone fragility.

People who do not fall into the 40-60 age category may be denied surgery due to a low chance of a positive result or the possibility of a more benign treatment.

Correction of the knee joint with an osteotomy is recommended for patients who meet the following characteristics:

• mild to moderate arthritis that only affects one knee
• middle age category;
• optimal weight;
• high mobility of the knee joint: the ability to straighten - bend at least 90 degrees;
• the presence of pain caused by arthritis and manifested only during the period of activity or prolonged standing;
• consent to long-term rehabilitation;
• consent to walk with crutches for 6-8 weeks after surgery.

If the operation is carried out correctly, the positive result will remain for a long time.

Preparing for the operation

MRI of the knee

Prior to osteotomy, confirmation of the diagnosis and determination of the amount of bone tissue to be removed is required. Required research:

• radiography;
• MRI, which uses special magnetic waves to create an image of the structure inside the knees;

A comprehensive examination allows you to understand how high the level of effectiveness of the planned procedure will be.

Before performing an osteotomy, it is recommended to consult a doctor regarding the medications used. You may need to temporarily stop taking certain medications, such as anti-inflammatory and blood thinners, for about a week. This measure increases the effectiveness of surgical intervention.

The operation is done exclusively on an empty stomach, therefore, at least 8 hours in advance, it is necessary to refuse meals, and 3 hours before drinks.

Features of knee surgery

The joints should be corrected until the disease has become more severe and has not led to the loss of the patient's ability to work. With advanced pathologies, arthroplasty is recommended, which involves replacing the affected joint or part of it.

The main task of osteotomy is to normalize the ratios of the surfaces of the knee joints, improve blood circulation in bone tissues. It is possible to remove the load from the affected area, which is subsequently transferred to a healthy limb for full functionality. Stagnation of blood in nearby tissues is prevented, as a result of which the risks of destruction of the cartilaginous tissue of the knees are eliminated.

Result of corrective knee osteotomy

The result of corrective osteotomy depends on the correct calculation of the deformity angle and further surgical correction. To prevent relapse, it is recommended to take 3-4 healthy degrees. Doctors use imaging technology to measure the part of the bone that needs to be removed. Careful control increases the effectiveness of the event.

An incision is made in the skin, and thin wires are placed in the knee to facilitate the removal of the bone. The doctor carefully removes part of the knee joint at a certain angle. The remaining parts are fastened with special medical screws. At the end of the procedure, the tissues are sutured in layers and treated with antiseptics.

Corrective osteotomy of the knee usually takes 1-3 hours, after the operation it is necessary to stay in the hospital for 2-3 days. In some cases, the doctor extends the length of stay in the hospital if he sees complications.

Features of rehabilitation

After corrective osteotomy of the knee joint, rehabilitation is mandatory for the full restoration of knee functions. The set of measures includes:

1. Taking painkillers.
2. Cold compresses for 15-20 minutes four times a day.
3. During rest, the position of the operated leg is higher than the body to eliminate swelling, improve blood circulation and lymph outflow.
4. Caring for sutures to prevent inflammation, keeping them clean and dry.
5. Using crutches or a walker initial stage. The timing of the use of aids is determined by the doctor.

It is necessary to develop a knee after an osteotomy under the supervision of a physiotherapist after 6-8 weeks. The therapy is based on the gradual expansion of the range of motion and includes strength training.

Corrective osteotomy is a high-tech operation that is used to correct deformities of the lower extremities. Especially nice results the technique gives with deforming arthrosis of the knee joint. Moreover, knee osteotomy is an effective alternative to arthroplasty! This surgery is well tolerated by patients, so the installation of an artificial joint can be delayed for many years. Ideal for people who are accustomed to an active lifestyle!

How is a corrective knee osteotomy performed?

The operation involves an artificial "fracture" of the lower leg (as shown in the figure) and the installation of a special plate. This allows you to change the axis of the leg and accordingly relieve pressure on the damaged part of the cartilage.

An x-ray examination is mandatory before the operation. With the help of digital radiography, special axial images of the injured lower limb are taken. On a computer, these pictures are “stitched” into one picture. Anatomical angles and axes are measured directly on it, and the angle of deformation is calculated.

Then proceed to the corrective osteotomy of the knee joint. This surgery is minimally invasive: it is performed through a small incision and only under X-ray control. The doctor will not do any fraud "by eye", which guarantees a successful outcome of the operation!

The tibia is partially crossed (in medical terms - osteotomy) and the deformity is corrected. Then the zone is fixed in the required position. It is important that modern fixatives do not require external immobilization (for example, plaster overlay).

Features of knee osteotomy:

• The duration of the operation is 50 minutes
• Stay in the clinic - 3-4 days
• Limb loading (e.g. driving a car) – after 6 weeks
• Sports activities (skiing, football, running) - after 10 months

The patient is 69 years old. The axial image shows a severe deformity of the knee joint. Same patient 3 months after osteotomy of the knee on the right limb. Preparing for an osteotomy on the left limb.

The patient is 29 years old. Deforming arthrosis of the left knee joint (developed against the background of an injury as a result of an accident 5 years ago). During this time he was treated conservatively. There was no positive effect. Before the operation, the axis of the limb was displaced inward, pain in the knee after physical activity, swelling and limitation of joint mobility. In April 2012, an osteotomy of the left tibia was performed. The axis was corrected, the excess load on the femoral condyle was removed (pictured). Patient 2.5 months after surgery. The pain disappeared, the range of motion in the joint is full. Walks without additional means of support 8 weeks after surgical treatment.

The patient is 45 years old. Deforming arthrosis of the knee joint stage 2. For a long time I was worried about pain in the knee joint after exertion and at night. She was treated conservatively for a long time: sanatorium-and-spa treatment, intra-articular injections, anti-inflammatory drugs. The expected effect of the treatment was not. Operated by me in May 2012. Osteotomy of the tibia. At the control examination 2.5 months after the operation. There is no pain in the knee, he walks without a cane, the range of motion in the joint is full.

Patient 21 years old, rugby player. Chronic (2 years old) severe injury of the left knee: damage to the anterior cruciate ligament, cartilage defect of the medial femoral condyle (aseptic necrosis), damage to the medial meniscus. Disturbed by severe pain, there was instability in the knee. Pronounced deformity of the joint, defect of the femoral condyle. Completed corrective osteotomy, the anterior cruciate ligament was restored, the cartilage defect was corrected arthroscopically. Postoperative recovery is underway.

A procedure such as osteotomy of the knee joint is one of the most sparing forms of surgical intervention in the structure of bone and cartilage tissue. The operation is performed by affecting the tibia or femur in order to reduce pressure on the knee joint. Typically, it is carried out on early stages osteoarthritis and helps to reduce the severity of pain, restore normal mobility of the lower limb.

Indications and contraindications

Basically, corrective osteotomy is used to normalize the motor activity of a patient with deformation and degenerative-dystrophic changes in bone and cartilage tissue. The procedure itself is considered non-traumatic and bloodless, since an incision of no more than one centimeter is made for its implementation.

The main indications for the operation include degenerative changes in the cartilage, which provoke a violation of the axis of the lower limb. This pathological condition occurs due to injuries of soft tissues, ligaments and meniscus. Congenital anomalies of the limbs, the progression of gonarthrosis, and incompletely cured injuries of the knee joint are capable of provoking dystrophic disorders. Osteotomy is performed for disorders that develop against the background of rickets and bone tissue dystrophy.

With special care, osteotomy of the knee joint is performed in the presence of the following pathological conditions:

Preparation for the procedure

Preparatory measures begin with the diagnosis of the patient. The attending physician collects an anamnesis of complaints, a medical history and conducts an external examination of the joint. X-ray and MRI of the affected area are mandatory. Thanks to the data obtained, the orthopedist determines all structural changes in the joint cavity and draws up a plan for restorative measures after surgery. A week before the scheduled procedure, most medications are stopped. Alcohol and smoking are prohibited 14 days prior to knee osteotomy. People with injuries and erosions of the skin are not allowed to operate. In the presence of chronic diseases, it is important to bring them into remission before intervention.

How is it carried out?

Surgical intervention is based on individual features the patient's body and the degree of damage to the knee. There is a standard sequence of actions:

• An incision is made in the skin. After that, their edges are moved apart to the required indicators.
• An artificial graft or a pre-prepared part is inserted into the incision femur sick. All parameters are determined by computer calculations.
• A metal plate is placed to hold the bone fragment. For maximum fixation, knitting needles are used.
• The whole procedure is carried out under the control of an x-ray machine. This is necessary for making a fracture in the bone and correct insertion of the plate.

If the surgical intervention is carried out successfully, then the integrity of the patella is completely preserved and the patella tendons are not injured. At the same time, partial restoration of cartilage and a decrease in pain syndrome are noted, by normalizing the process of blood supply and eliminating congestion.

Bones take on an irregular shape and position if professional help has not been provided after the fracture. The essence of this procedure is that the diseased bone is broken and then fixed with the help of special plates or other devices so that it grows together and takes its natural shape. Osteotomy is used to achieve the following goals:

• return motor functions to the limbs, restore their performance;
• in practice plastic surgery osteotomy is used to lengthen the limbs;
• restore the base function.

Depending on the purpose of the procedure, the object of osteotomy changes. Say, in order to return the support function, this procedure is performed on the hip joint.

Corrective osteotomy is aimed precisely at restoring the position, shape and performance of the limbs after an illness or injury.

The process of the procedure

Training

The process of preparation for this operation consists in an extensive radiograph, during which the orthopedic surgeon receives images of the area that can be corrected from different angles. Thus, he chooses the optimal tactics for conducting the operation.

Corrective osteotomy procedure

Those bone structures that are subject to correction are artificially broken by an orthopedic surgeon during the operation, and then fixed at the right angle and in the required position. In order for the bones to grow together correctly, a special plate or other special means such as spokes and bolts. Thanks to modern technologies and in order to avoid complications in the form of contractures in adjacent joints, gypsum is not applied.

rehabilitation period

Rehabilitation lasts depending on which part of the body was operated on, for example, corrective osteotomy of the knee joint requires 12 weeks of rehabilitation. Moreover, the bones grow together for the first two months, the rest of the time they acquire the necessary strength. During this period of time, loads on the operated part of the body are excluded.

Indications

Corrective osteotomy is indicated for malunion of fractures. In addition, diseases such as:

• different types of arthrosis, including osteoarthritis and gonarthrosis;
• ankylosis of bones;
• rickets.

In addition, this operation is performed to delay the need to replace the joint with an artificial one, as well as to correct the prosthesis.

Contraindications

Osteotomy is contraindicated in diseases of the kidneys and liver, in disorders of cardio-vascular system. It can not be carried out if the patient has an exacerbation of any chronic disease, as well as in acute diseases. It is impossible to do an osteotomy for those who suffer from any diseases of a purulent nature.

Complications

This surgical operation is complex and quite risky. The following complications may occur:

• slow fusion of bones;
• the formation of suppuration;
• incorrect change in the position of the wreckage;
• the appearance of a false joint.

Prices and clinics

This operation is carried out only in well-equipped medical centers. For its implementation, specific experience of the doctor is required. Prices for corrective osteotomy depend on the nature and complexity of the operation.

Osteotomy is a surgical operation during which the anatomically correct position and / or shape of the bone is restored, due to which the supporting and motor functions of the musculoskeletal system are normalized.

How is an osteotomy performed?

At its core, an osteotomy is an artificial fracture that is performed in a strictly defined area of ​​​​the bone.

Depending on the characteristics of each specific situation, such an operation can be performed on a bone freed from soft tissues (open osteotomy) or in a less traumatic way - without excision of the skin and muscles (closed osteotomy). The first method remains preferable for most artificial fractures, as it provides a higher accuracy of all manipulations of the surgeon.

In order to make a fracture along the required line and prevent the formation of fragments, the operated bone is pre-drilled in several places. Such preparation makes it possible to make the direction and location of the fracture controlled - corresponding to the purpose of the operation.

After the fracture, the surgeon models the bone fragments, arranging them in the required way, and then fixes them in desired position special designs - screws, knitting needles, plates or other orthopedic devices.

Osteotomy is performed with the use of anesthesia, but the choice of a specific method of anesthesia (local anesthesia or general anesthesia) remains with the doctor.

When is an osteotomy indicated?

• incorrect bone fusion after a fracture - a situation that is not uncommon for fractures left without qualified treatment or after repeated injuries;
• impaired mobility or complete immobility of the joint due to degenerative, inflammatory, autoimmune diseases or traumatic injuries;
• bone deformity due to rickets, poliomyelitis or prolonged immobility of the patient, which is caused by muscle paralysis;
• congenital or acquired lameness caused by a difference in leg length;
• deformity and loss of joint mobility, which was the result of deforming osteoarthritis.

An operation to lengthen the bones of the lower extremities can also be performed not for medical reasons, but at the request of a patient who experiences psychological discomfort due to too short legs.

Classification of osteotomy

In addition to the difference between open and closed osteotomy, this orthopedic operation is classified according to the direction of the bone fracture, as well as to the intended purpose:

The direction of the artificial fracture can be:

• linear (oblique or transverse);
• stepped (staircase);
• Z-shaped;
• hinged (wedge-shaped, arcuate, spherical, angular).

The direction of the fracture is calculated in advance, and preference is given to the one that provides the maximum efficiency of the operation with minimal trauma.

According to the intended purpose in osteotomy, several varieties are distinguished:

1. Corrective. This type of osteotomy is designed to eliminate bone deformity resulting from malunion of a traumatic fracture, rickets, and other conditions that cause abnormal bone formation or fusion.
2. Derotational. With such an osteotomy, the surgeon eliminates the pathological mobility of the bone, which rotates around its axis. The operation is most often performed on the femur and ulna, which most often develop pathological rotation caused by bone curvature.
3. Bone length correction. It is carried out in order to lengthen/shorten one or both limbs (arms and legs) in order to eliminate lameness, and in case of asymmetry of the hands, to restore the ability to self-service and perform professional skills.
4. Reconstructive. It is performed to improve or restore the supporting function of a bone or joint.

Depending on the area of ​​the bone in which the curvature is observed, on the degree of deformation and other factors, a combined osteotomy can be performed, combining several types of surgery. Thus, in some cases, improving the support function of the lower extremities may require the removal of a deformed area of ​​the bone, followed by extremity lengthening.

Contraindications for osteotomy

Circumstances in which osteotomy is contraindicated are:

• severe disorders of the heart and / or lungs;
• blood clotting disorders;
• systemic infectious diseases;
• vascular disease, circulatory failure;
• circumstances of any nature that make it impossible to properly pass the recovery period.

On an individual basis, the decision to prescribe an osteotomy is made in the following cases:

• the patient's age is less than 14 or more than 60 years;
• the patient has low bone density and/or impaired growth of the bone matrix (osteoporosis, osteomalacia);
• underweight or overweight of the patient;
• significant violations of posture (scoliosis, kyphosis, hyperlordosis).

In each of these situations, the doctor focuses on the advisability of surgical intervention, and only after weighing the risks and benefits for the patient makes a decision on the need for surgery or on choosing another method of treatment/correction.

Preparatory stage

Before the appointment and operation, the patient is assigned a comprehensive examination, which includes:

In addition, when setting the exact date of the operation, the patient is given a list of recommendations for the preparatory stage. Among them are the cessation of taking medications containing aspirin and heparin, the refusal to consume alcoholic beverages and smoking, etc. 12-16 hours before the osteotomy, it is necessary to stop eating and drinking.

Important: during the consultation, it is necessary to inform the doctor about any features of the state of health, even if they seem unimportant. Any diseases of the heart, liver, respiratory organs, transferred in the past, may require correction of prescriptions and affect the choice of the preferred method of pain relief.

Recovery period after surgery

Rehabilitation after surgery can last from 1 month to six months, and its duration depends on the degree of complexity of the operation, the individual characteristics of the patient's health status and the intensity of the formation of new bone tissue.

Most often, fixing devices installed during osteosynthesis (fixation of bone fragments) become sufficient to avoid wearing plaster casts. Such a bandage can be applied for the first few days after the operation, after which it is removed. The exception is complex cases of osteotomy, in which multiple fractures were made in a relatively small area of ​​the bone. In this situation, it may be necessary to wear a cast for several weeks or months.

Also, when elongating the limbs, the patient requires skeletal traction or wearing an orthopedic apparatus. In the first case, the operated limb with a load suspended from it is placed on a special tripod. The size of the load and the duration of traction is assigned individually.

Wearing orthopedic appliances allows gradual and controlled adjustment of the force applied to the operated bone. The advantage of this method is the ability of the patient to move independently a few days after the operation. This, in turn, reduces the health risks associated with prolonged bed rest (congestion, atrophic processes in the muscles, etc.).

Complications after surgery

Surgical errors account for only a small proportion of complications (according to various estimates, from 1.2% to 3% of the total number of negative consequences). In all other cases, complications develop due to non-compliance with the recommendations in the recovery period, or become a consequence of self-correction of doctor's prescriptions or their complete disregard.

The most common unwanted effects are:

• improper fusion of bone fragments, which in most cases occurs when the loads on the operated area are exceeded;
• hematomas;
• not complete, but only partial restoration of the functions of the musculoskeletal system.

To minimize the likelihood of complications in the early postoperative period, medication is prescribed, and in the later period, physiotherapy, massage, exercise therapy, spa treatment, etc.