METHOD OF SURGICAL TREATMENT OF RECURRENT PATELLAR DISLOCATION IN CHILDREN

摘要

FIELD: medicine.;SUBSTANCE: invention relates to the field of medicine, namely traumatology and orthopedics, and can be used for surgical treatment of recurrent dislocation of the patella in children. Using a multilayer helical computed tomography method, spatial visualization of the bone structures of the knee joint is performed, the degree of damage to the patellar and femoral bone cartilage is determined. Degree of damage to the medial supporting patellar ligament, trans- and osteochondral injuries of the femoral surface of the patella are assessed by magnetic resonance imaging and the external condyle of the femur and the state of the surrounding soft tissues, including the state of their vascular network. Access is made to the knee joint by performing an antero-medial and antero-lateral incisions of the skin length of 0.5–1.0 cm. In antero-lateral access, place a 4 mm arthroscope with a viewing angle of 30°. Through antero-medial access, an arthroscopic probe is inserted and, using an arthroscope, the degree of chondromolation of the femoral surface of the patella and the lateral condyle of the femur and the presence of cicatricial changes in the tissues of the medial supporting patellar ligament are determined. From the medial side along the patella arthroscopic shaft with an obturator, a channel is formed in the subcutaneous fat and soft tissues, an arthroscopic shaft with an obturator is removed from the formed canal, a radiofrequency coblator electrode is inserted into the formed channel and perform extrasynovial dissection of the scar-altered tissue of the medial supporting patellar ligament with a radiofrequency cobblener power of 200–240 W and at the same time perform vascular coagulation at a power of 100–120 W of radio frequency coblator. From the lateral side along the patella, an arthroscopic shaft with an obturator is formed in the subcutaneous fat and soft tissues of the canal, an arthroscopic shaft with an obturator is removed from the formed canal, radiofrequency coblator electrode is inserted into the formed channel and perform extrasynovial dissection of the lateral supporting patellar ligament with the power of a radiofrequency cobalator of 200–240 W and at the same time perform vascular coagulation at a power of 100–120 W of radio frequency coblator. On the medial supporting patella, 4-5 separate annular seams are applied subcutaneously and subcutaneously at an interval of 1 cm with a resorbable "Vicryl 1" in the position of hypercorrection of the patella, tie the threads of each seam into a knot and immerse each knot under the skin, impose seams on the skin. Lower limb of the patient is fixed with a posterior plaster splint from the upper third of the thigh to the lower third of the shank in the position of extension of the knee joint to 180° for a period of 28–30 days. After removal of the splint, a course of rehabilitation treatment, restoration of movements in the knee joint and strengthening of the muscles of the thigh and lower leg is carried out.;EFFECT: method provides an increase in the effectiveness of treatment of recurrent dislocation of the patella in children by eliminating the signs of hypermobility and lateroposition, restoration of the anatomical integrity of the medial supporting ligament and joint capsule, exclusion of the patellar hyperplasia syndrome, reduction of blood flow to the knee joint during surgery, absence of hematosis of the operated joint in the postoperative period and prevention of the development of patello-femoral arthrosis.;1 cl, 3 ex