METHOD FOR SURGICAL TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE FEMORAL CONDYLES

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat osteochondritis dissecans of the femoral condyles. In the preoperative period, the spatial visualization of the affected condyles of the femur with the identification of the anatomical features of the shape and structure of the affected femur of the patient is determined by the method of multilayer spiral computed tomography. Magnetic resonance imaging is used to assess the state of the surrounding soft tissues, vascular and nerve structures that are not visualized when performing multilayer spiral computed tomography. After performing anesthesia with the patient in the supine position, arthroscopy of the affected joint is performed to exclude concomitant pathology from the menisci and cruciate ligaments, visualization of the cartilage is performed on the healthy condyles of the femur and tibia and on the patella. Arthrotomy of the joint is performed and the free bone-cartilaginous fragment is removed. Free mobile areas of cartilage are cut off along the edge of the defect within 1-3 mm. The bottom of the bone defect is treated with a shaver and drilled with a wire with a diameter of 1.5 mm over the entire area until blood is obtained on the surface of the defect, a template is cut out of the aluminum foil according to the shape of the identified bone defect. Then, a collagen bioresorbable membrane is cut out according to the size of a foil template, fibrin glue is applied to the surface of the defect, a collagen bioresorbable membrane is placed on the bone defect on either side of it and sutured to the bone defect, ensuring a dynamically uniform effect of the membrane on the cartilage tissue and expansion of the effective area of ​​interaction of the hyaline joint with membrane tissue. The wound is sutured in layers without drainage. The lower limb is immobilized in the position of maximum extension of the patient's lower leg. In this case, the ORTOKEEP membrane is used as a collagen bioresorbable membrane. In this case, the dimensions of the template made of aluminum foil in the shape of the revealed bone defect exceed the dimensions of the bone defect by 4-5 mm on all sides. At the same time, "Cryophyte" glue is used as the fibrin glue applied to the surface of the defect. In this case, the membrane placed on the bone defect is sutured with single interrupted sutures along the entire perimeter of the bone defect with a bioresorbable suture, observing the distance between the sutures from 3 to 5 mm.;EFFECT: method provides reduction of traumatism, acceleration of reparative regeneration and neoangiogenesis, reduction of terms of postoperative rehabilitation and patient's quality of life due to the sequence of implementation of methods of the method.;5 cl, 3 ex