Patent RU-2715920-C1 (RU)
Inventor: GOLUBEV IGOR OLEGOVICH
IPC: A61B17/56
Filed: 2019-11-01
Granted: 2020-03-04
Abstract: FIELD: medicine. 
     SUBSTANCE: invention relates to medicine, particularly to traumatology and orthopedics. In the preoperative period before performing the navicular correction, the method of standard X-ray imaging is used to determine the deformity of navicular in the frontal and lateral projections, as well as by multilayer helical computed tomography, spatial visualization of involved bone structures and signs of instability of ligamentous apparatus of carpal joint of injured extremity. In the position of the patient lying down after performing axillary conductive anesthesia and treating the surgical site with antiseptic solutions, a pneumatic cuff is applied on an area of the shoulder of the operated extremity and pressure is applied in cuff 310–320 mm Hg. Injured hand is fixed in the traction tower and an extension force of 5–5.5 kg is created. Ports of the skin incision in the distal direction with width of 5–6 mm are performed for port setting, wherein the midcarpal ulnar (MC-U) port is distal to the Lister’s tubercle at 2 cm between the fourth and fifth passages of the extensor tendons, then a radial midcarpal (MC-R) port is distal to Lister's tubercle 2 cm between the third and fourth passages of extensor tendons. Mosquito-type clamp is used to dilute the soft tissues within the ports and to form access to an midcarpal joint. In midcarpal ulnar (MC-U) port an optic is introduced with diameter of 2.9 mm with inclination of lens 30°. Probe is inserted through a radial midcarpal (MC-R) port and arthroscopy is used to diagnose the volume and level of damage of navicular bone, as well as the consistency of the wrist ligament apparatus and degree of degenerative joint changes. Then, after removing the probe into the medium-wrinkled radial (MC-R) port, the nippers and the raspatory are serially inserted and the false joint area is resected to the level of the "viable" bone tissue. Lens with diameter of 2.9 mm is placed in the resection area, and lens 30° is inclined, which is introduced through a radial midcarpal (MC-R) port to a palm capsule of the wrist joint at a level of resection of the navicular joint, on the palmar surface of the base of the hand in the projection of the zone of resection of the false joint of the navicular bone by the light mark of the arthroscope along the radial end of the tendon of the radial flexor of the hand an injection needle is made with its visualization by the arthroscope. In the direction of the injection needle, additional access to the resection area is made, and a mosquito-type clamp is introduced through the injection needle into the resection area. Branches are separated and the length and intra-navicular angle of the navicular bone. That is followed by antegrade arrangement of three pins along an axis of the navicular, having an EOC control and in the area of resection through a radial midcarpal (MC-R) port using an arthroscopic shaft, a prefabricated fragmented spongy transplant from the anterior superior spine of the iliac bone from the contralateral side of the patient is placed and compacted using a feeler. Dermal sutures are applied and subcutaneous pins resection is performed. 
     EFFECT: method provides reliable correction of axis and length of navicular bone, provides correction of dorsal instability of intermediate fragment of wrist bones, ensures preservation of vascularisation and proprioception of wrist joint, and also provides sufficient improvement of patient's quality of life. 
     1 cl, 1 ex