Rehabilitation for bone lengthening in the legs. Ilizarov apparatus: scope and features of application

Corrective osteotomy according to Ilizarov- orthopedic surgery performed to eliminate the true curvature of the legs. During the osteotomy, the bones are dissected and compression-distraction osteosynthesis according to Ilizarov is performed. By carrying out the operation, the deformities of the limbs are corrected with the true curvature of the legs, the disproportion of the segments lower extremities, growth increases.

Conducting corrective osteotomy of the bones of the lower leg is indicated for congenital and post-traumatic deformities of the tibia, as well as bone curvature caused by various diseases (rickets, metabolic and endocrine disorders, etc.). With the help of osteotomy, it is also possible to eliminate deformities of the foot and hip or several segments of the legs at the same time.

Correction of curvature of the legs is possible at any age. The presence of pronounced bone deformities is the reason for their elimination in childhood in order to prevent the development of serious disorders in the entire musculoskeletal system. Minor deformities that cause mostly cosmetic inconvenience are best treated after the patient reaches the age of 16 years.

Diagnosis of leg deformities includes an X-ray examination and computed tomography bones and joints (ankle, knee, hip), as well as computed, magnetic resonance imaging (MRI) and ultrasound scanning of the soft tissues of the legs and blood vessels. Modern methods diagnostics make it possible to present not only a planimetric, but also a stereometric picture of deformities, measure the length of leg segments with an accuracy of 0.1 mm, the degree of bone deformities, correlate them with the patient's height and model a new limb shape.

At the preoperative stage, the rotational characteristics of the bones of the feet, lower legs and thighs are assessed. The analysis of all the obtained data allows in the postoperative period to effectively control the device installed on the limb, achieve the necessary elongation of the segment, and also avoid the development of rotational and projection deformities.

Operation

Corrective osteotomy according to Ilizarov is performed in specialized departments of orthopedics or traumatology by specialists of the appropriate profile. The operation is carried out under general anesthesia within 2-2.5 hours, with X-ray control carried out during the operation.

A surgical incision 12 to 15 cm long is made along the anterior-lateral surface of the leg. Then the wound is expanded, dissection and detachment of the periosteum of the tibia. Next, the bone is cut at a distance of 5-6 cm below the knee joint with a special tool - an osteotome. After dissection of the tibia, its simultaneous or gradual correction is performed by fixing it in the apparatus.

If dissection of the fibula is required, then it is performed from the same access or an additional incision along the outer surface of the lower leg. By manipulating the fibula (bringing the head down and lengthening the bone), 4 options for correcting leg deformities are performed:

correction of deformities without increasing the length of the lower leg, bringing down the head of the fibula is not performed;
correction of deformities with a slight (up to 2 cm) increase in the length of the leg and bringing down the head of the fibula;
correction of deformities with an increase in the length of the lower leg, bringing down the head of the fibula is not performed;
correction of deformities with an increase in the length of the lower leg by more than 2 cm and bringing down the head of the fibula.

In the last two options, osteotomy of the fibula and their lengthening are performed. In the event that a rough protrusion of the bone protrusion - the head of the fibula - is observed on the outer surface of the knee joint, its slight reduction (up to 1 cm) is performed. This correction does not lead to dysfunction of the knee joint.

During operations on the legs, an improved version of the Ilizarov apparatus is used, which is small in size and does not interfere with the full range of motion in the knee joints. The Ilizarov apparatus consists of half rings and rings and is fixed on the limbs with the help of needles with a diameter of 1.8-2 mm, passed through the bone, as well as screw rods with a diameter of 4 mm. Small-sized rod devices allow patients to actively move already in the early postoperative period.

Features of the postoperative period

After corrective osteotomy in dynamics, X-ray and computer studies of the bones of the lower leg are performed, the patient is assigned an individual rehabilitation program. In the future, synchronous correction of the deformity (by no more than 1°) and bone lengthening (by no more than 1 cm) are performed daily. After being discharged home, patients can perform this procedure on their own by turning the nuts on the threaded rods of the device.

In the postoperative period, rehabilitation therapy is carried out: walking (first with a walker), joint gymnastics, exercise therapy, etc. When walking with the apparatus, it is important to fully load the limb, which contributes to the recovery processes.

The patient stays in the hospital for up to 20-25 days, then is discharged for outpatient treatment. The external fixation device can remain on the limb from 40-50 days (without leg lengthening) up to 4-8 months. The duration of wearing the device is affected by the degree of deformation and the need for limb lengthening. After control studies (CT of the proximal parts of the legs, topography of the lower extremities, radiography of the legs in 2 projections with the capture of the ankle and knee joints) the device is removed.

Risks and Complications

The mode of motor activity during the period of fixation of the lower leg with the device is limited, determined by the doctor individually and requires additional support (crutches). In the postoperative period, the elements of the device may break down, which will require their replacement during additional intervention.

The severity of the pain syndrome after the application of the apparatus may be different. Pain may be constant, which will require the use of analgesics, may increase with physical activity or non-compliance with the pace of distraction.

Rods or spokes penetrating soft tissues and bones often cause infectious and inflammatory complications. They require constant care: treatment with antiseptic solutions and dressings. In the event that inflammation develops near the pin, a threatening complication may occur - pin osteomyelitis, requiring serious antibiotic therapy, removal or replacement of the pins. In a more serious situation, the device is removed, long-term treatment infectious complication, and then the external fixation device is applied again.

Osteotomy, as well as the passage of rods or wires through soft tissues, can injure the vessels and cause bleeding and hematoma formation. In this case, a repeated intervention is also performed - stopping the bleeding, opening and draining the hematoma.

After removing the external fixation device, it is necessary to carry out rehabilitation treatment to eliminate muscle atrophy and restore the full range of motion in the joints. The duration of such treatment can vary from 1 to 5 months.

Everyone had heard about the leg lengthening operation, and some even experienced it for themselves. This is a rather lengthy and phased treatment, when the Ilizarov apparatus was applied to the patient, and he was forced to long time to be isolated from society, to constantly follow the rules for caring for the apparatus, besides, there were scars on the skin of the legs, there were frequent cases of bone infection and the development of osteomyelitis.

Israeli medicine - modern technologies

In modern foreign clinics, the traditional leg lengthening operation has been replaced by new sparing methods. In particular, Israeli specialists in the field of orthopedics have developed and proposed their own method of limb lengthening, which does not require large incisions and the application of an apparatus with many spokes, which has already been successfully used in practice and has proven undeniable advantages.

Today, any patient who needs lengthening of one or both limbs for any reason can be freely operated on in Israel using a new safe technology. Information about the treatment in Israel by this method can be obtained on our website through a free consultation through the contact form, or by phone with one of the leading specialists in the field of orthopedics and plastic surgery.

Leg lengthening surgery - indications

The question of limb lengthening may arise various reasons both medical and cosmetic.

These reasons are:

- congenital underdevelopment limbs with their shortening;

- shortening after severe fractures;

- shortening after bone resection for tumors;

- inflammatory process (osteomyelitis), leading to the destruction of the bone and its shortening;

- the desire of the patient (patient) to lengthen the legs and increase growth, i.e. With cosmetic purpose.

Most often, for medical indications, surgery is performed on one leg (lower leg, thigh or both segments), for cosmetic purposes, surgery is performed on both limbs.

A new method of leg lengthening in Israel

There is a modern Ilizarov technique, the cost of such a service, on average, is $ 50,000. But in our clinical center, such a technique is not offered to clients, since the technology, although effective, has a lot of complications, for example, in patients with postoperative period osteomyelitis is often observed, large scars remain, many all kinds of suppuration. In addition, in the postoperative period, patients suffer from severe pain, their motor activity is limited, and the results on different limbs may not match. The Ilizarov apparatus fixed only the lower limb from the outside. The technology required repetition of the intervention. The cosmetic effect was minimal.

There is an alternative which is innovative technology Precise Nail for leg lengthening, which is produced in Israel. The cost of the procedure for one leg in Israel is $55,000, for two - $103,000. For comparison: the cost of the same operation in the USA is $300,000, in Germany - $220,000. The cost of the operation includes all operating expenses, electromagnetic implants, individual approach anesthesia at the anesthesiologist, seven days of hospitalization in the clinic. Also, the price already initially includes all consultations with specialists - preliminary and postoperative, all preoperative diagnostics, consultations of doctors, rehabilitation.

The Israeli innovative Precise Nail technology is carried out at ASSUTA CLINICS. The technique is striking in its effectiveness and painlessness. Repeated surgical interventions and complications are excluded. There is no need to visit doctors after surgery.

The essence of the operation is that a telescopic magnetic intramedullary rod is inserted into the bone tissue. The technique helps to remove acquired and congenital defects that led to the shortening of the legs. Implantation is carried out without tissue trauma, using minimally invasive methods. Interestingly, the technique has no visual signs of the operation.

Precise Nail has become a real “revolution” in implantology modern medicine. Compared with the Ilizarov technique, such an operation is performed in a shorter period of time, with intervention, the tissues are minimally susceptible to injury, therefore, the likelihood of infection is minimal. Complications during the rehabilitation period are almost never encountered. Accordingly, there is no need to prescribe to the patient a large number of medicines. Precise Nail guarantees patients excellent psychological comfort.

Precise Nail is indicated for infected fractures and dwarfism, for neurological pathologies, excision of bone tissue oncology and genetic abnormalities.

Implantation itself is carried out in several stages. First of all, doctors find a site for a future incision. A hole is made in the bone. The wire is inserted into the medullary canal - it is a guide. It includes a proximal drill. When the drill with wire is withdrawn, a telescopic rod enters the cavity, lengthening the limb. On both sides, the rod is fixed with screws. In the desired localization, a dissection of the bones is done - an osteotomy. After that, all the incisions made are sutured.

Then the next stage is carried out. The task of doctors at this stage is to stretch the muscle chains and lengthen the bones. The procedure is as comfortable as possible, in one manipulation the rod moves apart by a quarter of a millimeter. To this end, doctors use special computerized equipment, when it is launched, a magnetic field is formed. The magnetic rod poles repel each other, thereby starting the action of the field. The rod starts to twist a little. The manipulations are repeated up to four times per day. This helps to lengthen the bone by one millimeter. Connective tissue grows in the zone of bone dissection near the rod. Thanks to the rod, you can lengthen the limb by almost one centimeter - up to eight millimeters! It is possible to act on the rod at home, the patient needs to go to the hospital only to control the progress of the correction.

If necessary, the patient is x-rayed and given directions for additional examinations. Treatment tactics are developed collectively by several medical doctors at a specially assembled council.

$55,000 for one leg implant and $103,000 for two leg implants. And these are the prices with a full all-inclusive package: hospitalization, anesthesiology, consultations, examinations, diagnostics, surgery, rehabilitation. Precise Nail is a profitable and effective technology that has proven its effectiveness.

As a cardinal means of solving the problem of short stature is the operation to lengthen the legs. It consists in lengthening the femur and (or) lower leg by several centimeters due to a surgical fracture and subsequent bone fusion.

Often, people, due to the peculiarity of their genetic data, injuries, hormonal failure, or other reasons, suffer from short stature. Many are willing to risk their health to get the missing few centimeters.

In the fashion and beauty industry, long legs are considered a big advantage, many women wear high heels to appear taller, but there are more drastic ways to make legs longer, such as surgery to increase height.

Cosmetic orthopedics

This is the correction of the lower and upper limbs with the help of surgical intervention. The main goal is to increase growth. This direction was formed relatively recently, at the end of the twentieth century, it was then that the first methods of reconstructive surgery for people with deformed limbs were tested.

Despite the presence of extensive experience around the world in the use of surgery to lengthen long tubular bones, with all the variety of methods, the main one is the Ilizarov method.

Operational technique for leg lengthening

Two methods are used to lengthen limbs:

How is leg lengthening surgery performed?

The operation to change the length of the limb is very painful, expensive and time-consuming, so before starting the operation, you should think carefully about whether it is really needed.

One of the frequently asked questions is, how much can you lengthen the leg? Modern ways surgical intervention to increase height allow you to lengthen the thigh up to 10 cm, and the lower leg up to 6 cm

The operation is performed in several stages:

Each spoke is attached to the tibia or to the fibula. If the pins are not placed with absolute precision, they can damage tissues or nerves;
Then a metal frame is installed, which helps to fix the knitting needles and keep all vital tissues intact;
Then, within about 10 minutes, an operation to fracture the bone takes place.

After the completion of the operation, in the next few months, the legs are lengthened with the Ilizarov apparatus, the distance between the bones will gradually increase due to the expansion of the frames in the apparatus. The bones will grow and stretch to fill the gap.

Important! The operation should not be regarded as simple and easy way to increase growth. It must always be remembered that any surgical intervention can have serious consequences that even a doctor is often unable to predict.

Indications and contraindications

There are absolutely no medical indications for cosmetic orthopedics. All reasons to have surgery are purely individual, the main of which are:

curvature of the legs;
Low growth;
The desire to reduce the waist by removing the ribs.

Surgery is prohibited for those who have such problems:

mental illness;
Violation of the central nervous system;
Diabetes;
Oncological diseases;
Arthritis;
Inflammatory processes of the skin.

It is also necessary to be prepared for the possible occurrence of complications after the operation:

Violation of the regenerative abilities of bone tissue, which will cause a longer wound healing.
Inflammatory process of the tissue around the Ilizarov apparatus.
Violation of the movement of the knee and ankle joint, which makes it extremely difficult to move (therapeutic exercises help to get rid of this problem).

How much does the operation cost

Prices for limb augmentation surgery depend on the technique used and the segment of the bone that needs to be enlarged - the femur or lower leg, and how much the length of this bone will be changed. The table shows the average price in Russia.

Prices at different clinics may or may not include cost preliminary diagnosis, Ilizarov apparatus, hospitalization and rehabilitation.

Rehabilitation

Recovery after such complex operation requires the obligatory performance of a certain set of exercises that must be performed regularly, and then it will undoubtedly be beneficial.

Most often, the cost of limb lengthening services includes a complex rehabilitation measures which help to restore the normal functioning of the leg. However, there are situations in which, after being hospitalized in the clinic, the patient is allowed to go home and then he recovers on his own.

In the rehabilitation period, swimming, light physical exercise, walking. After 2-3 months, you can start heavier loads, sports.

Important! The success of rehabilitation depends only on the patient himself. It must be remembered that recovery after such serious operations takes time and patience.

Pros and cons of surgery

The main benefit that leg lengthening surgery has to offer is efficiency. After the operation and the course of recovery, the result of increased growth will be guaranteed. However, do not forget about the disadvantages of this method, the main of which are:

Pain. From the moment of the operation and for the entire rehabilitation period you will be accompanied by severe pain that will have to be endured for several months.
Complications. Various complications may begin, such as inflammatory processes, the device may break, requiring a new surgical intervention, etc.
Time. For this operation, you will need to spend several months in the clinic, and after a few more months to recover through rehabilitation measures.
Price. Price this method increase in growth is extremely high, and not everyone will be able to pay for such an operation.

without surgery

If you are afraid of surgery, then try increasing your height with exercise. The result is not guaranteed, but if you are at a young age and you do not have an obvious curvature of the kole, then there may be an effect. Watch this video.

Instructions for use:

The Ilizarov apparatus was created in the early fifties of the twentieth century by the famous Soviet surgeon G. A. Ilizarov. The apparatus, made by Ilizarov, consists of four metal skeletal traction spokes, fixed on two rings and interconnected by movable rods. Over the years, this device has been gradually improved. The modern Ilizarov apparatus is made of titanium with a high strength index. Modern designs use titanium or carbon fiber rods instead of spokes. Rigid rings in it are replaced by plates, semicircles and triangles. Sufficiently light and small in size, a modern medical device is widely used in traumatology, aesthetic medicine and orthopedics to correct body proportions, curvature of the legs, congenital deformities, clubfoot, anomalies in the development of the bones of the foot. This device is used for rickets, pseudoarthrosis, fractures of various localization and complexity, as well as to increase growth in systemic skeletal diseases, to treat joint contractures, to eliminate soft tissue and bone defects that have arisen after tumors, infections or injuries.

Installation of the Ilizarov apparatus

The Ilizarov compression-distraction apparatus is designed for distraction (stretching) or compression (compression), as well as for long-term fixation of individual bone fragments. With any fracture, the edges of the bone can move as the muscles pull them in different directions. The use of the Ilizarov apparatus on the leg or arm in case of a fracture prevents the displacement of bone fragments. It reliably fixes ununited fractures and false joints and does not require the use of additional plaster immobilization. Along with the therapy of false joints and ununited fractures, the device is successfully used to correct the length of the limb.

The process of installing the Ilizarov apparatus on a leg or arm in case of a fracture occurs as follows. Through each bone fragment in the area of the fracture, two needles are passed with a drill, crossing them at a right angle. A pair of spokes of each bone fragment is fixed and fixed in a ring (half-ring) using a special key. When tightening the nuts on the movable rods, the distance between the rings changes. The convergence of the rings provides compression between the edges of the fragments. Due to the deformation of the spokes, the compression force gradually decreases. Therefore, the tension of the spokes must be monitored and adjusted daily. Skillfully manipulating the movable rods, it is possible to eliminate the displacement of fragments along the axis, angular deformities, and also to produce a closed reposition of bone fragments.

Leg lengthening with the Ilizarov apparatus is carried out in stages. First, the apparatus is applied to the patient, then the bone is dissected (osteometry) and the fragments are fixed using orthopedic apparatus. Gradual lengthening of the legs (distraction) begins about a week after the operation. The rate of limb lengthening is one millimeter per day. The rate of distraction depends on the individual tolerance of this procedure by the patient. Thus, the duration of distraction with lengthening of the limbs by five centimeters is from 50 to 75 days. The fixation period begins after the end of the leg lengthening period. Typically, the fixation period lasts twice as long as the distraction period.

About a month later, an operation is performed on the second limb. Limb lengthening operations are performed under anesthesia. The patient can walk with crutches on the second day. During the rehabilitation period, the patient is encouraged to swim and walk.

The Ilizarov apparatus is also used to eliminate the curvature of the limbs. During the operation, the bone is dissected at the site of its deformation, and then fixed in the correct position with the help of a device. The installation of the Ilizarov apparatus consists in passing the spokes through the bones and inserting the rods. Correction of the shape of the legs can be either gradual (deformity is eliminated during daily correction) or one-stage (correction is carried out right during the operation). Daily adjustments are made by the patient themselves. The apparatus is removed after the bones have fused in the correct position. Modern Ilizarov devices; are relatively small, so the patient can fully move almost immediately after surgery.

Advantages and disadvantages of the Ilizarov apparatus

Installation of the Ilizarov apparatus makes it possible to shorten the time for fusion of the fracture and reduce the likelihood of developing a false joint to almost zero. Partial load on the injured limb is possible already on the second or third day after the procedure.

However, this device also has its drawbacks. Rings often interfere with normal sitting and lying. Pinpoint scars remain at the puncture sites after removal of the device. Some reviews of the Ilizarov apparatus say that when using it, many patients experience swelling and aching pain that interferes with sleep.

Removal of the Ilizarov apparatus

Only a specialist can remove the device. As the reviews say, the Ilizarov apparatus is most often removed without prior anesthesia.

After removing the Ilizarov apparatus, small wounds remain on the damaged limb, which heal rather quickly. To speed up healing, you can treat wounds with disinfectants. Over time, almost imperceptible scars remain on the sites of the removed apparatus.

Instructions for use:

Leg lengthening with the Ilizarov apparatus is carried out in stages. First, the apparatus is applied to the patient, then the bone is dissected (osteometry) and the fragments are fixed with the help of an orthopedic apparatus. Gradual lengthening of the legs (distraction) begins about a week after the operation. The rate of limb lengthening is one millimeter per day. The rate of distraction depends on the individual tolerance of this procedure by the patient. Thus, the duration of distraction with lengthening of the limbs by five centimeters is from 50 to 75 days. The fixation period begins after the end of the leg lengthening period. Typically, the fixation period lasts twice as long as the distraction period.

Advantages and disadvantages of the Ilizarov apparatus

Removal of the Ilizarov apparatus

Only a specialist can remove the device. As the reviews say, the Ilizarov apparatus is most often removed without prior anesthesia.

Information about the drug is generalized, is provided for informational purposes and does not replace official instructions. Self-medication is dangerous to health!

Not only the speed of wound healing, but also the process of recovery of the operated person depends on how the suture will be applied. Therefore, doctors, instead of manually tightening the edges of wounds during operations, use staplers.

What is known about the types of staplers for endoscopic and open surgery? What are the advantages of using them in laparoscopic and minimally invasive surgery? When should they not be used?

We answer these and other questions.

Types of staplers in surgery, their purpose

Before talking about the types of staplers, let's clarify what they are.

Firstly, these are medical instruments.
Secondly, their purpose is to mechanically connect organs and tissues during operations on the most important organs, on vessels, etc.

Types of staplers

These semi-automatic devices, designed to mechanically suture organs or their parts - or suture a part of an organ that remains tightly during surgery - are divided into SA for:

Endoscopic interventions.
open surgery.

Staplers share:

For single-bracket and multi-bracket.
For making seams(linear, circular, oval, etc.) with the appropriate (longitudinal, transverse and oblique) placement of stitches relative to the seam line.
For applying one- and two-story external seams etc.

At the moment, in surgery (including endosurgery), the main types and modifications of suturing devices for suturing are in demand.

They are divided into devices:

Linear stitching: these are both disposable and reusable instruments used in anastomosis of tissues and organs, by gynecologists, thoracic surgeons, during surgical interventions on the organs of the gastrointestinal tract; SA is used, depending on the modification, for applying 2- and 3-row stitches in a checkerboard pattern.
Linear stapling and cutting (staplers with a knife): using this equipment, a specialist can apply a 2-row staggered suture, with parallel cutting of tissues between it; are actively used in endosurgery, in the formation of anastomosis and resections of internal organs.
Circular stitching and cutting: these are circular anastomosis devices that help the doctor make a 2-row staple suture with parallel removal of excess tissue.

Advantages and disadvantages of surgical staplers - indications and contraindications for use

After a team of engineers and doctors in the USSR in 1946-1950. created a technique for mechanical vascular suture using tantalum brackets applied with a special stapler, it was created a considerable number of models of devices for:

Vessels.
Nerves.
ear of the heart.
arterial duct.
Bronchov.
Root and lung tissue.
Esophagus.
Stomach.
Guts.
Bladder, etc.

And each of them in the appropriate situation is a real find.

Benefits of staplers

Let's talk about the benefits of stapling devices to help doctors solve a wide range of problems in laparoscopic and minimally invasive surgery.

Significantly expands the possibilities of surgical operations.
Improves the outcome of the operation.
Gives the opportunity to create all new methods of surgical treatment.

Secondly, they help:

Provide more precise adaptation of the edges of the joined tissues.
significantly (one squeeze of the handles or device lever is enough) to reduce the time for suturing.
Significantly increase the level of asepticity (due to tightness).
Ensure minimal trauma to adjacent tissues during operations.
Reduce blood loss.
Use in hard to reach places.
Contribute to favorable regeneration after surgery (this occurs with the help of uniform compression of the connected tissues along the suture line).

There are few of them. Let's talk about the main. This is about the impossibility of using a stapler when pathological change stitched fabrics, which is caused by tumors or inflammatory processes.

Design

As a rule, the design of staplers for surgery includes:

Sewing mechanism.
Drive unit.
Fixing link.

Best Stapler Models for Laparoscopic and Open Surgery - Major Manufacturers

In order for the operation to be successful, and for the stapler to have the maximum effect, it is important to buy surgical staplers from well-known manufacturers whose products meet the highest requirements of surgeons around the planet.

Main manufacturers

Ethicon Endo – Surgery (Ethicon): part of the Johnson & Johnson Corporation, is the world's largest developer, manufacturer and supplier of medical instruments, including devices for open and endoscopic surgery.
Covidien (Covidien): no less famous manufacturer of honey. equipment from the United States, whose branches, and there are more than a hundred of them, operate around the world.

Let's name the best models from several well-known companies.

A Brief List of the Best Stapler Models for Laparoscopic and Open Surgery

AUTOSUTURETM DST SeriesTM EEATM Circular Staplers with 22 and 35 cm stem and 3.5 and 4.8 cm staples.
Endo GIATM Universal mechanical suture system for 25 stitches using straight and curved cassettes.

Video: Endo GIA™ Universal Linear Anastomosis Stapler

Apparatuses TLC, "Advant 55", "Contour" (linear stapling-cutting), forming a four-row stapled suture (length 55, 75 or 100 mm) with parallel tissue dissection between its paired rows; an innovative safety system blocks the blade in the absence of a cassette.
Linear staplers with adjustable staple height TL-TLH and fixed staple height TX.
Linear NTLC staplers with adjustable staple closure height and TLC.
Contour curved staplers.
Endoscopic stapling and cutting articulators ETS and Echelon.

Medical instruments for making sutures from Advanced sterilization products, Molnlycke Health Care and etc.

1952 is the date of the development of the device, which received the name from the creator - G.A. Ilizarov, who made a revolution in medicine and started a new era in traumatology and orthopedics. The design is actively used in the treatment of fractures and their complications. The device allows you to compress and decompress the bones, preventing disability and restoring health.

Ilizarov apparatus - what is it

A simple design - a compression-distraction apparatus - is made of metal. The system is based on rods (spokes) made of titanium or carbon fiber that pass through bone fragments at an angle of 90 degrees. Metal rods are attached to the rings by movable transition elements, which can be used to change the length of the device. As a result, the doctor gets the opportunity to squeeze or stretch parts of the bone as the treatment requires.

Ilizarov apparatus - application

When squeezing, rigid compression occurs, and when stretched, distraction occurs. Therefore, the apparatus is called compression-distraction, and the therapy process is called compression-distraction osteosynthesis. Medicine has constantly improved the device and the use of the Ilizarov apparatus has become widespread to solve many problems - such as:

fractures of varying complexity;
rickets;
false joints;
pseudoarthrosis;
systemic diseases of the skeleton;
varus deformities of the knee joint;
insufficient growth;
the need to correct the proportions of the body, the curvature of the legs and solve other problems of aesthetic medicine.

Apparatus for splicing bones

One of the purposes of the modern design of the Ilizarov method is to fix bone fragments in fractures. A bone fusion apparatus is used for open and multi-comminuted fractures. The risk of debris displacement causes the possibility of loss of bone contact, improper union. The device regulates the distance between the tissues, increases the speed of fusion. The main plus is that the fracture is securely fixed so that the bones grow together in a normal way. Even if the device is applied to the shins, the patient can walk without waiting for a full recovery.

Leg lengthening with the Ilizarov apparatus

The length of the legs is determined by the bones: in order to change it, it is necessary to violate the integrity of the limbs. To do this, the bones in the thigh or lower leg are broken, and then a needle is inserted into the fracture site. Adjusting the distance with special nuts increases the distance by lengthening the bone. The average rate of distraction (stretching) is 1 mm per day. For a period of two months, an increase of 6 cm can be carried out. After the distraction period, a fixation period follows, the usual duration of which is 2 times longer than the leg lengthening time.

The use of compression-distraction devices in orthopedics is justified by medical and aesthetic indications. The process of distraction is a long one. From 6 to 12 months, the patient will need to use devices to increase the length of the legs and allow the young tissues to strengthen. Distraction causes pain, requires constant medical monitoring and long rehabilitation. Doctors recommend that you carefully familiarize yourself with the technique, study photos and videos on fixing and wearing a compression-distraction device before deciding to have an operation.

Installation of the Ilizarov apparatus

Although the small design looks simple, the installation process requires general or regional anesthesia to temporarily block the conduction of the nerve plexus of the staging site. Above the fracture, two needles are placed perpendicular to each other. For this, a drill is used. After the spokes are fixed on the rings (half rings), in which the rods are installed to adjust the distance. The number of rings can be any, depending on the nature of the fracture.

The operation to install the Ilizarov apparatus for limb lengthening is carried out in several stages. After the construction is applied, the patient is dissected the bone and the fragments are fixed with the apparatus. A week after this procedure, you can start the distraction process. Regardless of the reason for using the design, the tension of the spokes requires daily adjustment, and the patient's condition is tightly controlled.

The compression-distraction device requires special care, as it passes through the bone and can cause infection, provoke purulent inflammation. Knitting needles need to be disinfected in time using special solutions or 50% alcohol with water, which must be distilled. For processing, moisten a napkin in liquid and wipe all open areas of the knitting needle. One napkin is recommended to be used no more than two days, then it will have to be replaced.

Treatment with the Ilizarov apparatus

The main advantage of the technique is the preservation of the functionality of adjacent joints and muscles to a certain extent. Due to this feature, the treatment of fractures with the Ilizarov apparatus accelerates the regeneration of bone tissue for the rapid healing of any type of bone fracture:

diaphyseal;
intraarticular;
open;
gunshot;
complicated by purulent infection.

Ilizarov apparatus on the leg

A compression-distraction apparatus is used to compress or stretch the lower extremities. The Ilizarov apparatus on the leg helps to avoid the divergence of the edges of the bone after fractures, fixing them in a certain position. In orthopedics, this technique is used to eliminate bone defects, for example, to correct the shortening of one of the limbs. In aesthetic medicine, the apparatus is used, if necessary, to lengthen the legs.

Ilizarov apparatus on the arm

When on upper limb a complex form of fracture occurs; for fusion, the Ilizarov apparatus on the arm is used. This medical technique is used when it is necessary to correct the length and shape of the limb with a developmental defect. The device is installed on the forearm in case of fractures, in which the radius and ulna bones have significantly shifted.

Ilizarov apparatus on the thigh

Corrective hip surgeries can be performed in different ways:

using plates;
according to the Ilizarov method;
using intramedullary pins.

The Ilizarov apparatus on the thigh is sometimes used, but wearing it can create further problems:

contractures and subluxations of the knee joint;
obvious imbalances;
rough scars.

Ilizarov apparatus on the lower leg

In some cases of complex fractures in the shin area, it is impossible to heal bone fragments if conventional immobilization is created with plaster bandages. The Ilizarov apparatus on the lower leg is often used in the treatment of patients after car accidents and other situations in which injuries were received from a strong blow or a fall from a height. Multiple fragments, characteristic of injuries of this kind, are not capable of independent reposition in a cast. When using the Ilizarov method, the healing process is accelerated, the rehabilitation period is shortened.

How long is the Ilizarov apparatus worn?

The complexity of the correction that the bone undergoes determines how long the Ilizarov apparatus is worn. In most cases, compression or distraction is required for at least two months. For complex fractures, for example, on the lower leg, it may take from 4 to 10 months. When surgery is performed to lengthen the limbs or correct curvature, the spokes are worn for 6 months. The individual rate of bone tissue regeneration also affects the period after which it will be possible to remove the device.

How to walk with the Ilizarov apparatus

The period of use of the device is long, but the patient should not give up the whole habitual life. Walking with the Ilizarov apparatus is allowed and even necessary. The device can be hidden under wide clothing, which is easy to remove and put on. If it is necessary to fix the device on the leg, you can wear wide trousers that will hide the installed system and make it invisible in life and even in the photo.

When treating according to the Ilizarov method, a moderate load should be given to the bone after 1-2 weeks. However, the patient may develop inflammatory processes in soft tissues. If complications arise in the form of increasing pain, swelling, redness at the places where the device is applied, compresses from a solution of dimexide and distilled water are used. Antibiotics, such as doxycycline hydrochloride tablets, may also be prescribed. If complications persist after a few days, medical attention should be sought.

A special cover can reduce the likelihood of complications due to dust settling on the knitting needles. To sew it, use a breathable fabric. The cover is a cylinder with rubber bands that covers the limb from above and below. Such a cover is an excellent solution for compression or distraction correction, which uses the Ilizarov method.

The price of the Ilizarov apparatus

Compression-distraction devices are different, so it will be difficult to say exactly how much the Ilizarov apparatus (region - Moscow) costs. The traumatologist will determine the required configuration and complexity of the device, on which the final cost of the product will depend. The price is affected by the place for the treatment of which the kit is intended, the material of manufacture, equipment, and other features. Average cost:

only a set - 20-40 thousand rubles, can reach up to 600 thousand (depending on complexity);
operations (the price of the device is included in the price) - about 150 thousand rubles. (for both legs - 200 thousand);
doctor's consultations - 3-7 thousand rubles;
removal of structures - 3-5 thousand rubles;
topograms (X-ray in full growth) - 5 thousand rubles.

How to remove the Ilizarov apparatus

If the device is applied to the limb under anesthesia, then the removal of the Ilizarov apparatus is often carried out even without anesthesia. Spot wounds remain in places where the needles were inserted. They are dressed with dimexide or another disinfectant. If the bone tissue is not strong enough, then doctors can impose a fixing splint. Rehabilitation measures after withdrawal include:

massage;
physiotherapy;
gymnastics to restore mobility.

Timely started gymnastics and massage sessions will help restore blood flow, nutrition and limb mobility. The duration of rehabilitation is determined by the doctor. Wounds after removing the spokes are treated with disinfectants until they are completely healed. The doctor may prescribe ointments and creams against the resulting edema.

Video: How to install the Ilizarov apparatus

My diagnosis is a congenital shortening of the left leg. The difference of 5 cm interfered with life. When the doctor suggested that I correct the situation using the Ilizarov method, I agreed. It took a long time to get to the result. It was painful, difficult, but after 13 months I can walk without knitting needles and crutches on two identical legs. Fortitude and a good painkiller helped me cope with the problem.

The O-shaped curvature of the legs and short stature caused a lot of complexes in me, so I decided to have an operation. The device was put on me for 6 months. During this time, I grew by 3 cm and the legs became even. I went to work in wide trousers, no one knew that I had knitting needles. Only limped a little. Looking at old photos, I think why didn’t I do this before?

After a car accident, he received a comminuted fracture of the lower leg. The first month I was put on traction, but it did not help. As a result, knitting needles were installed. I'm still walking with the device. severe pain, puffiness or other changes are not present. I don’t load my leg much, while I’m afraid, I drink vitamins and calcium. The doctors are talking about a speedy recovery.

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on individual characteristics specific patient.

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