METHOD OF SURGICAL TREATMENT OF MALIGNANT NEOPLASMS WITH LESIONS OF THE DISTAL FEMUR WITH RESECTION OF THE FEMUR AND ARTHROPLASTY OF THE KNEE JOINT USING A SEMI-TIED ENDOPROSTHESIS

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine and namely to traumatology and orthopedics. It can be used for the surgical treatment of malignant neoplasms with damage to the distal femur. In the preoperative period, spatial visualization of the affected bone structures of the knee joint is carried out 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. A patient lies on his or her back under anesthesia. An incision of the skin and subcutaneous fatty tissue is performed along the inner surface of the affected thigh from the middle third medially bypassing the patella with excision of the preliminary biopsy site with the transition to the anterior surface of the leg to the projection of the tibial tuberosity. The medial broad muscle of the thigh is dissected. Access to the femoral shaft is provided. The capsule of the knee joint is dissected. The joint is opened. The patella is mobilized from the medial side, retracted laterally. The ligaments of the knee joint are dissected, the drug is isolated from the medial side in a single block together with the site of preliminary biopsy. The anterior and lateral surfaces of the femur are skeletonized. The level of resection is measured. Osteotomy is performed at a set level, the distal part of the femur is cut off from the underlying tissues. The drug is removed in a single block along with the malignant neoplasm, observing the principle of ablastic surgery with the capture of healthy tissues at all stages of the isolation of a single block. Hemostasis is performed. The medullary canal of the femur is processed. The bone marrow canal of the tibia is opened. The articular surface of the tibia is resected using an oscillating saw. A canal is drilled to accommodate the tibial component of the endoprosthesis. The fitting assembly of the endoprosthesis is performed and, after fitting, the femoral and tibial components of the endoprosthesis are assembled. A reconstruction cover made of polyester fabric is put on the tibial component of the endoprosthesis and the distal part of the femoral component of the assembled endoprosthesis, the end of which is sutured around the stem of the tibial component of the endoprosthesis. The tibial component of the endoprosthesis is installed in the bone and the femoral component of the endoprosthesis is installed in the femur. The components of the endoprosthesis are connected and the distal part of the femoral component of the assembled endoprosthesis is covered with a reconstruction cover. The end of the reconstruction cover is sutured around the distal part of the femoral component of the endoprosthesis, additionally tying the femoral and tibial components of the semi-connected oncological knee endoprosthesis. The freedom of movement of the installed endoprosthesis is checked by flexion and extension of the patient's lower limb in the knee joint. The wound is sutured in layers, leaving silicone drainage.;EFFECT: method provides radical removal of a malignant neoplasm, restoration of functional integrity and motor capabilities of the knee joint due to the use of a semi-tied endoprosthesis. ;3 cl, 2 ex