Ilizarov apparatus (Elizarov). Photo on the leg, arm, hip, setting, how much, how to wear

In order to create the best conditions for compression, stretching, bonding, as well as natural fusion of damaged bone tissue, the Ilizarov apparatus is used in medical practice. Due to the design features, it makes it possible to quickly correct congenital or acquired changes in the arm, leg or any other bone tissue.

Description of the Ilizarov apparatus

In the first half of the 1950s. traumatologist from the Kurgan regional hospital G. BUT. Ilizarov has developed a unique compression-distraction method for the treatment of various degenerative diseases of the supporting system, which has found its application throughout the world.

The dynamic type design, named after the inventor, originally consisted of 2 rings that were connected when movable rods, and 4 stainless steel X-shaped cross pins attached to the main holders.

Despite the fact that in the future, the Ilizarov apparatus continued to improve, its basic principle remained the same - ensuring a rigid fixation of the damaged bone without the possibility of displacement using specially designed pins, which are passed through the connecting the cloth.

In order for the specialist to influence the course of treatment, the main elements of the apparatus are fixed when using mechanically movable rods, which allow you to adjust the degree of exposure to the affected plot. This provides pre-planned pressure on the bone, which helps it stretch and bond.

Since the initial versions of the device were quite cumbersome and heavy, delivering the patient a lot of inconvenience, it was decided to make the structure light and small, while maintaining its reliability and versatility.

To do this, it was necessary to resort to the following changes:

• The steel spokes of the device, which are the connecting elements between the outer ring supports and the bony structure, have replaced strong titanium or carbon rods. In order to increase stability, special pads and solders were added to them. In this case, the maximum rigidity is provided by knitting needles with a diameter of 2 mm, however, knitting needles of 1.5-1.8 mm are often used;
• instead of solid rings, separate triangles or half rings were added to increase support. To provide greater rigidity, the components of the device can be connected to other elements that are superimposed on each other;
• the presence of a small number of dynamic parts made it possible to create various variants of the device, based on the method of application. This made it possible to treat almost all types of degenerative processes in the bones, including the phalanges of the fingers, metacarpal and metatarsal.

The Ilizarov apparatus on a leg or other bone tissue has no analogues at the moment. The doctor can select a complete set of the device based on the clinical picture of a particular patient. This dynamic application is made possible by the presence of unified elements.

The use of the Ilizarov apparatus

The main purpose of using the Ilizarov device is the correct fixation of bone fragments in the desired position. In addition, it can be used to correct the position of bone tissue. Thus, the apparatus is a kind of framework for the damaged area, which is able to solve a number of problems in many areas of medicine.

Surgical intervention using the device allows you to restore the natural integrity of the human skeletal system, the indications of which include the treatment of the following injuries:

• closed multiple, multi-splintered and fragmented fractures, including the spinal column;
• fractures of the pelvis, chest and other parts of the spine;
• old or new dislocations, open fractures;
• for augmentation in case of a lack of bone area in the presence of injuries that have been formed due to a pathological process, cancer, as well as after removing any third-party fragments;
• genetically determined malformations of skeletal groups - deformation, shortening, clubfoot and others;
• curvature of the legs with acute rickets;
• arthrosis of any type or acquired degenerative processes developing as a result of bacterial infection;

In the presence of complex fractures, specialists are not always able to match the affected fragments. In addition, the plaster cast often does not provide the desired effect in terms of bone fixation, which leads to the displacement of the fragments under the direct action of the muscle fibers. In this case, the Ilizarov apparatus is an excellent solution that allows you to reliably fix the limb using the inserted wires.

The Ilizarov apparatus is often used to eliminate aesthetic and visual imperfections. Among such patients, most often there are persons who have various congenital pathologies (for example, if the legs are not of the same length). Also, people who are embarrassed of their own growth often turn to this problem, because the use of a compression-distraction device allows you to lengthen the limb.

The technique of execution makes it possible to eliminate any false joints, as well as increase the thickness of the bone and restore soft tissues in the presence of complex degenerative processes. Using the device, you can normalize the natural function of bone tissue and regulate the volume of its mass.

Also, the device has found its application in orthopedic cosmetology, which allows it to correct any type of curvature and remove various defects in case of incorrectly performed arthroplasty.

Advantages and disadvantages of the treatment method

The main advantages of using the method of treatment using the Ilizarov apparatus include, before total, the possibility of rapid regeneration of damaged bone, as well as the ability to effectively eliminate defects.

The main advantages and disadvantages of treatment with the Ilizarov apparatus:

Dignity

Flaws

· Effective and accurate matching of the required bone fragments with further fixation. · Preservation of natural blood circulation. · Resisting muscle stress, which makes it harder for bone to heal, often causing displacement. · Protection of the aligned tissue and matched bone from various displacement or divergence of their edges. · Ability to quickly fix and adjust the length of the bone while reducing the possibility of shortening. · Correction and correction of various congenital defects that cannot be eliminated by other surgical methods. · Minimizing the risk of bone arthrosis at the fracture site. Possibility of painless movement in the early period, without waiting for the full fixation of the fracture, which makes it possible not to lose the supporting and motor function of the skeleton, thereby preventing muscle contracture. The patient can get up with the device 1-2 weeks after installation, which is possible due to the peculiarities of the design itself - the distribution of weight over the entire area of ​​the bearing surfaces.

Feeling extra weight when lying or walking, which causes discomfort to many. · Sometimes inability to sit or sleep normally. · Often, after installation, swelling and painful sensations appear. · Small scars remain at the entry points of the device, which may persist for a long period of time.

The above disadvantages do not play a significant role and relate to uncomfortable manifestations. Based on medical practice, the device has numerous advantages that outweigh absolutely all the disadvantages.

How is the device installed?

The technical and functional installation of the device is a rather complex task that requires surgeon of high accuracy of movement, as well as understanding of the design features and skill to quickly take solutions. The intervention is carried out in a well-equipped department, by a physician with extensive experience. Otherwise, serious complications are possible.

If necessary, an X-ray study of the nature of bone fragments and their location, secondary diagnostics are used. After that, the apparatus is preliminarily prepared by sterilization with boiling water and the use of a distilled substance. In order for the area of ​​the body to be anesthetized, anesthesia is performed.

Based on the severity of the patient's condition, the volume of further intervention, as well as the individual characteristics of the psyche, the patient is assigned general anesthesia. The injection site itself is also disinfected. The patient should be positioned on the operating table in such a way as to provide unimpeded access to the intended site for insertion of the wires.

In practice, there are the following installation features, based on the field of application:

• On the hand. A special table is used where the patient's limb is placed.
• On the foot. In case of a fracture of the lower leg, additional space is created with the help of a Beler splint and a retainer, which have special notches for the knees at both ends of the instrument. This technique allows you to provide the necessary rest and relaxation of muscle fibers.
• On the hip. In this case, the patient is placed in a special pillow under the gluteal region - from the side of the healthy section. This is done with the aim of drooping the operated limb, eliminating unwanted muscle tension.

The assembly is carried out during the intervention itself, for which the surgeon performs a number of actions:

• Spokes are inserted into the designated area for intervention at a right angle, taking into account any peculiarities and topography of nerve, vascular endings.
• In order to maintain the desired sterility, the knitting needles can be adhered using the napkins that were worn earlier balls and rubber stoppers treated with alcohol and boiling water - they are the ones that attach the device frame to soft tissues sick.
• The surgeon brings the needles to the bone tissue, piercing the skin and drilling holes in the desired area using a special electric drill. The device is installed in the direction in which the spokes intersect with each other.
• In order to avoid complications in the form of burns, the doctor can stop drilling for a certain time.
• After passing the wire through the bone tissue, the device itself is assembled. For this, support rings are superimposed, which are subsequently fixed using specialized holders. The nuts are also tightened on the connecting elements located parallel to each other.
• The correct position of the apparatus is checked, after which the doctor begins to tighten the spokes. To do this, one end is tightly fastened with a clamp, and the other is pulled out using a special element.

Depending on the desired effect, the Ilizarov apparatus is adjusted by rotating the main nuts, which are located at the base of metal rings that transmit the main force of gravity to the bone the cloth. So, for the compression effect, the nuts are tightened as tightly as possible, if there is a need to stretch the bone fragments, they are compressed, which leads to an increase in the distance between the support rings.

Specific treatment of patients with post-traumatic, congenital shortening of the fingers or metatarsal bones can be provided by installing a miniature version of the device.

In fact, the installation plan is always the same, regardless of the indication or the injured area of ​​the body. Based on the localization of the affected area and various complications in diseases, a larger number of arcs, screws or other elements that serve as a supporting structure can be used.

The lengthening of the device itself is a step-by-step procedure that includes the following steps:

1. Placement of the device on the area to be corrected.
2. Osteotomy is a special operation that allows you to cut the bone in the right place.
3. Fixation of different ends of the device to create the desired direction of growth.
4. Gradual lengthening of bone tissue after 7 days after growth;
5. A fixation period that corrects the deformed bone. This procedure is resorted to 1-2 months after the surgery.

Depending on the shape, length and volume of the bone tissue, the doctor can improve certain actions, which allows you to get the desired result.

How to take care of the device during treatment?

The Ilizarov apparatus on the leg or any other part of the body is a procedure that requires additional care. So, after a successful intervention, the patient is most often discharged for home continuation of therapy.

Before discharge, the patient is taught the basic rules and recommendations for the care and wearing of the device. The doctor may allow a small load on the operated area as early as 2-3 days after the operation, which includes independent movement with an emphasis on the affected leg. For this, crutches are assigned.

In order to exclude complications in the form of suppuration and other infections, it is especially important to adhere to the basic sanitary rules:

• every day, disinfect the opening areas at the point of contact of the skin with the knitting needles, as well as any other parts of the device. To do this, you can wipe the device with a napkin or dry cloth, which must first be moistened with alcohol or any other antiseptic solution.
• change napkins every 2-3 days, and after 2 weeks - every week;
• when using antibiotic drugs, strictly follow the instructions of the attending physician, where special attention should be paid to the dosage of the medicine. In the event that clinical manifestations (frequent pain, redness, swelling and purulent discharge) do not disappear for several days, you should immediately contact the surgeon.

If a patient experiences a misalignment or deformation of the pins, emergency medical attention is needed. Inattention can lead to irreversible complications that compromise the patient's overall health.

How long does the treatment process take?

There is no single answer to the question of how long the treatment process takes with the Ilizarov apparatus. Since the therapeutic course depends on the rate of bone tissue regeneration and other individual characteristics of the organism, the period may differ for different patients. The length of time that the device is worn takes into account such characteristics as the period of tissue connection, the force of pressure on the bone and the possibility of lengthening.

At the same time, the rate of dilution of bone tissue during limb lengthening is strictly limited to 1 mm per day. After reaching the required length, its individual elements are fixed, the patient waits for the general strengthening of the bone. The Ilizarov apparatus on a leg or any other bone tissue is stretched for 25-30 days with a possible lengthening of 2 cm, and 60-70 days at 5 cm.

The fixation phase should be at least 1-2 months, but most often it is extended by 5-6 months. In the presence of a splinter fracture, it can reach up to 8-9 months. In order to reduce the number of possible complications in the future, the process of joining the bone tissue should be carefully monitored. Neglecting this rule can lead to improper splicing of the limb. If there is a healed fracture, the device can be removed.

How is the device removed?

The Ilizarov apparatus on the leg is a device that must be removed under the strict guidance of a surgeon. Often, its removal is not accompanied by any painful sensations, while anesthesia may also not be used.

The device is removed based on the following step-by-step actions:

1. Removing the bearing spokes, clips and rings.
2. Biting each ring of the knitting needle, then pulling them out of the bone tissue.
3. Treatment of the puncture area with disinfectants.
4. Plaster cast.

The wounds that remain after using the device heal quickly enough. In order to speed up the process, various medications can be used, in particular - ointments and solutions. Scar tissue is often small in size, which does not cause severe discomfort to the patient.

Basics of the rehabilitation period

After the direct removal of the Ilizarov apparatus, it is recommended to start the load, which must be increased gradually. This rule is especially important for the density, thickness and strength of the bone to return to normal.

It is worth noting that women who have undergone the procedure should refuse to wear heels for six months. The legs, arms and other involved articular surfaces need natural blood circulation, which will provide them with important micronutrients, therefore, accelerate tissue regeneration.

Rehabilitation should include the following procedures:

• hydromassage, massage of the affected area;
  
• therapeutic gymnastics, small physical exercises;
• walking, swimming, using hydrogen sulfide baths.

The duration of the rehabilitation period is established by the attending physician. In addition to disinfecting and healing agents, the surgeon may prescribe creams or ointments that eliminate puffiness.

Physiotherapeutic procedures started quickly allow to restore natural blood flow in the limb in the shortest possible time, which leads to an increase in tissue mobility and elasticity.

Possibility of complications

Immediately after the direct installation of the device, some patients may experience complications such as frequent pain, swelling and feeling unwell. They are not caused by the device itself, but are the result of damage to the metal spokes during their penetration into the soft tissue area, as well as an individual reaction of the body.

In this case, small vessels and nerve columns can also be damaged, the localization of which during the surgical intervention is almost impossible to identify. All these are symptoms that disappear without a trace, after some time. Other serious complications relate to inflammatory processes within the patient's soft tissues, which are localized at the puncture sites.

Most often this is a consequence of the following symptoms:

• non-observance of important hygiene rules when wearing the device;
• infection or bacteria that can enter the wound during surgery;
• getting burns of varying degrees when drilling bone tissue.

In a number of the above cases, the doctor prescribes antibiotic drugs that can relieve the resulting symptoms. Pain relievers and bandages may also be used. In order to avoid negative complications that increase health risks, the doctor should cool the instruments before the intervention and use a drill at a reduced speed.

Also, during the operation, it is necessary to use a sterile cover with treated elastic bands at the end, which is put on over the device itself, thereby protecting rings, spokes and other elements from the ingress of infectious bacteria - dirt, dust and other things.

Despite the fact that the price for an operation using the Ilizarov apparatus can range from 150 to 400 thousand. rub. Taking into account the cost of the device itself, diagnostic procedures, consultation and hospital stay, in many cases this is the only way to remove a physiological deficiency. The technique allows you to increase height, correct unwanted curvature of the legs and straighten posture.

Video about the Ilizarov apparatus

Features of the Ilizarov apparatus: