Surgical leg lengthening, modern methods. Ilizarov method for bone lengthening Israeli medicine - modern technologies

Modern people are striving with all their might for an ideal appearance. Some are interested in the parameters and outlines of the body, others are interested in growth. Both women and men are willing to undergo invasive leg lengthening surgery in an attempt to increase their height, and in most cases, the increase in height occurs only a few centimeters. The patient will have to go to the results for a long time through pain and inconvenience (for example, wearing a special apparatus). How is it carried out, who is indicated and contraindicated, how much does such an intervention cost?

Indications and contraindications

According to experts, leg lengthening surgery is prescribed to correct a number of defects:

• Dwarfism (height up to 135 centimeters)
• Excessive leg curvature
• Lameness caused by a severe difference in length lower extremities

• Mental disorders
• Diseases of the central nervous system
• Arthritis, rheumatism
• Osteoporosis
• Diabetes
• Osteomyelitis
• Bone tuberculosis

Preparation period

Before starting all manipulations, the patient should consult with doctors (therapist, anesthesiologist, surgeon), pass a urine test (general), blood (general, biochemistry, coagulation), perform fluorography and radiography of the legs, ultrasound procedure joints.

15 days before the intervention, it is necessary to stop taking medications that thin the blood, drinking alcohol, smoking.

How is it carried out

Leg lengthening surgery is performed using one of two existing methods.

Intraosseous, or Bliskunova. A rod implant is inserted into the bone and fixes it from the inside. Very expensive and not very popular in Russia.

Transosseous, or Ilizarov. The leg is fixed with knitting needles and rings from the outside. They gradually move apart, which lengthens the legs. Requires wearing an unaesthetic outdoor apparatus, but it is inexpensive.

Surgery to increase height is a long, difficult, and sometimes dangerous process. For example, leg lengthening with the Ilizarov apparatus is quite painful and time-consuming.

About a month after the installation of a device for bone stretching, the patient is in stationary conditions. Approximately 5 days after the manipulation, you can begin to move up to 50 meters a day. During the entire lengthening period, the patient feels pain (an anesthetic is prescribed), and it can increase if the mode of motor activity or the rate of bone lengthening is disturbed.

The duration of distraction is from 5 to 7 months, after which the device can be removed. Then the fixation period begins (lasts from 4 months to six months, it is necessary to prevent deformities of the elongated lower extremities). At this time, the patient is at rest, sometimes special recovery exercises are carried out, since the lack of movement for a long time is fraught with muscle atrophy and serious joint problems.

Care after surgery

After lengthening the legs with the Ilizarov apparatus (or using the Bliskunov method), doctors recommend that you perform some actions to properly care for the leg area.

In stationary conditions

According to experts, within the walls of the clinic it is necessary:

• Visiting physiotherapy procedures from 2 days after surgery
• Taking medication to prevent thrombosis
• Practice deep breathing and coughing to avoid accumulation of fluid in the lungs
• Walking short distances regularly (using a walker or crutches)
• Training for self-adjustment of clamps
• Mastering the rules for caring for pins, zones of their external fixation

At home

At home after surgery, for proper bone distraction, you must:

• Use of walkers, crutches (it is important to protect the lower limbs from unnecessary loads until medical permission)
• Regular adjustment of the device according to the instructions (if it needs to be adjusted)
• Maintain proper nutrition, if necessary - taking calcium supplements
• Maintain hygiene of the external attachments of the device to prevent infection (especially around the attachments and pins)
• Keeping wounds (cuts) clean and dry until the doctor allows water procedures
• Perform exercises to strengthen and stretch the muscle structures of the legs
• Taking painkillers prescribed by a doctor
• Regular medical consultations and radiography to control bone growth (1 time in 15-20 days)

IMPORTANT: Dancing, active jumping, skating are allowed after about 1 year, but not earlier.

The primary results are evaluated after the distraction is completed, and the final results are evaluated 4 months after the rehabilitation period. Postoperative scars disappear in about six months.

Possible Complications

• Slow bone regeneration, usually due to smoking
• tissue inflammation
• Impaired mobility of the knee or ankle

Price

The price of the operation is determined by the bone segment that needs to be enlarged, as well as the enlargement parameters. The price usually includes from 30 to 50 days of stay in the hospital, outpatient medical supervision (depending on the method of correction and institution). On average, an increase in the lower leg is estimated at 3-8 thousand dollars, an increase in the hip - 4-10 thousand dollars.

Additional Information

An operation to increase height can be carried out in combination with the correction of calf deformities (if it is necessary to eliminate varus or valgus deformity).

Lengthening of one of the lower limbs can be performed (for example, after a congenital or acquired due to injury difference in leg length of more than 1.5 centimeters).

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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 of the lower limbs, and growth increases.

Corrective osteotomy of the lower leg bones is indicated for congenital and post-traumatic deformities of the tibia, as well as for 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 diagnostic methods 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 performed under general anesthesia for 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 dissected at a distance of 5-6 cm below the knee joint with a special instrument - 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 (lowering the head 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 lower 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 osteomyelitisrequiring serious antibiotic therapy, removing or replacing spokes. 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 removal of the external fixation device, restorative treatment is mandatory 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.

Leg lengthening with surgery is a surgical intervention that is performed using two methods. The first way is the most popular. For him, the Ilizarov apparatus is used. The second method is the Bliskunov method. Both methods have their contraindications. Leg lengthening surgery is prohibited if the patient has the following diseases:

• inflammation of the skin;
• diseases of the central nervous system;
• blood clotting disorders;
• diseases of the cardiovascular system.

Surgical lengthening of the legs by the Bliskunov method is a very traumatic and painful process, so it is much less popular.

The use of the Ilizarov apparatus may increase the size of the lower legs or thighs. You need to choose one thing, since operations cannot be performed on two parts of the body at once. The choice depends on the characteristics of the patient's body. The surgeon will advise the best and safest option. The legs are enlarged by 6 cm, and the hips by 10 cm. It should be noted how much the leg lengthening operation costs - the price for it varies from the number of centimeters.

How is leg lengthening surgery performed?

The length of the legs depends on the bones, so in order to increase the size, it will be necessary to violate their integrity. During the operation, a surgical fracture is made. But the bone does not break completely, only its surface layer. Moreover, lengthening the legs with the help of the Ilizarov apparatus makes a fracture in a certain place. If the lower leg is lengthened, then two bones need to be broken. Sometimes the operation takes place in stages, the bones of both legs "break" in turn.

Knitting needles are placed in the place of the fracture. They begin a gradual slow lengthening of the legs with the help of surgery. Three days after surgery, the patient can begin to walk short distances - 5-20 meters daily. Leg lengthening occurs one week after the operation. To increase the size, you need to tighten the special nuts. This is done four times a day, and the patient himself is responsible for the process. Every day the length increases by 1 mm. You can achieve a result of 6 cm in about two months. During this period, the patient either remains in the hospital or goes home after a month. Leg lengthening surgery will first bring pain. If you go home after the operation, then you need to treat the needles with disinfectants, otherwise there is a risk of infection.

After reaching the desired size, the apparatus is removed from the legs. But this is not the end of leg lengthening. This is followed by a fixation period, which protects young tissues from deformation. At the end of this period (which lasts about 4 months), a calm lifestyle will be required. It is necessary to exclude roller-skating and skating trips, long walks, outdoor activities, dancing for several months.

The whole procedure takes 6-12 months.

The length by which the legs can increase depends not only on the method of surgical intervention. An important role is played by the extensibility of the tissues of an individual organism. It also depends on the height of the person. In tall people, the length of the legs increases more. The leg lengthening operation is calculated according to the size of the body part, 10-15% of the original length is taken. Therefore, in tall people, the legs can grow by 6-8 cm. Before the operation, you need to decide on your appearance, because the proportions of the body are different for everyone, too long legs for some people will look ugly.

The cost of leg lengthening surgery is 3-10 thousand dollars. It depends on the prestige of the medical center and the increased length.

Leg lengthening operation using the Ilizarov apparatus, video:

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Reviews (8)

I have been wanting to lengthen my legs for a long time, but it is unlikely that I will ever decide on this operation.

Endure such torment for a year and a half ... Girls and boys, you are crazy heroes)))

good afternoon, I would like to know how much does leg lengthening surgery cost?

How much will it cost to increase the legs of the femur by 14 cm?

I would like to clarify about "operations cannot be performed on two parts of the body." Is it for one period of time or in general?

How much does it cost to lengthen the lower leg by 5cm?

Hello, could you please tell me how much the operation to increase the legs by 5 cm will cost? Thanks.

In Moscow, how much does it cost to lengthen the lower leg by 7 cm?

To create optimal conditions for fastening bone fragments of a limb segment, compression or stretching of bones, anatomically correct fusion, it is proposed to use a special design - the Ilizarov apparatus. This is a kind of corset for bones. It is widely used in many sections of clinical medicine - traumatology, outpatient, pediatric orthopedics. The Ilizarov apparatus is also successfully used in the beauty and health industry - in anthropometric cosmetology for the correction of congenital or acquired deformities of the limbs, for the correction of thighs and lower legs for aesthetic purposes.

How the device works

G. A. Ilizarov, a traumatologist-orthopedist of the regional hospital of the city of Kurgan, developed a compression-distraction method of treatment back in the early 50s, later he was awarded the academic title of professor, doctor of medical sciences. The technique is based on the use of a device located outside the patient's body, comparable to a kind of tunnel, in the center of which there is a limb that needs to be drawn up and fused.

The dynamic design for transosseous (external) osteosynthesis, named after the author of the invention, at that time consisted of 2 rings connected by movable rods, and 4 X-shaped crossed stainless steel wires fixed on ring supports.

In the future, the design was constantly improved, but the principle remained unchanged - with the help of special needles, held through the median sections of the damaged bone, a rigid fixation is provided, excluding any displacement. In order to be able to influence the course of therapy, the structure is fastened with mechanical movable rods, which allow dosed adjustment of the level of impact on the affected area, providing a given compression or stretching of the bone area. Early modifications were bulky, heavy, delivered a lot of inconvenience to patients. Get easy, reliable, small size design, universal and multifaceted, providing the greatest rigidity of fixation, allowed constructive innovations:

• steel wires of the Ilizarov apparatus, which are the connecting element between the outer annular supports and bone tissue, were replaced with high-strength titanium or carbon fiber rods. To enhance rigidity, they are equipped with special sharpening, soldering or thrust pads. The greatest rigidity is provided by knitting needles with a diameter of 2 mm, but more often 1.5 or 1.8 mm are used;

• instead of uncomfortable one-piece rings, triangles, half rings or separate arcs are used as a support. To give greater rigidity to the support, the parts are interconnected using additional fasteners, they can even overlap;

• the presence of a relatively small number of unified parts allows, in addition to the basic model for the treatment of deformities and damage to long tubular bones (the Ilizarov apparatus on the leg, arm - usually the lower leg and forearm), to complete options for almost any bone, incl. metacarpal, metatarsal and phalanges.

For each specific clinical case, doctors individually select the details and, depending on the nosological form, the localization of the pathology, the tasks set, mount their own special kind of design. The Ilizarov apparatus, which includes unified components and parts, has no analogues at the moment.

In what cases is the operation using the device indicated?

The design feature of the device allows fixing bone fragments in a given position, creating optimal mechanical and biomedical conditions for their rapid fusion. When assembled, it serves as a scaffold that solves a number of problems in various fields of medicine. Operation with the Ilizarov apparatus restores the natural integrity of the skeletal system, is indicated for bloodless treatment:

• severe bone fractures chest, pelvic, various parts of the spinal column;

• closed comminuted, crushed, multi-comminuted fractures along the diaphysis (central part of the tubular bone), metaphyseal (periarticular) fractures;

• fresh and chronic dislocations, open fractures;

• building up the missing area of ​​the bone in the presence of defects resulting from diseases, the destructive effect of tumors, osteomyelitis, after extracting small, unsuitable for regeneration, fragments of the injured bone;

• congenital malformations of the skeleton - shortening, deformation of the limbs, clubhand, clubfoot;

• true o- or x-shaped curvature of the legs with rickets;

• pseudoarthrosis of any localization, acquired bone changes due to arthritis, arthrosis, infectious diseases;

Advantages and disadvantages

The installation operation is used strictly according to the doctor's prescription, is indicated for adults and children. The principle of operation, purpose, device and installation procedure are identical. Manufacturers produce kits of the device of several standard sizes:

• 8 sizes for the shoulder, forearm, hand and lower leg - with an inner diameter of the rings from 80 to 225 mm;

• 5 sizes for the thigh - diameter from 120 to 180 mm.

A complete set of parts allows you to assemble a large number of options. For small patients, it is recommended to purchase a set of parts made of titanium. This material is resistant to corrosion, biologically absolutely harmless, the weight of the titanium apparatus is less than its steel counterpart. Its main advantages include the ability to obtain a readable, visualization-free image on x-rays, NMR and computed tomography and control the treatment process due to the fact that the titanium alloy does not exhibit magnetic properties.

Treatment with the Ilizarov apparatus allows:

• match and securely fix the fragments as accurately as possible;

• resist the force of the muscles approaching the diseased bone from different sides and pulling it in diametrically opposite directions, causing shifts;

• protect the combined fragments and the matched bone from displacement, divergence of edges, additional trauma, improper union;

• due to the ability to accurately fix and adjust the length of the bone to prevent its shortening during splicing;

• correct congenital changes - stretch a limb unequal in length, correct the shape;

• minimize the risk of formation of pseudarthrosis (false joint) at the fracture site;

• begin to move painlessly at the earliest possible time, without waiting for the complete consolidation of the fracture, which allows not to lose the motor and support function of the joints, to prevent muscle contracture. Possibility walk with the Ilizarov apparatus literally a week after its installation, it appears due to a design feature that allows you to distribute weight over the entire area of ​​\u200b\u200bthe bearing frame.

The disadvantages of treatment with the device in comparison with the positive effect are not significant, they basically boil down to the following:

• Feeling extra weight

• the device causes discomfort - it interferes with sleep, normal sitting and lying down;

• immediately after installation, swelling and pain appear;

• pinpoint scars remain at the entry points on the skin and can persist for a long time.

How the Ilizarov apparatus is installed

Technically, the installation of the Ilizarov apparatus is a complex task that requires a trauma surgeon to have mathematical accuracy of movement, understanding of the engineering structure, and the ability to make a quick decision. The operation is carried out in an equipped trauma department exclusively by an experienced specialist. He will need to study in advance the nature of the bone fragments and their location from the radiograph and assemble the necessary version of the apparatus from the details. They are pre-prepared - sterilized by boiling with distilled water. In order to anesthetize a part of the body during surgery, local anesthesia. Depending on the severity of the condition and the volume of the procedure, the patient may be prescribed and general anesthesia. The place of introduction of the spokes is disinfected.

The patient is positioned on the operating table so as to provide free access to the site of application of the guiding device. So, if the Ilizarov apparatus is installed:

• on the arm - use a side table and lay the diseased limb on it;

• on the leg (shin fracture) - the bed is created using a fixator, on a standardized Beler splint, which has special hip and knee cutouts at both ends, providing peace and relaxation of the muscles;

• on the thigh - a pillow is placed under the buttock from the side of the healthy part of the body so that the operated area of ​​​​the thigh hangs without tension.

Assembly is carried out directly during the operation, for this the surgeon performs the following steps:

• to the designated section of the bone at a right angle to its longitudinal axis, taking into account the topography of the vessels and nerves, brings the spokes;

• to maintain sterility, the needles are adhered to with a dry napkin, they are put on balls and rubber plugs treated with an alcohol solution, with the help of which the needles are attached to the patient's skin;

• the doctor brings the needles to the bone, piercing the soft tissues, and using an electric drill drills holes with them in a given fragment, the needles are inserted in mutually intersecting directions;

• often stops drilling to avoid burns;

• after passing the spokes through the bone, assembles the apparatus - imposes support rings, fixes them with special spoke holders, tightens the nuts on the connecting rings, installed parallel to each other, couplers and rods;

• checks the correct position and fastening, then proceeds to the tension of the knitting needles - one end is tightly fixed with a clamp, the second is first pulled out with the help of a spoke tensioner.

The device is adjusted by turning the nuts on the movable rods (rods) that hold the metal support rings that transfer the load to the bones. By changing the distance between them, they achieve:

• Compression effect - tightening the nuts and bringing the rings together.

• Stretching of bone fragments - increasing the distance between the rings with arches and weakening the compression.

Treatment of patients with congenital or post-traumatic shortening of the phalanges of the fingers, metatarsal bones is provided by installing a mini-device on the finger. It is divided into a basic and a dynamic part and consists of several (from 1 to 5) cantilever spokes fixed in the support. They are passed through the lower end of the metatarsal or metacarpal bone, the central section of the main phalanx of the finger, the nail and middle phalanges.

The installation scheme is the same for all indications and injured parts of the body - the manipulations are identical in cases when the Ilizarov apparatus is applied for a bone fracture and when cosmetic changes are made. Depending on the localization of the problem area and the complexity of the disease, a different number of semicircles and arcs can be used, which serve as the main supporting and regulating elements. Lengthening with the Ilizarov apparatus is a step-by-step procedure, including:

• Installation of the apparatus on a whole limb in need of correction.

• Osteotomy is an orthopedic operation in which the bone is cut.

• Fixing the ends in the desired position with a guide vane.

• Gradual lengthening of the limb - start distraction after 7 days, when the bone begins to grow.

• fixation period. Correction of the second leg is started no earlier than a month after the start of the operation.

This is how the shape of the bone is corrected.

Terms of wearing the device

To the question: how long the Ilizarov apparatus is worn, there is no unequivocal answer. The term is determined individually and depends primarily on the rate of bone tissue growth. The duration of wearing consists of the period of connection of fragments, elongation and a period of pressure. On the rate of dilution - bone traction, restrictions are set: 1 mm / day. Having reached the desired length of the bone or having made one-stage fixation of the fragments, they wait for the bones to strengthen and acquire their natural density. By timing, on average:

• the traction period lasts 20-30 days - with an elongation of 2 cm, 50-75 - an elongation of 5 cm;

• the fixation period is at least 1-2 months, but usually stretches for 4-6 months. with fragment fractures, 5-8 during orthopedic surgery.

The process should be constantly monitored to minimize the risk of improper splicing and the development of complications. If the fracture has healed sufficiently, after this time the removal of the Ilizarov apparatus is required.

Rules for wearing the device

After a successful operation, the patient is discharged for outpatient treatment. Before discharge, they are taught the rules of wearing and caring for the device. They are allowed to start loading the limb on the second day after the application of the spokes and to move independently, leaning on the sore leg and using crutches while walking to support, after a week. To eliminate the risk of suppuration, inflammation, it is important to adhere to sanitary standards and certain hygiene rules:

• daily disinfect open areas of the spokes and all parts of the device - wipe with a napkin moistened with medical or other high-quality alcohol, avoiding contact with the solution on the skin;

• change napkins every 2 days, after 2 weeks - every 7 days;

• when prescribing antibiotics by a doctor, strictly observe the prescribed dosage, if the symptoms (pain, swelling, redness, purulent discharge) do not disappear immediately notify the attending physician.

In case of misalignment or deformation of the spokes, an urgent health care. Ignoring the problem is fraught with irreversible consequences.

Fundamentals of rehabilitation after removal of the device

The removal procedure must be carried out by the same doctor who installed the device. In most cases, it does not cause severe pain, anesthesia is not required. How to remove the Ilizarov apparatus:

• Dismantling of bearing supports, rings, clamps.

• Biting one end of the needle and pulling it out of the bone.

• Treatment of puncture sites with disinfectants.

• Applying a plaster cast.

After removal, a gradual increase in load is recommended, because. thickness, strength and density of bone tissue decreased. It is forbidden to wear heels (allowed only after six months). The arm, leg after the Ilizarov apparatus and other joints need to restore normal blood circulation, which will provide nutrition to the limb and accelerated regeneration. The rehabilitation period should include:

• massage, hydromassage;

• medical gymnastics;

• hydrogen sulfide baths, swimming, walking.

Why and in what cases complications are possible

Immediately after installation, some patients experience swelling, pain. They are not called by the Ilizarov apparatus itself – pain, this is a consequence of damage by a metal needle (during its penetration into soft tissues) of small formations (vessels, nerve columns), the exact localization of which during the operation cannot be established.

Serious disadvantages of the technique include sometimes occurring inflammatory processes of soft tissues at the puncture sites. This may be due to:

• non-observance of hygiene rules during the period of wearing the device;

• getting into the wound of harmful bacteria during the operation;

• getting a burn at the time of drilling a bone that needs to be fused.

In this case, a course of antibiotics will be required. To avoid such a complication, it is recommended to cool the needles during the operation and use a low-speed drill. It is advisable to use a special sterile cover with rubber bands at the ends, which is put on over the device and protects the spokes from infection (dust, dirt).

The most popular clinics abroad:

• Israeli rehabilitation center Levinshtein;

• Ichilov Clinic in Tel Aviv;

• Diagnostix Institute for Diagnostics and Telemedicine in Germany.

The final price of the procedure has several components. First of all, it is determined by how much the Ilizarov apparatus costs. The price of a set of parts depends on the place of application, on average it is:

An essential component of treatment with the Ilizarov apparatus is the cost of the operation, it can reach 150-400 thousand rubles. and include the cost of the device, preliminary diagnostics, consultation with a doctor and hospital stay. The procedure is expensive, but it allows you not only to increase height, stretch your legs and correct curvature, but also quickly get back on your feet after a serious injury and bone fracture.

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 pins 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, in 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.

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 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.

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 apparatus. 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.

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:

1. Endoscopic interventions.
2. 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:

1. 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.
2. 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.
3. 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.

1. Significantly expands the possibilities of surgical operations.
2. Improves the outcome of the operation.
3. 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:

1. Sewing mechanism.
2. Drive unit.
3. 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

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

Video: Endo GIA™ Universal Linear Anastomosis Stapler

1. 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.
2. Linear staplers with adjustable staple height TL-TLH and fixed staple height TX.
3. Linear NTLC staplers with adjustable staple closure height and TLC.
4. Contour curved staplers.
5. 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 the 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 give recommendations for treatment based on the individual characteristics of a particular patient.

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