Surgery – Miscellaneous – Methods
Reexamination Certificate
2000-10-30
2002-07-16
McDermott, Corrine (Department: 3738)
Surgery
Miscellaneous
Methods
Reexamination Certificate
active
06418935
ABSTRACT:
BACKGROUND OF THE INVENTION
The present invention relates to a surgical method of reestablishing blood supply to the femoral head, which is avascular by a pathologic condition. This method prevents destruction of the femoral head and treats a disease called osteonecrosis of the femoral head, which is caused by interruption of blood supply to the femoral head. This method is composed of several surgical techniques including detachment of a bone block with attachment of a portion of muscle called Gluteus medius from the ilium of pelvis, curettage of dead bone from the femoral head through a window made in the femoral neck and head junction, insertion of the bone block into the femoral head and impaction of the bone chips, and reconstruction of the donor site with bone and/or bone substitutes.
Osteonecrosis of the femoral head is a disease resulting from an interruption of the blood supply to the femoral head. This condition leads to the destruction of the femoral head making the patients feel pain in the hip joint, limitation of joint motion, limping and, if it is severe, inability to walk.
There have been many kinds of surgical methods to treat this disease including core decompression, multiple drilling, osteotomy, bone grafting, and hip replacement. The fact that there have been many methods to treat this disease implies that there has been no single best method. The present invention is a kind of bone grafting. The previous methods of bone grafting can be divided into two categories: non-vascularized bone grafting and vascularized bone grafting.
The present invention is a kind of vascularized bone grafting which is superior to nonvascularized bone grafting. The previous methods of vascularized bone grafting were vascularized fibular grafting, vessel pedicle iliac grafting, and muscle pedicle bone grafting. The present invention is a kind of muscle pedicle bone grafting.
There have been several methods of muscle pedicle bone grafting. The muscles used for this procedure are two kinds: Quadratus femoris and Gluteus medius muscles in which the bone block was detached from the proximal femur and Sartorius and Tensor fascia lata muscle in which the bone block was detached from the ilium. The present invention uses Gluteus medius muscle with attachment of a bone block from the ilium and this point is one feature of this invention.
Even though there have been many methods to treat osteonecrosis of the femoral head, each method has advantages and disadvantages and there has been no single safe method to preserve the femoral head. Therefore, if the femoral head was destroyed despite efforts to preserve the femoral head, there has been no choice but to replace the hip with an artificial joint.
SUMMARY OF THE INVENTION
The present invention is a surgical method of reestablishing blood supply to the femoral head, which is in a avascular status by a pathologic condition by a method of muscle pedicle bone grafting. The invention uses Gluteus medius muscle with attachment of ilium in order to preserve the blood supply to the femoral head via the muscle. The method is composed of several surgical techniques including detachment of a bone block with attachment of a part of muscle called Gluteus medius from the ilium of the pelvis, curettage of dead bone from the femoral head through a window made in the femoral neck and head junction, insertion of the bone block into the femoral head and impaction of the bone chips, and reconstruction of the donor site with bone and/or bone substitutes. This invention has many advantages including: easy technique, strong support of the osteochondral portion of the femoral head which is important to prevent collapse of the femoral head, stable blood supply to the femoral head, early union of the bone graft, early rehabilitation, and minimal donor site discomfort.
REFERENCES:
Baksi DP: Treatment of osteonecrosis of the femoral head by drilling and muscle-pedicle bone grafting. J. Bone Joint Surg Mar. 1991; 73-B:241-245.
Baksi DP: Treatment of Post-traumatic avascular necrosis of the femoral head by multiple drilling and muscle-pedicle bone grafting. J. Bone Joint Surg May 1983; 65-B: 268-273.
Bonfiglio, M., et al.: Treatment of bone-grafting of ascptic necrosis of the femeral head and non-union of the femoral neck (Phemister technique) J. Bone Joint Surg., 40-A: 1329-1346, Dec. 1958.
Bonfiglio et al.: Aseptic necrosis of the femoral head and non-union of the femoral neck. Effect of treatment by drilling and bonegrafting)Phemister technique) J. Bone Joint Surg., 50-A: 48-66, Jan. 1968.
Cheung HS et al.: Vascularized iliac crest Grafts: Evaluation of viability status with marrow scintigraphy. Radiology 186:241-245, 1993.
Cho BC et al.: Treatment of osteonecrosis of the femoral head with free vascularized fibular transfer. Ann Plast Surg. 1998 Jun.:40(6):586-93.
Leung PC: Femoral head reconstruction and revascularization. Treatment for ischemic necrosis. Clin Orthop, 323:139-145, 1996.
Malizos KN et al.: Free vascularized fibular graft: a versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone. Microsurgery. 1992; 13(4):182-7.
Sotereanos DG et al.: Free Vascularized Fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop. 344:243-265. 1997.
Tang CL et al: Donor site morbidity following vascularized fibular grafting. Microsurgery. 1998;18(6):383-6.
Urbaniak JR et al: Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. J. Bone Joint Surg. 77A:681-694. 1995.
Yoo, MC et al: Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head; Clinical Orthopaedes and Related Research; No. 272:128-138, Apr. 1992.
Barrett Thomas C.
McDermott Corrine
Merchant & Gould P.C.
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