BG63743B1 - Osteal connection and method for its materialization - Google Patents

Abstract

The osteal connection is used in osteosynthesis for fixing of osteal fragments in human and veterinary medicine. It is formed between at least two osteal fragments (1,2 or 7,8), with surface contacts and connected by means of a fixing device (5). The contact surfaces are made in corrugation, so that the projections of one of the osteal fragments (1 or 7) would match the recess of the juxtaposed fragment (2 or 8). The fixing device is in the form of a bracket (5), including a non-metallic band (10) and fastener at one of the ends of the band. The fastener is in the form of a catch (12) for locking the band (10). The other end of band (10) is in the form of a piercing top (15). Band (10) is made of tissue compatible or tissue resorption plastic. 9 claims, 5 figures

Description

(54) BONE BINDING AND METHOD OF IMPLEMENTATION

Technical field

The invention relates to a bone ligament and a method of its implementation, which are used in osteosynthesis for fixation of bone fragments and for osteotomy treatment of both long tubular and flat bones in human and veterinary medicine to create conditions for adhesion and / or restoration of bone integrity and function.

BACKGROUND OF THE INVENTION

It is known that in the treatment of various dysplastic and degenerative-dystrophic diseases of the skeleton for the purpose of correcting or creating a support, and as a separate stage of another operation, osteotomy with subsequent osteosynthesis has been shown. In the shape of the cut can be linear (transverse, oblique and longitudinal) and figured (angular, stepped, extreme and grooved).

SU 825022 is known for the method of osteosynthesis, in particular bone osteosynthesis, in which the bone fragments are cut with teeth so that the tooth of one fragment exactly enters the tooth of the other fragment. These are teeth with sharp peaks and sharp depressions, in which the height is commensurate with the thickness in the middle of the tooth, and through the middle of the height of the tooth, perpendicular to the axis of the metal spokes. The practice of such teeth, especially in osteoporous bones, is associated with additional trauma to the diseased bone in the formation of the teeth, as cracking is possible. In addition, sharp peaks, as well as entire teeth, can easily break, as more force is applied when cutting. The time to prepare the bones for attachment is increased many times, which is not always acceptable, for example in breast surgery. Here, the entire bone shortens with the height of the teeth, and this can be a problem related to the postoperative functioning of the bone itself, as well as a cosmetic problem if insertion of a corrective implant is not desirable, for example with a sternum osteotomy.

It is known from EP 0596277 a fixing means made as a clamp for clamping in the form of a flexible non-metallic smooth strip comprising one end made as a punctured tip with a greater rigidity than the hardness of the strip so that it can penetrate the soft tissues and / or fasciitis, and another end made as a stopper in which the strap can be locked so that the compression on the bone fragments can be dosed. The fixing here relies on the penetration of sharp edges by the stopper into the smooth surface of the belt, which does not provide sufficient reliability of the connection and creates the possibility of sliding in the opposite direction.

SU 584853 is known for the tool for machining the contact surfaces of bone fragments, including the tail and the working part, the tail is made in the form of a handle and the working part is serrated. This tool is manual and cannot be used to mount a power tool. Furthermore, the notched part is not shaped to form corrugated profiles according to the invention.

SUMMARY OF THE INVENTION

A problem that is solved by the invention is that it shortens the healing time of the compared bones.

Another problem that is solved with the invention is that it improves the reposition of the treated bones, thus avoiding various anomalies in their healing.

Another problem that is solved is that a more secure fixation of the bone fragments is provided, which prevents their possible displacement.

Another problem that is solved is that it does not shorten significantly and do not injure the extra healed bone.

These and other problems are resolved by a bone connection between at least two bone fragments contacting at least one surface, the bone fragments being repaired and fixed to one another by a clamping means, including a latch, secured in a lock. The contact surfaces of the bone fragments are wavy in such a way that the projections of one bone fragment coincide with the recesses of the compared fragment. Preferably, the corrugated profile is configured so that the height between adjacent recesses and the projection of the profile is about 2 to 4 mm. This prevents bone fragments from moving apart and stabilizes reposition. In addition, the contact area is increased, which shortens the healing time of the treated bone. The small height of the protrusions does not lead to injury or damage to the treated bones during their formation. The strap is serrated on one longitudinal surface, in which there is an emphasis from the fastener. This guarantees the stability of the fixation and eliminates the possibility of sliding in the opposite direction as a result of the applied force on the strap.

The retainer is a bracket in the form of a flexible non-metallic strap for gripping and squeezing the bone fragments. The retainer bar is serrated on one longitudinal surface. At one end there is a fastener in the form of a lock in which the strap can be locked so that the compression on the bone fragments can be dosed. The retainer has a stop to limit the looseness of the retainer entering the teeth of the belt. The second end of the webbing is designed as a punctured tip with more rigidity than the hardness of the webbing so that it can penetrate through soft tissues and / or fasciitis. Dosage compression when tightening the retaining bracket provides the necessary compression to achieve closer contact between the repressed fragments, while not compromising the blood supply to the period. This reduces the likelihood of complications in the treatment process. The puncture tip provides atraumatic penetration of the clamp through the soft surrounding tissue. In addition, a secure retention is guaranteed, preventing sliding in the opposite direction.

The method of making the bone junction involves an initial linear or figured osteotomy of comparable bone fragments to form planar contact surfaces. The planar contact surfaces are further serrated to obtain a wavy profile in at least one direction so that, when the bone fragments are repositioned, the projections of one fragment coincide with the recesses of the comparative fragment. The height between the adjacent recesses and the projection of the corrugated profile is about 2 to 4 mm. After the bone fragments have been repositioned, they are fixed with at least one retainer.

In one embodiment of the invention, the wavy profile is obtained by sawing or milling.

The invention also includes a tool for machining the contact surfaces of bone fragments comprising a tail capable of being secured to a drill and a workpiece for cutting a portion of bone. The workpiece is rotary with a wavy profile along its length. The workpiece can be made as a milling cutter or a saw. This tool shortens the processing time for corrugated surfaces by guaranteeing a pre-determined cutting profile.

The tool according to the invention can be assembled, the tail and the working part being made separately. The tail extends at one end to which the working part is worn so that the two parts cannot rotate relative to each other. The working part is fixed axially. The composite tool allows you to change the workpiece according to the needs of the operation using the same queue, which reduces the volume of the toolbox.

Description of the attached figures

Figure 1 is a bone joint according to the invention after sternotomy;

Figure 2 is a bone joint according to the invention after a femur lengthening surgery;

Figure 3a - clamp for fixation of bone fragments after their reposition;

36 is a portion of a strip of the bracket of FIG. 3 with perforations along its length;

Figure 4 is a monolithic tool for processing corrugated contact surfaces for osteosynthesis;

Figure 5 is a composite tool for machining corrugated contact surfaces for osteosynthesis.

Examples of carrying out the invention

Figures 1 and 2 show two possible exemplary embodiments of the bone joint according to the invention.

Figure 1 shows a portion of the thorax where, at the osteotomy, the sternum is cut midway along its entire length. The bone fragments 1 and 2 contact the surface, with the profile of part 3 of the section in the region of the manubrium wavy so that the projections of one bone fragment coincide with the recesses of the comparative fragment. The height between adjacent indentations and protrusion of profile 3 in the case of a sternotomy is sufficient to be 2-4 mm, and the number of unilaterally extending projections or indentations in this case may be one or two. The profile of the remaining section 4 of the section in the area of the body and the sword-shaped outgrowth is linear. Fragments 1 and 2 are fixed to each other by a clamp 5. The wavy sternotomy, combined with the fixation, do not allow the two parts of the sternum to displace as a result of the natural processes of expansion of the chest during breathing or exercise in the postoperative period. A wavy sternotomy is possible along the entire length of the incision as well as other localization.

In one embodiment of the invention shown in FIG. 2, a bone implant 6, in this case two pieces, may be used to extend the femur. The longitudinal profile of each of the bone fragments 7 and 8 obtained after, for example, a standard figured Z-shaped osteotomy, for example, 100 mm in length, is wavy. The two fragments 7 and 8 are overlapped, for example, 50 mm long. Bone implants are inserted in the gaps between the edges of fragments 7 and 8 and the faces 9, longitudinally limiting the Z-section, 6. The longitudinal contact surface of at least one implant 6 is wavy. The shape and changes of the waveform in the area of overlap of bone fragments 7 and 8 and in the areas of implantation may be different. For example, the height and pitch of the implant profile 6 and the corresponding area in the bone fragment may be twice that of the overlap area. In this example, an extension of 50 mm is shown. Other forms of osteosynthesis are possible with a wavy profile of the contact surfaces in the treatment of the femur, for example without the use of implants, or the separation of the ends of fragments that are associated with a single implant, and others.

Shown in Fig. For retainer 5 is a clamp in the form of a flexible non-metallic non-stretchable strip 10 for gripping and squeezing the bone fragments. Along its length there are notches 11. At one end there is a stopper 12 in the form of a body with an opening 13, provided with a stop 14 on the inside, in which an opening 13 can enter the free end of the strip 10. When the tape 10 is pulled around the treated bone abutment 14 enters the tooth 11, limiting loosening of the fixation. The second end of the strip 10 is designed as a punctured tip 15, with the material of which it is made more rigid than the rigidity of the strip 10 so that it can penetrate through soft tissues and / or fasciitis. The material of which the tape is made can be tissue-compatible plastic such as polyamide, Teflon, polyurethane, or it may be tissue-resorbable plastic such as wickryl, PDS and the like. The top 15 can be constructed, for example, as a stainless steel metal insert. In one embodiment of the invention (FIG. 3b), the strip 10 can be perforated along its length, with the perforations 16 serving to sprout bone tissue therein. This strengthens the fixation over time.

The method of making the bone junction can be illustrated by the following specific example (Figure 1). A median longitudinal sternotomy is indicated for cardiac, vascular, or thoracic disease. After standard cleaning of the operative field and enclosure with sterile surgical linen, a longitudinal incision of the skin is made from the jugular well to the epigastrium. The soft tissues above the sternum are cut with an electroscalpel and hemostasis is performed. After reparation of the soft tissues from the jugular space and below the sword-like outgrowth of the sternum, a longitudinal linear sternotomy is made using a sternotome. After haemostasis, the incision walls in the area of the ebony manubrium are treated, for example by sawing or milling, to obtain a wavy profile 3 such that the projections on one side of the section are aligned with the recesses on the other side. Subsequent hemostasis is performed and surgery is then performed for the underlying disease. The wound from the sternotomy is closed, initially in the first, third, fourth and fifth intercostals, parasternally, one clamp 5 is secured, the punctured tip 15 being passed through the stopper 12. The clamps 5 made of polyamide have a width of tape. 2.5 - 3 mm. After comparing the wave profiles on both sides of the section 3 of the manubrium and the repositioning of the bone fragments 1 and 2, the clamps 5 are tightened in the case with a tensile force of 2.5.10 Pa. A US-made Panduit GS2B tensioner can be used for metered compression. After fixing, the strip 10 is cut off from the side of the puncture tip 15 beyond the stopper 12 so that the tissues are not further injured after sewing. After sewing the soft tissue and the skin, a sterile dressing is placed. In this way, a stable osteosynthesis of the sternum is provided, ensuring that the fragments are slid against each other in a longitudinal direction, achieving a tight contact on the contact surfaces. Fixation with non-metallic flexible brackets allows for urgent or planned resternotomy without wasting time removing the staples that cut with the bone, also allowing for radiographs and nuclear magnetic diagnostics.

As described above, 130 patients were treated by wavy sternotomy of the manubrium, with no displacement of the bone fragments in the postoperative period, and a sternum healing on average 10 days faster than the classical methods. In addition, experimental thoracotomies were performed on experimental animals - dogs, with similar results reported.

The wavy profile can be achieved by sawing or milling. An exemplary tool for treating the contact surfaces of bone fragments is shown in Figure 4.

The tool contains a tail 17 capable of being secured to a drill and a cutting part 18 to cut a portion of the bone. The working surface of the cutting part 18 is rotary with a wavy profile along its length. The cutting part 18 can be made as a milling cutter or a saw. Figure 5 shows a composite tool whose tail 17 and cutting part 18 are made separate. The tail 17 is of extension 19, having a square or other suitable cross section for torque transmission. The cutting part 19 is fitted with a cutting part 18 having a through hole whose cross-section in shape corresponds to the cross-section of the extension 19. The cutting part 18 is fixed axially by the tail 17 with a stop 20 and is pressed against the front by a screw connection 21. The stop 20 can be designed to support the bone and limit the length of the wavy surface.

The exemplary embodiments described are for illustration only and do not limit the invention, the scope of which is determined solely by the scope of the appended claims.

Claims (9)

Claims 1. A bone ligament comprising at least two bone fragments, each having at least one serrated contact surface, the projections of the contact surface of one bone fragment being disposed in the recesses of the contact surface of the opposite bone fragment including a retaining means for fixing and a fixed attachment of the bone fragments to one another, characterized in that the jagged contact surfaces of the bone fragments (1,2) are formed by a wavy profile; The locking means is a clamp made in the form of a flexible non-metallic strip (10) with notches (11) along one longitudinal surface and with a fastener at one end, made as a stopper (12) with a central opening (13) in which it is perpendicular mounting stop (14), 5 entering the notches (11). 2. The method of making a bone ligament according to claim 1, comprising treating the contact surfaces for osteosynthesis by initial linear or 10-figure osteotomy of comparable bone fragments to form plane contact surfaces, notching at least two comparable contact surfaces, the protuberances of one contact surface to enter the recesses of the other contact surface, repositioning of bone fragments with subsequent enclosure and compression at dosage ompresiya with fixing means, ha- 20 characterized in that that the toothing is to obtain a corrugated profile in at least one direction; the height between the adjacent recesses and the projection of the corrugated profile is from about 2 to about 4 mm. 25 Method according to claim 2, characterized in that the corrugated profile is obtained by sawing or milling. Bone jointing means according to claim 1, comprising a flexible non-metallic strip with one end made as a punctured tip and the other end provided with a fastener, characterized in that the strip (10) of the retainer is serrated (11) 35 along one longitudinal surface; the fastener is made in the form of a stopper (12) with a central opening (13), in which the stop (14) for entering the teeth is perpendicular. Fixing means according to claim 4, characterized in that the strip (10) has perforations (16) along its length for bone tissue penetration. Fixing means according to claim 4 or 5, characterized in that the strap (10) and the stopper (12) are made of biocompatible plastic or fabric-resorbable plastic. 7. A bone joint contact surface treatment tool according to claim 1, comprising a tail and a serrated workpiece, characterized in that the workpiece has a rotatably wavy surface (18) along its length and the tail is shaped as a mounting tail ( 17) for power tools. A tool according to claim 7, characterized in that the tail (17) and the toothed workpiece are made separately, the tail (17) extending (19) at one end to which the axially working part, both parts being secured against rotation relative to each other. A tool according to claim 7 or 8, characterized in that the rotary wavy surface (18) is formed as a cutter or a saw.