RU100392U1 - SUBMERSIBLE ROD FOR EXTERNAL PELVIS FIXING DEVICES - Google Patents

Abstract

 The immersion rod of the apparatus for external fixation of the pelvic bones, characterized in that it consists of an intraosseous part and a threaded one used to fix the rod with the apparatus, the intraosseous part is made in three sizes with a diameter of 4-5-6 mm, respectively, to three different immersion rods, the surface of the rod introduced into bone and soft tissue, covered with hydrocapapatitis.

Description

The utility model relates to medicine, namely to medical equipment in the field of traumatology and orthopedics for external fixation of the pelvic bones.

Violations of the integrity of the pelvic bones are noted in 12-20% of all cases of damage to the musculoskeletal system, of which in 27-52% unstable multiple injuries occur [Stelmakh, K.K. Treatment of unstable pelvic injuries: author. Thesis ... Doct. Sciences / K.K. Stelmakh. - Kurgan, 2005. - 54 s]. In recent years, external fixation devices equipped with different numbers and different designs of immersion rods have been used to treat such injuries. Basically, immersion rods of various geometric shapes are used, which does not always provide a reliable connection between the apparatus for external fixation of the pelvic bones and the bone [Blazhenko, A.N. Treatment of fractures and ruptures of the pelvic ring with external fixation devices based on the principle of anchor-spoke fixation to the bone: abstract. dis ... cand. honey. Sciences / A.N.Blazhenko. - Samara, 1999. - 16 p.]. After the insertion of the immersion rod into the bone, an osteolysis zone is formed around its perimeter, the connection of the rod with the bone weakens, and the rod becomes "unstable", therefore, the apparatus for external fixation of the pelvic bones cannot reposition and fix damage for a long time. When using immersed “unstable” rods, soft tissue inflammation is possible, which causes patient discomfort and can lead to removal of the rod.

Known immersion rods for apparatus for external fixation of the pelvic bones [Patent RU No. 2128020, from 03/27/99. Bull. No. 9] having a conical shape. The disadvantage of this immersion rod is the only size that does not allow to adapt the rod to the individual structural features of the pelvic bones in patients.

Known immersion rods for an apparatus for external fixation of the pelvic bones, consisting of a section inserted into the bone tissue, a smooth surface in contact with soft tissues and skin, and a screw part designed to fix the rod with the apparatus [Lobanov, G.V. Morpho-biomechanical choice of the type of bone-apparatus connection in the treatment of severe pelvic injury / G.V. Lobanov // Diagnosis, treatment and rehabilitation of patients with damage to the pelvic bones / ed. S.M. Kutepova. Yekaterinburg, 1996. - S. 42-48]. One of the disadvantages of these rods is the presence of a smooth surface in the middle part of the rod, which makes it possible for soft tissues to slip relative to the rod and in some cases leads to the development of aerobic infection and the inflammatory process around the rod. A limited area of the screw part of the rod reduces the reposition and fixation capabilities of the apparatus.

With the closest technical solution known immersion rods (figure 1) used in the apparatus for external fixation of the pelvic bones [Patent RU No. 46424, 07/10/2005] and selected by us as a prototype, the immersion part (1) of which has six sizes, the average part (2) is rough, the rest is coated with thread (3) for connection with the device. The disadvantage of this device is the cumbersome design of the apparatus due to the large number of immersion rods and insufficient fixation of the immersion rods with the apparatus due to the short part of the threaded surface (3) of the rod, the existing rough surface does not have osteoinductive properties inherent in hydroxyapatate.

The objective of the present invention is to develop the design features of immersion rods for devices for external fixation of the pelvic bones, providing reliable connection of the apparatus with the bone, which will improve its reposition and fixation properties, as well as reducing the possibility of developing inflammatory processes around the rods.

The technical result is achieved by using immersion rods (Figure 2) of three sizes, the diameter of the intraosseous part (4) of which corresponds to the width of the diploetic layer of the pelvic bones and the anatomical features of the region into which they are inserted. The upper part of the rod has a thread (5), which serves for fixing with the external structure of the apparatus. The rough loose surface of hydroxyapatite ensures bone growth in the immersion shaft, providing a solid fixation of the rod in the bone tissue. The bioactive coating of the core of hydroxyapatite (6) prevents the soft tissue from sliding around the core and prevents the multiplication of anaerobic and aerobic microflora, preventing the development of the inflammatory process around the core, which prevents the development of bone osteolysis and inflammation of soft tissues. A simple utility model is proposed that has significant advantages over immersion rods used in practical healthcare.

The technical result is achieved by the fact that the immersion rod of the apparatus for external fixation of the pelvis according to the invention consists of an intraosseous part and a threaded one used to fix the rod with the apparatus, the intraosseous part is made in three sizes with a diameter of 4-5-6 mm, respectively, to three different immersion rods, the surface of the rod, introduced into bone and soft tissues, is covered with hydrocapapatitis.

The proposed utility model is illustrated by graphic material. The figure 2 presents a drawing of the proposed immersion rod having an intraosseous part (4), a threaded (5) and a part coated with hydrocapapatite (6).

Practical use of the proposed invention. In accordance with the width of the diploetic layer of the pelvic bones and the anatomical features of the injection area, an immersion rod with the required diameter of the intraosseous part is selected. During the operation, small punctures of the skin are made in the places of the alleged insertion of the immersion rods, an awl is formed in the channel through which the immersion rod is inserted to the depth of the intraosseous part, then the threaded part of the rod is fixed with nuts with the external design of the apparatus.

Examples of practical use:

Example 1

Patient K., 56 years old, was admitted to the Tyumen Design Bureau No. 2 after a road injury. As a result of the examination, a clinical diagnosis of Rotationally unstable pelvic damage was established. A rupture of the pubic symphysis with a 4 cm difference, a rupture of the anterior section of the right sacroiliac joint. ” The patient underwent surgery - pelvic osteosynthesis with an external fixation device in the form of a front support using the proposed design of immersion rods. In accordance with the anatomical features and the width of the diploetic layer of the pelvic bones, immersion rods with the necessary diameter of the intraosseous part were chosen (rods with a diameter of 4 mm were used). Before the introduction of the rods from small punctures of the skin, guide channels were formed with an awl, along which the immersion rods were inserted to the depth of the intraosseous part, then the rods with the external structure of the apparatus were fixed with nuts using the threaded part. The patient is activated 3 days after surgery. Fixation lasted for 3 months. Fusion of gaps achieved. For the entire period of fixation in the apparatus, the patient did not experience instability of the rod. When removing the rods had to apply significant physical effort, which indicates a strong connection of the rod with the bone. Inflammatory processes during the observation of the patient are not marked.

Example 2

Patient P., aged 26, was admitted to the Tyumen Design Bureau No. 2 after a catastrophe. On the basis of clinical and radiological data, a diagnosis of vertically unstable pelvic damage was established. Fracture of the ilium on the left, pubic and ischial bones on both sides. Vertical displacement of the left half of the pelvis. " The patient underwent an operation - pelvic osteosynthesis with an external fixation apparatus in the form of an annular support using the proposed design of immersion rods. In accordance with the width of the diploetic layer of the pelvic bones and the anatomical features of the injection area, we selected rods with the necessary diameter of the intraosseous part (rods with a diameter of 5 mm were used). Before the introduction of the rods from small punctures of the skin, guide channels were formed with an awl, along which the immersion rods were inserted to the depth of the intraosseous part, then the rods with the external structure of the apparatus were fixed with nuts using the threaded part. The patient is activated on the 6th day after the operation. Reposition bias was performed for 12 days. Fixation lasted for 2 months. Fusion of fractures in the achieved position is achieved. For the entire period of fixation in the apparatus, the patient did not experience instability of the rods. When removing the rods had to apply significant physical effort, which indicates a strong connection of the rod with the bone. Inflammatory processes during the observation of the patient are not marked.

Example 3

Patient C.36 years old was admitted to the hospital # 2 from a remote area of the region 3 weeks after a road injury with a diagnosis of “Vertically unstable pelvic damage.” Rupture of the sacroiliac joint on the right, compression fracture of the lateral mass of the sacrum on the left, fractures of the pubic and ischial bones on both sides, rupture of the symphysis. The vertical displacement of the right half of the pelvis. Rotational displacement of the left half of the pelvis. " The patient underwent an operation - pelvic osteosynthesis with an external fixation apparatus in the form of an annular support using the proposed design of immersion rods. In accordance with the width of the diploetic layer of the pelvic bones and the anatomical features of the injection area, rods with the required diameter of the intraosseous part were chosen. Before the introduction of the rods from small punctures of the skin, guide channels were formed with an awl, along which the immersion rods were inserted to the depth of the intraosseous part, then the rods with the external structure of the apparatus were fixed with nuts using the threaded part. The patient is activated on the 12th day after the operation. Reposition bias was performed for 17 days. Fixation lasted for 3 months. Fusion of gaps and consolidation of fractures in the achieved position have been achieved. For the entire period of fixation in the apparatus, the patient did not experience instability of the rods. When removing the rods had to apply significant physical effort, which indicates a strong connection of the rod with the bone. Inflammatory processes during the observation of the patient is not marked.

This device was introduced on the basis of the Design Bureau No. 2 of Tyumen and used in the treatment of 15 patients. The fixation period in the apparatus averaged 89 days. Assessment of the economic and positive effect of the proposed device is carried out in comparison with the prototype and is presented in the table. The absence of inflammation in the area of the rods made it possible to reduce the hospital stay of patients by an average of 12 days, the frequency of dressings decreased from 3-4 times a week to 1 time per week. The economic effect amounted to 18 thousand 840 rubles in the treatment of 15 patients. The lack of re-hospitalization allows you to save 1 million 884 thousand rubles per 100 operated.

Table Distinctive features of the proposed device in comparison with the prototype Signs Prototype Proposed device 1. The number of sizes of immersion rods 6, which creates excessive cumbersome apparatus. 3 rods provide optimal conditions for osteosynthesis, taking into account the individual structural features of the pelvic bones. 2. The presence of bioactive coating Absent. Hydroxyapatite was used, which allows this device to be attributed to nanotechnology. Hydroxyapatite refers to biologically active substances that improve the processes of reparative regeneration of bone tissue. 3. Characterization of the surface of the device A rough surface only in the area of the shaft in contact only with soft tissues. Rough porous surface in the area of the shaft in contact with soft tissues, as well as with bone tissue, which creates conditions for bone tissue to grow into the porous surface of the rod, which enhances the fixation properties of the device 4. Duration of inpatient treatment 32 beds / day 20 beds / days 5. The need for re-hospitalization as a result of the development of postoperative complications Repeated hospitalization is recorded in 13.8% of cases of pelvic osteosynthesis No cases of re-hospitalization Number of weekly dressings 3-4 times 1 time 6. The cost of surgical treatment of the 1st patient 73 thousand 440 rubles 54 thousand 600 rubles 7. The cost of surgical treatment of 100 patients, taking into account the occurrence of postoperative complications 7 million 344 thousand rubles 5 million 460 thousand rubles

Claims (1)

The submersible rod of the apparatus for external fixation of the pelvic bones, characterized in that it consists of an intraosseous part and a threaded one used to fix the rod with the apparatus, the intraosseous part is made in three sizes with a diameter of 4-5-6 mm, respectively, to three different immersion rods, the surface of the rod introduced into bone and soft tissue, covered with hydrocapapatitis.