RU108946U1 - DEVICE FOR REPOSITION AND FIXING OF ATLANT'S BLOCKING Fractures - Google Patents

Abstract

 The device for reposition and fixation of burst fractures of the atlas consists of two locking knitting needles with screw thread, pointed ends and removable reposition parts, including: a metal arc, two reposition bowls, brackets for fixing reposition bowls, reposition and fixing nuts, two guide conductors, screws fixing guides-guides of 2 channels of guides-guides at an angle of 35 ° to the horizontal and 10 ° to the frontal plane.

Description

The utility model relates to the field of medicine, namely, to medical equipment in the field of traumatology, orthopedics and neurosurgery, designed to reposition and fix fractures of the first cervical vertebra (atlas).

Fractures of the first cervical vertebra are severe injuries of the craniovertebral region and are accompanied by a significant discrepancy in the lateral masses of the atlas, which leads to total instability and impaired supportability of the cervical spine. Atlant fractures account for 43% [Stulik J., Vyskocil T., Sebesta P., Kryl J. Combined atlantoaxial fractures. Acta Chir Orthop Traumatol Cech. 2005; 72 (2): 105-10] and 25% [Kakarla U.K., Chang S.W., Theodore N., Sonntag V.K. Atlas fractures. Review Neurosurgery. 2010 Mar; 66 (3 Suppl): 60-7] from fractures of the craniovertebral region. The domestic literature describes conservative treatment methods using plaster casts to fix the spine. Foreign authors have developed a method of treatment with a halo device. The devices described in the literature are intended for long-term fixation of the spine with bulky structures. However, in available domestic and foreign literature, we have not identified devices for minimally invasive reposition and fixation of Atlant fractures (Jefferson fractures).

A device for fixing stable Jefferson fractures using a gypsum corset is described [Kesterson L., Benzel E., Orrison W., Coleman J. Evaluation and treatment of atlas burst fractures (Jefferson fractures). J. Neurosurg. 1991 Aug; 75 (2): 213-20.]. This device is applicable only to patients with injuries that do not require reposition.

A device for fixing Atlant fractures with a halo-apparatus using parts from the Ilizarov apparatus and a plaster corset [Vetrile S.T., Kolesov S.V. Efficiency of halotraction in surgery of the cervical spine. Journal of Neurosurgery NN Burdenko, 2001. - No. 1. - S.15-19], as well as a device for reposition and fixation of fractures of the craniovertebral region with a gallopart without applying a gypsum corset [N.Boos, M.Aebi. Spinal disorders. Springer 2008. P.847-848]. Both of the described devices allow only indirect traction reposition due to the tension of the capsule-ligamentous apparatus of the cervical spine and craniovertebral transition, which excludes a direct effect on bone fragments and it is far from always possible to achieve anatomical reposition.

Amory J.F. et al. proposed a device for open reposition and fixation of Atlant fractures and damage to the cranio-vertebral region using screws and plates [Haid R.W. Jr. et al. Advances apinal stabilization. Karger. 2003. P.128-130]. The proposed method was used by us as a prototype. The use of this device is accompanied by significant blood loss and a high risk of infectious complications.

The objective of the present invention is to develop a new, technically simple device for minimally invasive reposition and fixation of bursting Atlant fractures.

The technical result is simple, not requiring large material costs, based on the use of removable repositional parts and fixing bursting vertebral fractures of spokes with a threaded surface and pointed at the end (Figs. 1, 2, 3).

The technical result is achieved by the fact that the device for reposition and fixation of burst fractures of the atlas, according to the invention, consists of: two locking knitting needles with screw threads, pointed ends and removable reposition parts, including: a metal arc, two reposition bowls, brackets for fixing reposition bowls, reposition and fixing nuts, two guide conductors, screws fixing guide conductors, 2 channels of guide conductors at an angle of 35 ° to horizontal and 10 ° to the frontal plane tee.

The proposed utility model is illustrated by graphic material. The figure 1 shows the details of the device, consisting of: a metal arc (1), an arm for fixing the reposition bowl (2), reposition bowls (3), reposition nuts (4), fixing nuts (5), guide conductors (6), screws fixing guide conductors (7), channels (8) of guide conductors with given angles (β = 10 °) and fixing spokes (9). The figure 2 presents the reposition bowl with the guide conductor (side view), consisting of: reposition bowls (3), the guide conductor (6), the screw fixing the guide conductor (7), the channel (8) of the guide conductor with the given angle (α = 35 °) and the fixing spokes (9). In figure 3 - a spoke having a screw thread on a surface with a pointed end (9). On the figure. 4 - regimen of fixing spokes (9) with an angle α = 35 ° in C _I (10) and C _II (11) vertebrae (front view). The figure 5 is a diagram of the introduction of fixing spokes (9) in the C _I (10) and C _II (11) vertebrae (side view).

The proposed device is used as follows: in the operating room, in the patient’s position on the back, after processing the surgical field, under vertical anesthesia, two vertical incisions are made below the mastoid processes 2-3 cm long. Using clamps, transverse processes of the first cervical vertebra are isolated. After that, repositional bowls with guide conductors fixed to it are installed on the transverse processes. With the compression of the repositional bowls, the reposition of laterally displaced lateral lateral masses of the atlas is achieved, the position of which is controlled intraoperatively using an electron-optical transducer (EOP) in two projections (direct through the mouth and lateral). After that, transarticular fixation is performed with spokes with a diameter of 1.5 mm through the holes in the guide-guides at an angle of 35 ° to the horizontal and 10 ° frontal plane. Fixing knitting needles are inserted into the bone tissue to a depth of 3-3.5 cm, the position of the knitting needles is controlled by the image intensifier tube in two mutually perpendicular planes. With the correct position of the locking knitting needles, the parts of the removable repositioner are removed in the following sequence: at the beginning, the screw fixing the guide-guide, then in series the guide-guide and a metal arc with repositional bowls.

An example of the practical use of the device.

Example 1

Patient R., 56 years old, was injured as a result of a load falling on the roof of a truck (at a construction site), received a vertical blow to the parietal region. From the place of injury he was delivered to the GPU TO OKB No. 2 of the city of Tyumen. On admission examined (examination by a traumatologist, neurosurgeon, clinical minimum, radiography of the cervical spine in the direct, lateral projections and through the mouth). On the day of admission to the clinic, a burst Atlant fracture with lateral displacement of the lateral masses was diagnosed.

The patient was hospitalized in the traumatology and orthopedic department. After preoperative preparation on November 27, 2008, a minimally invasive operation was performed: "Reposition of the burst Atlant fracture and transarticular fixation" using the proposed device.

Progress of the operation: in the operating room, in the patient’s position on the back, after processing the surgical field under general anesthesia, two vertical incisions were made below the mastoid processes 2.5 cm long on both sides. Using clamps, transverse processes of the first cervical vertebra were isolated. After that, repositional bowls with guide conductors fixed to it were installed on the transverse processes. With the compression of the repositional bowls, the reposition of laterally displaced lateral lateral masses of the atlas, the position of which was controlled by the image intensifier in two projections, was achieved. Then transarticular fixation was performed with spokes with a diameter of 1.5 mm with thread and pointed ends through the holes in the guide-guides at an angle of 35 ° to the horizontal and 10 ° frontal plane. The spokes were inserted into the bone tissue to a depth of 3 cm, the position of the spokes was monitored using an image intensifier tube in two mutually perpendicular planes. The position of the locking knitting needles is correct. The guide conductors fixed by threaded connections are disconnected and the device is taken out of the wounds in parts: the screw fixing the guide conductor is removed, then the guide conductor and the metal arc with repositioning bowls.

In the postoperative period, the wound healed by primary intention, the cervical spine to the bone fusion was fixed by the head holder “Philadelphia”. Control radiography and computed tomography (CT) scan of the cervical spine after 3 months. after surgery, bone fusion was observed. Locking knitting needles removed after 3 months. 03/31/2009. The relationship in the cervical spine after removal of the spokes is correct, the function is in full.

Example 2

Patient O. 23 years old. He was injured as a result of diving headlong down into the water on July 2, 2009. From the scene of the incident he was taken to the GPLU TO OKB No. 2 of Tyumen. Upon receipt, he moved independently, while supporting his head with his hands. Upon admission, he was examined by a traumatologist and a neurosurgeon, and a radiography of the cervical spine was performed in a direct (through the mouth) and lateral projections. Diagnosis at admission: "Closed Jefferson fracture." After preoperative preparation, the patient underwent surgery. Progress of the operation: in the operating room, in the patient’s position on the back, after treatment of the surgical field under general anesthesia, two vertical incisions were made below the mastoid processes along the sternocleidis 2.5 cm long on both sides. Using clamps, transverse processes of the first cervical vertebra were isolated, repositional bowls with guide conductors fixed to it were installed on the transverse processes. By compression of the reposition bowls, the reposition of the displaced lateral masses of the atlas, the position of which was controlled by the image intensifier tube in two projections, was achieved. After that, transarticular fixation was performed with spokes with a diameter of 1.5 mm through the holes in the guide guides at an angle of 35 ° to the horizontal and 10 ° frontal plane. The spokes were inserted into the bone tissue to a depth of 3 cm, the position of the spokes was monitored using an image intensifier tube in two mutually perpendicular planes. The position of the locking knitting needles is correct. The device was removed from the wounds in parts: the screw fixing the guide-guide was removed, then the guide-guide and a metal arc with repositional bowls were subsequently removed. The patient was under the supervision of an orthopedic traumatologist for 6 months. Knitting needles removed after 3.5 months. in the operating room under general anesthesia. In the long-term period, she does not notice pain; the function of the cervical spine has fully recovered.

The proposed device has been tested in the clinic of traumatology, orthopedics and HPH of the Tyumen State Medical Academy in the treatment of burst Atlanta fractures. Conducted 14 operations. High efficiency of using the proposed device is noted. The device greatly simplifies the reposition and fixation of bursting atlant fractures. In addition, it reduces the risk of infection in the area of fixators, since all external repair devices are removed at the end of the operation, and internal fixation eliminates the need for a patient to be in massive fixing devices for a long time (thoraco-cranial gypsum dressing such as Minerva or a halo apparatus). This device allows you to reposition burst Atlant fractures directly affecting bone fragments, while the presence of a guide-conductor allows transarticular fixation of the atlanto-axial joints. Provided there is external fixation by the Philadelphia head clamp, the rigidity of fixation with threaded spokes is sufficient to achieve bone fusion fracture. Given the low invasiveness when using this utility model, the time spent by the patient in the hospital is significantly reduced compared with patients who underwent open reduction and fixation of fractures. The advantages of the proposed utility model in comparison with the prototype are presented in the table. The economic effect compared with the prototype and for 100 patients is 5804900 rubles. rub.

Claims (1)

The device for reposition and fixation of burst fractures of the atlas consists of two locking knitting needles with screw thread, pointed ends and removable reposition parts, including: a metal arc, two reposition bowls, brackets for fixing reposition bowls, reposition and fixing nuts, two guide conductors, screws fixing guides-guides of 2 channels of guides-guides at an angle of 35 ° to the horizontal and 10 ° to the frontal plane.