RU112022U1 - DEVICE FOR IMPLEMENTING OSTEOSYNTHESIS - Google Patents

Abstract

A device for the implementation of osteosynthesis, containing a body with a rigidly T-shaped fixed guide sleeve with a hole with a diameter of 10.0 mm for a jig sleeve with the possibility of its movement and fixation with a set screw, characterized in that a guide sleeve with a hole in diameter 8.0 mm for the coordinate bar with a guide sleeve rigidly fixed at the end of the bar with a 2.0 mm hole for a lined (10.0 mm each) coordination spoke with the possibility of adjusting and fixing it, located in the same plane with the axis of the jig bushing channel and perpendicular its axis.

Description

The utility model relates to medical equipment, namely to surgical instruments used in traumatology and orthopedics, and can be used for cortical osteosynthesis of the calcaneus and intramedullary osteosynthesis of tubular bones.

A device known as a “needle guide” comprising a housing with bone fixing elements and a guide assembly having a spoke holder located in the housing with the ability to move in the same plane and rotate, characterized in that, in order to ensure the movement of the spokes in all planes, the spoke holder is made in the form of a ball with a tube having a longitudinal channel under the spoke and installed in the housing using plates with an opening for a ball of a spoke holder located in the housing with the possibility of movement in the plane of the plates and fixing via clamps the plates (RF patent №2012276, 15.05.1994).

It is known "Device for osteosynthesis of fractures of the proximal end of the humerus" containing a osseous plate with holes and teeth for insertion into the head of the humerus, characterized in that the length of the teeth is 150-180% of the diameter of the head of the humerus, and the immersed half of the teeth are made parallel to each other and at an angle of 95-140 ° to the axis of the plate, and the osseous halves of the teeth diverge at an angle of 30-40 ° and are curved arcuately along the longitudinal relief of the metaphysis (RF patent No. 2143862, 10.01.2000).

A device is known "Self-locking needle for the treatment of fractures of the femoral neck" containing a sharpened proximal end, characterized in that the proximal end of the spoke is an elastic locking element made, for example, in the form of an elastic lobe, in the treatment of unstable fractures at the distal ends of the spokes emerging from bones, springs are located (RF patent No. 25159, 09/20/2002).

Known devices do not allow knitting needles to precisely specified bone coordinates.

A device for transosseous osteosynthesis of fractures of the surgical neck of the humerus. The device contains two arcs connected by threaded rods, brackets and transosseous clamps. The device is characterized in that the proximal portion of the spoke fixing the head of the humerus is corkscrewed with a length of 1.5-2.5 cm and a diameter of turns from 0.8 to 1.2 cm (RF patent for utility model No. 72842, 10.05. 2008).

The closest in technical essence is a "device for conducting knitting needles", containing a guide with a hole for the conducted knitting needles, pivotally mounted in a fork. The device is also equipped with a threaded rod and a removable additional guide knitting needle and a bracket for securing the conducted and additional guide knitting needles at a distance sufficient to accommodate the limb. The plug is made at the end of a threaded rod (RF patent No. 2197916, 02/10/2003).

The disadvantages of the prototype device include: the inability to accurately hold the spoke in the bone in the absence of free space on the opposite side of the bone, for example, in the spongy bone in the direction of the articular surface or along the axis of the medullary canal inside the tubular bone, as well as the complexity of the design, its manufacture and use.

The objective of the claimed device is the development of a simpler and more effective design that ensures accurate holding of the knitting needle in the calcaneus, ending blindly, in the direction of the articular surfaces, as well as for accurately holding the guide needle from the epimetaphysis of the tubular bone inside the medullary canal to the specified coordinates when performing intramedullary osteosynthesis .

The problem is solved in that the device for osteosynthesis is equipped with a housing with two bushings, one of which has one of the replaceable conductive bushings with a hole of a certain diameter: 1.5 mm, 2.0 mm, 2.5 mm 3.5 mm or 4 , 5 mm for holding a spoke or drill, as well as the fact that the device is equipped with a coordinating spoke, with the possibility of adjusting its position and fixing on the coordinate rod, which, in turn, is fixed in the second sleeve of the housing with the possibility of adjusting its position and fixing.

The technical result is the provision of stable fixation of a calcaneus fracture, with minimal trauma to the soft tissues, due to the exact conduct of the spokes or the formation of channels in the bone for the screws in the given coordinates, due to the number and position of fragments; the ability to regulate in several planes provided by the proposed device allows you to hold the spoke or execute a channel in the bone in the right direction from the first time, which significantly reduces the radiation load on the patient and the doctor when using fluoroscopy and reduces the duration of the operation. This is achieved by the fact that the coordinating spoke, having divisions with a pitch of 1.0 cm, is perpendicular to the axis of the hole of the conductor sleeve and provides the arrangement of the device parts at a distance sufficient to accommodate the limb segment, as well as the ability to adjust the distance between the end of the coordinating spoke and the axis of the conductor sleeve channel. Thus, the spoke or drill is carried out in exactly the specified direction: in the plane of the device axes and at a predetermined distance from the end of the guide pin.

The utility model is illustrated by drawings (Fig.1-10), which in a perspective view shows the proposed device.

A device for osteosynthesis (Figure 1-2) comprises: a housing 1, a guide sleeve 5, T-shaped fixed at one end of the housing 1, with a hole with a diameter of 8.0 mm for a coordinate rod 2 and a threaded hole for a set screw 6, T-shaped at the opposite end of the housing 1, a guide sleeve 7 with a hole with a diameter of 10.0 mm for a conductor sleeve 3 and a threaded hole for a set screw 8; coordinate rod 2 with installation holes 12 made along its entire length with a pitch of 15.0 mm, with a guide sleeve 9 rigidly fixed to the end of the coordinate rod 2 with a threaded hole for the set screw 10 and with a hole with a diameter of 2.0 mm for a coordinating spoke 4 with a diameter of 2 , 0 mm, located in the same plane with the axis of the channel of the conductor sleeve 3 and perpendicular to its axis, divisions with a pitch of 10 mm are plotted on the coordinating spoke 4; a set of conductive bushings 3 pointed from one edge and provided with a handle 11 from the other edge, for the convenience of axial movement in the bush 7, having a hole for spokes and drills with a diameter of 1.5 mm, 2.0 mm, 2.5 mm, 3.5 mm and 4.5 mm; On the outer surface of the conductor sleeve 3, a flat is made to prevent rotation when fixing it with the set screw 8. The conductor sleeve 3 is located in the hole of the guide sleeve 7, by longitudinal movement it is set to the required position and fixed with the set screw 8. The coordinate rod 2 is located in the holes of the guide sleeve 5, by longitudinal movement is installed in the required position and fixed by the set screw 6. Coordinating spoke 4 is installed in the hole guide sleeve 9 and is fixed in position by the set screw 10.

All parts of the device are made of stainless steel. The device is disinfected after each use. In addition to the listed parts of the device for osteosynthesis, the following notation is shown and entered in the figures (Figs. 3-10): 13 — X-ray contrast grid, 14 — foot, 15 — spoke 1.5 mm in diameter, 16 — calcaneus, 17 — cannulated screw “ FusiFIX ", 18 - image of the calcaneus on a computer tomogram, 19 - point" B ", corresponding to the projection of the point of the spoke 15 on the lateral surface of the calcaneus, 20 - point" C ", corresponding to the projection of the inlet of the spoke 15, 21 - point" A " corresponding to the actual location of the point of the spoke 15 in f accurate bone. These designations explain the use of the device in clinical practice.

A device for osteosynthesis is used as follows.

To determine the position of the fragments in the preoperative period, X-ray of the calcaneus 16 is made in standard projections, if necessary, computed tomography 18 is performed (Fig. 5), the results of which, taking into account the location of the fragments, determine the position of the axes and lengths of the knitting needles and screws.

The patient is placed on an X-ray opaque operating table on a healthy side, so that the outer surface of the foot 14 is directed upward. After processing the surgical field, under the control of fluoroscopy, a closed or, if necessary, open reposition of calcaneus fragments 16 is performed using one of the known methods. An X-ray coordinate grid 13 is placed on the outer surface of the foot 14 in the projection of the calcaneus 16 and a lateral radiograph of the calcaneus 16 is performed (Fig. 3), based on which, focusing on the cells of the grid 13, marks are applied on the skin corresponding to the planned projections on the lateral surface of the calcaneus bone 16 of the tip of the spoke 15 and the projection of its inlet (Figure 4). Knowing the length of the interval "AB", calculated according to computed tomogram 18 between the lateral wall of the calcaneus 16 and the tip of the needle 15 planned for holding (Figure 5), moving the coordinating spoke 4 in the sleeve 9, set the interval "ab" to the same length ( ab = AB) between the end of the coordinating spoke 4 (point "b") and the intersection of the axis of the coordinating spoke 4 with the axis of the hole of the conductor sleeve 3 (point "a"). In a predetermined position, the coordinating spoke 4 is fixed with a set screw 10 (FIG. 6). Moving the coordinate rod 2 in the guide sleeve 5, set the length of the interval "AC" between the intersection of the axis of the coordinating spokes 4 with the axis of the hole of the conductor sleeve 3 (point "a") and the near edge of the guide sleeve 5 equal to the length of the segment "AC" (Figure 5.) between the tip and the inlet planned for holding the spoke 15. plus 2-3 cm (ac = AC + 3 cm). In a given position, the coordinate rod 2 is fixed in the guide sleeve 5 with a set screw 6 (Fig.7).

Using the markings on the skin obtained after radiography with an X-ray contrast coordinating grid 13 (Figs. 3–4), the tip of the coordinating spokes 4 pierce the skin along the outer surface of the foot 14 in the projection of the calcaneus 16 above the previously planned point “B”. The proposed device is positioned so that the axis of the coordinating spoke 4 is located in a horizontal plane, after which the coordinating spoke 4 is immersed through soft tissue all the way to the “point B” of the lateral wall of the calcaneus 16. A skin incision up to 1.0 cm long is performed in the previously projected projection the corresponding inlet "C", through which, using the handle 11, immerse the junction sleeve 3, moving it in the hole of the guide sleeve 7, all the way to the "point C" of the wall of the calcaneus 16 and fix paid-screw 8 (Figure 8). Through the hole of the conductor sleeve 3, the spoke 15 is carried out to a predetermined depth, being guided by the residual length of the spoke 15, knowing its full length (Figure 9). In a similar way, the remaining planned spokes 15 are carried out. Osteosynthesis with spokes 15 can be independent, but to improve the stability of fixation, spokes 15 are, according to a known method, self-cutting cannulated spongy screws, FusiFIX screws 17 (Figure 10).

In the surgical treatment of fractures of tubular bones (intramedullary osteosynthesis), the use of the device is similar to that described above. For knitting needles and drilling channels of different diameters, a set of conductive bushings of appropriate diameters is proposed.

The performance of the claimed device is confirmed by a clinical example.

Patient C - new, 30 years old, medical history No. 852, was treated in the traumatology department of City Hospital No. 1, from July 21, 10 to August 12, 10, with a diagnosis of Closed comminuted intrasolar impression fracture of the right calcaneus with displacement of fragments, 07/30/10 Surgical treatment was performed: minimally invasive open reduction (skin incision 1.0 cm), cortical metal osteosynthesis with cannulated spongy screws inserted through knitting needles made using the proposed device. The limb was fixed with a plaster cast for up to 6 weeks. On the third day after the operation, the patient began to take a plaster cast, engaged in exercise therapy for the ankle and subtalar joints, after 1.5 months the patient was allowed a metered load on the limb, using an orthopedic insole, after 2.5 months the patient began to walk at full load. When walking metal structures do not interfere.

Thus, the claimed device allows for accurate, in three planes, the holding of knitting needles, both an independent type of fixation and for installing cannulated screws, which significantly improves the stability of fixation, reduces the time of surgery, reduces radiation exposure to the patient and the doctor, due to the lack of need repeatedly to reconnect the spoke and to control its conduct by fluoroscopy.

The use of the proposed device allows for cortical calcaneus osteosynthesis, can also be used when conducting a guide needle for subsequent intramedullary osteosynthesis of the thigh, lower leg, shoulder, ulna and radius, intramedullary osteosynthesis with segments of the knitting needles of the bones of the hand and foot. We performed 48 operations using this device: 21 on the calcaneus, 6 on the thigh, 7 on the shoulder, 12 on the lower leg, 1 on the ulna, 1 on the radius. In all cases, satisfactory results were obtained, confirmed by observation of patients over the next 12-18 months after surgery.

The utility model has the following advantages:

The device is technologically uncomplicated to manufacture, does not complicate the work of a trauma surgeon, ensures high quality of surgical treatment due to the precise holding of knitting needles, which ensures, accordingly, accurate holding of cannulated screws, improves the stability of fixation of fragments, reduces the radiation load on the doctor and patient, reduces the duration of the operation , which reduces the incidence of intra- and postoperative complications.

Claims (1)

A device for performing osteosynthesis, comprising a housing with a rigidly T-shaped guide sleeve with a hole with a diameter of 10.0 mm for the conductive sleeve with the possibility of its movement and fixing with a set screw, characterized in that a guide sleeve with a hole with a diameter is rigidly fixed to the body T-shaped 8.0 mm for a coordinate rod with a guide sleeve rigidly fixed at the end of the rod with a 2.0 mm hole for a lined (10.0 mm) coordination needle with the possibility of its regulation and fixing, located ennuyu coplanar with the axis of the channel and the sleeve of conductor perpendicular to its axis.