RU158953U1 - DEVICE FOR BONE TRANSPLANT FACILITATION FROM THE ILL BONE COMB - Google Patents

Abstract

A device for collecting a bone graft from the iliac wing crest, including a working part made in the form of a hollow body without a lower base, in the form of a parallelepiped, the upper base of which has a rigidly fixed tube with an internal threaded thread and a straight handle screwed into it with a cap and external thread, as well as a pair of holes with a diameter of 0.5 cm for extraction of the transplant, while the side faces from below are made as double-edged blades, case dimensions: height 2.5 cm, width 2.0 cm, length 5.0 cm.

Description

The proposed utility model relates to medicine, namely to orthopedics and traumatology, and can be used if necessary to take a cortical-spongy bone graft from the iliac crest.

Plastic surgery with a cortical-spongy transplant has long been widely used in traumatology and orthopedics with the goal of replacement, support and stimulating osteogenesis in the treatment of false joints and bone defects. One of the most common methods of bone grafting is autoplasty with a cortical-spongy graft taken from the iliac wing. This is due to both good blood supply to the bone tissue and the possibility of taking a sufficient volume of tissue without the threat of disturbing the supporting and protective properties of the pelvis. However, the traditional method of graft collection using known devices is not without drawbacks, these include:

1. The likelihood of the osteotomy line going beyond the intended limits with a weakening of the mechanical strength of the anterior iliac crest;

2. The formation on the donor site of a step defect, which is a cosmetic defect and may cause inconvenience when wearing clothes.

A known instrument for collecting a bone graft in the form of a cylindrical hollow cutter. (Comparative analysis of different methods for taking bone grafts from the iliac crest for spinal fusion. Drakin A.I., Baskov A.V., Uchurov O.N., Baskov A.V. Bulletin of Traumatology and Orthopedics named after N.N. Priorov . 2008, No. 3. P. 71-74.)

A disadvantage of the known instrument is that when it is used, there is a high probability of penetration into the pelvic cavity with damage to the pelvic organs, the bone graft is a cylinder with a base diameter of 4 mm, which does not always correspond to the shape of the replaced defect, therefore, repeated graft pickups may be necessary, which increases operation time and necessitates the expansion of access. The disadvantages of the device include the need to use a drill, which complicates the process technology.

The closest adaptation adopted for the closest analogue is a chisel. The traditional technique of graft collection from the iliac crest using a chisel involves the following sequential actions.

Make an incision along the projection of the ridge to the bone. Using a wide raspator, muscles are separated from the inner and outer surfaces of the bone for a length corresponding to the size of the required transplant. Then, with a chisel, a thin bone plate is knocked down from the upper surface of the ridge and turned away to the side, after which they also begin to take the graft with a chisel. Depending on the task, the graft is taken with one or both cortical plates of the iliac wing or generally only from the crest. The transplant can be taken in a single block of the appropriate shape and size, or in the form of several fragments. The disadvantages of the traditional method is the difficulty of taking a bone graft at a time, one block of the required size, which leads to the need for re-collection of the graft, or the graft is unreasonably large. Moreover, the use of this method leads to the formation of a cosmetic defect due to a violation of the integrity of the iliac crest (Fig. 1 - defect of the iliac wing when receiving a graft using a bit.)

The objective of the proposal is to create the ability to simultaneously obtain a bone graft of a given size. Technical result:

1. Elimination of the likelihood of graft splitting and osteotomy line beyond the intended bone limits;

2. Preservation of the functional anatomy of the donor site.

The essence of the utility model is that the device is made in the form of a hollow parallelepiped-housing without a lower base - the working part, the upper base of which has a rigidly fixed tube with an internal thread and a straight handle screwed into it with a cap, with an external thread, and a pair of holes with a diameter of 0.5 cm for the extraction of the graft, while the side faces from below are made as double-edged blades, and a number of frame sizes are provided: 2.5 cm high, 2.0 cm wide, and 5.0 cm long., 4 , 0 cm., 3.0 cm.

For a better understanding, the device is schematically depicted in figure 1 - a general view of the working part of the device and figure 2 - a general view of a removable handle, where 1 is a rigidly fixed tube with internal thread, 2 is a body, 3 is a handle, 4 is a hat on a handle, 5 - openings for extracting the graft, 6 - sharp edges, blades, 7 - threaded connection.

The device is used as follows. Patient position on the back or on the side. Access the projection of the iliac crest to the bone. The muscles are separated by a raspator from the outer surface of the ilium wing for a length corresponding to the size of the required transplant. Then, after connecting the handle 3 to the tube 1 with the working part of the device 2 by means of the threaded connection 7 of the handle 3, the working part of the device is installed in the place designated for graft taking, departing from the top of the iliac crest 1.5-2 cm, with a base with sharp edges 6 perpendicular to the cortical plate of the ilium wing, taking one hand by the handle 3 with a few blows of the hammer on the hat 4 of the handle, introduce the device into the iliac wing, until the intersection of both cortical plates and / or imaging that through the holes 5, then the device is removed, by the handles 3, together with the autograft located inside the working part of the device. The graft is taken as a single unit of the appropriate shape and size, which are determined by the selected size of the working part.

The proposed device was applied to 15 patients, while it was found that the device provides the possibility of simultaneous graft capture as a single unit, the required size, depending on the selected standard size of the working part. The design features of the device make it possible to avoid both the osteotomy line leaving the area selected for graft capture and the splitting of the graft itself, which remains inside the working part of the device. A reduction in the time spent on this stage of the operation was also noted. Example: Patient M., 43 years old, diagnosis: chronic post-traumatic osteomyelitis in remission of the left ulna. False joint of the left ulna in the middle third. 3 years ago he received an open fracture of the left ulnar bone. At the place of residence, intramedullary osteosynthesis of the ulna was performed with a metal rod. The postoperative period was complicated by a purulent infection. For this reason, the rod has been removed. 1.5 years after the removal of the rod, a pathological fracture of the left ulnar bone occurred and a false joint formed. 11.11.2014, the patient was admitted to a staged treatment. A resection of the pseudoarthrosis was performed, a 3 × 2 × 2.5 cm graft, taken using the device from the iliac wing crest, was placed in place of a bone defect 3 cm long, and osteosynthesis of the forearm was performed using the Ilizarov apparatus. There was a fusion of the fracture. As a result of treatment, limb function was restored, complaints of pain, discomfort, cosmetic defects at the site of graft collection were absent. At the follow-up examination after 1 month: there were no complaints of pain, discomfort, cosmetic defects at the site of graft collection.

Patient S., 54 years old, diagnosis: chronic post-traumatic osteomyelitis in the stage of remission of the right tibia. False joint of the right tibia in the lower third. Anamnesis: A patient received an open fracture of the right tibia 4 years ago. At the place of residence, a synthesis plate was performed. The postoperative period was complicated by a purulent infection. For this reason, the metalwork has been removed. 1 year after the removal of the rod, a pathological fracture of the right tibia occurred and a false joint formed. 2.12. 2014 was admitted to a staged treatment. A resection of the pseudoarthrosis was performed, after which a 4 cm long bone defect was formed, a 4 × 2 × 2.5 cm graft was taken to the site of the bone defect, taken using the device from the iliac wing, as follows: access was made to the projection of the iliac crest bones. The muscles were separated by a raspator from the outer surface of the iliac wing for the length corresponding to the size of the necessary transplant, then the working part of the device was installed in the place designated for graft collection, departing from the top of the iliac crest 1.5-2 cm, with a base with sharp edges perpendicular cortical plate of the iliac wing and several strokes of the hammer on the handle hat, the working part of the device was inserted into the iliac wing, until the intersection of both cortical plates visualization through graft holes, then the device removed, the handle, together with autograft located inside the working of the device. Thus, the graft was taken as a single unit 4 × 2 × 2.5 cm in size necessary to replace the defect formed after resection of the false joint. Osteosynthesis of the lower leg was performed by the Ilizarov apparatus. There was a fusion of the fracture and restoration of limb function, when discharging a complaint of pain, discomfort, cosmetic defects at the site of the graft collection were absent. At the follow-up examination after 1 month, there were no complaints of pain, discomfort, cosmetic defects at the site of graft collection.

Claims (1)

A device for collecting a bone graft from the iliac wing crest, including a working part made in the form of a hollow body without a lower base, in the form of a parallelepiped, the upper base of which has a rigidly fixed tube with an internal threaded thread and a straight handle screwed into it with a cap and external thread, as well as a pair of holes with a diameter of 0.5 cm for extraction of the transplant, while the side faces from below are made as double-edged blades, case dimensions: height 2.5 cm, width 2.0 cm, length 5.0 cm.

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