RU169919U1 - DEVICE FOR FEMALE - Google Patents

Abstract

Applies to medicine, devices for transosseous osteosynthesis, allows you to apply metered traction efforts to the femur in the distal-lateral direction relative to the pelvis to ensure its correct physiological position. The device contains the pelvic and femoral modules. The pelvic module is made of two arcs (4), left and right, interconnected in a horizontal plane by telescopic distraction rods (7). Spokes (1) and / or intraosseous rods (2) are fixed on each of the arches. The left arch is intended for attachment to the wing (5) of the left iliac bone, and the right arch is used for attachment to the wing (5) of the right ilium. The femoral module consists of an arch (4) and two rings (9) arranged in series one above the other, interconnected. On each ring there are knitting needles that are designed for fastening in the distal part of the femur. Intraosseous rods are installed on the arch of the femoral module, which are intended for attachment to the femur in the region of the greater trochanter. The pelvic module is pivotally connected to the femoral module by telescopic distraction rods directed in the distal lateral direction from the pelvic module to the femoral module. Three telescopic distraction rods are installed, through hinges (8), one end on the arch of the femoral module, the other end on the right (left) arch of the pelvic module. The fourth telescopic distraction rod through the hinges at one end is mounted on the ring of the femoral module, the second end is mounted on one of the telescopic distraction rods connecting in the horizontal plane of the arc of the pelvic module.

Description

Technical field

The utility model relates to medicine, to devices for transosseous osteosynthesis. More specifically, to external fixation devices intended for the treatment of diseases of the hip joint, accompanied by a violation of the anatomical integrity of the joint with pronounced proximal dislocation of the greater trochanter and rigidity of soft tissues, for example, diseases such as the false joint of the femoral neck or congenital dislocation of the hip.

State of the art

A known method of two-stage endoprosthesis replacement of the hip joint ([1], RU 2141804). Reduce the proximal end of the thigh to the required level by skeletal traction. Traction is carried out for the tuberosity of the tibia, spokes are carried out, they are fixed on a bracket, the bracket is connected with the load. Periodically increase the load, achieving reduction, after which the load is reduced in such a way as to keep the femoral component at the achieved level for 5-6 weeks. Then carry out the installation of the endoprosthesis of the hip joint. For traction, devices similar to the device for skeletal traction of the lower limb ([2], RU 2054899) are usually used, it contains a tire, a vertical frame, a bracket with a spoke, a cable with a load fixed on the bracket, and traction.

The use of this device [2] when implementing the method [1] does not provide physical activity of the patient in the process of lowering the thigh and is not very effective with severe rigidity of the hip joint. Hypodynamic complications are possible, the patient is forced to stay on the bed before surgery for the installation of the endoprosthesis for a long time, 6 weeks.

A known method of treating hypoplastic coxarthrosis ([3], RU 2288657). The method [3] includes dosed lowering of the femur using an external fixation device, resection of the head and neck of the femur, installation of the femoral and pelvic components of the endoprosthesis. First, the head and neck of the femur are resected and the pelvic component of the endoprosthesis is implanted, then the femur is reduced to a large trochanter distal to the pelvic component within two to three weeks, after which the femoral component of the endoprosthesis is implanted and the head is inserted into the cavity. The external fixation device described in the method [3] contains 4-5 knitting needles held in the wing of the pelvic bone, the knitting needles are fixed in the arch (pelvic module), 4 knitting needles with thrust pads are held in the lower third of the femoral diaphysis, the knitting needle is fixed in the ring (femoral module). The arc and the ring are interconnected by telescopic rods with hinges. The connection of the arc and the ring allows a gradual distraction to the necessary reduction of the femur.

In this method [3], the neck is resected and the head is removed from the cavity, and the pelvic component of the endoprosthesis is implanted. Then, with the external fixation device, a metered reduction of the femur to an equal leg length is carried out, followed by implantation of the leg and head of the endoprosthesis. The device described in the method [3] is attached to the pelvic iliac wing with knitting needles, which are fixed on one arc, i.e. for fixation to the wing of the ileum of the pelvis, a monolateral (located on one side) pelvic module of the external fixation device is used. To fix the diaphysis of the femur, the device contains a femoral module from one distal ring. This reduces the stability of fixation of the device on the pelvis and reduces the stability of the fixation of the thigh relative to the pelvis, which increases the possibility of inflammatory complications, and does not provide for the direction of traction efforts to increase the offset of the femur. The design provides insufficient stability of fixation and does not allow to apply traction to the femur aimed at its lateralization.

There is a method of one-stage bilateral hip arthroplasty for bilateral dysplastic coxarthrosis with complete dislocation and high displacement of the femoral heads ([4], RU 2397720). The method [4] describes an external fixation device (external fixation apparatus, for example, Ilizarov), it contains two blocks (for the left and right limbs), symmetrically mounted on both sides at the level of the hip joints. Each block contains a pelvic support in the form of an arch (pelvic module), to which the spokes held in the iliac wing are fixed, and a femoral support in the form of a ring (the femoral module), to which the spokes made through the femoral diaphysis are fixed, the supports are connected by threaded distraction rods. Blocks for the left and right limbs are interconnected by threaded rods, beams and form a bilateral arrangement. Method [4] provides for the reduction of both thigh bones to a physiological level, followed by hip replacement.

The disadvantage of the external fixation device described in the method [4] is the inability to apply traction to the femur aimed at lateralization of the femur, it is only possible to bring it down. For the treatment of diseases of one hip joint (right or left), for example, such as a false joint of the femoral neck or congenital dislocation of the thigh, a design that is excessively bulky involves the fixation of two hip joints at once, which significantly limits the patient's motor activity and adversely affects the treatment process . Each femoral support (femoral module) of the right and left blocks contains one ring, while the stability of fixation is ensured only when connecting the femoral supports mounted on the left and right limbs, which limits the patient's mobility, when installing the femoral support on only one limb is not provided fixation stability.

The essence of the technical solution

The technical problem to which the utility model is aimed is to optimize the process of lowering the thigh, to ensure traction of the thigh simultaneously in the distal and lateral directions towards the physiological position, to reduce the risk of complications due to the anatomically more favorable direction of movement of the thigh, to increase the stability of fixation and support when this patient mobility.

The technical result consists in the possibility of applying metered traction efforts to the femoral module and the femur fixed therein in the distal-lateral direction relative to the pelvic module mounted on the wings of the ilium.

The technical result is achieved in that the device for lowering the femur contains: a pelvic module, which is made of two arches, left and right, interconnected in a horizontal plane by telescopic distraction rods, spokes and / or intraosseous rods are fixed on each of the arches, the left arch designed for attachment to the wing of the left ilium, the right arch is designed for attachment to the wing of the right ilium; the femoral module, consisting of an arch and two rings arranged in series one above the other, interconnected, spokes are installed on each ring that are designed to be mounted in the distal part of the right (left) femur, intraosseous rods are installed on the arch of the femoral module, which are designed for attachment to the right (left) femur in the region of the greater trochanter; the pelvic module is pivotally connected to the femoral module by telescopic distraction rods directed in the distal lateral direction from the pelvic module to the femoral module; while three telescopic distraction rods are installed through hinges at one end on the arch of the femoral module, the other end on the right (left) arch of the pelvic module, the fourth telescopic distraction rod through hinges at one end is mounted on the ring of the femoral module, the second end is mounted on one of the telescopic distraction rods connecting in the horizontal plane of the arc of the pelvic module.

The above essence ensures the achievement of the claimed technical result.

The utility model is illustrated by a diagram that depicts a General view of the device for lowering the femur, showing the pelvis and femurs of a person.

Utility Model Implementation

A device for lowering the femur in the treatment of, in particular, the false joint of the femur on the right, accompanied by high proximal dislocation of the femur and rigidity of the soft tissues consists of knitting needles (1), intraosseous rods (2), bolts with a L-shaped head (3), right and left arc (4) (made in the form of a sector of a ring with holes). The arches (4) are fixed to the wings (5) of the right and left ilium. Four spokes (1) are fastened to the right arch (4) by bolts (6), which are passed through the wing (5) of the right ilium from the side of the affected hip joint. On the left arch (4), three intraosseous rods (2) inserted into the wing (5) of the left ilium are fixed with bolts with a L-shaped head (3). The right and left arches 4 are connected in the horizontal plane by two telescopic distraction rods (7), together form a pelvic module (not shown separately in the diagram). Telescopic distraction rods (7) are mounted on arcs (4) by means of hinges (8). The device for lowering the femur also contains a third arch (4) and two rings (9), located sequentially one above the other, together forming the femoral module (not shown separately in the diagram). Rings (9) can be composite of two half rings (not shown in the diagram). On the arch (4) of the femoral module, three intraosseous rods (2) are inserted into the area of the greater trochanter (in the metaphysis) of the right femur with bolts with a L-shaped head (3). Rings (9) are located in the distal part of the femur. The rings (9) and the arch (4) of the femoral module are interconnected. The rings (9) are interconnected using three docking (threaded) rods (10). The proximal ring (9) is connected to the arch (4) of the femoral module by three telescopic distraction rods (7). Telescopic distraction rods (7) of the femoral module are parallel to each other. They can be mounted on support strips (11). The rings (9) are located at a distance of 10 to 15 cm from each other. The elements of the device are fixed with nuts (12). On each of the rings (9) of the femoral module, two spokes (1) are held by bolts (6) and nuts (12), held at an angle (preferably from 30 to 40 °) with respect to each other. The pelvic module is pivotally connected to the femoral module by telescopic distraction rods (7) mounted in parallel and directed in the distal-lateral direction from the pelvic module to the femoral module. Three telescopic distraction rods (7) are fixed on the arch (4) of the pelvic module from the side of the affected hip joint by single-plane hinges (8) (single-plane) and are directed, parallel to each other, in the distal-lateral direction to the arch (4) of the femoral module, with which connected by two-plane hinges (8). The fourth telescopic distraction rod (7) through hinges (8) is installed at one end on the proximal ring (9) of the femoral module, the second end is mounted for movement on one of the telescopic distraction rods (7) connecting the left and right arches in a horizontal plane ( 4) the pelvic module.

Use of utility model

A device for lowering the femur, for treating the pseudoarthrosis of the femur on the right, accompanied by high proximal dislocation of the femur and rigidity of the soft tissues, is mounted on the patient. To do this, under anesthesia in the operating room from the affected hip joint (right), into the wing (5), through the crest of the right ilium, 4 or 5 spokes (1) are carried out in the front-back direction, which are fixed with bolts (6) and nuts ( 12) to the right arc (4). On the contralateral side (left), through point punctures of the skin, into the wing (5) along the front surface of the crest of the left iliac bone, three intraosseous rods (2) are held, which are fixed with bolts with a L-shaped head (3) and nuts (12) to left arc (4). The left and right arches (4) are connected by telescopic distraction rods (7), fixing them with nuts (12), thereby forming a pelvic module. On the affected (right) lower limb in an oblique-transverse direction, two pairs of knitting needles (1) are carried out, two knitting needles (1) intersecting at an angle of 40 ° at a distance of 10 to 15 cm from each other. Each pair of knitting needles (1) is fixed to a separate ring (9) with bolts (6) and nuts (12). The rings (9) are interconnected by threaded rods (10). Through the proximal part of the right (affected) femur of the lower limb in an oblique-transverse direction, three intraosseous rods (2) are drawn, which are fixed with bolts with a L-shaped head (3) and nuts (12) to the arch (4). The arc (4) is connected to the proximal ring (9) by three telescopic distraction rods (7), fixing them with nuts (12), thus forming the femoral module. The pelvic module is connected to the femoral module using telescopic distraction rods (7) directed in the distal lateral direction from the pelvic module to the femoral module. In this case, the direction of the vector of the resulting traction force toward reduction and offset is taken into account to place the affected femur and elements of the hip joint in a physiologically correct position, symmetrical to the counter lateral healthy hip joint. During treatment with telescopic distraction rods (7) connecting the pelvic module to the femoral module, distraction and lowering of the femur are performed. After reaching the correct (symmetrical healthy limb) physiological position of the affected femur, the device for lowering the femur is removed, joint replacement is performed.

Industrial applicability - a device for lowering the femur can be manufactured using modern industrial equipment and can be used for other purposes in clinical departments specializing in the treatment of orthopedic diseases using external fixation devices.

Claims (1)

A device for lowering the femur, characterized in that it contains a pelvic module made of two arches connected to each other in a horizontal plane by telescopic distraction rods, one arch of the pelvic module for the side of the affected hip joint is designed to be attached to the wing of the ilium by means of knitting needles, the second arc the pelvic module is designed for attachment to the iliac wing through intraosseous rods, the femoral module consists of an arch and two rings located sequentially one above the other, interconnected, spokes are installed on each ring that are designed to be attached to the distal part of the femur, intraosseous rods are installed on the arch of the femoral module, which are designed to be attached to the femur in the region of the greater trochanter, the pelvic module is articulated with the femoral module telescopic distraction rods directed in the distal lateral direction from the pelvic module to the femoral module, while three telescopic distraction The rod was installed through hinges at one end on the arch of the femoral module, and at the other end on the arch of the pelvic module for the side of the affected hip joint, the fourth telescopic distraction rod through the hinges at one end is mounted on the ring of the femoral module, the second end is mounted on one of the telescopic distraction rods connecting in the horizontal plane of the arc of the pelvic module.

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