RU175313U1 - CURVED CHISEL BIT FOR BONE PROCESSING - Google Patents

Abstract

The technical solution relates to medicine, to a surgical instrument for mechanically treating bone, removing bone tumors, for cutting off contaminated, pathologically altered bone tissues. The bit contains a handle 1, butt 2, working part 3. The end 4 of the working part has a grooved geometric shape and equipped with a cutting edge 5. The working part is made with two bends 7, 8, so that the longitudinal axis 9 of the end of the working part is offset from the longitudinal axis 10 of the handle and is at an angle to it in the range from 0 to 10 degrees. The grooved deepening of the end of the working part with the inner surface 11 is turned to the side to the longitudinal axis of the handle. The technical solution is aimed at solving the applied problem - facilitating the processing of the lateral surface of the bone fragment and its end in order to give it the desired shape, when immersing osteosynthesis, when processing the osteomyelitis focus, when removing necrotic tissue, with corrective osteotomy of the bone. The chisel allows you to quickly and safely handle the lateral surface and the end of the bone fragment. The technical result consists in maintaining the ability to cut (chipping) bone tissue when installing the handle of the bit in a position close to the parallel longitudinal axis of the bone. 6 c.p. f-ly, 12 ill.

Description

The technical solution relates to medicine, to a surgical instrument intended for mechanical processing of bone, removal of bone tumors, for cutting off contaminated, pathologically altered bone tissues. It can be used during operations in the treatment of the musculoskeletal system with purulent lesions and their consequences received after high-energy injuries, military injuries, unsuccessful surgical interventions. In particular, it can be used in the treatment of osteomyelitis foci, in the surgical treatment of false joints, in the treatment of infected false joints with concomitant bone osteomyelitis, and in the removal of foreign objects (screw fragments, bone cement, sequesters) from the bone.

In the treatment of various bone lesions, mechanical treatment is often required. Tubular bone after a violation of integrity, for example, by a fracture or osteotomy, is divided into at least two bone fragments. Each of the bone fragments has a lateral surface; this is a surface located along the external contour of a bone cross-section, an end face and an edge. The butt - the surface facing the place of violation of the integrity of the bone. The bone fragment along the lateral surface may contain formations in the form of an overgrown, altered bone tissue, and pathologically altered bone tissue. For mechanical processing of bones, surgical access to the site of violation of the integrity of the bone (fracture, osteotomy), the focus of osteomyelitis, the affected or defective area is used. For access, a soft tissue incision or tissue dissection resulting from an injury is used. The lateral surface of the bone, located in depth closer to the place of surgical access, dissection (incision, wound) of soft tissues, is called the front surface. The lateral surface of the bone located deeper (deeper) from the place of surgical access, dissection (incision, wound) of soft tissues, is called the posterior surface. The same designations apply to bone fragments obtained as a result of violation of the integrity of the bone, in relation to their location to the site of surgical access, the front surface of the bone fragment is located closer to the incision depth, the posterior surface of the bone fragment is located further down from the incision.

The tool used for machining bone is widely known. There are osteotomes and chisels of various geometrical shapes and locations.

In particular, it is known for tubular bone osteotome ([1], RU 2306879). The osteotome contains a handle, which is made with a butt for striking it, and a working part. The direct working part is fixed on the handle and has a cutting edge (blade) at the end, a spike and an elongated restrictive guide plate with a convex part. The cutting part of the spike is made concave. The spike tip and the end of the bounding guide plate are bent towards each other.

Known by the osteotome ([2], SU 1297826), containing a handle made in one piece with a pick, the working part is curved sickle-shaped. The end of the working part is equipped with a pointed tenon on the concave side, and a plate on the convex side, the edges of which protrude above the tenon.

However, these analogues [1, 2] do not allow bone processing when the longitudinal axis of the handle is parallel, or almost parallel, to the longitudinal axis of the bone. The location of the working end relative to the longitudinal axis of the analog handle [1, 2], does not allow you to set the working end on the side surface of the bone fragment to cut it, so that the handle was parallel, or almost parallel, to the longitudinal axis of the bone fragment. Analogs [1, 2] are adapted for transverse osteotomy; they are not convenient for processing the end face of a bone fragment with overgrown bone tissue along the lateral surface of the bone, when bone is separated from soft tissues and scars. The geometric shape of the working end of the analogues [1, 2] does not have a grooved shape (a groove in the form of a groove) and is not suitable for processing the lateral surface of a bone fragment from its end.

Known by the osteotome ([3], 1801385), containing a handle equipped with a main pick and an additional pick, the working part is curved. The working end is equipped with a pointed tenon over which a restriction plate is placed on one of its sides.

This analogue [3] is intended for transverse osteotomy of the bone, does not contain a gutter at the working end, the working end is not displaced relative to the longitudinal axis of the handle, the geometric shape of the working end does not allow efficient processing of bone growths along the lateral surface of the bone fragment. It is not convenient for processing bone fragments when they are fixed in the Ilizarov apparatus.

Known elevator-osteotome ([4], 13535) containing a handle and a working element. The handle is equipped at the end with a shock pad, under which a hexagonal neck is located. The working element has a fold. The end of the cutting part of the working element, made in the form of a plate, has a concave rounded shape and a triangular shape in cross section. The lateral protruding parts on both sides of the end of the working part are rounded with a semicircle in cross section.

In this analogue [4], the cutting edge is directed at an acute angle to the longitudinal axis of the handle, the cutting force when it hits the handle is transferred to the side from the direction of impact, this design is not convenient for processing the end of the bone fragment in the wound when the tissue overgrowth along its lateral surface . They do not allow processing the lateral surface of the bone in the case when the longitudinal axis of the handle is parallel, or almost parallel, to the longitudinal axis of the bone.

Chisels and osteotomes [1, 2, 3, 4] are intended for processing the bone by direct impact on the bone with a sharp edge (cutting edge, blade), the handle is installed perpendicular to the longitudinal axis of the bone or at an angle to it. In some surgical cases, for example, when treating a focus of ostomyelitis, false joints, sequesters, when the limb is fixed in an external fixation device, it is not possible to perform osteotomy of the bone by setting a bit in the wound perpendicular to the longitudinal axis of the bone. Treatment with analogues [1, 2, 3, 4] in this case requires an increase in the incision (wound) and is accompanied by damage to the soft tissues adjacent to the bone. Such bits [1, 2, 3, 4] do not allow safe and high-quality processing of the bone fragment along the lateral surface. In hard-to-reach places, when bone tissue from the soft tissues and scars is prevented from overgrowing the bone tissue of the ends of the bone fragments, or when the bone fragment is processed, with direct exposure to an osteotome [1, 2, 3, 4], it is necessary to unnecessarily skilletate the bone (to separate the periosteum), which entails increased blood loss, increased operation time, increased risk of purulent and trophic complications. When working with straight chisels [1, 2, 3, 4] along the lateral surface of the bone (along the front or back surface), there is a high risk of the chisel or osteotome slipping off the bone with damage to blood vessels and nerves; .

Known by osteotome ([5] - Product catalog of KLS Martin Group company No. 34, section No. 23 bone surgery, page 518, Lexer osteotome article 23-135-07 (catalog tool C34, “kls martin group”, 23 Bone surgery , 518, Bone surgery 23-135-07-04 Gouge, acc. To Lexer, silicone coated Handle, 7 mm, 22 cm,) search by catalog number is available on the company's website, access mode: http: //www.klsmartin. com / catalog / en / search? search-text = 23-135-07). The osteotome contains a handle with a butt, a working part, a cutting edge (straight blade) at the end of the working part. The end of the working part is made in a grooved shape (has the shape of a gutter). The working part is straightforward, the total length of 220 mm.

This analogue [5] is intended for processing the bone using direct exposure, the handle is installed perpendicular to the longitudinal axis of the bone or at an angle to it. The working end is not offset relative to the longitudinal axis of the handle. The geometric shape of the working end does not allow you to effectively handle the growth of bone tissue along the lateral surface of the bone fragment. When processing bone along the lateral surface, there is a high risk of the working end slipping off the bone and damage to blood vessels and nerves. By analogy [5], it is not possible to quickly and efficiently process the lateral surface and the end of the bone fragment to the desired geometric shape. The bit [5] is short, which is inconvenient when working.

Known bit ([6] - Product catalog of the company "Geomed", bit Lexer, article OD 3091001 (GEOMED Medizin-Technik, GmbH & Co. KG, LEXER HOHLMEISSEL ABGEW 10MM 27,5CM, Geomed-Artikel Nr. OD 3091001), available search by catalog number on the company’s website, access mode: http://www.geomed.de/index.php?id=106&L=). The bit contains a textolite handle, a working part, the end of the working part is equipped with a cutting edge and has a geometrical shape of the gutter (i.e., the blade is grooved). The end of the working part is bent with respect to the body of the working part and the longitudinal axis of the handle. The bit has a total length of 275 mm. The body of the working part has the shape of a straight rod with a diameter of 10 mm.

This analogue [6] does not contain a butt, the handle is not suitable for striking with a surgical hammer. The working part has a bend located closer to its cutting edge, a kind of “bent spoon” is formed, while the body of the working part has a rectilinear shape (straight rod). The working end has a width of about 15 mm, and not; convenient for working with the tibia. The analogue does not allow to process a bone fragment from one surgical incision along the lateral surface, setting the handle parallel to, or almost parallel to, the longitudinal axis of the bone, while the cutting edge will not cut off bone tissue and growths on the bones. In addition, the bit [6] is short, which is inconvenient during operation, when the external fixation device is installed on the limb.

Chisel ([7] - Product catalog of the company "Geomed", chisel article OD 2950501 (GEOMED Medizin-Technik, GmbH & Co. KG, LEXER HOHLMEISSEL GEB 5MM 25CM, Geomed-Artikel Nr. OD 2950501), search by catalog number on company’s website, access mode: http://www.geomed.de/index.php?id=106&L=) is the closest to the claimed technical solution. The bit [7] contains a textolite or plastic handle, a working part, the end of the working part has a smooth bend, is equipped with a cutting edge and has the shape of a chute. The width of the working part (in the gutter area) is 5, 10 and 15 mm. Total length 250 mm. The groove-shaped recess is made on the concave side of the bend of the working part.

However, the chisel [7] also does not provide the convenience of processing the end face and lateral surface of the bone fragment through a single incision, especially when the external fixation device is preliminarily applied to the limb. The shape of the working part does not allow you to set the handle of the bit when processing the bone in parallel, or almost parallel, to the longitudinal axis of the bone (bone fragment). The total length of the bit, with a handle and a working part of 250 mm, is not enough for the surgeon to work comfortably if the limb is fixed in an external fixation device (AVF), since the AVF supports limit the space around the operated limb. When processing the lateral surface of the bone, the chisel [7] can often slip and it is necessary to increase the surgical wound. Chipping a bone is time consuming.

The claimed technical solution, a chisel-shaped chisel for processing bones (hereinafter chisel) is aimed at solving an applied problem - facilitating the processing of the lateral surface of the bone fragment and its end in order to give it the desired shape, when immersing osteosynthesis, when treating the focus of osteomyelitis, when removing necrotic tissue , with corrective osteotomy of the bone. The chisel allows you to quickly and safely handle the lateral surface and the end of the bone fragment. The geometric shape of the working part provides the working end and the cutting edge with easy access to the bone fragment through the wound, even when fixing bone fragments with an external fixation device. Ease of impact with a surgical hammer is ensured, with a minimal chance of the blade sliding deep into the soft tissue, where vessels and nerves are usually located. As a result of using the chisel, the bone does not undergo excessive skeletonization, the surgical wound has the minimum required size, blood loss is reduced, the operation time is reduced, the risk of trophic and purulent complications, the risk of damage to nerves and blood vessels is minimized. The bit can be installed in a section (wound) at any angle towards the longitudinal axis of the bone, even almost parallel to the longitudinal axis of the bone, including when it is fixed by an external fixation device,

The technical result consists in maintaining the ability to cut off (chipping) bone tissue when installing the handle of the bit in a position close to parallel to the longitudinal axis of the bone (in parallel with a deviation of ± 10 ° to the longitudinal axis of the bone or bone fragment).

The technical result is ensured by the fact that the bit contains a handle, a butt, a working part, the end of the working part has a grooved geometric shape and is equipped with a cutting edge. It differs in that the working part is made with two bends, so that the longitudinal axis of the end of the working part is offset from the longitudinal axis of the handle and: it is at an angle in the range from 0 to 10 degrees, the grooved recess of the end of the working part with the inner surface facing toward the longitudinal handle axis.

The specified entity ensures the achievement of the claimed technical result.

In this case, the total length of the bit should be from 300 to 400 mm, where the length of the handle with a butt is from 100 to 160 mm. Depending on the manufacturing technology, manufacturing cost, at a particular manufacturing enterprise, ease of use, the bit may be; made with some differences. The handle, the butt and the working part can be made integrally and be integral, or can be performed separately, as separate parts from which the bit is assembled. The handle and the working part can be connected with the possibility of separation, while a threaded connection, or a threaded connection of the "father-mother" type equipped with a latch, can be used. The bit is preferably made metal, from an alloy of stainless corrosion-resistant steel or titanium alloys approved for use in medicine. The handle can be made of non-metallic materials, such as polyamide, textolite, fluoroplastic, and other polymeric materials. The butt is preferably made of metal, while it can be integral with the handle, and can be made as a separate structural element. The working part can be heat treated to give it high hardness and wear resistance. The hardness of the working part should be in the range from 48 to 65 HRC. The surface of the metal parts of the bit must be shiny or matte. Roughness from 0.16 microns to 0.63 microns. The working part can be processed by electrochemical polishing with a roughness of 0.32 mm. The inner surface of the grooved end of the working part with a roughness of 0.63 microns.

The technical solution is illustrated by graphic materials.

FIG. 1 - bit, general view;

FIG. 2 - bit, side view;

FIG. 3 - bit, top view;

FIG. 4 - bit prefabricated embodiment, side view;

FIG. 5 - bit as in FIG. 4, with spaced parts, the butt is shown in section;

FIG. 6 - grooved end of the working part of the bit, General view;

FIG. 7 - grooved end, cross section;

FIG. 8 - chisel, photo from above;

FIG. 9 - bit, side photograph;

FIG. 10 - position of the bit when processing a bone fragment;

FIG. 11 - position of the bit when processing a bone fragment;

FIG. 12 - position of the bit when processing a bone fragment.

Implementation of a technical solution.

The bit contains a handle 1 (Fig. 1; 2; 3; 4; 5; 8; 9), butt 2 (Fig. 1; 2; 3; 4; 5; 8; 9), a working part 3 (Fig. 1; 2; 3; 4; 5; 8; 9). The end 4 (Fig. 1; 2; 3; 4; 5; 8; 9) of the working part 3 has a grooved geometric shape (Fig. 6; 7) and is equipped with a cutting edge (blade) 5 (Fig. 1; 2; 36; 8; 9). The body 6 (Fig. 1; 2; 3; 4; 5; 8; 9), the working part 3 is made with two bends 7, 8 (Fig. 1; 2; 4; 5). The longitudinal axis 9 (Fig. 1; 2) of the end 4 of the working part 3 is shifted relative to the longitudinal axis 10 (Fig. 1; 2) of the handle 1 by a distance “e” equal to 25 mm (Fig. 2) and is located at an angle “ϕ "Equal to 4 ° (Fig. 2). The grooved deepening of the end 4 of the working part 3 with the inner surface 11 (Fig. 1; 6; 7) is turned to the side toward the longitudinal axis 10 of the handle 1. The total length “L” of the bit is (Fig. 3) 305 mm, the length “a” of the working part 3 (Fig. 3) is 165 mm, the length "c" of the grooved end 4 of the working part 3 is 55 mm, the width "b" of the grooved end 4 of the working part 3 is 20 mm The end 4 of the working part has a one-sided sharpening on the outside and a sharpening on the sides, the edge of the sharpening and the inner surface 11 of the grooved recess at the intersection form the cutting edge 5 (blade). In FIG. one; 2; 3; 8; 9 shows a bit in which the handle 1, the butt 2 and the working part 3 are made as a whole, from a steel rolling bar of a hexagonal section. The bit is made of an alloy of stainless corrosion-resistant steel approved for use in medicine. The working part 3 (Fig. 1; 2; 3; 8; 9) is heat-treated to give it high hardness and wear resistance, the hardness is 58 HRC. The surfaces have a roughness in the range from 0.16 μm to 0.32 μm. The inner surface 11 of the grooved end 4 with a roughness of 0.63 μm. In FIG. four; 5 shows a bit in which the handle 1, the butt 2 and the working part 3 are made as separable parts from which the bit is assembled. The working part 3 and the butt 2 (Fig. 4; 5) are made of stainless corrosion-resistant steel, the handle 1 (Fig. 4; 5) is made of polyamide.

Using a technical solution.

The technical solution is used in the treatment of patients with purulent lesions of the musculoskeletal system and their consequences resulting from high-energy injuries, military injuries, and surgical interventions. In the operational incision, the working part of 3 bits is introduced. Spend the end of 4 bits deep into the surgical wound and set on the surface of the bone fragment 12 (Fig. 10; 11; 12). At the same time, the length of the working part 3 allows you to enter the end of the 4 bits in the operational incision with superimposed supports AVF. It is convenient for the surgeon to use a long chisel since the handle is outside the supports of the AVF and they do not interfere with the manipulation. The cutting edge 5 abuts against the bone fragment. Hold the bit in the desired position for the handle 1 with one hand. With a free hand, they take a surgical hammer 13 (Fig. 10) and strike on the butt 2. The force from the blow is transmitted through to the cutting edge 5, the cutting edge 5 cuts into the bone tissue and cuts off (cuts off) a fragment of bone tissue. The cutting edge 5 of the bit is successively moved along the machined surface of the bone fragment 12 and hit with a hammer 13 on the butt 2, the bone fragments are cut off and the desired geometry of the bone fragment 12 is formed. The curved geometric shape of the working part 3 allows the end 4 of the working part 3 of the bit to be inserted deep into the wound, set cutting edge 5 on the rear lateral surface of the bone fragment 12. The grooved geometric shape of the end 4 of the working part 3 allows you to cover the bone fragment along the lateral surface and gently cut a larger volume of bone tissue than a straight blade without damaging the surrounding soft tissue. The bit allows you to process the entire lateral surface of the bone fragment 12, including the front one, sharpen the end face of the bone fragment 12, perform transverse osteotomy with the formation of a hole and chamfer on the bone fragments 12. The combined and integral bit are used in the same way.

The claimed technical solution is made and tested by the authors in the Ilizarov Center, Kurgan.

Claims (7)

1. The bit is grooved curved for processing bone, containing a handle, a butt, a working part, the end of the working part has a geometrical shape and is equipped with a cutting edge, characterized in that the working part is made with two bends, so that the longitudinal axis of the end of the working part is offset relative to the longitudinal axis of the handle and is located at an angle in the range from 0 to 10 degrees, the grooved recess of the end of the working part with the inner surface facing the longitudinal axis of the handle. 2. The bit is grooved curved for processing the bone according to claim 1, characterized in that the total length of the bit is in the range from 300 to 400 mm. 3. The chisel grooved curved for processing bone according to claim 1, characterized in that the handle, butt and working part are made as a whole. 4. The chisel grooved curved for processing bone according to claim 1, characterized in that it is made collapsible. 5. The chisel grooved curved for processing bone according to claim 3, characterized in that it is made of an alloy of stainless corrosion-resistant steel. 6. The chisel grooved curved for processing bone according to claim 4, characterized in that the handle is made of polyamide, the working part and the butt of the metal. 7. The chisel grooved curved bit for bone processing according to claim 1, characterized in that the hardness of the working part is in the range from 48 to 65 HRC.

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