RU177222U1 - Microsurgical tendon holder for tendon suture - Google Patents

Abstract

The invention relates to medicine, in particular to traumatology and surgery, and can be used when performing both traditional and microsurgical suture of limb tendons. A microsurgical tendon holder for performing a tendon suture consists of a handle made of stainless steel with a cylindrical shape, an adapter, bent at an angle, the distal part of which has a clamping device that allows you to reliably fix the removable working nozzle, made in the form of a U-shaped "two killer ”with parallel-running needles having concentric-type tips. The technical result of using the utility model is better adaptation and fixation of the tendon ends, non-invasiveness and precision of surgical procedures in the process of performing a tendon suture, shortening the duration of surgery, reducing the risk of complications and improving the results of treatment of injuries of limb tendons .

Description

The invention relates to medicine, in particular to traumatology and surgery, and can be used when performing both microsurgical and traditional suture of limb tendons.

Surgical reconstruction of damaged tendons is a widely demanded and technically difficult surgical intervention. Firstly, this is due to the increased frequency of tendon injuries. Secondly, with adverse outcomes of surgical interventions due to the complexity of the anatomical structure of the tendons and surrounding tissues, additional trauma to the tendon tissue (violation of its ultrastructure, sagging) when performing a suture (compression with tweezers or a clamp). In the process of suturing to hold the tendon, it is necessary to squeeze and intercept it repeatedly with the working parts of the tweezers or clamp with each ligature, which increases the duration of the surgical intervention and injures the tendon and the surrounding tissue. The result of which is a violation of the adaptation of the ends of the tendon, deformation and thickening of the latter at the site of the suture and, as a result, a violation of its regeneration with a pronounced scar-adhesion process, leading to impaired limb function and temporary or permanent disability. Often, revision interventions (tenolysis, repeated suture of the tendon), as well as significant physically, temporarily and financially costly medical efforts, the use of expensive medications and equipment to restore lost functions are required.

The above problems interpret the development of new methods and devices that will allow gentle work with tendon tissue and ensure precision tendon suture. The developed device will prevent the development of complications, minimize social and economic damage and the cost of providing specialized assistance to this category of victims.

State of the art

To date, a large number of surgical instruments are known used to hold tissues and manipulate them in the process of performing a surgical suture. Known medical tweezers and clamps used, including for holding tendons: surgical tweezers; anatomical tweezers: a - straight; 6 - curved; Billroth clamp, etc. (Medicon Instruments. Catalog No. 12. Surgical instruments and appliances. Medicon, Tuttlingen, 1986 .; GM Semenov, Modern surgical instruments. - St. Petersburg: Peter, 2006. - 352 p.). However, a specialized tool for holding just a tendon was found in only one published patent (utility model RU No. 42168). This device for fixing the tendon is used in the surgical treatment of injuries of the tendon-ligamentous apparatus and contains articulated jaws with a rack, handles and working ends made in the form of a groove with symmetrically located through longitudinal grooves and grooves on the lateral edges of the groove. The working end of one of the branches is equipped with pins facing the opposing branch. (Big Medical Encyclopedia. - T. 8. - Ed. 3rd. - M., 1978. - p. 291). This device allows you to reliably fix the tendon when performing a suture. However, the use of this clamp is not intended to perform a microsurgical suture of the tendon, the working ends (troughs) may interfere with sufficient visualization of the tendon and suturing oriented in different planes. Girth of the tendon along the perimeter involves its exposure over a large extent and trauma to the mesentery, compression of the vessels supplying it. Possible non-dosed compression of the tendon. This tool has not been widely used in surgery.

The objective of the invention is to develop a device involving atraumatic and stable fixation of the tendon in the process of performing its microsurgical suture, excluding compression of the tendon and impaired blood supply, facilitating the procedure for applying a microsurgical tendon suture and ensuring its precision.

Utility Model Disclosure

The novelty of the proposed device is that for the first time for fixing the tendon when performing the tendon suture, the needle component of fixation is used, the diameter of the needles of which is less than the diameter of the tendon bundles, which reduces their trauma. The tendon is minimally exposed throughout, which allows for work with a limited surgical field. The tendon holder allows not only to reliably hold the tendon, but to freely move the sections of the stitched tendon for their exact comparison (simultaneously bend, rotate, deflect, pull the tendon). It is not required to hold the tendon with tweezers, with multiple interception, which minimizes the intraoperative tendon injury (compression, compression, bending) and reduces the time of the operation. The device provides a comparison and fixation of segments of the tendon to perform almost all traditional tendon sutures, and the imposition of a microsurgical suture.

In FIG. 1 shows a diagram of a utility model of the proposed device, which consists of a reusable handle (1). Handle material is stainless medical steel. The length of the handle is 11.5 cm, the diameter is 5.0 mm. The handle has a cylindrical shape, and on the cross section - the shape of a circle. The round cross-sectional shape and the size of the handle provide the convenience and reliability of gripping and holding the tool at the time of use. The upper end of the handle is rounded, and the other has a conical shape and an internal thread with a diameter of 1.5 mm and a length of 3.0 mm. The thread is used to connect the handle to the adapter (2). The adapter has two parts. Its upper part is equipped with an external thread with a diameter of 1.5 mm, a length of 3.0 mm, which serves to connect with the handle. The upper part of the adapter has a cylindrical shape, and on the cross section - the shape of a circle¸ length - 3.0 cm. Diameter - 1.5 mm. The distal (lower) part of the adapter is located at an angle of 135 (to the upper part and has the shape of a trapezoidal pad 6.0 × 3.0 × 2.0 mm in size, 1.0 mm thick. In the center of the pad there is a threaded hole with a diameter of 1.0 mm The hole is used to fix the clamping device (3). The material of the adapter is stainless medical steel. The clamping device is made of titanium. It has a trapezoidal shape with dimensions of 6.0 × 3.0 × 2.0 mm, a thickness of 1.0 mm There is a hole in the center of the clamping device with a micro screw (4) diam trom 1.0 mm, 5.0 mm long. On the inner surfaces of the platforms facing each other, there are two longitudinal grooves that allow reliable fixation of the working nozzles. The device is equipped with removable working nozzles (5). The nozzle is a U-shaped "two-pronged "With parallel running needles from 10 to 20 mm long, 0.3 mm in diameter with a concentric tip. The material from which the nozzle is made is stainless medical steel. The above details are interconnected by screwing, which ensures structural unity and the possibility of implementing a device for its functional purpose, namely: retention of the tendon when making a seam, ensuring its axial strength, the ability to rotate and bend it at the required angle, to perform traction of the tendon without compression on it without breaking its structure.

The inventive tool, it is advisable to complete with different sizes of the working nozzles, since the anatomical dimensions of the tendons and their shape have significant differences.

The sterilization mode of the instrument does not differ from the sterilization of standard surgical instruments.

FIG. 2 shows a photo of a microsurgical tenderider:

FIG. 2A - handle and nozzle with adapter in disassembled form;

FIG. 2B - handle and nozzle with adapter assembly, side view;

FIG. 2C - handle and nozzle assembly, front view.

The technical result.

The microsurgical tendo-holder for performing a tendon suture allows not only to reliably hold the tendon, but simultaneously bend, rotate, retract, and pull the tendon. Tendon retention with tweezers is not required, which minimizes the intraoperative tendon injury (compression, compression, kink). The proposed device allows you to work with a limited surgical field and facilitate the flashing of the tendon, ensure its axial strength, improve the accuracy of adaptation of the ends of the tendon, reduce the time of surgery, thereby reduce the risk of complications and improve the results of the tendon suture, increase its strength, reduce treatment time.

The inventive tool, it is advisable to complete with different sizes of the working nozzles, since the anatomical dimensions of the tendons and their shape have significant differences.

The sterilization mode of the instrument does not differ from the sterilization of standard surgical instruments.

Implementation of a utility model.

An operation using a microsurgical tenderizer is performed in a patient position lying on his back, on an operating table, under combined anesthesia. The upper limb is set aside at an angle of 90 °, laid on a side table.

In the middle third of the shoulder, a pneumatic tourniquet is applied, the surgical field is treated three times with a solution of iodopyrone. Surgical access to a damaged tendon is performed.

The ends of the damaged tendon are isolated and mobilized. Assemble the components of the tender holder (handle and adapter with clamping device) by screwing. The clamping device fixes the required size U-shaped nozzle. Puncturing the ends of the tendon, stringing them on the nozzle of the tenderizer, immersing the needles in the thickness of the tendon along its axis and bring them together, precisely adapting them with respect to each other. The ends of the tendon with a tool during the suturing process can be rotated and bent at the required angle, traction of the tendon without compression on it, without violating its structure. To suture the back of the tendon, use the crank to rotate. Any existing tendon suture is performed, after which the instrument is removed. The tendon suture is wrapped with peritendinium, which is also sutured with a microsurgical suture. Hemostasis is performed, layered wound closure. The operation ends with the application of skin sutures and plaster immobilization. At the end of the operation, the tool is disassembled into components and processed. After removing the sutures on the 13th day, the patient proceeds to develop passive movements in the joints of the operated finger (exercise therapy, mechanotherapy). Plaster immobilization is carried out for a period of 2-3 weeks. After removing the gypsum tire, physiotherapy, physiotherapy exercises, and massage are performed.

Example 1. Patient B., 45 years old, Diagnosis: Injured damage to the tendons of the deep flexors of the 4 and 5 fingers of the left hand. The patient 1 year ago was injured by glass at the level of 4 and 5 of the metacarpophalangeal joints. The initial surgical treatment of the wound was performed, the suture of the tendons was not made. The wound healed first.

Under regional anesthesia, zigzag sections were made on the palmar surface of 4 and 5 fingers from the nail phalanx to the base of the fingers. The distal ends of the tendons of the superficial and deep flexors of the 4 and 5 fingers are excised with the stumps of the deep flexors of 1.0 cm left at the point of attachment to the distal phalanx. The proximal ends of the tendons are stitched together end-to-end with the main intra-barrel, four-core microsurgical suture using a microsurgical tendon holder. Silicone implants are placed in the tendon bed and hemmed to the remaining stumps of the tendons of the deep flexor 4 and 5 fingers. The wounds are sutured. Primary healing.

The second stage of plastic surgery was performed after 3 months according to the method described above. During the operation, a revision of the microsurgical suture area was performed. The suture is consistent, the ends of the tendons firmly fused together end to end without visible diastasis. The cicatricial-adhesion process in the circumference of the suture is not expressed. Good sliding properties of tendons were noted. The operation is completed by suturing the wounds. Plaster immobilization for a period of 3 weeks. Passive movements from 3 days after surgery, active from 2 weeks. The postoperative period was uneventful. In the postoperative period, magnetotherapy, a course of physiotherapy exercises, and massage were carried out.

The patient was examined after 6 months. The brush function is complete. The patient works in his specialty (turner).

A two-stage method of tendonoplasty of the flexor of the fingers with a microsurgical suture was used in the clinic in 10 cases in 9 patients. Excellent (9) and good (1) functional results were noted. There were no bad outcomes of operations. The average duration of surgery was reduced by 25%. No postoperative complications were observed.

Thus, the proposed method allows to reduce the duration of the operation and labor costs of the operating team, to reduce the number of postoperative complications.

Improving the functional results of operations, reducing the duration of the operation is due to the fact that, in comparison with the use of tweezers or clamps, the proposed tender holder provides:

1. Careful dosed approach of the ends of the tendon and their precise adaptation in relation to each other;

2. The possibility of non-compression fixation of the ends of the tendon throughout the operation;

3. Minimal trauma to the tendon tissue, excluding its compression, kink, damage to the mesentery;

4. Reducing the time of suturing, by reducing the number of irrational manipulations;

5. The ability to perform operations without the assistance of an assistant.

The holder was tested in an experiment on rabbits (10) and in a clinic on the basis of GAUZ GKB No. 4 of Orenburg when performing a suture of limb tendons (10 operations) and has established itself as a convenient tool in the work of a surgeon, ensuring the precision and speed of performing a microsurgical tendon suture.

Claims (1)

A microsurgical tendon holder for making a tendon suture consists of a handle made of stainless medical steel having a cylindrical shape, an adapter bent at an angle, the distal (lower) part of which has the shape of a trapezoidal platform, in the center of which there is a threaded hole for fixing the clamping device made made of titanium, in the center of the clamping device there is a similar hole with a microscrew placed in it, on the inner surfaces of the platforms facing each other friend, there are two longitudinal grooves that allow you to reliably fix the removable working nozzle, made in the form of a U-shaped "two-pronged" with parallel-running needles having tips of a concentric type.

Images