RU182499U1 - GUIDE DEVICE FOR PERFORMING DOUBLE SHORTING OSTEOTOMY - Google Patents

Abstract

A useful model to the field of medicine, namely medical instruments used in traumatology and orthopedics, specifically to devices guiding the saw when performing an osteotomy, and can be used in reconstructive orthopedic operations to perform a double shortening osteotomy of the thigh.

The guide device for performing a double shortening osteotomy comprises a support part 1 and a guide part 2. The support part comprises a support bar 3 with a threaded rod 4 located in the middle and protruding downward from the surface of the bar. On the threaded rod 4, with the possibility of removal, bone fixatives 5 are installed, intended for insertion into the bone 6 through punctures of soft tissues. The guide portion contains slotted guides 7 of the saw, placed on two parallel guide rods 8, protruding upward from the surface of the carrier bar. The ends 9 of the guide rods are fixed to the free ends 10 of the carrier bar. Slot saw guides are installed with the possibility of changing the distance between them by longitudinal movement along the guide rods. Slotted guides of the saw are made in the form of plates 11 mounted parallel to each other with a gap 12, intended for the introduction of the blade 13.

The technical result is manifested when using the device and consists in reducing the complexity and duration of surgery, reducing the amount of intraoperative blood loss. 9 s.p. f-ly, 8 ill.

Description

The field of technology.

The utility model relates to the field of medicine, namely medical instruments used in traumatology and orthopedics, for guiding the saw blade when performing an osteotomy, and can be used in reconstructive orthopedic operations to perform a double shortening osteotomy of the tubular bone.

Various devices are known that allow transverse, oblique, chevron and other types of osteotomy, as a rule, known devices are designed to perform osteotomies on a specific segment. For example, a device is known for V-shaped subtroenteric osteotomy in combination with complete hip joint replacement (source [1]: A new device for V-shaped subtroenteric osteotomy in combination with full hip replacement. / T. Hotokebuchi [et al.] // Arthroplasty Journal. 2006 January 21 (1): pp. 135-137. (A new device for a V-shaped subtrochanteric osteotomy combined with total hip arthroplasty / T. Hotokebuchi [et al.] // J. Arthroplasty. - 2006 . - Vol. 21. P. 13 5-137.)). The device consists of two parts: the femoral saw guide (guide part) and the original rasp (supporting part) inserted into the femoral canal. The saw guide includes a housing and a handle. The guide body contains two rows of grooves symmetrically located relative to its longitudinal axis and at an angle to each other, made in the form of cuts (slots) from the side surface of the body to its middle. Holes located at an interval of 5 mm are made along the midline of the saw guide body and the rasp, for the introduction of spokes (pins). The rasp serves as a supporting part. A number of rasp holes should be aligned with a number of saw guide holes. Through knitting needles through two cortical layers, the body is connected to the rasp, and the device is fixed relative to the femur. A saw is inserted into the grooves of the guide to perform an osteotomy. Saws are made at an angle to each other and with a set interval (5 mm). Allows you to perform a figured resection of a fragment of the femur.

However, this device [1] has several disadvantages. One of them is the need to double-install the guide body on the femur to perform proximal and distal osteotomy. After filing and removal of the device, the completion of the osteotomy is required by removing the remaining bone bridges with a chisel or saw, which also increases the time of the operation. Holes and grooves located with an interval of 5 mm do not allow you to accurately vary the size of the excised fragment, the distance between the position of the saw changes discretely. The grooves are located at an angle to each other, so the shape of the bone after performing an osteotomy does not allow rotation of one bone fragment relative to another after performing primary osteotomy.

A device for conical osteotomy of the femoral neck (source [2]: patent RU 2189791. Publ. September 27, 2002), comprising a body with bone rods, the body is made in the form of a curved plate with a cover, between which a sleeve with an annular ring is mounted for rotation a protrusion having a Central hole for putting on the protruding end of the guide spokes and a side hole oriented at an angle to the axis of rotation of the sleeve and made to enter a cylindrical cutter. However, the design of the device [2] does not allow a shortening osteotomy of the femur.

A guiding device for osteotomy is known (source [3]: patent SU 1505528. Publ. 07.09.1989) containing a fixing element (support part) made in the form of a lining with holes for screws and a housing with a scale fixed to it, with a slit axis the guide (the guide part) is located in the housing perpendicular to the axis of the lining and is connected with the guide through a pair of brackets and two pairs of rods fixed in mutually perpendicular planes

The device [3] is intended only for performing transverse rotational osteotomy of the femur, does not allow for shortening osteotomy of the femur, does not allow to vary the size of the excised fragment.

A guiding device for osteotomy is known (source [4]: patent application RU 2014145382. Publ. 10.06.2016)., Comprising a housing with a scale, a fixing element and a guide. The fixing element (supporting part) is made in the form of two pairs of curved grippers mounted on opposite ends of the body, interconnected by a threaded cylindrical rod and mounted on the rod between the screw grips, and the saw guide is made in the form of at least two slotted guides (guide part) with holes and a slotted slot

However, in the device [4] the fixing element (supporting part) is made in the form of two pairs of curved grippers mounted on opposite ends of the housing. To fix this device [4], a wide mobilization of the femur for the installation of grips is required, which inevitably increases the invasiveness of the operation. The device does not allow you to set and vary the size of the excised fragment.

Known guide for osteotomy (source [5]: patent RU 116337. Publisher: 05/27/2012), comprising a body (guide part) and a plate plate with a stop (support part) and a hole on the mounting end. The housing at one of the ends is equipped with a threaded leg with a nut and transverse through grooves made at different angles to its longitudinal axis, and the fixing end of the lining is a rectangular recess for the handle having a hole on the fixing end, while the grooves of the lining are oriented to the working end of the lining, installed together with the handle on the threaded leg of the housing.

Known guide saw for osteotomy (source [6]: patent RU 159058. Published: 01/27/2016). The guide for osteotomy contains a housing, a plate overlay, an angular bracket, locking screws with nuts, and a retractor. The body is equipped with a through groove for installing the saw blade (guide part), and a central axial hole for installing the locking screw. The plate overlay (supporting part) contains a mounting part with a stop and a hole, a working end, a handle. The corner bracket is made in the form of a plate bent at a right angle, contains arcuate grooves at the ends. In this case, the housing is installed at one end of the angle bracket, so that the locking screw is placed in the Central axial holes of the housing and the arcuate groove of the angle bracket and fixed with a nut. The angular bracket is installed with the end on the fastening part of the plate plate, is in contact with the stop, and fixed with a locking screw located in the hole of the plate plate and the arcuate groove of the corner bracket.

However, the device data [5; 6] are designed to perform a wedge-shaped resection of bone areas, the grooves of the guide part are made at an angle to the working end of the lining. The device does not provide for direct fixation to the bone, the supporting part is not fixed to the bone, but is held by the hand by the handle. The devices do not allow for a double shortening osteotomy of the femur, for one installation of the device, do not allow to set and vary the length of the excised bone fragment.

A device for osteotomy is known (source [7]: patent RU 179187. Publisher: 05/03/2018). The device includes a support part connected to a guide (guide part) having a slotted slot for passing a cutting element through it. The supporting part is made in the form of a vertically elongated plate arched curved in cross section with through holes evenly spaced along its longitudinal axis to fix the position of the device relative to the bone. The guide is connected to the plate from one of its end faces by means of a hinge with a locking screw with the possibility of positioning the guide and fixing it at a predetermined angle in the preoperative planning angle of the bone segment cut line. The simplified design of the device allows you to perform a simple transverse or oblique osteotomy, and to resect the bone segment with the subsequent parallel convergence of the bone ends connected in one axis.

This device [7] the supporting part is installed invasively on the bone, layer-by-layer provide surgical access to the bone structures, the supporting part is pressed tightly against the bone. This design increases the invasiveness of the operation. Moreover, to perform a shortening osteotomy, it is necessary to rearrange the device to a new location. The device does not allow you to pre-set and vary the size of the excised bone fragment.

Thus, existing devices do not allow a double shortening transverse osteotomy of the femur to be minimally invasive (i.e., without cutting soft tissues to install the device), for one installation of the device (i.e., without having to reinstall the device to perform a second bone section), while providing the necessary distance between the lines of the osteotomy (i.e. the ability to pre-control the desired length of the excised fragment of the bone).

The essence of the technical solution.

The objective of this utility model is to develop a device that allows, using a saw, corrective osteotomy of the tubular bone at two levels (double shortening osteotomy), obtaining congruent filings of bone fragments and removing a fragment of the required length.

The technical result is manifested when using the device and is to reduce the complexity and duration of surgery. The specified technical result is the result of the following particular technical results: the device can be installed minimally invasively, the device provides the ability to position the saw blade in a given location, the device allows you to perform a bone cross-section in two places at a given distance, the device allows you to set and adjust the length of the bone fragment to be excised, the device allows to obtain congruent surfaces of the remaining bone fragments, which improves the conditions for subsequent oligations of bone fragments.

The problem is solved in that the guide device for performing a double shortening osteotomy contains a supporting part and a guiding part. It is characterized in that the supporting part comprises a carrier bar with a threaded rod located in the middle and protruding downward from the surface of the bar. With the possibility of removal, threaded rods are installed on the threaded rod, intended for insertion into the bone through soft tissue punctures. The guide portion comprises slotted guide rails of the saw placed on two parallel guide rods protruding upward from the surface of the carrier bar. The ends of the guide rods are fixed to the free ends of the carrier bar. Slot saw guides are installed with the possibility of changing the distance between them, by longitudinal movement along the guide rods. Slot saw guides are made in the form of plates mounted parallel to each other with a gap designed to introduce the saw blade.

The specified entity provides the claimed technical result, which is manifested when using the device - reducing the complexity and duration of surgery, as well as reducing the amount of intraoperative blood loss.

The device can be installed minimally invasively, since fixation is carried out by bone retainers, which are injected into the bone minimally invasively through punctures of soft tissues. The device provides the ability to position the saw blade in a given place, since the slotted guides of the saw are mounted with the possibility of longitudinal movement along the guide rods. The device allows you to perform a bone cross-section in two places at a given distance, since it contains at least two slotted saw guides, which are installed with the possibility of changing the relative position, the distance between the slotted clearances for introducing the saw blade. The device allows you to set and adjust the length of the bone fragment to be excised by moving the slotted guides of the saw along the guide rods. The device allows to obtain congruent surfaces of the remaining bone fragments, due to the fact that the slit guide plates are installed in parallel, the shape of the cut surface on the two fragments is the same.

At the same time, it is provided that the support bar can be made of a radial shape, in the form of a sector of a flat ring or from assembled from two parts in a radial shape. The threaded rod is installed in the hole on the carrier bar and fixed with nuts. The guide rods are installed in the holes on the carrier bar and fixed with nuts. Preferably, the bone retainers are made in the form of spokes (with a diameter of 1.5 to 2 mm) or in the form of screw rods with a diameter of 2 to 4 mm. It is assumed that the bone retainers on the threaded rod are fixed with fasteners made in the form of two clamping washers, one of which is equipped with a transverse groove designed to accommodate the bone retainer, clamped on the threaded rod with two nuts. Slotted saw blades are mounted for movement along the guide rods, and can be moved by rotating the nuts mounted on the threaded guide rods. The slotted guide of the saw may contain two, three plates mounted parallel to each other with a gap designed to introduce the saw blade. Preferably, washers are arranged between the plates in thickness corresponding to the width of the gap.

The technical solution is illustrated by the following graphic materials:

FIG. 1- diagram, guide device, general view;

FIG. 2- diagram, guide device (threaded rod 4 and guide rods 8 are fixed on the support bar 3 with nuts 14), general view;

Figure 3 is a diagram, a guiding device (bone retainers 5 are made in the form of rods-screws 15), General view;

FIG. 4- diagram, guide device (guide rod 8 is equipped with a scale 16), general view;

FIG. 5 is a diagram, a guiding device (contains two slotted guides 7, one of which contains three plates 11 and two gaps 12 for accommodating the saw blade 13), general view;

FIG. 6 is a diagram, a guide device (extreme slotted guide 7 is fixedly mounted on the guide rods 8), General view;

FIG. 7 is a photograph, a guiding device (prototype, assembled from parts included in the set of parts of the Ilizarov apparatus, contains two slotted guides 7, one of which contains three plates 11 and two gaps 12 for accommodating the saw blade 13), front view;

FIG. 8- photograph, guiding device (prototype, assembled from parts included in the set of parts of the Ilizarov apparatus, it can be seen that the carrier bar 3 consists of two radius bars), side view.

Implementation of a utility model.

The guide device for performing a double shortening osteotomy contains a supporting part 1 (Fig. 1 to 8) and a guiding part 2 (Fig. 1 to 8). The supporting part 1 contains a carrier bar 3 (Figs. 1 to 8) with a threaded rod 4 (Figs. 1 to 8). The threaded rod 4 is located in the middle (in the center) of the carrier bar 3 and protrudes downward (the direction “down” / “up”), in the text it is used to simplify understanding, where the designation “down” is indicated, it assumes a direction in one direction, indicated "up" implies the direction in the opposite (reverse) side) from the surface of the carrier bar 3. On the threaded rod 4, with the possibility of removal, two bone retainers 5 are installed (Fig. 1; 2; 4; 5; 6; 7; 8) . Bone fixators 5 are intended for insertion into bone 6 (Figs. 1 to 8) through soft tissue punctures. The guide part 2 contains slot saw guides 7 (Fig. 1 to 8), placed on two parallel guide rods 8 (Fig. 1 to 8), protruding upward from the surface of the carrier bar 3. Ends 9 (Fig. 1 to 8 ) guide rods 8 are fixed on the free ends 10 (Fig. 1 to 8) of the carrier bar 3. Slot saw guides 7 are mounted with the possibility of changing the distance between them by longitudinal movement along the guide rods 8. Slot saw guides 7 are made in the form of plates 11 (Fig. 1 to 8) installed parallel to each other to friend with a gap 12 (Fig. 1 through 8), intended for the introduction of the saw blade 13 (Fig. 1; 2; 3; 4; 5; 6). Slot guides 7 are fixed on the guide rods 8 with nuts 14 (Figs. 1 to 8), and when the nuts 14 are rotated, they can move along them. In this case, the extreme slotted guide 7 can be fixed motionless on the supporting rods 8, since to change the distance between the slotted guides 7 it is sufficient to provide the possibility of displacement along the guide rods 8 of one slotted guide 7, for example as shown in FIG. 6 located closer to the carrier bar 3. The threaded rod 4 and the guide rods 8 can be rigidly fixed to the carrier bar 3, as shown in FIG. one; 3, or the threaded rod 4 and the guide rods 8 can be fixed on the supporting bar 3 by means of nuts 14-washers with the possibility of removal, as shown in (Fig. 2; 4; 5; 6; 7; 8). As bone fixatives 5 for insertion into bone 6 through punctures of soft tissues, needles can be used, as shown in FIG. one; 2; four; 5; 6; 7; 8 or screw rods 15, as shown in FIG. 3. Guide rod 8, as shown in FIG. four; 5; 6 can be equipped with a scale 16, with a predetermined interval between strokes, for measuring and visual control of the distance between the slotted guides of the saw 7. The carrier bar 3 can be made in a radial shape, in the form of a sector of a flat ring, as in FIG. one; 2; 3; four; 5; 6, or the carrier bar 3 can be assembled in two parts in a radial shape, as shown in FIG. 7; 8. Holes 17 (FIG. 4; 5; 6; 7; 8) can be made on the carrier bar 3 for fastening the threaded rod 4, the guide rods 8, nuts 14, and also facilitating the construction. The guide rods 8 can be installed in the holes on the carrier bar 3 and fixed with nuts 14, or rigidly fixed on the carrier bar 3. The slotted guides of the saw 7 are mounted for movement along the guide rods 8, by rotation of the nuts 14 mounted on the guide rods 8 made threaded. However, the mechanism for shifting the slit guide 7 along the guide rods 8 can be performed differently (not shown in the diagrams), for example, the guide rods 8 can be made smooth, and the slot guide 7 can be fixed on them by creating additional friction, for example, if instead nuts 14 to use a sleeve with a screw (not shown in the diagrams), when tightening the screw, the sleeve stops on the guide rod and prevents the slotted guide 7. The number of gaps 12 for the saw blade 13 in each slotted guide 7 may also be 1.2 or 3 depending on the number of plates 11. For example, in FIG. 5; 7; 8, the slit guide 7 located closer to the carrier bar 3 contains three plates mounted parallel to each other with a gap 12 for introducing the saw blade 13, washers (not shown on the diagrams) are located between the plates 11 in thickness corresponding to the width of the gap 12. By changing the thickness of the washers, it is possible to adjust the width of the gap 12. On the presented graphic materials (Figs. 1 to 8), the bone retainers 5 on the threaded rod 4 are fixed with fasteners 18 made in the form of two clamping washers (not indicated on emax), one of which is equipped with a transverse groove designed to accommodate the bone retainer 5, clamped on the threaded rod 4 with two nuts 14. In FIG. 7; 8 shows photographs of a guiding device assembled from parts included in the set of parts of the Ilizarov apparatus. The device contains two slotted guides 7, one of which contains three plates 11 and two clearances 12 for accommodating the saw blade 13. The carrier bar 3 consists of two radius bars with holes where the ends of the radius bars are interconnected by a threaded rod 4 and nuts 14. Number 2 pieces of bone fixators 5 and their corresponding fastening elements 18 are shown, but more can be used, for example, three bone fixators 5 and three fasteners 18. Additional clearances 12 in the slot guide 7, consisting of t the plate plates 11 can be used during an osteotomy to shorten the distal bone fragment, if such a need arises during the operation. Use of utility model.

Preoperative planning is carried out, during which the optimal level of a shortening osteotomy is selected from radiographs, and the longitudinal value (length) of the excised bone fragment is determined. The mutual position of the slotted guides 7 is set, for this purpose the nuts 14 on the guide rods 8 are rotated, moving the slotted guide 7 along the guide rods 8 to one or the other side, depending on what distance should be between the osteotomy lines. The distance between the gaps 12 of the two slit guides 7 corresponds to the length of the excised bone fragment. The device is sterilized. In the operating room, in accordance with preoperative planning, the previously prepared device is oriented parallel to the bone and fixed on it. For fixation to the bone, bone retainers 5 are used, they are inserted into the bone and then connected to the threaded rod 4 by fasteners 18. To perform a double osteotomy of the femur, the saw blade 13 is placed in the gap 12 of one slot guide 7 and the bone 6 is cut, then the saw blade 13 are placed in the gap 12 of the other slit guide 7 and the bone 6 is cut. As a result, a bone fragment is formed, which is removed. The osteotomy planes are parallel to each other, i.e. the remaining bone fragments are easily matched. The size of the excised fragment with a shortening osteotomy corresponds to preoperative planning. If necessary, in the process of performing an osteotomy, it is possible to change the distance between the levels of osteotomy in the operating room, after fixing the device to the bone. To increase or decrease the distance between the levels of the osteotomy, a longitudinal displacement of one slit guide 7 relative to the other slit guide 7 is performed by rotating the nuts 14 along the guide rods 8. The device allows, using a saw, correcting the osteotomy of the tubular bone at two levels (double shortening osteotomy), having received congruent bone filings and removing the bone fragment of the required length. When using the device, in comparison with analogues, the complexity and duration of surgical intervention are reduced. The device is fixed on two bone retainers 5, minimally invasive, and provides the ability to position the saw blade 13 in a given location on the bone 6. The size of the excised bone fragment is set in advance, which eliminates additional manipulations in the operating room.

The device allows you to perform a cross section of the bone 6 in two places at a predetermined value, without reinstalling the device. The volume of intraoperative blood loss is also reduced, parallel congruent surfaces of bone fragments are obtained, which contributes to better consolidation of bone fragments.

The proposed device was implemented by the authors, a prototype was made, which is used at the Ilizarov Center, Kurgan, when performing a double shortening osteotomy of the thigh.

Claims (10)

1. A guide device for performing a double shortening osteotomy, comprising a support part and a guide part, characterized in that the support part comprises a support bar with a threaded rod located in the middle and protruding downward from the surface of the support bar, bone fixators are mounted on the threaded rod with the possibility of removal, designed for insertion into the bone through soft tissue punctures, the guide portion contains slotted saw guides placed on two parallel guide rods, protrusions upward from the surface of the carrier bar, the ends of the guide rods are fixed to the free ends of the carrier bar, slotted guides of the saw are mounted with the possibility of changing the distance between them by longitudinal movement along the guide rods and are made in the form of plates mounted parallel to each other with a gap intended for introduction saw blades. 2. The device according to p. 1, characterized in that the carrier bar is made of a radial shape in the form of a sector of a flat ring. 3. The device according to p. 1, characterized in that the carrier bar is made detachable and assembled from two parts in a radial shape. 4. The device according to claim 1, characterized in that the bone retainers are made in the form of spokes. 5. The device according to p. 1, characterized in that the bone retainers are made in the form of rods-screws. 6. The device according to claim 1, characterized in that the threaded rod is installed in the hole on the carrier bar and fixed with nuts. 7. The device according to claim 1, characterized in that the guide rods are installed in the holes on the carrier bar and are fixed with nuts. 8. The device according to claim 1, characterized in that the two slotted saw guides are mounted to move along the guide rods by means of nuts placed on the threaded guide rods. 9. The device according to claim 1, characterized in that the washers are located between the plates, the thickness corresponding to the width of the gap. 10. The device according to p. 1, characterized in that the fasteners are made in the form of two clamping washers, one of which is equipped with a groove designed to accommodate the bone retainer, clamped on the threaded rod with two nuts.

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