RU1837849C - Method of introduction of bone fixing member and apparatus for determining angle and depth of penetration of bone fixing member and jig - Google Patents

Description

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The invention relates to medicine, in particular to traumatology and orthopedics. The purpose of the invention is to provide a given spatial location of the flexo-bone fixative in the medullary cavity of a long bone while reducing the duration and traumatic ™ operation.

This goal is achieved by using a device for determining the angle and level of insertion of a bone fixative into the bone and a special conductor.

Device for determining the angle and

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by inserting a bone fixative into the bone

(Fig. 1) consists of a plate 1 connected to the strips 3 by rods 2 having sections of multidirectional threads. A slider 4c is mounted on the slats with a pivotally mounted adjusting screw b, on which a guide tube 5 is placed with the possibility of angular movement, the supporting end of which is pivotally connected to the slider 4. The guide tube 5 has inserts of various diameters (not shown). used depending on the diameter of the used bone fixative. The plate 1 and strips 3 are made rectangular and made of an elastic material.

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The device is used as follows. A device is attached to the roentgenogram (or the skygram from it) of the long bone into which the fixer is to be inserted, so that the plate 1 on one side and the strips 3 on the other are oriented parallel to the long axis of the bone. The rods 2 are rotated, which ensures that the curvature of the plate 1 and the strips 3 coincide with the anatomy of the compact layer of the bone that limits the bone marrow cavity. After that, a flexible bone retainer, similar to which is to be used in operation, is inserted into the guide tube 5. In this case, the flexible retainer abuts the plate 1, slides along it for some time, and then, deviating, returns to the level of the straps 3. Moving according to the slats 3, the slider 4 and changes with the help of the adjusting screw b the angle of inclination of the guide tube 5, plan the desired path of passage of the flexible bone retainer along the bone marrow cavity. At the same time, the indicators of the inclination of the guide tube (angle) and the location of the slider (level) will reflect the optimal choice and guarantee success during the operation.

The conductor (Fig. 2) consists of two rigidly connected tubes of different diameters 1: one of them is a guide and serves to insert a bone retainer, an additional tube with a spoke inserted into it serves as a conductor retainer. The submersible end of the tubes is cut off at an angle of 20 °. At the fastening end of the guide tube at an angle of 60 °, a latch 2 is attached to it with a graduated spoke 3. Into the fastening end of the guide tube 1 using a threaded connection 4 at an angle of 30 ° to a bracket 5 is attached to the tubes T and in the same plane with them. At its free end, at an angle of 90 °, in the same plane with the tubes 1, a fixer 6 is attached with a movable graduated spoke 7 inserted into it.

The conductor is used as follows (Fig.Z). During surgery, an experimentally established level of insertion of a bone fixative into the bone is noted on the skin of a limb segment. Through a puncture of the soft tissues, the conductor is brought to the bone at the required level and fixed with a needle to the cortical plate. Using marks of graduated knitting needles 3, tubes 1 are set at a certain angle to the long axis of the bone. If a bone fixer is inserted into the bone marrow cavity near the joint and in the direction opposite to it, the installation angle of the tubes 1 is determined by the marks of the graduated knitting needle 7 (Fig. 4). A channel is made through the guide tube in the adjacent cortical plate and a bone fixer is inserted into it.

For example Patient I., 47 years old, diagnosis: deforming arthrosis of the right hip joint. 11/10/90, an intertrochanteric osteotomy of the Mac Marre type was performed under peridural anesthesia. Fragments are fixed with 2 knitting needles stretched over 2 rods inserted into the distal fragment. The duration of the needles was 15 minutes. This is achieved due to the fact that prior to surgery, the angle and level of insertion of the spokes are determined using the device. One of them was introduced from the outer surface of the bone, indented 19 cm from the top of the greater trochanter at an angle of 40 °, the second - indented distally for another 3 cm, at an angle of 35 °.

The sequence of actions of the surgeon was as follows. The top of the greater trochanter is marked with a spoke introduced into this area. A mark is placed on the skin of the outer thigh surface with a solution of brilliant green, located at a distance of 19 cm from the inserted needle. A conductor is brought to this bone level through a puncture of soft tissues and fixed with a spoke to the adjacent cortical plate. Then, the graduated spoke is fixed at the 40 ° mark in the spoke. The angle of inclination of the conductor with respect to the long axis of the bone in the frontal plane was limited by the emphasis of the graduated knitting needle in the bone. A cortical plate is perforated through a guide conductor tube using a drill with a diameter of 3 mm. A 2 mm spokes with a length of 400 mm was introduced into the formed channel and pierced to the subrovert region. Similarly, but with different administration parameters, a 2-spoke was made. Departing from the level of insertion of the distal needle 5 cm, at a distance of 4 cm from each other, 2 rods were inserted into the femur. An intertrochanteric osteostomy was performed with medialization of the distal fragment. Both punching needles are alternately pierced through the proximal fragment until they appear above the skin in the trochanteric region. Stops are formed at the central ends of the spokes, and peripheral strains are fixed to the rods.

Thus, the proposed method provides the necessary spatial orientation of the flexible body in the bone marrow cavity of a long bone. In this case, the manipulation of administration is carried out with minimal trauma. Preliminary calculation of bone fixation insertion parameters reduces time

the patient’s stay in the operating room, which reduces the material costs of the operation. Devices are designed to implement the method on all long bones.

Claims (3)

1. A method of introducing a bone fixer, including determining the angle and level of insertion of a bone fixer from an x-ray using a device for determining coordinates and introducing a bone fixer through a conductor, characterized in that the introduction of a flexible bone fixer into the bone is preliminarily performed using x-ray - frames and devices for determining the angle l of the insertion level of the bone fixative, as a result of which the optimal coordinates of its insertion are determined. 2. A device for determining the angle and level of insertion of a bone fixer, containing a base with scales and analogue of a bone fixer, different We note that the base is made in the form of a HOK, connected to the plate by rods, Having plots with multidirectional a thread placed on the slider slats with a pivotally mounted adjusting screw, on which the guide tube is movably placed, whose supporting end has the ability to interact with the slider, the slats and plate being rectangular and elastic, the scale is made on the adjusting screw, and the bone analog the retainer is located in the guide tube. 3. A conductor comprising a guide tube, a conductor-to-bone retainer and means for adjusting the position of the guide / tube, characterized in that the conductor retainer is made in the form of a spoke placed in an additional tube that is attached to the guide tube, means for adjusting the position of the guide the tube is made in the form of a fixed fixator with a graduated spoke fixed to the fastening end of the guide tube and having a threaded connection with the fastening end of the guide tube of the bracket with a special th and graduated needle at its free end. .,.: and and and and and b / w .,.: V i and and /