RU207099U1 - Wire cerclage device - Google Patents

Abstract

The utility model relates to surgical instruments, in particular to traumatology and orthopedics, and can be used during the application of a wire cerclage for periprosthetic femoral fractures. The technical result of the utility model is to simplify the fixation of periprosthetic fractures of the femur, reduce the likelihood of damage to anatomical structures, reduce the trauma of surgical intervention, reduce the incidence of postoperative complications. connected at their intersection by a hinge. The stem parts contain handles that are connected to the working jaws. The branches are made in the form of a conductor and a repositioning part. The branch of the conductor is made in the form of a tube with a slot for the wire. The branch of the repositioning part is made on the inner surface with a guide groove for the wire at an angle to the longitudinal axis of the device. The hinge is single-axis and collapsible. A cylindrical protrusion is made in the repositioning part. In the middle third of the conductor, three holes are made for a cylindrical protrusion. When a cylindrical protrusion is inserted into one of the aforementioned holes, a uniaxial hinge is formed.

Description

The utility model relates to medical technology, namely to devices used in traumatology and orthopedics, can be used when performing wire fixation of long bone fractures.

A simple and reliable method of fixation for "oblique" or "spiral" fractures of the diaphysis of the tubular bone is the application of a wire cerclage, for this the wire is drawn around the bone, the ends of the wire are twisted relative to each other to create compression. At the same time, circular wire cerclage can be used both separately and in combination with other methods of fixation.

When conducting the wire in the metadiaphyseal region, including the thigh, quite often, technical difficulties arise due to the developed muscular complex, the presence of dense fascial septa. In this regard, the implementation of this procedure using standard instruments increases the duration of the surgical intervention and the volume of iatrogenic injury, which worsens the results of treatment. To prevent possible undesirable consequences, simplify the technique of performing the procedure, and reduce the amount of injury, it is necessary to use special devices.

Known invention "Device for osteosynthesis of long tubular bones" (Patent RU No. 2655108 C1, IPC A61B 17/82, A61B 17/80 - 23.05.2018, bull. No. 15), in which the structure is made of wire with a diameter of 1 mm has a length from 90 mm to 140 mm, over 2/3 - 3/4 of its length in the center and at the ends it is flattened, has a width of 1.5-2.0 mm and a thickness of 0.5-0.7 mm, and on the concave side the central section of the wire with the help of a pointed striker forms transverse dents. The invention provides a reduction in the time of performing intraoperative manipulation and the entire operation of immersion osteosynthesis. The flattening of the ends of the device makes it easier to carry out the wire cerclage. Then the ends of the device are wound up behind each other and twisted with pliers.

The disadvantages of the device include

The complexity of manual production with the specified parameters.

Lack of control over the conduction of the wire in soft tissues.

High risk of wire rupture due to existing cross-notches.

Also known is the "Method of fixing bone fragments during endoprosthetics of pertrochanteric fractures of the femur" (Patent RU No. 2610861 C2, IPC A61B 17/56 - 16.02.2017, Bul. No. 5), which consists in the fact that through the fragments of the greater trochanter a canal is formed in which is injected with a wire cerclage. Directly with the end of the wire, they go around the posterior surface of the proximal femur and bring it out from the front above the lesser trochanter. Next, a loop of an 8-shaped seam is formed using the same end of the wire around the small trochanter. Tie two ends of the wire on the anterior surface of the proximal femur, create compression to the femur diaphysis.

The disadvantages of this method include

Difficulty drawing the wire directly around the bone.

Lack of special tools for the formation of a cerclage channel and control of the location of the wire.

The closest to the proposed utility model is "Conductor of tension strips and wires" (Patent RU No. 2281060 C1, A61D 1/00, A61B 17/04 - 10.08.2006, bull. No. 22). The device contains a handle and a working part with a groove. The working part has a cover and a groove for fixing the tightening strip with a groove for the wire. On the working part, the groove for the wire is made along the entire length and in the center of the groove. The cover is installed in runners and has a working end in the form of a rounded stop. The guidewire with cerclage material is brought through the operating wound to the bone, prepared from above from the soft tissues, and the soft tissues are separated in the form of a narrow cavity by a translational movement along the bone perimeter with the working end of the limiter. After removing the working end of the guide from the other side of the bone, the lid is grasped by the opening with the teeth of hemostatic or surgical forceps, and by moving upwards and to the side opposite to the handle, the lid is moved until it is completely removed. Thereafter, the lagging strip and wire are available for circular fixation of the bone fragments. Then, the bone fragments are circularly fixed with a tightening strip, which is fixed with a wire, and by rotating the handle in the opposite direction from the working end, the guidewire is taken out from under the bone and then outside the operating wound.

The disadvantages of the device are

Difficulty controlling the position of the guidewire in a large array of soft tissues.

Impossibility of conducting wire only with the help of the device.

The closest to the proposed model is the utility model "Surgical cable passer instrument and methods" (Patent US No. 2018153603 A1, IPC A61B17 / 88 - 06/07/2018), in which the device consists of two tubes, handles, a hinge mechanism, after inserting the tubes around the bone and the attachment of the handles, through the channels of the tubes, the wire is drawn around the circumference of the bone.

The disadvantages of the described model include

Inability to perform fracture reduction using the device.

The difficulty of passing the wire through the conductor channel around the entire circumference.

The complexity of the jaws of the device around the bone and further assembly of the instrument.

The technical result of the utility model is to simplify the application of a wire cerclage with a preliminary reduction of bone fragments, reduce the trauma of fixation with a wire, ensure complete control of the wire, and reduce the frequency of possible postoperative complications.

The technical result is achieved by the fact that the device for conducting a wire cerclage is made of medical steel, two crossing S-shaped, counter-curved rod parts connected at the place of their intersection by a hinge, the rod parts consist of two handles and a working part, the peculiarity is that it consists of two collapsible intersecting rod parts, there are three holes in the middle third of the conductor part, a cylindrical protrusion-hinge is made in the repositioning part, when the two parts are connected, the cylindrical protrusion-hinge is inserted into one of the holes and forms a uniaxial hinge. The rod parts are S-shaped, bent, contain handles that are connected to the working jaws; when the handles are squeezed, the jaws come closer together, which ensures fracture repositioning. The working part of the conductor part consists of a tube with a slot on the inner surface, into which the wire is inserted. A groove is made along the inner surface of the branch of the repositioning part, directed at an angle to the longitudinal axis of the device. After performing the reduction, passing the wire through the slot in the guide jaw and along the guide groove of the jaw of the repositioning part, the wire goes into the operating wound above the surface of the femur. The ends of the wire are twisted until the fracture line is compressed, the hinge is pulled apart, and parts of the device are separately removed from the wound.

The essence of the utility model is illustrated by drawings, which show:

in fig. 1 is a side view of the conductor part;

in fig. 2 is a side view of the repositioning part;

in fig. 3 is a top view of the repositioning part;

in fig. 4 - assembled device.

In the figures, the following positions are indicated by numbers:

1 - guide part, 2 - repositioning part, 3 - handle, 4 - jaws, 5 - single-axis collapsible hinge, 6 - tube, 7 - holes for the protrusion-hinge, 8 - guide groove, 9 - cylindrical protrusion-hinge.

The device consists of two parts and contains the following elements: rod parts of the device, part-conductor 1, repositioning part 2, consisting of handles 3 and jaws 4, single-axis collapsible hinge 5, the working part of the conductor consists of a tube with a slot 6 along the entire length of the inner surface jaws, at the point of transition of the handle to the jaw, three holes are made for the protrusion-hinge 7, on the inner surface of the jaw of the repositioning part, a guide groove 8 is made, in the area of transition of the handle to the jaw, a cylindrical protrusion-hinge 9 is made.

Implementation of the utility model.

Osteosynthesis with wire cerclage using the proposed device is carried out as follows:

During the operation with a fracture of the tubular bone, the end of the wire is inserted into the slot 6 of the jaw of the guide part of the device 1. Its working part 4 is carried along the perimeter around the bone, separating the surrounding soft tissues, and the jaw of the repositioning part of the device 2 is carried out along the perimeter around the bone from the opposite side. The cylindrical protrusion-shair 9 is compared with one of the holes 7 of the guide part (depending on the diameter of the tubular bone) and both parts of the device are connected. If necessary, reposition - squeeze the handles 3. The cerclage wire is pushed along the channel of the guide jaw and then with the transition along the guide groove 8 until it appears in the operating wound. The wire cerclage is tightened by twisting the ends of the wire around each other. The device is disassembled in the area of the hinge 5, parts of the device 1, 2 are removed, while the wire remains in the area of the fracture around the femur.

The use of this device allows to reduce iatrogenic trauma of soft tissues, to control the location of the wire, to simplify the reposition of bone fragments and fixation with wire cerclage.

Clinical example.

Patient P., born in 1955, was admitted to inpatient treatment with a diagnosis of Bilateral coxarthrosis IVst. FTS 2st. Mixed contracture of the hip joints.

According to the patient, he considers himself sick for about 20 years, denies injury. Conservative treatment courses without significant positive dynamics are aimed at surgical treatment - total hip arthroplasty. On admission: The length of the limbs is D = S, severe lameness, the patient moves with the help of two canes. Movements in the right hip joint are sharply painful. The range of motion in the right hip joint is limited: extension / flexion 10-0-90, adduction / abduction 15-0-20, internal rotation / external rotation 10-0-10. The range of motion in the left hip joint is limited - extension / flexion 10-0-100, adduction / abduction 15-0-20, internal rotation / external rotation 10-0-10. Sensitivity movements of the toes are preserved. Ripple a. dorsalis pedis is preserved on both feet.

On the X-ray of the pelvis - deformity of the femoral heads, osteosclerosis of the articular surfaces, osteophytes of the acetabulum region, usulation of the articular surfaces - bilateral deforming arthrosis of the hip joints IVst.

The patient was prepared for total right hip arthroplasty. Under spinoepidural anesthesia, in the supine position of the patient, an anterolateral approach was performed along the Hardinge. An oscillator saw was used for resection at the level of the neck, and the head of the femur was removed. The acetabulum was cut with cutters, the acetabular component was installed on the bone cement. The canal of the femur was opened with a curette; during the processing of the medullary canal with rasps, an incomplete fracture about 3 cm long was revealed in the proximal part of the femur. In order to prevent further spread of the fracture, to prevent the interposition of bone cement between the fragments and to achieve the primary stability of the components of the endoprosthesis, it was decided to fix the fracture area with a wire cerclage. The branch of the proposed device with the inserted wire is drawn along the cortical surface of the bone, bending around it in a circle, the second part of the device is inserted, the device is connected in the region of the uniaxial hinge, compression is performed in the fracture area, a metal wire is drawn around the bone. To create the necessary compression, the ends of the wire are twisted with a medical tool. The ends of the jaws are open, the device is removed from the fixation area, while the wire remains in the fixation area. The femoral component of the endoprosthesis is installed on the bone cement. The postoperative wound was sutured in layers.

On the control X-ray, the position of the components of the endoprosthesis is correct, the proximal femur is fixed with a wire cerclage, the penetration of bone cement in the fracture area is not visualized.

The patient was activated, the postoperative period was without complications, the wound healed by primary intention. The control X-ray after 3 years showed no signs of instability of the components of the endoprosthesis. The support ability of the operated limb and the function of the right hip joint were restored.

Claims (1)

A device for carrying out a wire cerclage, made of medical steel, two intersecting S-shaped, counter-curved rod parts, connected at the point of their intersection by a hinge, the rod parts contain handles that are connected to the working branches, characterized in that the latter are made in the form of a conductor and of the repairing part, the conductor jaw is made in the form of a tube with a slot for the wire, the jaw of the repairing part is made on the inner surface with a guide slot for the wire at an angle to the longitudinal axis of the device, the hinge is single-axis and collapsible, while a cylindrical protrusion is made in the repairing part, in the middle the third of the conductor has three holes for the cylindrical protrusion, while when the cylindrical protrusion is inserted into one of the aforementioned holes, a uniaxial hinge is formed.

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