RU2264795C2 - Method and device for carrying out transosseous osteosynthesis - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: method involves introducing wire into bone fragments, drilling hole with hollow drill along the wire, introducing external rod along the wire, fixing the external rod in external fixation apparatus, applying compression by creating support by means of projecting rod platform thrusting against external cortical bone layer and screwing threaded part of the external rod into another cortical layer of a bone fragment. Prolonged medicament introduction is carried out into bone fracture zone. The external rod for performing transosseous osteosynthesis is designed as a rod having projecting platform with a through cannulated hole. An area for screwing into bone is available on one of its ends and the other end is fixable in the external fixation apparatus. The cannulated hole receives guiding wire or for introducing drugs. Area for screwing into bone is threaded for being built in into cortical layer of fractured bone fragment. The end fixable in the external fixation apparatus is threaded. The projecting platform thrusting against external cortical bone layer is available on smooth area between the threaded part and threaded end.

EFFECT: enhanced effectiveness of treatment; high accuracy in setting fixing member; prolonged introduction of drugs into fractured zone.

2 cl, 2 dwg

Description

The invention relates to medical equipment, namely to devices and methods for transosseous osteosynthesis in traumatology and orthopedics.

Known methods of transosseous osteosynthesis using external fixation devices, including closed supports, to which the spokes are fixed, held transosseously. Their disadvantage is the difficulty of installing the spokes to perform optimal osteosynthesis.

Closest to the claimed one is the method of introducing external Shants screws (Müller M., Algover M., Schneider R., Willinger X., Manual for internal osteosynthesis. M., 1996. P.368), which consists in screwing the screw into the hole previously drilled in bone fragments after reposition. Then, the Shants screw is fixed statically in the outer modular frame of the external fixation apparatus.

The disadvantage of the method selected as a prototype is the inability to accurately install the retainers in the desired plane and in the desired area of bone fragments with closed osteosynthesis.

A device is known for transosseous osteosynthesis in the form of an external Shants screw (Schanz screw). This is a rod of circular cross section with a thread for insertion into the bone at one end and a thread for fastening in the apparatus at the other. (Müller M., Algover M., Schneider R., Willinger X. Guidelines for internal osteosynthesis. M., 1996. S.368).

The disadvantage of this device is that the Shants screw does not have a cannulated through hole, therefore it cannot be carried into fragments along the Kirschner needle as a guide to the desired bone site.

The closest analogue device according to the patent of the Russian Federation No. 2192191, 2002. In the known solution, the outer rod is made in the form of a rod with a shoulder. In addition, the design features of the device do not allow you to enter drugs through it and do not provide either a static or dynamic compressive effect on fragments or fragments during treatment.

The objective of this invention is to improve the quality of treatment of fractures by transosseous osteosynthesis due to a more accurate installation of the fixative in the desired plane and the desired area of bone fragments and prolonged administration of drugs in the area of bone fracture.

The task is achieved in that for the implementation of transosseous osteosynthesis, a method is proposed that consists of inserting a needle into bone fragments, drilling a hole through a needle with a hollow drill, into which an external shaft is inserted through a needle, securing the external shaft in an external fixation device, and compressing creating emphasis by the protruding platform of the rod on the outer cortical layer of the bone and screwing the threaded section of the outer core into another cortical layer of the fragment, and prolonged administration of medicinal products bones in the area of bone fracture.

According to the invention, for the implementation of the claimed method, an external rod for transosseous osteosynthesis is proposed, made in the form of a rod with a protruding platform and with a through cannulated hole, at one end of which there is a section for screwing into the bone, and the other end is made for fixing in the external fixation device, wherein the cannulated the hole is made for a guide needle or the introduction of medicinal substances, the section for screwing into the bone is threaded for placement in the cortical layer of the fragment the end for fixing in the external fixation apparatus is threaded, the protruding platform is made to abut the outer cortical layer and is located on a smooth section between the threaded section and the threaded end.

According to the scientific, technical and patent literature in medicine, devices of the claimed design and methods for their implementation in transosseous osteosynthesis are not known.

Figure 1 shows the device of the proposed outer rod, which is made in the form of a metal rod 1 with a diameter of 5 to 6 mm with a through cannulated hole 2 with a diameter of 1.5 to 2.1 mm, at one end of which there is a thread 3 for insertion into bone fragments and a smooth area 4 from 5-8 mm, which goes into a protruding no more than 2 mm platform 5 with a width of 2.5 to 3 mm. The other end has a thread 6 for fixing in the supports of the external fixation apparatus.

On figa, 2b, 2c shows the implementation of the method of application of the claimed device. After an open reduction, fragments and fragments are injected with a Kirschner needle 7 in the desired area. A hole is created in the bone along the spoke with a hollow drill, into which the outer shaft with the cannulated hole 2 is inserted until it stops with the pad 5 into the outer cortical layer of the bone. Then the needle is removed. Compression is provided by a persistent protruding platform 5 located on one cortical bone layer, by screwing the threaded section 3 of the outer shaft into another cortical fragment layer. This creates a static, and later in the process of treatment, dynamic compression is possible by dosed screwing the rod. Due to the threaded part 6, the outer shaft is fixed in the external fixation apparatus (for example, in the Ilizarov apparatus). Through the cannulated opening 2, according to indications, drugs are introduced into the bone fracture zone.

The essence of the claimed invention is illustrated by example. Patient Denyushev I.B., No. 17994, was admitted to the hospital 03/12/2003 with a diagnosis of

Car injury: Closed head injury. Brain concussion. Closed comminuted fracture of the external condyle of the right tibia with displacement. SHOCK-1. Osteosynthesis of bone was performed in a deferred order according to the proposed technique. Through standard access, an open reduction was performed, in the required plane, the Kirschner spoke was inserted into the fragments, through which the declared outer core was introduced through the hole drilled by a hollow drill and the necessary compression was created. Then the spoke is removed. The rod is fixed with a thread in the Ilizarov apparatus. The wound is sutured in layers. In the postoperative period, an antibiotic solution was injected into the fracture zone. The wound healed by primary intention. In satisfactory condition, two weeks after the operation, the patient was discharged for outpatient treatment, and functional rehabilitation treatment was started. The total duration of treatment until full recovery is 3.5 months.

Thus, the method of transosseous osteosynthesis and a device for its implementation provide an increase in the strength of the joint of the outer shaft and bone, the ability to technically simply set the shaft in a predetermined location (even without exposing the fracture zone), and perform closed osteosynthesis. They create conditions for both static and dynamic compression of bone fragments and fragments during treatment. The possibility of splitting the bone with the introduction of the outer shaft is prevented. Provides long-term administration of drugs (dynamic - during the entire treatment period) into the zone of bone fracture through the cannulated hole in transosseous osteosynthesis. The method and device can be used during osteosynthesis with external fixation devices of various models, which allow osteosynthesis of various bone zones. At the same time, repeated traumatic surgical interventions are not required to remove metal structures from the bone after the end of treatment.

Claims (2)

1. The method of transosseous osteosynthesis, which consists in the fact that the needle is inserted into bone fragments, a hole is drilled through the needle with a hollow drill, the outer shaft is inserted through the spoke, the outer shaft is fixed in the external fixation apparatus, characterized in that it provides compression by creating a protruding stop the site of the rod on the outer cortical layer of the bone and screwing the threaded section of the outer core into another cortical layer of the fragment and the long-term introduction of drugs into the bone fracture zone. 2. The outer rod for implementing the method according to claim 1, made in the form of a rod with a protruding platform and with a through cannulated hole, at one end of which there is a section for screwing into the bone, and the other end is made for fixing in the external fixation device, the cannulated hole made for the guide needle or the introduction of medicinal substances, the department for screwing into the bone is threaded for placement in the cortical layer of the fragment, the end for fixing in the external fixation device is made threaded The protruding platform is made to abut the outer cortical layer and is located on a smooth area between the threaded section and the threaded end.

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