RU2273463C2 - Kavchuck apparatus for externally reducing and fixing fractured bone fragments and method for carrying out automatic or semiautomatic fractured bone fragments reduction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device has fixing support members, reduction and fixation rods, ball and socket joints, transosseous fixing members and sliders having threaded holes for receiving the distraction rods and reduction support members. The reduction support members are oval and/or triangular and/or square and/or hexagonal and/or rectangular and/or unclosed angular and/or U-shaped manufactured from straight or curved racks having through holes all along the whole length for fixing threaded rods. The sliders have two plates enveloping the rack and worm or tommy bar drive. Fixing support members of various shapes bearing transosseous fixing members are attached to the racks of reposition support members. The transosseous fixing members are attachable directly to the reposition support members. Method involves applying the apparatus and reduction system composed of interlinked units like X-ray apparatus having optoelectronic image tube or ultrasonic device or nuclear magnetic resonance device sending signals describing splitter relations to computer with appropriate computer software switching-in electromotors connected to the sliders and distraction rods in required sequence. Fractured bone fragments are reduced via drives and in automatic mode. Method involves applying the apparatus. Surgeon analyzes data describing fractured bone fragments relations obtained from X-ray apparatus having optoelectronic image tube or ultrasonic device or nuclear magnetic resonance device and switches electromotors with drives to sliders and distraction units in given sequence on control panel and fractured bone fragments are reduced in semiautomatic mode.

EFFECT: high accuracy controllable fractured bone fragments reduction and fixation.

10 cl, 19 dwg

Description

The field of technology.

The invention relates to medicine, namely to devices for osteosynthesis, and can be used for external (extra-focal) reposition and fixation of bone fragments in fractures of tubular bones in the diaphyseal and metaphyseal areas.

The prior art.

Known apparatus G.A. Ilizarov for transosseous osteosynthesis, which consists of supports in the form of arcs and rings with mounted spokes, which are interconnected by threaded rods that form blocks for fixing the proximal and distal fragments, distractors and nodes for regulating and fixing the position of the supports and knitting needles made in the form of connected strips, sliders and washers, the apparatus is equipped with an additional ring that is installed between the blocks of the proximal and distal fragments and connected to them by means of impactors, and the nodes of the regul The fixing and fixing positions of the supports and knitting needles are located on an additional ring, while the strips are equipped with flanges at the ends with a threaded hole, the axis of which coincides with the plane of the surface of the strips, the sliders are made in the form of brackets with threaded ends, and the washers have a prismatic groove tangent to the hole ( A.S. USSR No. 1055599, A 61 B 17/18, publ. Bull. No. 43, 1983).

The disadvantages of the analogue are that structurally, the apparatus does not include the possibility of repositional movements in all directions in the required volume without remounting the apparatus and dismantling new parts.

There are also known methods of applying Ilizarov external fixation apparatuses and others with reposition of fragments in the apparatus in different ways - by adding new parts (plate prefixes) or by shifting the spokes along the ring with their subsequent tensioning, all this is carried out manually by the surgeon under the radiological control of the ratio of the fragments by a series of radiographs or fluoroscopy with using an electron-optical converter (EOP) (Osteosynthesis, edited by Corresponding Member of the Academy of Medical Sciences of the USSR, Prof. S. S. Tkachenko, “Medicine”, Leningrad, 1987, pp. 116-117).

The disadvantage of the aforementioned analogue is the insufficient repositional capabilities of these devices and methods of reposition by them, since there is no way to make forced repositional movements with fragments in the devices due to their repositional capabilities. Therefore, to achieve reposition before applying the devices, preliminary reposition on special tires or skeletal traction is used, and displacements of fragments after applying the device are eliminated by adding new elements and remounting the devices (adding plate attachments, introducing additional knitting needles, shifting the spokes along the ring, followed by their tensioning, etc. item), which excludes the possibility of repositioning fragments without changing the design of the apparatus and makes it impossible to reposition fragments automatically th mode.

The closest in technical essence to the claimed apparatus is the compression and distraction apparatus Okulicha G.S., which consists of frames made in the form of two squares, on which are placed sliders with spokes, clamping screws, and swivels, spheres are installed between the frames in the corners which are wrapped and connected by threaded rods with multidirectional threads; coupling screws tie each pair of frames; sliders have slots and clamps for knitting needles. In addition, the edges of the corners of the frames are equipped with rectangular thread (AS USSR No. 548267, A 61 B 17/18; publ. Bull. No. 8, 1977).

The disadvantage of the prototype can indicate that in the apparatus of Okulich G.S. it is not possible to carry out repositional movements in all planes in the required volume without remounting its nodes, in addition, the use of rods for fixing fragments is not expected, additional technical difficulties arise when conducting mutually crossed pairs of spokes that are parallel in parallel at a small distance from one another and are attached to one pair of frames; the inability to perform reposition in automatic and semi-automatic modes.

The technical task is to create an apparatus for external reposition and fixation of bone fragments, which would ensure accurate controlled reposition and fixation of bone fragments due to the constructively incorporated possibility of a full range of repositional movements in all planes without remounting the apparatus or adding new nodes and parts and which would work as a manual a mode where the sliders move with a wrench by the surgeon himself; semi-automatic mode, where the sliders move from the electric motor drives, and their movement parameters are selected by the surgeon by pressing the buttons on the control panel, and in the automatic mode, where the sliders move from the electric motor drives, and the motion parameters of the reponier supports or rods are selected by the computer, in addition, the device must provide reliable fixation of fragments, have a simple design, minimal volume and weight of nodes and parts with a wide range of clinical applications.

SUMMARY OF THE INVENTION

The stated technical problem is solved by the Kavchuk apparatus for external reposition and fixation of bone fragments, which consists of repairing and fixing supports for sliders, ball joints and distraction and fixing threaded rods.

The apparatus uses oval, triangular and square repair bearings, which are mounted from straight and curved gear racks. Reiki have through holes along the entire length.

Curved gear racks are of two types: segmented gear racks, which are segments of a circle, and angular gear racks, which are angles with rounded corners.

All forms of repairing supports (oval, triangular and square) are assembled from segmented or angular gear racks.

The angular gear racks round the angles of the supports, and the segment rails optimize the shape of the supports, which leads to an increase in the volume of movement of the sliders on the supports and, as a result, an increase in the repositioning capabilities of the apparatus.

In a simplified version of the apparatus, only direct gear racks are used, from which all forms of repair bearings are assembled. Four gear racks are connected at the corners, forming a square support. The triangular support is assembled by their three toothed racks, which are connected at the corners by trims, forming an equilateral triangle with cut corners (in order to reduce the size of the support). Oval supports in this case are replaced by hexagonal, which most accurately describe the shape of the oval, or rectangular. These two forms of supports, assembled from straight rails, functionally correspond to the oval support and replace it, but rectangular supports increase the size of the apparatus and therefore are rarely used.

On the gear racks of the repairing bearings placed sliders, which are two plates that span the gear rack. The plates have a worm or gate drive and a threaded hole for connecting the distraction rods. When the worm rotates, the slider moves along the gear rack of the support, and when the distraction rod rotates, it moves along the latter.

It should be noted here that there is another design variant of the apparatus’s support legs, in which the support legs are assembled not from gear racks, but from threaded rods - straight or curved. When bent, chamfers are required on the sides of the threaded (rods to remove the most deformed sections of the thread, which allows the nut to move along the bend. The sliders move along the threaded rods with the help of nuts or the rotation of the rod itself. In this case, the sliders are cube-shaped parts with two perpendicular threaded One hole for the passage of the support rod, and the second for the distraction rod. The shapes of the reposition supports and their functions are similar to the typical rack supports of the apparatus.

In the apparatus, the reparatory supports are placed in a rotated position. They are displaced relative to one another in the axial plane and their sides are projectively crossed. The square support has eight points of projection intersection of the sides, the triangular support has six points, and the oval (hexagonal and rectangular) four points. Repositioning supports are interconnected by three or four distraction rods through sliders that are located at the points of projection intersection of the sides of the supports. At the same time, on the proximal support, the distraction rods directly pass through the holes of the sliders, and on the distal support they are connected to the sliders through ball joints.

When using square and triangular repairing supports, it is possible to mount the device with three or more repairing supports (for double and multi-split fractures).

Each reponential support on a more distal fragment is attached to the distraction rods, which extend from the more proximal support through ball joints, and has a full range of repositional movements in all planes. This allows the device to repair each fragment separately.

When using oval supports (hexagonal rectangular), there are only four points of intersection of the supports, which allows connecting no more than two repairing supports with distraction rods.

Square repositioning bearings are rotated in the axial plane one relative to another at an angle of 45 degrees, triangular - at an angle of 60 degrees, oval (hexagonal, rectangular) - at an angle of 90 degrees.

Such an arrangement of the supports and the sliders on them enables a wide range of movements of the repairing supports relative to each other in all planes by moving the sliders in a certain sequence, as well as the ability to correct the distraction rods with angular displacements of the supports. Appliances with oval and triangular supports have the largest volume of reponing movements and somewhat smaller volume with square supports.

In case of clinical need, a device version with triangular or square supports located in parallel is mounted, which requires the use of an additional part - a threaded reposition rod, which is fastened with two sliders on each corner of the reponential supports (for triangular - three reposition rods, for square - four reposition rods on the support ), and the distraction rods are attached to the reposition rods (on the proximal support, the distraction rods pass through the holes in the reposition rods, and and the distal ones are attached to reposition rods through ball joints). In this case, the reponent supports are not offset along the axis one relative to the other, and repositional movements are performed by moving the repositional rods along the corners of the reponent supports.

Fixing supports of various shapes (rings, half rings, planks, corners, squares or figures similar to repositional supports, etc.) are fixed to the repairing supports using threaded fixing rods that pass through the holes in the gear racks. transosseous fixation (transosseous rods, knitting needles, nails). Elements of transosseous fixation, if necessary, are also attached to the reparatory supports.

If necessary, not circular, but one-sided placement of the apparatus on the limbs (unilateral apparatus), for example, overlaying the apparatus on one bone of the forearm, the apparatus is mounted with half square supports - it is actually divided in half in the plane of the longitudinal section of the bone. In this case, the closed square reparatory supports of the apparatus turn into an unclosed angular and U-shaped reparatory supports, which are placed on one side of the limb. These supports are connected by means of distraction rods through sliders at the points of their projection intersection. With the help of fixing rods, various forms of fixing supports, half rings, squares, and slats are fixedly attached to the repairing supports.

Repositional movements are carried out in the same way as on open supports.

The second variant of the unilateral apparatus is mounted from carbohydrate supports (halves of square or triangular repairing supports), which are placed in two parallel pairs and fastened together by one or more distraction rods (see Fig. 9/19).

On each carbide support there is a positioning rod, which is attached to the support through sliders. To the repositioning rods of each pair of supports it is fastened with a strap with holes for fixing the transosseous rods.

The movement of the reposition rods along the supports in different directions, as well as the supports one relative to the other on the distraction rods, gives reposition movements in all planes and directions.

The set of essential features of the proposed solution of the Kavchuk apparatus for external reposition and fixation of bone fragments has a causal relationship with the achieved effect:

- the rounding of the corners of the reparatory supports and the optimization of their shape by segment rails enable more free movement of the sliders, thereby expanding the functionality of the apparatus;

- thanks to the special shape of the reparatory supports and their rotationally displaced arrangement relative to one another (offset by 45, 60 and 90 °), it is possible to move the reponential supports and fragments with them in all planes and directions without remounting the apparatus, adding new units and parts, which in turn, makes possible not only manual hardware reposition of fragments with a wrench, but also semi-automatic and automatic hardware reposition of fragments.

The automatic mode of hardware reduction of bone fragments is provided thanks to the reposition system, which consists of interconnected elements:

- a fluoroscopy apparatus with an image intensifier tube or an ultrasound scan, or NMR, which provide information on the ratio of broken bone fragments;

- a computer with an appropriate program for matching displaced bone fragments;

- electric motors with drives for moving the sliders on supports and distraction rods;

- The reposition apparatus, which performs the reposition of bone fragments and their fixation.

In automatic mode, hardware reposition of fragments is performed as follows:

a reposition and fixation apparatus is superimposed on the fragments of a broken limb;

- drives from electric motors are attached to the parts of the apparatus, which provide the movement of the sliders;

- the ratio of fragments is determined according to fluoroscopy of the image intensifier tube or ultrasound, or NMR studies;

- these data are analyzed by a computer that sends signals to the control panel to turn on and off the electric motors in a certain sequence;

- from the drives of electric motors, the sliders move along the repairing supports and distraction rods, performing the necessary repositional movements with fragments.

The advantage of this method is the simplicity, speed and quality of the reduction of fragments, as well as the fact that a good reposition result does not depend on the qualifications, skills, way of thinking and subjective properties of the surgeon. The system automatically corrects the fragments, and the participation of the surgeon is reduced to technically simple operations: introducing the rods into the bone fragments and fixing them in the device.

The positive result of the reposition now no longer depends on what level of the hospital the patient is and what qualification level the surgeon is conducting the operation.

In semi-automatic mode, hardware reposition is carried out in this way: data on the ratio of fragments is not analyzed by a computer, but by a surgeon who, according to the monitor (EOP, SPL, NMR), presses the buttons on the control panel, turning on and off the electric motors in the desired sequence, and thus repositions fragments.

Manual hardware reposition of fragments is carried out by the surgeon himself, who moves the sliders, turning the worms of the sliders and the distraction rods according to the data on the ratio of fragments.

The design of the apparatus allows reposition without replacement of parts and remounting of the apparatus.

The invention is explained by the figures of the graphic image, where

figure 1 - General view of the apparatus of the Kavchuk for external reposition and fixation of bone fragments with two oval repairing supports;

figure 2 is a General view of the apparatus with two hexagonal repaired supports;

figure 3 is a General view of the apparatus with two triangular reversing supports with rounding corners;

figure 4 is a General view of the apparatus with two triangular reparatory supports mounted from straight rails;

figure 5 is a General view of the apparatus with two square repaired supports mounted from straight rails;

in Fig.6 is a General view of the apparatus with three square repaired supports mounted from straight rails;

Fig.7 is a General view of the apparatus with two parallel located triangular reparatory supports mounted from straight rails;

on Fig is a General view of the unilateral apparatus with an open angle and U-shaped repaired supports;

figure 9 is a General view of the unilateral apparatus with open parallel angular repaired supports;

figure 10 is an image of an oval reponent supports in axial projection;

11 is an image of hexagonal supports in axial projection;

in Fig.12 is an image of a triangular rounded reponor support in axial projection;

in Fig.13 is an image of a triangular repairing supports mounted from straight rails in axial projection;

on Fig - image of a square repaired supports mounted from straight rails in axial projection;

Fig. 15 is an image of a triangular repairing support with three repositioning rods at angles in axial projection;

in Fig.16 is an image of the angular and U-shaped repairing bearings in axial projection;

on Fig is an image of an angular repositioning support with a repositioning rod in axial projection;

on Fig is a diagram of the hardware reposition of fragments in automatic mode;

on Fig - scheme of hardware reposition of fragments in semi-automatic mode.

All figures of the graphic image have a common numbering of the parts depicted on them, where

- oval repairing supports - 1;

- hexagonal - 2;

- triangular repairing supports - 4;

- U-shaped repairing open support - 5;

- angular repair bearings - 6;

- distraction rods - 7;

- reposition rods - 8;

- sliders - 9;

- nuts - 10;

elements of transosseous fixation:

- rods - 11.

The Kavchuk apparatus for external reposition and fixation of bone fragments works in this way.

The elements of transosseous fixation (rods (11), knitting needles, which are attached to the fixing and, if necessary, to the reponent supports, are introduced into the distal and proximal bone fragments. The reponent supports are placed so that they are displaced in the axial projection one relative to the other by the required angle ( oval reparatory supports (1), hexagonal (2), rectangular - 90 °, triangular reparatory supports (3) - 60 °, and square reparations (4) - 45 °).

The reponizing and fixing supports, which are located on the proximal fragment, are interconnected by thread rods in one block, similarly, the reponding and fixing supports on the distal fragment are connected to each other in the second block. The sliders (9) on the repairing supports (1, 2, 3, 4, 5) are located at the points of projection intersection of the sides of the supports, and the repairing supports (1, 2, 3, 4, 5) are interconnected by distraction rods (7) carried out through the sliders (9). Thus, the proximal and distal blocks are interconnected.

By displacing the supporting supports along the distraction rods (7), displacements of fragments along the length and at an angle are eliminated. By moving the sliders (9) along the repositioning supports in a certain sequence, all displacements of fragments in the axial plane — in width and rotational — are eliminated, and the position of the distraction rods (7) is corrected with the angular displacement of the support (the support projectively decreases or increases in this case).

If it is necessary to increase the reponing movements in the apparatus and in the presence of several bone fragments (double fractures, etc.), which requires reposition of each fragment separately, the number of reponing supports of the apparatus (triangular or square) increases to three or more. Each additional support is displaced relative to the previous one at an angle of 60 ° if it is triangular (3), and at an angle of 45 ° if it is square (4). The supports are interconnected by distraction rods (7) through sliders (9). In this case, bone fragments are fixed directly to the repairing supports.

If there is a clinical need, a device version is mounted with triangular (3) or square (4) supports placed in parallel. With two sliders (9), a reposition rod (8) is attached to each corner of the reponential support (for triangular supports - three reposition rods (8), for square supports - four reposition rods (8) on the support), and distraction rods (7) pass through reposition rods. In this case, the reponier supports 3 and 4 are not axially displaced relative to one another. Repositional movements are performed by moving the repositional rods in the corners of the repositional supports.

The Kavchuk apparatus for external reposition and fixation of bone fragments can operate in manual, semi-automatic and automatic modes. In the semi-automatic and automatic modes, the movement of the sliders (9) is carried out by the electric motor drive, and in the automatic mode, the sequence of these movements and the most perfect reposition of fragments is provided by a computer program.

All parts of the Kavchuk apparatus are made of metal, can be made of other materials (plastics, etc.) that meet the necessary requirements.

EFFECT: Kavchuk apparatus of external reposition and fixation of bone fragments is created, which makes it possible to carry out forced controlled reposition of bone fragments in all planes and their reliable fixation. The design of the apparatus allows to carry out the full range of movements with fragments in all planes without remounting the apparatus or adding new units and parts and does not change depending on the position of the fragments and clinical tasks. The device is as simple as possible in design, has a classic construction with a minimum number of parts: supports, distraction rods and their fastening elements - sliders. Repositional movements in all planes are possible due to the special forms of the supporting bearings, their rotated position and the ability to move the sliders along the supports, and not due to the creation of a separate repositional unit, which is added to the classic design of the device. The device has a minimum volume and weight of parts and assemblies, designed for a wide range of clinical applications.

A method for hardware reposition of bone fragments has been created, which consists in the presence of a reposition system that makes it possible to reposition bone fragments in automatic and semi-automatic modes.

Claims (10)

1. Apparatus for external reposition and fixation of bone fragments, containing fixing supports, distraction and fixation rods, ball joints, elements of transosseous fixation, characterized in that it is equipped with sliders with threaded holes for distraction rods and reparation supports, the latter are oval, and / or triangular, and / or square, and / or hexagonal, and / or rectangular, and / or open angular, and / or U-shaped from straight or curved gear racks having through holes, along the entire length for fastening of fixing threaded rods in them, the sliders consist of two plates covering the gear rack of the worm or grip drive, fixing supports of various shapes are fixedly fixed to the gear racks of the replacing bearings, on which the transosseous fixation elements are placed, the latter can be attached directly to the replacing supports. 2. The apparatus according to claim 1, characterized in that the reporter supports are offset relative to each other and their sides projectively intersect, with the square support having eight points of projection intersections of the sides, triangular - six points, oval, or hexagonal, or rectangular - four points, and the sliders are located at the points of projection intersection of the sides of the supports, and distraction rods that connect the reponent supports to each other pass through the sliders. 3. The apparatus according to claim 2, characterized in that the square reparatory bearings are offset relative to each other at an angle of 45 °, triangular - at an angle of 60 °, oval, or hexagonal, or rectangular - at an angle of 90 °. 4. The apparatus according to claim 1, characterized in that when using square and triangular repairing supports, the device is mounted with three or more repairing supports for double and multi-fragmented fractures, and each repairing support, which is located distally, is attached to the distraction rods that go from a support located proximal through ball joints and has the ability to fully reposition movements in all planes, which makes it possible to reposition three or more fragments in one apparatus. 5. The apparatus according to claim 1, characterized in that it is equipped with a threaded reposition rod, triangular or square supports are placed in parallel, and a threaded reposition rod is mounted with two sliders on each corner of the reposition supports: with triangular reposition supports - three threaded reposition rods, with square - four, and the distraction rods are attached to the threaded reposition rods: on the proximal support, the distraction rods pass through the holes in the threaded reposition rods, and on the distal - are attached to the threaded rods positioning rods through ball joints. 6. The apparatus according to claim 1, characterized in that it consists of an open angular and U-shaped repairing supports placed on one side of the limb, and interconnected by distraction rods through sliders at the points of projection intersection of the sides of the supporting supports, to which are threaded fixing fixing rods of various shapes are fixedly fixed with rods: half rings, squares, strips. 7. The apparatus according to claim 1, characterized in that it is equipped with threaded replacement rods and is mounted from angular supports placed in two parallel pairs and fastened together by one or more distraction rods, on each angular support there is a reposition rod that is attached to it through sliders, moreover, to the threaded reposition rods of each pair of supports it is fastened with the help of strips with holes to fix the transosseous rods. 8. The apparatus according to claim 1, characterized in that the sliders and distraction rods are connected to the drives of electric motors with the ability to turn on and off automatically in a certain sequence by a computer depending on the result of fluoroscopy, and / or ultrasound, and / or NMR, or semi-automatically through a panel surgeon management. 9. The method of hardware-based automatic reduction of bone fragments, which consists in applying the apparatus according to claims 1-8 and in the presence of a reposition system, which consists of interconnected elements: a fluoroscopy apparatus with an electron-optical transducer or ultrasound transducer, or NMR, which signals the ratio fragments to a computer with the appropriate computer program, which includes in a certain sequence electric motors connected with sliders and distraction rods through the drives, and in automatic mode carries out reposition of bone fragments. 10. The method of hardware semi-automatic reduction of bone fragments, which consists in superimposing the proposed apparatus according to claims 1-8 and in that the surgeon analyzes the data on the ratio of bone fragments from the fluoroscopy apparatus with image intensifier or ultrasound, or NMR and connects electric motors with drives to the sliders and distraction rods in a certain sequence on the control panel and semi-automatically repositions bone fragments.

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