RU2285500C2 - Method for fixing endoprosthesis to mandibular bone fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device has end rods to be introduced into bone and arch for binding the rods. The arch is placed bed. The prepared bone fragment is bandaged with at least two coils reticulated fabric before being set. The fabric is manufactured from titanium nickelide monofiber, forming supporting structure between bone fragment and fixing member in this way. Repeated bandaging of the bone fragment is carried out with free portion of the reticulated fabric over the fixing member after the fixing member being cooled, fixing member arch being disposed in the prepared bed over the reticulated fabric and intraosseous rods being introduced. To form supporting structure between bone fragment and fixing member, reticulated fabric manufactured from titanium nickelide monofiber is used. Its width is 20-25 mm and mesh diameter is equal to 1.5-2.5 mm.

EFFECT: enhanced effectiveness in reconstruction lower extremity defects.

2 cl, 5 dwg

Description

The invention relates to medicine, specifically to maxillofacial surgery, surgical dentistry, and can be used mainly in the reconstruction of defects of the lower jaw.

A known method of fixation of bone fragments, implemented using a device for the treatment of defects of the lower jaw (copyright certificate of the Russian Federation No. 1799567, Mcl A 61 B 17/58), which is a flexible metal plate made of a material with a shape memory having means for attaching to a transplant and fastening elements for fixing to the bone fragments of the lower jaw in the form of end sections of the plate bent towards each other.

In accordance with this method, a pre-cooled device is placed on the graft, pressed against it with two to three clamps, after heating the device, it takes the desired shape and gives the desired shape to the graft, then only parts of the device protruding outside the graft are re-cooled, the deformed ends of these parts are introduced devices into previously formed openings in own fragments of the jaw. After heating and form restoration, the end sections of the plate bent towards each other are rigidly fixed in the holes, providing tightening and compressing effects.

There is also a method of fixing bone fragments, implemented by the device according to the patent of the Russian Federation No. 2129843, M. cl. A 61 B 17/68, according to which, at the skeleton ends of fragments of the lower jaw that are aligned in the correct position, holes are made in which the originally unbent fixing elements of titanium nickelide are inserted, previously cooled under chloroethyl. When warming the patient's body with heat, the fixing elements take their original shape, bringing together, connecting and compressing bone fragments.

Closest to the claimed is a method of fixing an implant of the lower jaw, implemented by the device according to patent No. 20044216, M. cl. A 61 P 2/28, according to which at the ends of the remaining fragments of the lower jaw a perceptive bed is made for the endoprosthesis and holes for its fixation to these fragments using fixators with shape memory.

Known methods have the following disadvantages:

- supporting parts of fixators and bone fragments have a small area of interaction. When informing them of the functional load, the degree of bone resorption in the area of their implementation increases, the dislocation of the structure develops, which leads to functional failure of the endoprosthesis;

- fixators with shape memory have a strong compression effect, often cause impaired intraosseous circulation and bone sequestration.

The objective of the invention is to reduce the number of complications, improving the quality of treatment and rehabilitation of maxillofacial patients.

The problem is solved due to the fact that in the method of fixation of the endoprosthesis to bone fragments of the lower jaw, which removes non-viable bone fragments or resects the tumor part of the lower jaw, and at the ends of the remaining fragments of the lower jaw form a bed and holes into which the intraosseous rods are pre-installed of a cooled fixator made of titanium nickelide, according to the invention, the bed is made under an activating arc connecting the intraosseous rods of the fixer, made integral with the endopod by otosis, and before the introduction of the intraosseous rods, the prepared bone fragment is bandaged with at least two turns of a mesh fabric made of titanium nickelide monofilament, and after cooling the latch and placing its activating arc in the prepared bed over the mesh fabric and introducing the intraosseous rods, re-bandage the free bone part of the mesh web over the retainer to stabilize the position of the endoprosthesis.

The invention is illustrated in the drawing, which shows:

figure 1 - a bone fragment of the lower jaw to which you want to attach an endoprosthesis;

figure 2 - installed endoprosthesis, made at the same time with clamps on both ends;

figure 3 - mesh cloth (bandage) made of monofilament titanium nickelide, which performs the function of a supporting structure between the bone fragment and the retainer;

figure 4 is a bone fragment of the lower jaw after the first bandaging before installing the latch;

in Fig. 5 - the same bone fragment after the installation of the latch and re-bandaging.

The operation is carried out as follows.

During the operation, non-viable bone fragments are removed or the part of the lower jaw resected by the tumor is resected, and after operative access to the viable fragment of the lower jaw 1, a bed 2 is formed in its cortical layer to place the activating arch 3 of the retainer, which is a continuation of the body of the individual endoprosthesis 4 and consists of from two multidirectional intraosseous rods 5, 6, interconnected by an activating arch 3. Holes 7, 8 for intraosseous rods 5,6 are also made in the bone fragment. The bone fragment prepared in this way is bandaged with at least two turns of the free edge of the mesh web 9. The fixators, which are the end sections of the endoprosthesis, are cooled, for example, under chloroethyl and the activating arch 3 of the clamp is placed over the mesh web in the prepared bed 2, and the intraosseous rods 5 , 6 are inserted into the prepared openings 7, 8. As warming and restoration of the original form, the latch is fixed in the formed bed. To stabilize the position of the endoprosthesis, the bone fragment is already bandaged with the free part of the mesh tissue already over the fixative. As a result, a peculiar mesh superelastic coupling is formed on the bone fragment, in the thickness of which there is a retainer. It optimizes the pressure of the fixative on the bone fragment and stabilizes the position of the endoprosthesis. An endoprosthesis fixed in this way is covered with soft tissues and sutured in layers.

To form the supporting structure between the bone fragment and the fixative, it is most advisable to use a mesh cloth of titanium nickelide monofilament with a width of 20-25 mm and a cell diameter of 1.5-2.5 mm.

With a mesh size of less than 1.5 mm, the penetration of soft tissues through the mesh web may be difficult, and with a mesh size of more than 2.5 mm, the area of the support may be insufficient.

The width of the blade 20-25 mm is the most optimal, because allows you to form a support structure in two to three turns.

The effectiveness of the technical result is confirmed by clinical trials.

Example.

Department of head and neck tumors of the Omsk Oblast Clinic, Case history No. 403, patient A., 63 years old, diagnosis: Ameloblastoma of the lower jaw with spreading from 46 teeth to the jaw body on the right with transition to the frontal section, body, branch and condylar process on the left.

An individual endoprosthesis is made of titanium nickelide, the end parts of which are made in the form of fixators, including two intraosseous rods connected by an activating arch.

Under intubation anesthesia from the submandibular access, a resection of the affected fragment from 46 tooth was performed with exarticulation of the left temporomandibular joint. A bed was formed for installation, subcortically along the oblique jaw line of the activating arch of the endoprosthesis retainer and two holes for intraosseous rods: a distal intraosseous rod for insertion of a fragment of the lower jaw on the right and the medial intraosseous rod into the thickness of the retromolar region for insertion into the basal edge of the body. The prepared bone fragment was bandaged with two turns of a mesh cloth of titanium nickelide monofilament. The latch was cooled and mounted on top of the mesh web: the activating arc was laid in the prepared bed and multidirectional intraosseous rods were inserted into the previously formed holes. After warming and restoring the shape, the fixer, made at the same time as the endoprosthesis, is fixed in the bone fragment. To stabilize the position of the endoprosthesis, a bandage of the bone fragment was repeated with the free end of the mesh fabric made of titanium nickelide monofilament fixed in it. Fabrics and leather are sutured in the usual way.

The postoperative period was favorable. Main functions: external respiration, articulation, speech function, external aesthetic effect - restored on the 30th day. Fixation of the endoprosthesis to a fragment of the lower jaw upon observation of the patient after 1 year is good, which is clinically and radiologically confirmed.

Claims (2)

1. The method of fixation of the endoprosthesis to bone fragments of the lower jaw, including the removal of non-viable bone fragments or resection of the affected part of the lower jaw by the tumor, forming at the ends of the remaining fragments of the lower jaw a bed for the endoprosthesis and holes into which intraosseous rods of a pre-cooled titanium nickelide fixative are installed, characterized the fact that the endoprosthesis-retainer has end parts in the form of rods placed intraosseously, and an arc connecting the rods placed in the bed, before installation and the fixator bandage the prepared bone fragment with at least two turns of a mesh web made of titanium nickelide monofilament, forming a support structure between the bone fragment and the fixator, and after cooling the fixator, placing the fixator arch in the prepared bed over the mesh web and introducing the intraosseous rods repeated bandaging with the free part of the mesh web of the bone fragment over the fixative. 2. The method according to claim 1, characterized in that for the formation of the supporting structure between the bone fragment and the fixative, a mesh web of titanium nickelide monofilament with a width of 20-25 mm and a cell diameter of 1.5-2.5 mm is used.

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