RU2309693C2 - Device for reposition and fixation of fractures of pelvic bones accompanied with taer of front and rear semirings - Google Patents

Abstract

FIELD: medicine; traumatic surgery.

SUBSTANCE: device has pelvic support made of half-arcs connected for shift relatively each other, reposition unit mounted onto half-arcs of pelvic support and threaded rods for introduction into pelvic bones; rods are fastened to support. Reposition unit is made of two lateral planks with openings, longitudinal and lateral threaded rods, axial longitudinal threaded rod, fixing and adjusting nuts, arm-pieces and connecting members made with mutual perpendicular openings. Lateral threaded rods are fixed by means of arm-pieces to half-arcs and they are mounted in openings of connecting members, disposed at lateral threaded rods; threaded rods are tightly fixed in two lateral planks provided with openings. Connecting members are placed at free ends of lateral threaded rods. Longitudinal axial rod is placed in mutual perpendicular openings of connecting members. Threaded rods of pelvic bones at half-arcs is made by cone-shaped and sphere-shaped washers and fixing nuts. Lateral threaded rods can be shifted in relation to longitudinal axial rods by means of adjusting nuts. Distance between longitudinal and axial threaded rods is also regulated. Arm-pieces can be moved along corresponding lateral threaded rod. Horizontal and vertical shift of fragments of bones are excluded.

EFFECT: universality of usage; better reposition abilities.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used to reposition and fix stale and old pelvic fractures, including eliminating the vertical displacement of half of the pelvis and restoring the integrity of the pelvic ring.

A known method of treating damage to the pelvic ring and compression-distraction apparatus for its implementation [1]. On the knitting needles and threaded rods inserted into the ridges and the anterior lower iliac spine, a support ring of two arches is mounted, which is closed on the front and rear surfaces of the pelvis by adjusting threaded rods on the brackets. The ring is centered relative to the pelvis of the patient and placed at an angle of 60-75 ° to the horizontal plane.

The main disadvantages of the known device are:

- the closed external frame is rather bulky, inconvenient for the patient and care for him;

- arcs are closed on the front and rear surfaces of the pelvis by threaded rods, which limits the repositional capabilities of the external fixation apparatus, mainly in the sagittal plane;

Closest to the proposed is a device for reposition and fixation of fractures of the pelvic bones [2], which contains two half-arcs with two or more pairs of threaded threaded rods fixed in them using fixing nodes. The half-arcs are interconnected by means of a reposition unit having the ability to move the rods in a horizontal plane. A node for skeletal traction is attached to the semi-arches, in which a threaded rod inserted into the pelvic bone is damped.

However, the known device also has significant disadvantages:

- half-arcs are interconnected using telescopic rods or beams with shanks with the ability to reposition the pelvic bones only in the horizontal plane;

- not provided for the possibility of eliminating the vertical displacement of half the pelvis;

- does not have a sufficient level of stabilization of the posterior pelvic half ring;

- fixation of transosseous elements (threaded rods) is carried out using brackets, which does not provide the necessary angular stability of the node;

- the use of threaded rods M 6 as part of the reposition unit does not provide sufficient rigidity for fixing the pelvic bones.

Based on the existing level of known structures for the treatment of pelvic fractures with rupture of the anterior and posterior half rings, the task was set: to increase the universality of the use of the device and its repositional capabilities by ensuring the elimination of horizontal and vertical displacements of fragments of the pelvic bones, as well as stabilizing the ruptures of the anterior and posterior pelvic rings .

The problem is solved as follows.

In the device for reposition and fixation of fractures of the pelvic bones with a rupture of the front and rear half rings containing the pelvic support, consisting of half arches connected with the possibility of movement relative to each other, a reposition unit mounted on the half arcs of the pelvic support and threaded rods mounted on it for insertion into the pelvic bones, reposition unit consists of two transverse bars with holes, longitudinal and transverse threaded rods, axial longitudinal threaded rods, fixing and adjusting nuts, brackets and filled with mutually perpendicular holes of the connecting elements, the transverse threaded rods are fixed with brackets to the arcs and installed in the holes of the connecting elements placed on the longitudinal threaded rods, and the latter are rigidly fixed in two transverse bars with holes, the connecting elements are placed at the free ends of the transverse threaded rods, in mutually perpendicular openings of which a longitudinal axial rod is placed, the fastening of threaded rods for the pelvic bones on Meadows are carried out using conical and spherical washers and fixing nuts, it is possible to use the help of adjusting nuts to move the transverse threaded rods relative to the longitudinal threaded rods, to increase the distance between the longitudinal and axial threaded rods, to move the brackets along the corresponding transverse threaded rod.

We explain the significant differences of the proposed device:

Fastening the tension ends of the threaded rods to the pelvic support using spherical and conical washers provides:

- a greater degree of freedom of the angles of inclination and directions of transosseous elements, thereby achieving the optimal location of the rods in the bone relative to the reposition unit;

- sufficient "angular" stability of transosseous elements in the node;

The implementation of the reposition unit of two transversely arranged strips with holes in which longitudinally threaded rods are fixed with connecting elements with mutually perpendicular holes placed on them, and the placement of transverse threaded rods fixed in brackets along the edges of the pelvic support in free holes, eliminates displacement of fragments of the pelvic bones in three planes: sagittal, frontal, horizontal.

Placing the connecting elements with mutually perpendicular holes at the free ends of the horizontal threaded rods, installing a longitudinally axial threaded rod in the free holes of the connecting elements, and arranging the reposition unit in the form of a triangular prism with the base turned inward provides additional structural stability, eliminates rotational displacement of half of the pelvis and develops sufficient compressive force, including in the region of the posterior pelvic half ring.

Patent studies on subclasses А61В 17/56, 17/60, 17/62, 17/66, 17/68, 17/72 and analysis of scientific and medical information reflecting existing technologies and designs for the treatment of pelvic fractures with anterior and the posterior half rings and the vertical displacement of the half of the pelvis did not reveal devices identical to the one proposed. Thus, the proposed device is new.

The interconnection and interaction of the essential distinguishing features of the proposed device ensures the achievement of a new technological medical result in solving the problem: they increase the universality of the device and its repositional capabilities by ensuring the elimination of horizontal and vertical displacements of the fragments of the pelvic bones, as well as the stabilization of ruptures of the anterior and posterior pelvic rings. Thus, the proposed technical solution has an inventive step.

The proposed device for the treatment of pelvic fractures with a rupture of the anterior and posterior half rings and a vertical displacement of half of the pelvis is industrially applicable in the field of practical healthcare. The device is simple and affordable to manufacture at the present stage of development of the medical industry. Osteosynthesis using the proposed device can be reproduced repeatedly and does not require the use of exceptional means for implementation.

The essence of the design of the proposed "Device for reposition and fixation of fractures of the pelvic bones with a gap of the front and rear half rings" is illustrated by drawings, which show:

Figure 1 - General view of the device;

Figure 2 - connection of the tension end of the threaded rod and half-arc.

A device for reposition and fixation of fractures of the pelvic bones with a rupture of the front and rear half rings, containing the pelvic support, consisting of half arcs 1 and 2, connected with the possibility of movement relative to each other, and reposition unit 3 mounted movably on the pelvic support. On the half-arches 1 and 2 of the pelvic support, with the help of conical 6, spherical 7 washers and fixing nuts 8, threaded rods 5 are tightly fixed, containing tension 4 and mortise 17 ends. Repositioning unit 3 consists of two strips 9 with holes located transverse to the body axis, in which threaded rods 10 are rigidly fixed in the longitudinal direction. On the threaded longitudinal rods 10, connecting elements 12 are fixed with mutually perpendicular holes 13. In the free holes 13 the connecting elements 12 are installed in the transverse direction threaded rods 14, fixed with brackets 15 at the edges of the pelvic supports from half arcs 1 and 2. At the free ends of the transverse threaded sh ang 14 has connecting elements 12 interperpendicular with holes 13 in which the longitudinally arranged axial threaded rod 16. In this case, the reposition unit 3 has the shape of a triangular prism with the base facing inwards.

Apply the proposed device as follows:

The cut-in ends 17 of the threaded rods 5 are inserted through the skin incisions-punctures into the region of the anteroposterior awns (one rod on each side), into the wings of the iliac bones (one or two rods on each side) in the direction of the supraclavicular region until contact with the opposite cortical layer. The number of inserted threaded rods 5 is determined by the nature of the damage to the pelvic bones (4 - for fractures of type B, 6 - for fractures of type C). The tension ends 4 of the threaded rods 5 are rigidly fixed to the half arcs 1, 2 of the pelvic support using conical 6 and spherical 7 washers and fixing nuts 8. The plane of arrangement of the half arches 1, 2 is brought closer to the front with the formation of an angle between them. The next step is the installation of the reposition unit 3. The brackets 15 with a threaded shank are rigidly fixed to the half-arcs 1, 2 of the pelvic support. The brackets 15 of the opposite sides are connected to each other by means of longitudinal 10 and transverse 14 threaded rods M 8, strips 9 with holes, connecting elements 12 with mutually perpendicular holes 13 and adjusting nuts 11 so that the reposition unit 3 takes the form of a triangular prism with the base facing inside, and has four levers of influence on bone fragments.

Elimination of the vertical displacement of half the pelvis is carried out by moving the threaded rods 14 located transversely relative to the threaded rods 10 located longitudinally to the axis of the body, using the adjusting nuts 11.

Compression in the sacroiliac joint is achieved by means of adjusting nuts 11 by increasing the distance between the longitudinal threaded rods 10 and the axial threaded rod 16.

By moving the brackets 15, fixing the distal end of the floor of the arcs 1, 2, inside, using the adjusting nuts 11 along the corresponding transverse threaded rod 14, the anatomy of the pubic joint is restored.

Thus, the proposed "Device for reposition and fixation of fractures of the pelvic bones with a gap of the front and rear half rings" has universal properties. This device allows you to eliminate the displacement of bone fragments of the pelvis in three planes, provides stable osteosynthesis of the pelvic bones with sufficient compressive force, including in the region of the posterior pelvic half ring. The technology for using the device is simple and affordable for most specialized departments.

The design of the device does not have fragile or difficult to manufacture parts, convenient for the patient.

Information sources

1. Patent No. RU 2117452, 1998. A method for treating the pelvic ring and a compression-distraction apparatus for its implementation.

2. Patent No. RU 2159091, 2000. Device for reposition and fixation of pelvic fractures.

Claims (1)

Device for reposition and fixation of fractures of the pelvic bones with a rupture of the anterior and posterior half rings, containing the pelvic support, consisting of half arches connected to move relative to each other, a reposition unit mounted on the arches of the pelvic support and threaded rods mounted on it for insertion into the pelvic bones characterized in that the reposition unit consists of two transverse bars with holes, longitudinal and transverse threaded rods, an axial longitudinal threaded rod, fixing and regulating to brackets and connecting elements made with mutually perpendicular openings, while the transverse threaded rods are fixed with brackets to the arcs and installed in the openings of the connecting elements placed on the longitudinal threaded rods, and the latter are rigidly fixed in two transverse bars with holes at the free ends of the transverse threaded rods are placed connecting elements in the mutually perpendicular holes of which are placed a longitudinal axial rod, the fastening of threaded erasers of the pelvic bones on the semi-arches was carried out using conical and spherical washers and fixing nuts, and it is possible to use the help of adjusting nuts to move the transverse threaded rods relative to the longitudinal threaded rods, to increase the distance between the longitudinal and axial threaded rods, to move the brackets along the corresponding transverse threaded rod.

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