RU2324441C2 - Device for manual osteoperforation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: said utility invention relates to medical tools and may be used in surgical orthopedy and traumatology. The device for manual osteoperforation is designed as a bone awl and includes stylette, screw, threaded rod with a longitudinal slot, plate, and bracket. The stylette has the possibility of fixation of the threaded rod slot by opposite driving of the nuts. At the end of the threaded rod, a plate is fixed; the plate has the form of a cross-type handle with brackets fixed at the periphery. The brackets are made for increasing the cohesion with the hand of the surgeon and for increasing manipulating qualities.

EFFECT: increases efficiency of surgical therapy of patients with shaft fracture of femoral bone.

4 cl, 1 ex, 3 dwg

Description

The device relates to medical equipment, namely to instruments used in operative orthopedics and traumatology.

In surgical orthopedics and traumatology, bone awl is widely used. It finds application both in self-formation (without using a drill) of the intraosseous canal, and as a tap (for the purpose of applying a bone notch) before making holes on the bone surface that is smooth and slippery for a rotating drill. Osteoperforation is widely used to improve blood supply and accelerate bone remodeling in case of aseptic necrosis, osteochondropathy of the pineal gland and apophysis, osteoarthritis, activation of reparative osteogenesis in hypoplastic false joints, as well as for the formation of transosseous canals with lavsanoplasty and transossal muscle fixation, dry muscles .d. This tool largely determines the accuracy of the important stages of the operation and, ultimately, the effectiveness of the entire surgical intervention. As a prototype device, we selected the standard orthopedic awl described in the manual by G.E. Ostroverkhov, Yu.M. Bomash and D.N. Lubotsky "Surgery and topographic anatomy" (1996). The prototype consists of a working part (stylet) and a pen. In our opinion, this tool has significant disadvantages:

1) the irremovability of the parts of the tool, especially its stylet, which significantly limits the terms of its operation;

2) the rigidity of the stylet sewed with the impossibility of without damaging the instrument to give it a shape that is different from the original (direct) and optimal for each particular case. Therefore, there is practically no possibility of forming a stylet bend and varying its curvature, based on the conditions and needs of each individual surgical intervention;

3) the cone shape of the stylet of the awl with an extension from its tip to the handle of the tool and a diameter of more than 3 mm (4-6 mm). When the intraosseous canal is formed with an awl to a depth of more than 0.5 cm from the bone surface (for example, when performing a transossal suture), a “splitting effect” occurs with an inevitable decrease in the mechanical strength of the bone and the risk of wedging it. Meanwhile, with the uniform (cylindrical) shape of the stylet and its diameter (from 1.2 to 2.0 cm) slightly exceeding the diameter of the used surgical needle (0.8-1.8 cm), the probability of weakening bone strength is minimized;

4) the strict standard of the factory tool with one or two (usually conical or trihedral) types of sharpening the stylet determine the inability to choose the optimal type of sharpening an awl. In contrast to the given types of sharpening, which are not rational, and permissible (by no means always) only for spongy bone tissue, standard Kirchner knitting needles provide the possibility of a wide selection of sharpenings: a) trihedral; b) in the form of a drill; c) spear-shaped; g) spear-shaped with an expanded end; e) one-sided (feather-shaped); e) with a groove (Fig. 1, a, b, c, d, e, e);

5) the oxidizability of the stylet metal, which is why, often before the operation, the operating sister or surgeon has to clean the rust from the edges of its tip;

6) the small thickness (up to 0.6 cm) and the oblong shape of the awl handle, which continues along the vector of his stylet, do not always provide a convenient and tight grip on the instrument with the surgeon’s brush with adequate emphasis on the bone. This is due, firstly, to the insufficient contact area of the end part of the handle with the palm of the hand of the surgeon - and, accordingly, to the excess load per unit area. Secondly, the elongation of the shape of the handle along the stitch stylet vector causes the irrational bending of the surgeon’s hand with its often excessive tension and dulling of the “muscular sense” during channel formation in a dense bone. All this can lead to a decrease in the accuracy of manipulation and the effectiveness of the intervention.

In order to prevent these shortcomings, a device for manual osteoperforation is proposed (Fig. 2), consisting of parts of a set of Ilizarov apparatus and including a fragment of the Kirschner needle (1), nuts (2), a threaded rod with a longitudinal slot (3), a plate (4) and brackets (5) (figure 3). In the manufacture of the device, a fragment of the spokes is placed in the slot of the rod and fixed by counter-tightening the nuts. Moreover, to increase the reliability of fixing the knitting needles, especially if it has a diameter of more than 1.5 mm, you can use not two, but three (figure 2) or four nuts. At the other end of the rod with two counter-tightened nuts, a plate is fixed, on the peripheral holes of which one bracket is installed. The presence of the latter provides a more convenient grip of the tool handle and, therefore, the optimal handling properties of the awl. The cruciformity of the device handle prevents the irrational bending of the surgeon’s hand with its possible overstrain and dullness of the “muscular sense” during the formation of the canal in the dense bone.

As an example of the application of the proposed device, the following observation.

Patient Z., 47 years old, was delivered by a passing vehicle from the accident scene to the trauma department of the Republican Orthopedic and Trauma Center (RTC) in Makhachkala on 02.02.2003 half an hour after an intra-car injury with a diagnosis of: Concomitant injury: Concussion; Bruise of the chest (especially its right half); Closed anterior-upper dislocation of the sternal end of the right clavicle; Bruises, abrasions of the body.

Under local anesthesia, 20 ml of a 1% solution of novocaine into the area of the right sternoclavicular joint was an attempt to close the dislocation. However, firstly, a complete dislocation could not be completely eliminated (a subluxation remained), and, secondly, when the maximum abduction of the right shoulder girdle was discontinued, the dislocation recurred. A gypsum splint was applied according to the Turner and indications were presented for the planned operation - open reduction of the clavicle dislocation with lavsanoplasty of the sternoclavicular ligament.

02.12.03, the operation was performed as planned.

Open reduction of the sternal end of the right clavicle with lavsanoplasty as follows. In the position of the patient on his back under general anesthesia from the middle of the sternum grip with the transition to the right sternocleidomastoid joint and clavicle, an arcuate incision of 7 cm length was made. The fascia and periosteum were dissected. The latter is separated by a raspator, and the collarbone, after establishing the cartilage disc in its place that prevents it from being closed, is set under the visual control of the surgeon. For stable retention of the clavicle and prevention of relapse of its dislocation, lavsanoplasty of the sternoclavicular ligament was performed. For this, in the collarbone, departing 1 cm from its articular end, we proposed an osteoperforator with a stylet from a Kirchner needle, 1.8 mm in diameter and feather-shaped sharpening, two parallel channels were formed. In the handle of the sternum, continuing the latter, two parallel somewhat curved channels are also formed from the middle of the articular surface of the sternum to the front surface of its handle, 1 cm indent from the articular edge. A strong double lavsan ligature (No. 4) was drawn through transossal channels, tightened and fixed by one triple and two double knots in the set state of the clavicle. Dislocation is set reliably, lavsanoplasty is wealthy. The wound is sutured in layers. A plaster cast was applied from a healthy shoulder girdle to the fingers of the right hand. The wound healed first. The patient was discharged for outpatient treatment on February 21, 2003. After 4 weeks, the span was removed, and after two weeks of rehabilitation therapy, the patient began his main work (university teacher). The result of treatment is regarded by us as good.

Therefore, the advantages of the proposed device are the following:

1) the interchangeability of the components of the tool (especially its stylet), which significantly increases the duration of its operation;

2) the plasticity of the Kirschner needle allows you to give the stylet of the instrument any shape, for example, slightly bend its end to better match the transossal channel being formed to the curvature of the operating needle;

3) the cylindrical shape of the stylet of the device without expanding it from the tip to the handle. Therefore, when the intraosseous canal is formed with an awl to a depth of more than 0.5 cm from the bone surface, the “splitting effect” does not occur with a decrease in the mechanical strength of the bone and the risk of wedging it;

4) a wide selection of the type of sharpening stylet. So, in addition to irrational trihedral sharpening, it is possible to use a stylet with sharpening in the form of a pen, spear, one-sided, with a groove, like a drill;

5) blade metal - optimal, combining mechanical strength with biological inertness. The latter quality (inertness, non-oxidizability) is significant, although the tool is not intended for non-surgical stay (long stay) in the patient's tissues. So, the standard awl is oxidized and often needs to remove the formed rust from the tip of the stylet;

6) the awl handle allows you to control the tool most conveniently, rationally and easily, which is due to both its cross-shaped shape and a fairly wide base. In addition, the brackets installed in the peripheral openings of the plate — the brackets — increase the handling properties of the device due to its better grip and prevention of the surgeon's fingers slipping from it. A large area of contact between the palm of the hand and the wide handle of the instrument causes a smaller load per unit of its area under pressure sewed on the bone;

7) the possibility of osteoperforation not only by manual pressure and rotational movements of the tool, but also by hammer blows along the axis of its threaded rod. This technique, for example, is convenient when forming osseous incisions before drilling holes on the bone surface that is smooth and slippery for a rotating drill;

8) the cost-effectiveness and simplicity of manufacturing the device due to the need and sufficiency of the minimum details of a standard set of Ilizarov apparatus, as a rule, which is a mandatory accessory of the operating room of any orthopedic and traumatological department of medical institutions of the country.

Thus, the proposed device improves the efficiency of surgical treatment of patients with diaphyseal fractures of the femur.

Claims (4)

1. A device for manual osteoperforation in the form of a bone awl, including a stylet, nuts, a threaded rod with a longitudinal slot, a plate and brackets, characterized in that the stylet has the ability to be fixed in the slot of the threaded rod by counter-tightening the nuts, while at the end of the threaded rod a flat base a plate fixed in the form of a cruciform handle with brackets located on the periphery made to increase traction with the palm of the surgeon and to increase the handling properties is fixed. 2. The device according to claim 1, characterized in that it is made of parts of a set of Ilizarov apparatus. 3. The device according to claim 1, characterized in that the stylet is made in the form of a fragment of a Kirchner needle. 4. The device according to claim 1, characterized in that it has replaceable components that are variable in length, area and shape, types of sharpening, cylindricity, ductility and a combination of mechanical strength with biological inertness of the stylet.

Images