RU2329075C2 - Arthroscopy technique implying low-frequency ultrasound - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for arthroscopy joints treatment. Invention substance lies in arthroscopic intervention through standard accesses by means of arthroscopic devices. Thus intraarticular structures are affected by ultrasonic waveguide. Wave guide body performs low-frequency ultrasonic oscillations of frequency, at least, 26.5 kHz transferred by ultrasonic generator.

EFFECT: invention application provides clean edges of processed intraarticular anatomic structures, thereby, reduces time of operative intervention and reduces trauma number, as well as prevents complications.

Description

The invention relates to medicine, in particular to orthopedics and traumatology, and in particular to methods for treating injuries and diseases of large joints. It can be used in departments performing arthroscopic interventions.

A known method of arthroscopy, which uses tools with mechanical transmission to its working part of the movements of the hand of the surgeon. The method of using a mechanical tool is described by V.A. Mitskevich in the article "Arthroscopy of the knee joint. Menisci removal", see Internet address www.galateya.net/common/knee.htm. [one].

Tool kits for arthroscopic interventions, produced by many companies, include box cutters, scissors, arthroscopic scalpels, curettes, etc., of various sizes. See advertising materials from the websites of manufacturers and their distributors for various sets for arthroscopic interventions from Azimut (Russia, St. Petersburg), Endemic (Russia, Kazan), Arthrex and Stryker (USA), "Karl Storz" (Germany).

This toolkit is used in the vast majority of domestic and foreign clinics.

However, when using a mechanical instrument, in most cases considerable effort is required to capture and dissect movable intraarticular structures and the ideal sharpness of the cutting part of the instrument, while it is not always possible to achieve sufficient purity of the edges of the processed anatomical structures, see V.A. Mitskevich. Arthroscopy of the knee. Menisci removal, p. 5 fig. 8 and p. 6 fig. 14, as well as printing of materials from a number of foreign sites devoted to arthroscopy, in particular arthroscopy of the knee joint, which show the appearance of menisci after resection with mechanical tools, which contributes to the development of synovitis in postoperative period and osteoarthrosis.

However, when using a mechanical instrument, hemostasis is impossible, therefore, in the early postoperative period, as a rule, hemarthrosis occurs, which requires additional manipulations, for example, punctures of the operated joint, and lengthens the patient’s hospital stay, as well as the rehabilitation period.

To "grind" the machined edges of the intraarticular structures, a motorized method using a shaver is used. However, high purity of the processed edges of the anatomical structures is not achieved, see, for example, the appearance of the shavers of the firms "Karl Storz" and "Stryker", as well as the appearance of the meniscus processed by the shaver after resection of the latter.

Known is the electrosurgical method of influencing intraarticular structures when performing arthroscopy, which consists in bringing a high-frequency electric current to the treated structures, which allows cutting and coagulation without tissue carbonization; knife electrodes and needle electrodes are used to make incisions and dissections, and electrocoagulation electrodes are used to coagulate and smooth articular cartilages [2], see information from the Azimut Scientific-Industrial Complex sites www.azimut.spb.ru/modules/screen/show dev .php? dep = 18kit = true & DevlD = 185, ERBE Elek-tromedizin GmbH, www.erbe.ru/RUSSIAN/APPLICAT/hf ortho.html and Arthrex (www.arthrex.ru/download/artrocare.doc).

Using these electrodes, it is possible to perform incisions in any direction - forward, reverse and lateral, and micro-sized electrodes provide freedom of action for the surgeon in cramped conditions during operations on the joints.

However, this method requires the use of expensive equipment (disposable electrodes, etc.). In addition, dissection and coagulation are performed by different electrodes, which is inconvenient and increases the time of surgery.

The aim of the invention is to provide a method of exposure to low-frequency ultrasound on intraarticular structures during arthroscopy. The use of ultrasonic waveguides-tools does not require significant efforts to capture and dissect movable intraarticular structures, while achieving clean edges of the processed anatomical structures, which will reduce the time of surgical intervention, reduce its invasiveness, and prevent complications (hemarthrosis, damage to articular cartilage and other intraarticular joints) structures during processing), reduce treatment time, thereby significantly reducing the cost of surgery.

The specified goal and technical result are achieved as follows.

The currently existing method of arthroscopy is used through standard approaches using arthroscopic instruments, which are used to resect, dissect, excise, cut off intraarticular structures and smooth articular cartilage in case of damage.

But in contrast to the known in the proposed method, the effect on the intraarticular structures is carried out by means of an ultrasonic waveguide-tool, made in size and shape of its working part in relation to the corresponding effect, while the working part of the waveguide-tool performs vibrations transmitted to it by a low-frequency ultrasonic generator with a frequency of at least 26.5 kHz.

As a close analogue of the proposed method, you can take the electrosurgical method of exposure to intraarticular structures when performing arthroscopy according to the source of scientific and technical information [2].

The proposed method of surgical arthroscopy using low-frequency ultrasound for intraarticular structures is as follows.

Diagnostic arthroscopy is performed under anesthesia, the necessary amount of benefits is determined, after which ultrasonic waveguides-tools are used for manipulations on intraarticular structures. The latter are connected to the acoustic unit of the generator of low-frequency ultrasonic vibrations. The waveguides-tools are protected along the entire length with a special tube with the exception of the working part in order to avoid attenuation of the oscillation amplitude when the waveguide-tool comes into contact with surrounding tissues.

The working part of each waveguide-tool is made in size and shape with respect to the corresponding impact - cutting, dissection, excision, cutting and smoothing of articular cartilage. The impact on intraarticular structures during arthroscopy is carried out by lightly contacting the working part of the waveguide-instrument, which performs low-frequency ultrasonic vibrations with a frequency of at least 26.5 kHz with the processed anatomical structure of the joint.

In addition to cutting (dissection, cut-off, chondroplasty), hemostasis is simultaneously carried out due to coagulation of blood vessels in the affected area. The exposure time to the anatomical structure of the joint by the waveguide tool is from 3 to 20 seconds.

The application of the proposed method allows simultaneous cutting and hemostasis, to achieve high purity of the edges of the processed structures, thereby eliminating additional processing. Most manipulations are performed with a minimal set of waveguides, which will significantly reduce the time for arthroscopy.

Of particular note is the relatively low cost of an ultrasonic generator with two acoustic nodes and a set of waveguide instruments for it. Their total cost is comparable to the cost of 5-6 basket cutters of domestic production and is much lower than the cost of a shaver and is much cheaper than an electrosurgical instrument.

It should be noted that the waveguides-tools practically do not wear out and after appropriate sterilization can be used again and again.

We performed a series of experiments on resected menisci of the knee joint. The experiments were performed on menisci removed from the knee joint no more than two hours ago in a glass container filled with isotonic sodium chloride solution (imitation of the intraarticular medium during arthroscopy).

The meniscus was completely placed in the liquid; one of its free ends was clamped. A waveguide (of the Scalpel type) in the center of the meniscus made a cut through the entire thickness with a light touch. It should be noted that cavitating when a waveguide is placed in a liquid medium does not interfere with visualization in the visibility range of the arthroscope.

In the coming months, it is planned to conduct clinical trials of the proposed method.

Literature

1. V.A. Mitskevich. Arthroscopy of the knee. Menisci removal. http://www.galateya.net/common/knee.htm.

2. Electrosurgical method of influencing intra-articular structures when performing arthroscopy and tools for implementing the method, http // www.azimut.spb.ru / modules / screen / show.

Claims (1)

The method of arthroscopy, carried out through standard accesses using arthroscopic instruments, characterized in that the impact on the intraarticular structures is carried out by means of an ultrasonic waveguide-tool, while the working part of the waveguide-tool performs low-frequency ultrasonic vibrations transmitted to it by an ultrasonic generator with a frequency of at least 26, 5 kHz.