RU2332181C2 - Method of implanting intercondylar endoprosthesis of knee joint and device set for implementing it - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: claimed method involves a series of surgical actions with usage of the device set including trocar, conical cutter, universal wrench of frame cutter, insert, bolt, pin wrench, trocar bolt, extractor, tool holder, pin, flat cutter, tibia complex template, pin, nail, tibial component guide template and femoral component guide template. The method involves mechanical processing of joint ends, drilling out of medullar canals for endoprosthesis rods, their fixation, with processing of joint ends performed in conical pattern and cutting beds between condyles according to template, endoprosthesis components fixation and interconnection.

EFFECT: method and device set enable more complete recovery of knee joint function.

2 cl, 26 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore the functions of the knee joint.

A known method of implanting a knee endoprosthesis, which consists in processing the articular ends under the rods and the base of its components with a hammer and chisel, saw and drill, with subsequent installation and fixation of the components of the femur and tibia (see, for example, Yumashev "Traumatology and orthopedics" , M .: "Medicine", 1983, p. 79).

However, the known method of implantation does not allow sufficiently firmly fixing the elements of the endoprosthesis in the articular ends, and the process of processing them with a chisel and drill often leads to chips and cracks in the bones, inaccuracies and errors in the size of the bed under the base and legs of the endoprosthesis.

The task at hand is to increase the accuracy and strength of fixation of endoprosthesis elements in the articular ends of bones, while reducing surgical trauma.

The technical result is achieved by the fact that implant implantation is carried out using a special kit developed by the authors of the instrumentation.

The essence of the invention lies in the fact that the proposed method provides for a series of sequential actions of the surgeon using devices and devices that allow you to quickly and accurately mechanically process the articular ends and firmly fix the elements of the endoprosthesis in them.

A set of devices for implementing the implant implantation method consists of a trocar 1, a conical cutter 2, a universal key 3, a body cutter 4, an insert 5, a bolt 6, a key rod 7, a trocar bolt 8, an extractor 9, a holder 10, a pin 11, flat milling cutters 12-13, a template of the femoral component 14, a template of the tibial component 15, a pin 16, a pin 17, a guide template of the tibial component 18-19 and a guide template of the femoral component 20-23.

Trocar 1 consists of a round rod 1.1 with a pointed end 1.2, equipped with three cutting edges. Rod 1.1 is connected to the hexagonal shank - 1.3 through the base 1.4. The shank 1.3 has a groove 1.5 under the latch of the universal key 3 (figure 1).

Trocar 1 is used to open the bone marrow channels of the articular ends of the bones from their articular surfaces.

Cone cutter 2 consists of a rod 2.1, on one end of which there is a cutting head 2.2, and on the other - a lock clutch 2.3 at the end of pin 2.4 with a base 2.5 and a hexagonal shank 2.6.

The shank 2.6 has a groove 2.7 under the latch of the universal key 3 (figure 2) and risks for assessing the depth of drilling of the bone marrow canal.

Cone cutter 2 is used for processing (reaming) of the bone marrow canals of the femur and tibia under the rods of endoprosthesis 1 and 2 (see AS).

The universal key 3 consists of a round rod 3.1, at one end of which there is a head with a latch 3.2 for capturing the hexagonal shanks of mills and rods, and at the other end there is a handle 3.3 for rotating the key 3 (figure 3).

The universal key 3 serves to hold and rotate the cutters when drilling bones and rods of the endoprosthesis when they are screwed into the bone marrow channels of the articular ends.

Case cutter 4 consists of a round shaft 4.1 with a hexagonal shank 4.2 with an annular groove 4.3 at one end and with a hollow cylinder 4.4 at the other end. At the end of the cylinder is a cutting head 4.5 with teeth 4.6 (figure 4).

Case cutter 4 serves for undercutting in the articular ends of the bed under the body of the femoral 13 and tibial 14 components of the endoprosthesis.

The insert 5 is a plastic sleeve 5.1 with a stepped channel. On the one hand, it has a flange 5.2 of larger diameter, cut by axial longitudinal slots 5.4 (figure 5).

The insert 5 serves as a gasket between the rubbing surfaces of the cutter 13 and the templates of the femoral and tibial components 14 and 15.

The bolt 6 consists of a rod 6.1 with a threaded end 6.2, a hexagonal shaft 6.3 and a base plate 6.4. The shank 6 has an annular groove 6.5 under the latch of the head 3.2 of the key 3 (Fig.6).

The bolt 6 is an adapter from the key 3 to the shanks of the rods of the endoprosthesis 1 and 2 (see.with.).

The socket wrench 7 is made in the form of a sleeve 7.1 with a stepped axial channel. On the one hand, the key is equipped with a hexagonal shank 7.2. On the other hand, it has a series of teeth 7.3. The shank 7.2 is equipped with an annular groove 7.4 under the latch of the head 3.2 of the key 3 (Fig.7).

The socket wrench 7 serves to screw in the rods of the endoprosthesis 1 and 2 (see.with.).

The trocar bolt 8 is a rod 8.1, at one end of which there is a hexagonal shank 8.2 under the head 3.2 of the universal key 3, and at its other end there is a pointed pin 8.3 with cutting edges.

Between the pin 8.3 and the shank is the base 8.4 (Fig. 8).

The trocar bolt 8 is a retainer of the guide template of the femoral component 20-23, used to form a bed under the template of the femoral component of the endoprosthesis 14.

The extractor 9 consists of a rod 9.1 with a threaded end 9.2, a hexagonal shank 9.3 with an annular groove 9.4 under the latch of the head 3.2 of the key 3 (Fig.9).

The extractor 9 serves to remove the components of the endoprosthesis in case of damage.

The holder 10 consists of a handle 10.1 with knurling on the surface, the boot 10.2 and a threaded rod 10.3 (figure 10).

The holder 10 is used to stuff the components of the endoprosthesis 9 and 23 (see A.S.) onto their rods 1 and 2 (see A.S.) screwed into the bone marrow channels of the articular ends.

The pin 11 consists of a rod 11.1 with a pointed end 11.2 and a threaded shank 11.3. The front of the rod is equipped with flats 11.4 and 11.5 (Fig.11).

Pin 11 serves as a guide for the cutter when processing the articular surface of the tibia.

Flat cutter 12 consists of a sleeve 12.1 with a stepped axial channel and a mushroom head 12.2, on the end site of which there are cutting edges 12.3 (Fig. 12).

Case cutter 12 is used for undercutting the bed under the components of the endoprosthesis.

Assembled, the case cutter 12 consists of an insert 13.5 inserted into the axial channel of the cutter 12, which is fixed with a pin 13.3 with a shaft 13.4 having a hexagonal shank 13.5 with an annular groove 13.6 under the latch of the head 3.2 of the key 3 (Fig. 13).

The template of the femoral component of the endoprosthesis 14 consists of a neck 14.1 (Fig. 14a, b), a head 14.2 with a pin 14.3 (Fig. 16), through the ring 14.6 of which and the hole in the head 14.2, a pin 14.4 is inserted (Fig. 17).

Template 14 serves to prepare the site for the bearing surfaces of the body of the femoral component of the endoprosthesis 9 (see AS).

In Fig.16 shows the pin 14.3, and in Fig.17 - the pin 14.4.

The template of the tibial component of the endoprosthesis 15 is made in the form of a L-shaped part with a stepped channel 15.1 and a wall 15.2. At the end of the template 15 with a threaded channel 15.3 is a visor 15.4 (Fig. 15).

The template 15 serves for the precise processing of the bone under the tibial component of the endoprosthesis 23 (see.with.).

The guide template of the tibial component of the endoprosthesis 16 consists of a cylinder 16.1, the channel 16.2 of which has an enlarged opening 16.3 from the bottom and ends with a threaded channel 16.4 from the top.

The axis of the channel 16.4 is offset by an angle α relative to the axis of the channel 16.2 and perpendicular to the plane of the visor 16.5, on which there is a threaded channel 16.6, coaxial to the channel 16.4 (Fig. 18 is a side view in section and Fig. 19 is the same, top view).

The guide template 16 is designed to form a bed under the body of the template of the tibial component of the endoprosthesis 15.

The guide template of the femoral component of the endoprosthesis 17 consists of a cylinder 17.1, the axial channel 17.2 of which also passes into the axial channel 17.3 of a smaller diameter. On top of the channel 17.2 has a coaxial widened hole 17.4. The upper part of the guide template 17 relative to its lower part has an inclination at an angle β of a different sign for the patterns of the left and right limbs (Figs. 20-23).

The guide template 17 is designed to prepare the bed template of the femoral component 14 of the endoprosthesis.

The proposed method is as follows.

Access to the knee joint is a longitudinal medial incision of the Payra type with a length of 15-20 cm, enveloping the patella from the inside, with the limb extended. The capsule of the joint is opened with a parapatellar incision. The patella is dislocated outwards, after which the joint is bent at an angle of 90 °. Both cruciate ligaments are excised and the lateral and posterior sections of the joint capsule are mobilized.

Having retreated 1 cm above the anterior margin of the intercondylar fossa, using the trocar 1, the bone marrow canal of the femur is opened (Fig. 24, item 1).

An opened bone marrow canal is expanded with the help of conical cutters 2, successively increasing their diameter (Fig. 24, item 2).

Without removing the last conical cutter 2 from the bone marrow canal, remove the key 3 from its shank and push the case cutter 4 onto the shank. After securing its key 3 to the shank, rotate the cutter 4 to form a bed under the cylindrical part of the endoprosthesis body, using the cutter shank as a guide 2.3, 2.4, 2.5 (Fig.24, pos.3).

The conical cutter 2 is removed from the bone marrow canal, the conical shaft 1 (see AS) of the endoprosthesis is inserted into it. Using the key of the rod 7, mounted on the rod 1 (see AS) of the endoprosthesis with a bolt 6 and the universal key 3 put on its shank, screw the endoprosthesis rod 1 (see AS) of the endoprosthesis into the bone marrow canal the femur.

A guiding component of the femoral component 20-23 is put on the shank of the rod 1 (see AS) of the endoprosthesis screwed into the marrow canal and strengthened with a bolt 6 and a trocar bolt 8 to prevent its rotational movements.

Using an oscillating saw along the contour of the guide template 20-23, the intercondylar region is processed under the base of the template 14 of the femoral component.

The guiding template 20-23 is removed and the template 14 of the femoral component is put on the shank of the rod 1 (see a.s.). A flat mill 13 is put on pin 14.3 and, using a key 3, the articular surfaces of the femoral condyles are machined under the bearing surfaces of the femoral component 9 (see A.S.).

The milling cutter 13 and the template 14 of the femoral component are removed and the femoral component 9 (see AS) of the endoprosthesis is installed. For nozzle femoral component 9 (see.with.) Use the holder 10 (Fig.26).

Having completed the preparation of the bed for the femoral component of the endoprosthesis, proceed to the formation of the bed of its tibial component. For this, immediately before the anterior fossa of the intercondylar elevation of the tibia using the trocar 1, the bone marrow canal is opened. They process it with the help of conical mills 2, with a successively increasing diameter. The immersion depth of the cutter 2 in this case is controlled by ring-shaped risks on its shank 2.3, 2.4 and 2.5 (not shown in the drawing). The processing of the channel is stopped when they feel significant resistance to the rotation of the cutter 2. Remove the universal key 3, leaving the cutter 2 in the bone marrow channel (Fig.25, pos.1 and 2).

Without removing the last conical cutter 2 from the bone marrow canal, remove the key 3 from its shank 2.3, 2.4 and 2.5 and push the body cutter 4 onto it. Fasten the key 3 to its shank 4.2 and rotate the cutter 4 to form a bed under the cylindrical part of the tibial component body the endoprosthesis, using the shank 2.3, 2.4 and 2.5 of the cutter 2 as a guide (Fig. 25, item 3).

The conical cutter 2 is removed from the bone marrow canal and the conical shaft 2 (see AS) of the endoprosthesis is inserted into it. Using the key 7, mounted on the rod 2 (see A.S.) of the endoprosthesis, screw 6 using the key 3, screw the rod 2 (see A.S.) into the bone marrow canal of the tibia (Fig. 25, pos. 5).

On finger 5 (see AS) of rod 2 (see AS) of an endoprosthesis screwed into the medullary canal, a guide template of the tibial component is put on (Figs. 18 and 19) and strengthened with a trocar 6 bolt to the tibial bones (Fig.25 pos.5). Along the contour of the guide template (Fig. 18, 19), an area of the intercondylar elevation of the tibia under the base of the template (Fig. 15) of the tibial component is processed with an oscillating saw and put on the finger 5 (see a.s.) of the rod 2 (see a. C.) endoprosthesis template (Fig. 15) of the tibial component. A flat cutter (Fig. 13) is put on the pin (Fig. 11), screwed into the template (15), and with the help of a key 3, the articular surface of the tibia is machined under the bearing surface of the tibial component 23 (see A.S.) of the endoprosthesis.

Finally, the template (Fig. 15) of the tibial component and the cutter (Fig. 13) are removed and the tibial component of the endoprosthesis 23 is installed (see AS).

For nozzles of the tibial component 23 (see.with.) Use a holder (figure 10).

After installation of the components of the endoprosthesis, they are connected with a connecting finger 17 (see A.S.), the patella is adjusted, the wound is sutured in layers.

The offer can be accepted in orthopedic and trauma clinics.

Its use allows you to more fully restore the function of the knee joint.

Symbols (see.with.) Belong to the positions of the description of the USSR copyright certificate No. 1540819, cl. A61B 17/58, 1988.

Claims (2)

1. The method of implanting an intercondylar knee joint implant, consisting in machining the articular ends and drilling the bone marrow canals under the implant rods with their subsequent fixation by screwing, characterized in that they use a set of devices for implementing the method of implanting an intercondylar knee joint implant according to claim 2, machining the channels are carried out under the cone, the bed under the components of the endoprosthesis is milled between the condyles according to the guiding template, first introduced into the channels and fix threaded rods of the endoprosthesis are made, then the components of the endoprosthesis that connect to each other are fixed at their protruding ends. 2. A set of devices for implementing the method of implanting an intercondylar knee joint endoprosthesis according to claim 1, comprising a saw, a chisel and a drill, characterized in that it further comprises a trocar, a conical cutter, a universal key, a body cutter made to push the conical cutter onto the shank, flat a milling cutter, a bolt, a key-rod, a trocar bolt, an extractor, a holder, a pin, guiding templates for the femoral and tibial endoprosthesis, made to push the endoprosthesis on the conical shaft, a pin and a pin.

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