RU2370233C1 - Method of modular osteosynthesis by taylor apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Screw-rods are introduced into proximal and distal bone fragments. Inside Taylor apparatus rings, by means of slats, screws and nuts sectors of ring 1/3-1/4 are fastened, to which transosteal elements are fixed. After correction of bone fragments position, sectors are connected to each other, and Taylor apparatus is dismantled.

EFFECT: method ensures minimisation of external fixation apparatus after necessary correction of bone fragments position, as well as possibility to optimise conditions of bone wound healing.

23 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat fractures, multiplanar deformities, false joints of long tubular bones.

There is a method of osteosynthesis by the Ilizarov apparatus (V. I. Khlopkiy. Ilizarov method in the treatment of diaphyseal fractures of the lower leg bones / V.I.Khrupky, A.A. Artemyev, V.V. Popov, A.N. Ivashkin. - M.: GEOTAR- MED, 2004. - 96 p.), Which consists of several stainless steel rings, to which transosseous elements are attached with special clamps. The rings of the Ilizarov apparatus are interconnected by connecting rods or hinges. The disadvantages of this device are:

1. The device based on 3-4 supports is bulky and inconvenient for the patient.

2. The need for partial remounting of the apparatus (installation of articulated subsystems to eliminate each of the components of the deformation) when eliminating multi-plane deformations.

Closest to the proposed is a method of osteosynthesis with a Taylor apparatus - Taylor Spatial Frame (Taylor CJ Correction of general deformity with the Taylor Spatial Frame Fixator / CJTaylor. - Memphis: Tennessee, 2002. - 26 p.), Which is a device based on two supports to which, with the help of transosseous elements, the proximal and distal bone fragments are attached, respectively. The supports are interconnected by six telescopic rods (striations). Changing the lengths of each of the telescopic rods leads to a three-plane movement of the fragments. To determine the magnitude of the changes of each of the telescopic rods, which will provide the necessary position of the bone fragments (during reposition, correction of deformation), use a special computer program.

The disadvantages of this device are:

1. Taylor's apparatus remains cumbersome throughout the entire fixation period.

2. The construction under consideration does not imply the possibility of dynamization, which is one of the important methods of “education” of bone regenerate at the end of the fixation period.

The technical result of the invention is a phased minimization of the external fixation apparatus (reduction of bulkiness) after correction of the position of the bone fragments (elimination of deformation, reposition of the fracture), as well as optimization of fracture healing conditions due to the possibility of dynamization of the structure.

The result of the invention is achieved by the fact that inside the rings of the Taylor apparatus using sectors, bolts and nuts, sectors 1/3 and 1/4 of the ring are fixed to which transosseous elements are fixed. After correcting the position of the bone fragments, the sectors are interconnected, and the Taylor apparatus is dismantled.

The drawings show:

Figure 1 Photo: Securing the sector ј of the ring inside the ring of the Taylor apparatus:

1 - Taylor apparatus ring;

2 - sector 1/4 of the ring;

3 - bracket for 2 holes;

4 - a bolt.

Figure 2 Fixation of the bone to the sectors fixed in the rings of the Taylor apparatus:

1 - Taylor apparatus ring;

2 - sector 1/4 of the ring;

3 - bracket for 2 holes;

5 - screw rod, fixed with brackets;

6 - telescopic rods of the Taylor apparatus (strata).

Figure 3 The external fixation device after dismantling the external supports and installation of connecting rods between the sectors:

2 - sector 1/4 of the ring;

5 - screw rod, fixed with brackets;

7 - connecting threaded rod.

Figure 4 X-ray diffraction patterns of the patient before surgery: direct projection.

Figure 5 Photographs of the patient before surgery: lateral projection.

Fig.6. X-ray diffraction patterns of the patient after surgery: direct projection.

Fig. 7 Radiographs of the patient after surgery: lateral projection.

Fig.8 Photos of the patient after surgery: standing front view.

Fig.9 Photographs of the patient after surgery: standing side view.

Figure 10 Photos of the patient after surgery: function in adjacent joints.

11 Photographs of the patient after surgery: close-up apparatus.

Fig. 12 X-ray diffraction patterns of a patient eliminating fragment displacement: direct projection.

Fig. 13 Radiographs of a patient eliminating displacement of fragments: lateral projection.

Fig. 14 Radiographs of the patient after dismantling the outer rings and telescopic rods (strata) of the Taylor apparatus: direct projection.

Fig. 15 Radiographs of the patient after dismantling the outer rings and telescopic rods (strata) of the Taylor apparatus: lateral projection.

Fig.16. Photos of the patient after dismantling the outer rings and telescopic rods (strata) of the Taylor apparatus: standing front view.

Fig. 17 Photographs of a patient after dismantling the outer rings and telescopic rods (strata) of the Taylor apparatus: standing side view.

Fig. 18 Photographs of the patient after dismantling the outer rings and telescopic rods (strata) of the Taylor apparatus: function in adjacent joints.

Fig. 19 Photographic radiographs of a patient after fracture consolidation: direct projection.

Fig. 20 Radiographs of the patient after fracture consolidation: lateral projection.

Fig.21 photographs of the patient after consolidation of the fracture: standing front view.

Fig.22 photographs of the patient after consolidation of the fracture: a side view of a standing.

Fig. 23 Photographs of a patient after fracture consolidation: function in adjacent joints.

The method is as follows: sectors 1 / 3-1 / 4 of the ring are placed inside the rings of the Taylor apparatus. The sectors are attached to the rings using connecting plates, bolts and nuts. 2-3 screw rods are inserted into each bone fragment, which are attached not to the rings of the Taylor apparatus, but to the sectors. After eliminating the deformation and displacement of the fragments, the internal sectors are interconnected by threaded rods or hinges (if, after repositioning, the sectors are not strictly perpendicular to the anatomical axis of the bone). Then the outer rings and telescopic rods of the Taylor apparatus are dismantled. This leads to a significant reduction in the dimensions of the external fixation apparatus. In addition, the “released” parts of the Taylor apparatus can be reused. The apparatus is dynamized at the end of the fixation period “traditionally”: 1-2 mm are removed from one of the supports of the nut of the connecting threaded rods.

Demonstrate what was said by clinical observation.

Patient B., 18 years old, medical history No. 115/2007. As a result of the fall of January 15, 2007, a closed fracture of the bones of the right tibia with displacement of fragments occurred. 02/05/2007 modular transosseous osteosynthesis with a Taylor apparatus was performed. Fragment displacement was eliminated within 3 days, after which 09.02.2007 the internal sectors were connected by the threaded rods of the Ilizarov apparatus, and the rings and telescopic rods of the Taylor apparatus were dismantled. 7 days before the dismantling of the apparatus, the design was dynamized. The fixation period was 115 days. A week after removing the external fixation apparatus, the patient began to work.

Information sources

1. Fragile V.I. Ilizarov method in the treatment of diaphyseal fractures of the lower leg bones / V.I.Khrupky, A.A. Artemyev, V.V. Popov, A.N. Ivashkin. - M.: GEOTAR-MED, 2004 .-- 96 s.

2. Taylor C.J. Correction of general deformity with the Taylor Spatial Frame Fixator / C.J. Taylor. - Memphis: Tennessee, 2002 .-- 26 p.).

Claims (1)

A method of modular osteosynthesis with a Taylor apparatus, comprising introducing screw rods into the proximal and distal bone fragments, characterized in that sectors 1 / 3-1 / 4 of the ring are attached to the rings of the Taylor apparatus using trims, bolts and nuts, to which transosseous elements are fixed, after correcting the position of the bone fragments, the sectors are interconnected, and the Taylor apparatus is dismantled.

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