RU2381015C1 - Device for introduction of osteoplastic material - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device contains a funnel, a guide pin and a pusher. The guide pin in its upper part is threaded to be screwed on the funnel. The device is also provided with a handle which is attached with a bushing and a screw to the guide pin and height adjusted. The guide pin comprises the pusher. The latter projects from the lower edge of the guide pin by 5 mm.

EFFECT: invention provides the controlled, targeted and directed introduction of osteoplastic material into a defect of vertebral body, prevented migration of a transplant and reduced risk of intraoperative injury of posterior vertebral structures.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for the introduction of osteoplastic materials in the replacement of bone defects resulting from fractures of the vertebral bodies, including against the background of osteoporosis.

Known surgical instrument for installing a bone graft with a set of tubes of different sizes. A bone graft of appropriate size may be placed in the tubes. When the tube moves in the opposite direction relative to the graft capture area, the bone graft enters the tube capture zone (US Pat. No. 6,309,395).

However, this tool is intended only for work with large grafts and cannot be used for the introduction of small grafts. The use of this tool is limited.

Closest to the claimed is a surgical instrument for introducing bone grafts into the vertebral body through dorsal intrapedicular access. This medical tool consists of a funnel, a guide and a pusher. The funnel of the device is integrated with the guide, and they make up a single design. A bone graft of the appropriate size is placed through the funnel and guided by the translator into the bone defect zone (Walter Dick. Internal Fixation of Thoracic and Lumbar Spine Fractures. Hans Huber Publishers. Toronto, Lewiston NY, Bern, Stuttgart. - 1995, p. 77 -81).

However, this tool does not allow to introduce osteoplastic material to the optimal depth, determined during preoperative planning; does not provide a stable position of the instrument in the wound, and its arbitrary sliding and mobility pose a risk of trauma to the posterior vertebral structures, especially with osteoporosis.

The objective of the invention is to provide a device for introducing osteoplastic material into a defect of the vertebral body, which provides controlled, targeted and directed introduction of the material, prevents transplant migration and reduces the risk of intraoperative damage to the posterior vertebral structures, including osteoporosis.

The task is achieved due to the fact that the device is collapsible, has a handle that, with the help of a sleeve and a screw, is attached to the guide with the ability to move it to a predetermined level, a pusher is installed in the guide, the latter protrudes by 5 mm beyond the lower edge of the guide.

The technical result from the use of the invention is to provide improved results for the treatment of patients due to the design features of the device, allowing to establish and control the direction and optimal depth of introduction of osteoplastic material and thereby reduce the risk of intraoperative damage to surrounding tissues and achieve complete restoration of the vertebral body. The device is made collapsible, which allows you to enter as a small-fragmented (through the funnel), and visco-fluid (without funnel) osteoplastic material. The necessary direction and optimal depth of introduction of osteoplastic material is provided with the help of a handle, which allows the surgeon to control the position of the instrument in the wound and to control the direction of introduction of the material. The sleeve 2 limits the length of the lower part of the guide introduced into the defect, since it rests on the outer surface of the vertebra. The handle allows the surgeon to hold the guide in the desired position and to prevent both his involuntary slipping out of the wound and a dangerous depression in it. As a result, in the process of introducing osteoplastic material, the pusher passing through the guide and projecting 5 mm beyond its lower edge is always located inside the defect below the outer surface of the vertebra. All this prevents damage to the posterior structures of the spine, provides targeted delivery of osteoplastic material, eliminates its migration and damage to the neurovascular structures.

The drawing shows a device for introducing osteoplastic material, which consists of a pusher 6, a guide 4, a handle 1, a sleeve 2, a screw 3 and a funnel 5. The handle 1 is attached to the guide 4 by a sleeve 2 and a screw 3. In the upper part of the guide 4, a funnel 5 is fastened with a thread, the inside of which is inclined at an angle of 60 ° for better gliding of the osteoplastic material. A pusher 6 is mounted in the guide 4, which protrudes by 5 mm beyond the lower edge of the guide.

The operation of the device is as follows. The handle 1 is installed and fixed using a sleeve 2 and a screw 3 on the guide 4 at a predetermined level from its lower edge, which is immersed in the area of the bone defect. The level of attachment of the handle is determined during preoperative planning by measuring CT scans of the damaged vertebra. The funnel 5 is screwed onto the upper part of the guide 4. Then the lower part of the guide 4 is inserted into the defect of the vertebral body, while the sleeve 2 rests on the outer surface of the vertebra. Using the handle, the guide is held in position at a predetermined depth determined during preoperative planning. Osteoplastic material is placed in the funnel 5 and through the guide 4 using the pusher 6 translationally injected into the defect of the vertebral body. A pusher protruding beyond the lower edge of the guide prevents the occurrence of increased resistance in the exit zone of the material and seals it in a limited space.

Clinical example. Patient D., 57 years old, was hospitalized in the department of emergency vertebral trauma 01/07/07 with complaints of pain in the thoracolumbar spine. From the anamnesis it was found that a few hours before admission the patient was injured when falling on her back from a height of her own height. The department conducted a comprehensive clinical, radiological, and computed tomography examination. The clinical diagnosis was established: closed uncomplicated incomplete explosive fracture of the body of the Th12 vertebra (type A3.1). Osteoporosis of the spine 2 degrees.

X-ray morphometry of the thoracolumbar spine was performed. Kyphotic deformation of the damaged segment of the spine 12 °, loss of height of the ventral column of the body Th12 38%. Computed tomography shows a shift of fragments into the spinal canal by 21%. Densitometrically, it was noted that osteoporosis of the spine on the basis of the T criterion was equal to -2.8 SD.

Under endotracheal anesthesia, the patient’s position on the abdomen in the position of slight extensia, a linear incision was made from the spinous process Th11 to L1, the skin, fiber, and superficial fascia were dissected. To the right and left of the spinous processes, the lumbar fascia is dissected. Muscles are detached from the spinous processes of Th11-L1. Half-arms and articular processes are exposed. Under the EOP control, in accordance with the anatomical landmarks, transpedicular screws were inserted into the roots of the arches of Th11 and L1 vertebrae from two sides. Awl of 4 mm on both sides formed holes in the roots of the arch of the Th12 vertebra. A device for introducing osteoplastic material is installed. Bone granules in a volume of 5 g were introduced into the body of the damaged vertebra through the guide. Then installed transpedicular screws.

Mounted transpedicular construction. On the control radiographs, a complete correction of kyphotic deformation and restoration of the height of the ventral part of the vertebral body are noted. Hemostasis. Layered seams on the wound. Aseptic dressings. During the operation, the daily dose of the antibiotic was intravenously administered.

Postoperative course without features. Skin sutures were removed on the 8th day after surgery. The patient was discharged in satisfactory condition. Control examinations were performed 4 and 8 months after surgery. On the control radiographs of the spine in the direct and lateral projections, the correction of the kyphotic deformation of the damaged segment and the restored height of the damaged body are preserved. General condition is satisfactory. The result of the treatment is rated as excellent.

Claims (1)

A device for introducing osteoplastic material, made collapsible and containing a funnel, a guide and a pusher, a guide in the upper part of it is equipped with a thread for screwing a funnel, characterized in that the device has a handle that is attached to the guide with a sleeve and a screw it to a predetermined level, a pusher is installed in the guide, the latter protrudes by 5 mm beyond the lower edge of the guide.

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