RU2391933C1 - Method of transosteal osteosynthesis of long bones of extremities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Carried out is introduction into proximal and distal fragments of rods-screws and mounting of apparatus of external fixation. Rods-screws are fixed to external semi-rings. Internal semi-rings after correction of fragments position are dismantled.

EFFECT: method ensures reduction of construction size, increase of patient's live quality during fixation period.

1 ex, 9 dwg, 1 tbl

Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used for osteosynthesis of injuries of the femur and tibia.

A known method of transosseous osteosynthesis of diaphyseal fractures of the lower leg according to the method of G.A. Ilizarov (figure 1), according to which at the level of the proximal metaepiphysis of the tibia, two base knitting needles are carried out at an angle of mutual intersection close to 60 °. At the level of the distal metaepiphysis, a second pair of base knitting needles is carried out. Then mount the external fixation apparatus on the basis of three to four ring supports (2 supports - basic, 1 or 2 - parafractory). Distraction is applied and two parafracture reposition and fixation knitting needles with thrust pads are carried out. As an example, figure 1 presents a diagram of transosseous osteosynthesis according to G.A. Ilizarov for fracture of the lower leg bones in the upper third [Shevtsov, V.I. The apparatus of Ilizarov. Biomechanics / V.I. Shevtsov, V.A. Nemkov, L.V. Sklyar. - Kurgan: Periodicals, 1995. - 165 p.].

According to the "Method for the unified designation of transosseous osteosynthesis" [Solomin L.N. et al. Method for the unified designation of transosseous osteosynthesis // Methodical recommendations of the Ministry of Health of the Russian Federation No. 2002/134. - St. Petersburg, 2004. - 24 p.] The layout of the external fixation apparatus is as follows (the diameter of the supports is conditionally selected):

The specified method of transosseous osteosynthesis has several disadvantages:

1. an apparatus based on 3 or 4 ring supports is bulky and inconvenient for the patient, such a layout should be maintained throughout the entire period of fixation;

2. The use of an annular proximal base support prevents complete flexion in the knee joint;

3. the use of only knitting needles during transosseous osteosynthesis leads to a gradual decrease in the stiffness of osteosynthesis due to the weakening of their tension;

4. when carrying out basic knitting needles, soft tissues are “stitched” where their thickness and displacement during movements in the knee and ankle joints are relatively large; this increases the risk of contractures and infectious complications;

5. when correcting deformations, the use of annular supports throughout the entire period of fixation does not allow the patient and the doctor to reliably evaluate the shape of the lower leg, such as the reduction of legs in circular devices.

Closest to the proposed invention is a method of combined ("spoke-rod") transosseous osteosynthesis of fractures of the tibia [Mykalo, D.A. Combined transosseous osteosynthesis for fractures of the lower leg bones and their consequences: abstract. dis. ... cand. honey. Sciences / Mykalo D.A. - SPb., 2008. - 25 p.] (Figure 2), according to which through the proximal metaepiphysis of the tibia a base spoke with a thrust pad in the frontal plane is drawn. At the level of the distal metaepiphysis, a second base spoke is held with a thrust pad through both lower leg bones. Mount the apparatus of three or four supports. In this case, the proximal support is 2/3 or 3/4 of the annular, and the intermediate ones are composed of sectors - 2/3 and 1/3 of the annular support. Distraction is applied, parafractory transosseous elements are introduced - screw rods and reposition.

To ensure sufficient rigidity of fixation of bone fragments, one more screw rod is introduced into each bone fragment (figure 2):

All transosseous elements are carried out only in the projections of the so-called "recommended positions". In their projections there are no main vessels and nerves, the displacement of soft tissues during movements in adjacent joints is the smallest [Solomin, L.N. The basics of transosseous osteosynthesis with the apparatus of G.A. Ilizarov / L.N. Solomin. - St. Petersburg: Morsar AB, 2005. - 544 s].

As the formation and restructuring of interfragmental regenerate, after 2-3 weeks, the first stage of the modular transformation of the external fixation apparatus is performed - the distal base support is dismantled (Fig. 3):

The second stage of modular transformation is performed after 8-10 weeks: a sector 2/3 of the circumference is dismantled at the parafracture support. Thus, after this support is a sector 1/3 of the ring support (figure 4):

Minimizing the layout of the apparatus reduces the incidence of contractures and infectious complications, and improves the quality of life of the patient.

The disadvantages of this method include:

1. the bulkiness of the external fixation apparatus until its modular transformation is completed (the apparatus consists of three to four supports, one of which is 2/3 of the circle, the rest are circular);

2. the use of the proximal support, which is 2/3 of the annular, makes it impossible to reduce the legs in the external fixation apparatus, which creates inconvenience when walking, also makes it difficult to assess the shape (silhouette) of the lower limb and its biomechanical axis. The ability to reduce legs during the period of fixation by devices is extremely necessary for the correction of deformities of the lower extremities, especially in aesthetic orthopedics, because this allows the patient and the attending physician to evaluate the result of the treatment and, if necessary, perform the correction.

The technical result of the invention is to reduce the bulkiness of the structure, improve the quality of life of the patient during the period of fixation, making it possible to reduce both legs to their contact in the external fixation apparatus; This method of transosseous osteosynthesis can also be used for osteosynthesis of long bones of the upper limb, which will allow the patient to easily bring his hand to the body, which is especially important for osteosynthesis of the humerus.

The result of the invention is achieved by the fact that the joints of the half rings are placed in the sagittal plane, and the screw rods are fixed to the outer half rings (Fig. 5). After that, the necessary reposition unit is mounted between the supports. After the necessary correction of the position of the bone fragments, the layout of the apparatus is minimized (modular transformation of the apparatus is performed): the inner half rings are removed from each of the supports (Fig.6). The possibility, as a result, of bringing the legs to their touch facilitates the patient’s gait, makes it possible to objectively assess the contour of the legs, which is especially important for the aesthetic correction of their shape.

The drawings are shown.

Figure 1 - layout of the external fixation apparatus for transosseous osteosynthesis of lower leg bones according to G.A. Ilizarov.

Figure 2 - scheme of combined transosseous osteosynthesis for damage to the bones of the leg, full layout.

Figure 3 - layout of the AVF after the first stage of modular transformation.

Figure 4 - layout of the AVF after the second stage of modular transformation.

Figure 5 - diagram of transosseous osteosynthesis of the bones of the leg according to the proposed method (full layout).

6 is a diagram of transosseous osteosynthesis of lower leg bones according to the proposed method (after modular transformation).

Fig.7 - the appearance of the patient C. before surgical treatment.

Fig. 8 is the external view of patient C. after eliminating deformation in external fixation apparatuses.

Fig.9 - the appearance of the patient C. after the dismantling of external fixation devices.

The table shows.

Table 1 - indicators of the rigidity of fixation of bone fragments in various layouts of external fixation devices.

The method is as follows: when performing osteosynthesis, the external fixation apparatus is mounted so that the joints of the half rings are placed in the sagittal plane, and the screw rods are fixed to the outer half rings. After that, the necessary reposition unit is mounted between the supports. After the necessary correction of the position of the bone fragments, the layout of the apparatus is minimized (a modular transformation of the apparatus is performed): the inner half rings are removed from each of the supports. The possibility, as a result, of bringing the legs to their touch facilitates the patient’s gait, makes it possible to objectively assess the contour of the legs, which is especially important for the aesthetic correction of their shape.

As an example, figure 5 presents the original layout for osteosynthesis of damage to the tibia in the upper third. The layout diagram is as follows:

After performing modular transformation, the apparatus is located only on the outer surface of the segment and does not interfere with limb reduction (Fig.6):

To confirm the stability of fixation of bone fragments when using the developed transosseous apparatus layout, comparative bench tests were carried out according to the original method (patent No. 2226139, new medical technology No. FS-2005/021). Table 1 shows the values of the stiffness indicators of osteosynthesis when using various configurations of external fixation devices. The developed arrangement of the external fixation apparatus (Fig.6) provides the rigidity of osteosynthesis 1.1-2.3 times greater than the layout according to G.A. Ilizarov (Fig.1) and 1.1-3.6 times less than the layout developed by D.A. Mykalo (figure 4).

Clinical example. Patient S., 32 years old, was admitted to RNIITO them. R.R.Vredena regarding bilateral varus deformity of both legs (Fig. 7). 05/08/2008, osteotomy of both tibia in the upper third, the application of external fixation devices on both legs in accordance with the proposed method. Deformation of both legs was eliminated within 2 days with the help of hinges. The final “residual” correction was performed after dismantling the internal parts of both supports, which allowed the patient to bring her legs to their touch (Fig. 8). In addition, such a modular transformation of the apparatus allowed the patient to walk more comfortably. The device is dismantled after 3 months (Fig.9).

METHOD FOR EXTREME OSTEOSYNTHESIS OF LONG EXTREMITY BONES

Table 1 AVF layout Rigidity, N / mm; N / g transverse longitudinal rotational K _{Ma / front} K _{Ma / Sagit} K _{Ma / prod} K _{Ma / mouth} in figure 1 3.0 2.1 53.0 2,8 figure 2 18.0 17.0 115.0 13.0 figure 3 11.5 9.5 85.0 8.0 figure 4 10.0 8.0 75.0 7.0 figure 5 8.2 4.4 75 6.3 6 6.8 2.2 70 5.3

Claims (1)

A method for transosseous osteosynthesis of diaphyseal injuries of long bones of the extremities, including introducing screw rods into the proximal and distal fragments and mounting an external fixation device, characterized in that the joints of the half rings are oriented in the sagittal plane, the screw rods are fixed to the outer half rings, the inner half rings after correction of the position of the fragments dismantle.

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