RU2415653C2 - Method of anchor fixation of bone fragments with application of string and anchor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. Method of anchor fixation of bone fragments with application of string is characterised by the following: applied string is made of metal with shape memory, at least, two anchor devices are reversely wedged in fragments, connected with elastic arch and tightened with string from metal with shape memory. Anchor device contains shank, core, lock, bush and compensator. Shank is made in form of tube with levers, neck and intraosteal leg. Levers have holes for screws for fixation of elastic arch. Intraosteal leg has thread and longitudinal cuts in which lugs are located on axes. Lugs are connected with spring and are installed movably. Core is installed in shank coaxially. Lock has thread connection with shank neck with possibility of rotation and ensures core travel along shank axis and fixes core position along shank axis. Core travel ensures lug rotation around axis with movement of lug from shank opening and picking up bone fragment with lug. During core lifting spring tension performs return of lug into shank opening. Bush has bed for string and has possibility of threading, lowering along leg and resting with its base on bone fragment. Compensator ensures transmission of rotation effort to lock toward threading.

EFFECT: inventions ensure increase of efficiency of rehabilitation of patients with violation of facial skeleton integrity of various genesis by improvement techniques of fixation application.

3 cl; 19 dwg

Description

The group of inventions relates mainly to maxillofacial surgery and can be used for the rehabilitation of patients with impaired integrity of the facial skeleton of various origins.

The reliability of fixation of the maxillofacial bone fragments, despite some successes, remains unresolved to date. The modern technical level is provided by a large arsenal of means and methods of osteosynthesis, proven by many years of application experience. The advantages of osteosynthesis as an operative method contain an internal conflict, namely, that the fixation of fragments is achieved, as a rule, at the cost of causing a significant additional trauma to the patient on the operating table.

The dynamics of the consolidation process makes serious demands both on the strength of the retainer itself and on the presence of vulnerabilities in the immobilizing structure, which undergoes deformations under the influence of destabilizing forces. The margin of structural strength is necessary for the timely inclusion of the functional activity of the damaged bone, while the degree of compression of the fragments should not go beyond the average compression range (100-200 N / cm ² ), optimal for the reparative regeneration of bone tissue. Difficulties in establishing uniform compression over the entire fracture area, due to the complex configuration of the maxillofacial bone structures, are exacerbated by the problem of bone resorption in places of contact with the fixative. The technical increase in the power of the latch does not live up to expectations and does not provide functional stability of the fragments, because the rigidity of the metal support under functional load leads to rapid bone resorption or even to its destruction [3].

Known plate osteosynthesis, which involves the dissection of tissues and the disclosure of the damage zone, fixation with screws on the bone fragments of the plate of the desired configuration, followed by the removal of retainers at the final stage of treatment. Optimization of special tools, the use of high technologies and the improvement of operating equipment have reduced the damaging effect of the intervention and improved cosmetic treatment results [5].

According to the biomechanical characteristics, mini-plates with screws are the most durable clamps of all existing. However, the stability of fixation depends on the rate of resorption in the places of support of the fixative in the bone and the area of microdestruction of the bone in the fracture area, and simultaneous compression of fragments cannot guarantee stability of fixation for the entire period of consolidation, as indicated by failures in the clinic. Due to bone resorption in the places of support of the fixative, the force of compression between the fragments decreases already on the 1st day, then it can completely disappear [3]. Making any amendments during treatment without causing additional trauma does not provide for plate osteosynthesis.

The trauma of submersible platelet osteosynthesis is its most debated drawback. Dissection of soft tissues, fascia and muscles is associated with a risk of damage to blood vessels and nerve trunks, subsequent trophic disorders, scarring and cosmetic defects. Additional trauma is caused by repeated surgery, dictated by the need to remove the clips.

External osteosynthesis using external devices does not require wide incisions, does not affect the focus, provides for dynamic correction and external removal of the structure. Known terminal devices, spoke-rod, devices with a cross-shaped and parallel introduction of knitting needles [1]. The spoke devices have a wide range of applications due to the combination of elasticity with high strength of the retainer, corresponding to the mechanical parameters of the bone. The knitting needle is tiny, causes minimal additional trauma, does not create excessive contact stresses in the zone of the highest concentration of volume fractures and provides the maximum contact area of the fixator with the bone. Of particular importance is the use of spoke devices in the field of the condylar process of the lower jaw, small in size, located in close surroundings of other anatomical structures.

Designs for external fixation cause minimal operational trauma, allow you to create and control compression-distraction of fragments, but at the same time they are bulky, uncomfortable and pose a risk of infection of the area of contact of the bone with the parts of the fixative. External structures have the lowest fixing qualities and do not provide uniform compression along the entire fracture plane, while maintaining diastasis from the side opposite to the position of the fixators [3].

The nodes of the structure, which is a U-shaped spacer system, weaken under conditions of deformation overloads, under the influence of the lever efforts of the supports. The price of joint instability was determined using a computer model of the structure fixing bone fragments with a diameter of 10 mm. Rotations of the rods in the structural joints within one angular degree were carried out - for the purity of the experiment - with the exception of longitudinal displacements in the joints. The instability at one point of the device reduced the contact area of the fragments by 2%, the second unstable connection led to a 15% decrease in the joint area, and the backlash of the fragment at the place of support of the latch reduced the contact area of the fragments by 26.6%, while the fragment diastasis was 1, 12 mm.

At the time of applying an external fixation device, a “competition” begins between the healing of the fracture and the decrease in structural strength due to loosening of the rods and other implantable parts of the fixative. An unstable assembly can compromise the external structure under conditions of real deformation overloads and cause a secondary displacement of fragments as a result of a decrease in the rigidity of the system.

Materials with thermomechanical memory have opened up new prospects in ensuring the reliability of fixation. Alloys based on titanium nickelide are strong, light, resilient, resistant to aggressive influences and can develop considerable efforts when restoring shape in a certain temperature regime. The combination in a miniature fixer of high elasticity with resistance to loads allows it to ensure timely and uniform compression of fragments for the entire period of consolidation, despite the development of osteoporosis in the places of contact of the fixator with the bone. The delicate values of contact forces and stresses created by fixators with shape memory prevent bone destruction and create the most optimal conditions for reparative regeneration of bone tissue [2, 4]. However, the possibilities of retainers with thermomechanical memory remain not fully realized due to the invasiveness of the immersion method of installing and removing implants. A negative side effect is the eruption of bone tissue by the legs of the fixative in case of volumetric micro-fractures in the area of the edges of the fragments.

Thus, submersible platelet osteosynthesis, causing additional tissue injury, does not have tools to influence the dynamics of consolidation. External fixing devices allow you to adjust the consolidation process only by delaying the spatial-geometric correction of the position of the fragments, which is not enough to maintain uniform stable compression in the mode of power loads and continuous bone resorption. The retainers with thermomechanical memory correspond to the biomechanical parameters of the bone, create the correct autonomous compression with optimal values of contact stresses, but lose their advantages due to additional damage caused by operating trauma.

The search for the optimal means of osteosynthesis that reduce the risk of surgical complications is carried out taking into account the following requirements: minimal tissue trauma, indifference of materials, resistance to mechanical stress, and elimination of repeated operations. This can be solved due to the miniaturization of the fixative and rational access to the area of damage, bone treatment should be carried out without a burn and causing additional microcracks. All components of osteosynthesis should provide conditions for the functional stability of fragments [3].

The mechanical strength of the fixative is a prerequisite, but not sufficient, for successful osteosynthesis. Bone resorption in the region of the fixator support, similar to the process of thawing an ice floe, is an important link in the chain of causes of the mobility of the junction of fragments. Local osteoporosis occurs during the first day after the installation of any metal fixator and quickly, already at the initial stage of osteosynthesis, neutralizes the adhesion density of the support to the bone. The intensity of resorption proceeds uniformly throughout the entire period of consolidation and reaches an average of 38-40% in 3 weeks. During the formation of bone marrow, the entire system of immobilization of bone fragments should be as motionless as possible, and there are rather narrow limits of permissible micromotion of bone fragments, violation of which will slow down the consolidation process. As the contact density of the fixator with the bone decreases, the mobility of the junction of the fragments under the action of biasing forces increases, with a movable joint and diastasis of more than 100 μm, bone fusion according to the primary type of reparative regeneration - by directly forming bone tissue in the intermediate space - becomes impossible, bone marrow is formed by the secondary type, at a later date, the fusion is accompanied by bone resorption along the fracture line and occurs only after the periosteal bone cuff of the stool IT fragments.

The rapid loss of fixation density of the fixative with the bone due to resorption, leading to a violation of the stability of fragments, is a common problem for all types of maxillofacial osteosynthesis. Under such conditions, the equilibrium state of the immobilization system, which has elements of self-regulation, is of key importance. Catches with thermomechanical memory most fully meet the requirement of timely and autonomous restoration of system equilibrium.

Known anchor, a device for holding a floating means in place due to interaction with soil or ice. The holding force of the anchor is on average 10-12 times its weight [6].

Known anchor (German. Anker, lit. - anchor) - a part for fastening parts of structures and machines [6]. A metal anchor is a highly reliable fastener, in a certain way - by means of an anchor lock jammed in the well - increasing adhesion between the main fastener and the base, which is a material of various strengths, to the required level (Encyclopedia of technology).

Known maxillary retainer, made in the form of a plate bracket of titanium nickelide, containing legs bent towards each other, connected to the shoulder of the bracket with jumpers; the bracket is made in a W-shape, and additional legs bent towards each other are formed with the help of opposite slots located on the shoulders of the bridge, while the pointed ends of the legs are bent inward with the formation of fixing spikes (RF patent No. 2051642, application No. 5054865/14, publication date 1996.01.10, auth. Medvedev Yu.A., Bezrukov V.M., Konyakhin A.F.).

Known biocompatible wear-resistant nanostructured thin-film material used as coatings in the manufacture of implants operating under load, with high hardness, low modulus of elasticity, high adhesion to the substrate, low friction coefficient and wear rate, high resistance to elastic fracture and plastic deformation, low surface roughness (RF patent No. 2281122, application No. 2005120397/15, publication date 06/30/2005, ed. Levashov EA, Shtansky DV).

In the literature there is no mention of a method similar in technical essence to the claimed one.

As a prototype of a device that ensures the implementation of the method, an implant is used, which is used as a leg for fixation in the bone. The implant contains a osseous part, an intraosseous leg and an element of porous material. The leg is a tube with longitudinally split and outwardly curved petals of material with shape memory. A porous element is disposed coaxially with the inside of the tube. The invention provides reliable primary self-fixation of the implant and secondary in the long term (RF patent No. 2254102, application No. 2003106046/14, publication date 2005.06.20, author Solomin L.N., Shaboldo O.P., Dolgopolov V.V., Zhabin G.I., Vasiliev A.V., Bogdanov A.V.). It should be noted the lack of cyclicity in the operation of the device.

The task to which the invention is directed is to increase the reliability of fixation of bone fragments by:

- improvements in the shape of the retainer with the properties of a reversible change in the geometry of its supporting part;

- the use of metal strings with shape memory for external retraction of locking devices, similar to a bowstring;

- reducing the degree of negative effect of resorption on the strength of fixation of fragments through the use of a compensator device.

This problem is solved by the claimed method of anchoring the bone fragments with the application of a string, characterized in that the string used is made of metal with shape memory, at least two anchor devices are reversibly jammed in the fragments, connected by an elastic arc and pulled together by a metal string with shape memory. An anchor device containing a trunk, a core, is characterized in that it has a shutter, a sleeve and a compensator, the barrel is made in the form of a tube with levers, a neck and an intraosseous leg, the levers have holes for screws for fastening the elastic arch, the intraosseous leg has a thread and longitudinal slots in which the paws are located on the axes, the latter are connected by a spring and mounted movably, the core is installed coaxially in the barrel, the shutter is threadedly connected to the barrel neck with rotation and allows the core to move along the axis the barrel and fixes the position of the core along the axis of the barrel, the movement of the core ensures the paw is rotated around the axis with the paw being pulled out of the lumen of the trunk and hooked up with a bone fragment, when lifting the core, the spring tension returns the paw to the lumen of the trunk, the sleeve has a bed for the string and has the ability to twist, lowering the leg and stop with its base on the bone fragment, the compensator ensures the transmission of the rotational force to the shutter in the direction of twisting. The device may have a removable metal core with shape memory, the core may be made in the form of a tube and carry a removable metal core with shape memory, the barrel lever may have a landing pad.

The technical result provided by the given set of features is the ability to use the anchor device for external fixation of fragments of the maxillofacial bones with the possibility of removing the anchor after the fracture is fused, the optimal form of the device, providing mechanical strength of the fixer, tight contact of the anchor with the bone due to reversible jamming in the well, providing dynamic compression at the junction of fragments with an externally installed string; ensuring safe and timely correction contact density with the bone and preventing the weakening of the fixation strength, as well as providing the ability to adjust the treatment process, if necessary, without causing additional injury to surrounding tissues.

The invention is illustrated by drawings, in which:

figure 1 presents the device anchor,

figure 2 is a vertical section of the shutter,

figure 3 is a vertical section of the intraosseous legs,

figure 4 - the operation of the device anchor,

figure 5 - compensator,

figure 6 is a vertical section of the intraosseous legs with the released legs,

7 is a mini-board prepared for the formation of an elastic arc,

on Fig - a string of metal with shape memory,

figure 9 - the use of a drill with a protective cover in drilling wells,

figure 10 is a diagram of the installation of an elastic arc and string on the device,

figure 11 is a General view of the structure, fixing the bone fragments,

Fig.12 - cavity anchor,

on Fig - trunk cavity anchor,

on Fig is a vertical section of the core of the cavity anchor,

on Fig is a vertical section of the intraosseous leg of the cavity anchor,

in Fig.16 - compensator cavity anchor,

on Fig - rocker,

on Fig is a diagram of the use of the rocker arm,

on Fig - an example of the use of cavity anchor for intracavitary manipulations in the reduction of fragments of the anterior wall of the frontal sinus.

The anchor device comprises a barrel 6, a core 15 mounted coaxially in this barrel, a shutter 8, a sleeve 2, a dome 5 and a compensator 18. The barrel is made of a titanium alloy in the form of a tube with levers 7, a neck 9 and an intraosseous leg 1. The levers have holes for screws for fastening the elastic arch, the neck has slots 11 and a scale 10, and the intraosseous leg has a thread and longitudinal slots located 120 ° around the circumference, in which the tabs 17 are located on the axes 18, the latter are connected by a spring 16 and mounted movably. The core is made of metal with shape memory with a wear-resistant coating applied to the end sections and has a shoulder 14. The shutter is made of wear-resistant material, has the shape of a glass with an annular bridge 13 inside and longitudinal ribs 12 on the outside, with arrow-shaped protrusions facing the scale 10. The shutter has a threaded connection with the neck of the barrel, is rotatably connected to the core, while the collar 14 of the core is placed in the shutter chamber formed by the inner ring jumper 13. The sleeve is made of bioinert itanovogo alloy has the shape of a tube with an internal thread for connecting to the intraosseous stalk, equipped with a thrust collar and has the possibility of twisting, the lowering of the leg and the abutment by its base on the bone fragment. In the drum 3 of the sleeve is made bed 4 for the string. The lower edge of the elastic dome has a round arch, forming a space for placing an aseptic pad on the end of the drum. The compensator includes a frame 21, a spiral 20 with a key and a clamp 19.

Anchor works as follows. The shutter 8 is a regulator of reversible jamming of the anchor in the well of the bone fragment. A turn of the shutter by one turn ensures the movement of the core 15 along the axis of the barrel by a distance equal to the pitch of the thread, and a corresponding shift in the position of the ribs 12 relative to the scale 10. The movement of the core allows the foot 17 to rotate around axis 18 with the lower pole of this foot extending from the borehole. The release of the paw provides a bone fragment pickup and jamming of the intraosseous leg in the well. The rotation of the foot occurs with the voltage of the spring 16, providing reversibility of jamming. When the core is lifted, the spring tension returns the paw to the trunk clearance. The sleeve 2, equipped with a thrust washer, ensures the strength of anchor anchoring in the bony fragment well, protects soft tissues from the cutting edge of the thread of the intraosseous leg and performs a frame-forming function, protecting the trunk from lateral deformations. The dome 5 is a container for the placement of antiseptic agents, provides a tight connection between the sleeve and the intraosseous leg and prevents the penetration of infection into the outbreak. The compensator 18 performs the function of a shutter closer, the key of the spiral 20, fixed by a clamp 19 in the neck of the neck, provides an emphasis for the compensator, and the created voltage of the spiral ensures the transmission of the rotational force of the shutter in the direction of twisting.

At least two anchor devices installed in the bones of the bone fragments are connected by an elastic arc that acts as a spring strut. This elastic arc is formed from at least two mini-boards, bending their ends at a right angle, and fasten with screws on the levers of the devices. Both devices, connected by an elastic arc, are pulled together with a metal string with a shape memory placed in the sleeves of the bushings. The string has a Q- or S-shaped configuration with end sections bent at right angles for ease of installation. On the device, anchors connected by an elastic arc and pulled together by a string, install compensators with a voltage of the spirals.

The method of anchor fixation of bone fragments with stringing is carried out in the following sequence. On the skin in the projection of the bone fragment, the projection of the fixation point is determined based on the nature of the damage and the anatomical and topographic features of the zone. At a localized point, observing the rules of asepsis and antiseptics, a small cosmetic incision is made, the size corresponding to the diameter of the sleeve cone, and through this incision, the wound is deepened to the bone fragment, using blunt extension of soft tissues, if necessary using retractors. Thus, access to the bone fragment with the minimum necessary dissection of tissues. Drilling a well in a bone fragment is carried out using a drill with a silicone cover that protects the soft tissue from damage by the cutting edge. The ratio of the diameter of the drill to the diameter of the barrel is 1: 1.1. When drilling, make sure that the silicone cover functions as a “well”, resting its base on the outer compact plate of the fragment, and the immersion depth of the working part of the drill into the bone is controlled by the amount of cover displacement along the shank scale. Depending on the size of the fragment, the thickness of the spongy layer and the topographic and anatomical features of the zone, a blind or through hole is formed in the bone fragment. After the formation of the well, the drill is removed, while making sure that the cover continues to rest with its base on the outer compact plate until the cutting part of the drill leaves the well of the fragment. The sheathed drill is removed from the wound, bone chips are removed by electric suction, and the wound is toilet.

Before installing the device, the shutter 8 is unscrewed to the position where the tabs 17 are fully retracted into the borehole, and the sleeve 2 is lowered along the intraosseous leg 1 to the lower position so that only the intake part of the thread of the leg protrudes from the cone. An anchor is introduced into the wound, if necessary using retractors, and the butt end is placed at the wellhead. By rotating the barrel by the levers, the leg is immersed in the well to the required depth, while making sure that the cone of the sleeve acts as a "well", which rests its base on the bone fragment.

Fixation of fragments is carried out using at least two anchor devices reversibly stuck in the wells of adjacent bone fragments according to the procedure described above, after which the fragments are compared.

The levers of both devices are oriented to each other in an advantageous manner for installing an elastic arc, taking into account the topographic curvature of the region.

After the mutual positioning of the devices, they are jammed in the wells. The rotation of the shutter 8 release the paws 17 from the lumen of the barrel, while the rotation of the shutter is continued until resistance appears, indicating that the edges of the paws stop in the spongy bone or in a compact plate. The degree of release of the legs is reflected on a scale of 10 cervix. Optimum is the average degree of release of the legs, when jamming is provided taking into account the upcoming compensation for bone loss. To firmly fix the legs in the well, the sleeve 2 is twisted completely into the bone, while holding the levers of the barrel in a given orientation. An aseptic gasket is laid on the end of the drum 3 and pressed by a dome 5. The compensator 18 is mounted on the neck of the barrel with a voltage of spiral 20, the key of this spiral is inserted into the slot 11 and fixed with a clamp 19. The legs of the second device are jammed in the neighboring well by similar manipulations. Aseptic dressings are applied to skin wounds in places of fixation.

The devices are connected by an elastic arc using at least two mini-boards, the length and configuration of the latter are set taking into account the topographic curvature of the region, and the end sections are bent for fixing by screws on the levers 7.

String overlay: the shape and size of the string are selected individually, taking into account the characteristics of the region and the magnitude of the necessary pulling force. To ensure dynamic compression, the string must be installed with voltage, and its length should be less than the distance between the external contours of the bushings on the fixed devices. Before application, the string is cooled with liquid nitrogen to a temperature of manifestation of superelasticity, stretched and laid in the boxes of the bushings. Under the action of contact heating, the string will exhibit the shape-restoration effect and provide uniform counter-contraction of the devices similar to a bowstring with springy tension of the elastic arc, as well as timely displacement of the intraosseous leg in the bore as the resorption in the support region and compaction of the junction of the fragments during bone resorption along the fracture line.

The installation of a compensator with a spiral voltage ensures the transfer of rotary force to the shutter, the movement of the core along the axis of the barrel, timely extension of the legs and sealing contact with the bone as the resorption.

The weakening of the fixation strength of the intraosseous legs in the well is eliminated by an additional turn of the shutter, by adjusting the magnitude of the spiral voltage, by twisting the sleeve all the way into the bone. The uniformity of compression at the junction of the fragments, if necessary, is regulated by changing the configuration of the elastic arc. The choice of strings with the characteristics of the developed effort, commensurate with the biomechanical properties of the damaged area of the bone, control the amount of compression.

After restoration of the anatomical integrity of the bone, the dismantling of the immobilizing structure is carried out in the reverse order. Unscrewing the shutter to its highest position eliminates core pressure, while the spring allows the tabs to return to the borehole. After jamming the device, the string and mini-boards are removed. When twisting the trunk, the sleeve is held with a stop in the bone until the intraosseous pedicle is completely removed from the well. The properties of materials with shape memory used in the manufacture of anchor parts are used to prevent jamming of the core in the barrel during deformation of the device: before disassembling, the lock is subjected to contact cooling to the temperature range of superelasticity. After removal of the device, the necessary wound treatment is performed and sutured with a cosmetic suture.

To fix bone fragments of medium size and remote manipulations in the lesion, a cavity anchor can be used. The structural differences of the cavity anchor are as follows: the barrel neck has longitudinal slots and contains stops 28, the core is made in the form of a tube, has angular grooves 25 to accommodate the dowels 27 of the rod 24, and also has a scale and guide grooves 29. The protruding parts of the stops 28, placed in the guide grooves 29, prevent the rotation of the core and fix the limits of movement of this core along the axis of the barrel. Coaxially located in the core is a rod 24 made of metal with shape memory. The rod gives additional strength to the device and prevents deformation of the core, the installation of the dowels 27 in the corner grooves 25 occurs with the voltage of the spring washer 26 and provides a connection of the rod with the core, fixed from longitudinal displacements. Removal of the rod provides access through the channel of the core to deep tissue structures in the area of the lesion for diagnostic and treatment procedures. The landing site 23 of the lever has a regular relief in the form of ribs of a triangular profile. The slot of the intraosseous leg is made in the form of a rectangular window with a spring groove 30, a niche 31 is made at the base of the foot, which places the spring 16 so that the part of this spring protruding from the niche is placed in the spring groove. The configuration of the outer edge of the foot corresponds to the thread profile at the location of this foot. The shutter of the cavity anchor has an opening 22 for accommodating the compensator frame, as well as for visual control of the degree of release of the legs on the core scale. The cavity anchor compensator is made in the form of a sliding glass and is equipped with an antiseptic gasket 32, the configuration of the frame 21 repeats the shape of the opening 22, the clamp has internal slots and is connected to the spiral fixed from rotation.

Differences in the use of cavity anchors are as follows. Assembly and disassembly of the device, the rotation of the shutter and the release of the legs are carried out with a fixed rod in the angular grooves of the core. The degree of release of the legs is controlled on a core scale in the shutter opening. The rod is removed from the core channel only for the period of intracavitary manipulations.

The devices are connected by an elastic arc according to one of two options based on the orientation of the levers of both devices achieved during installation. If the levers are located in one line, a rocker made of an elastic alloy with regularly alternating screw holes and jumpers in the shape of triangular profile ribs is used for rigid connection of devices. The beam is placed on the levers of the devices so that the jumpers are located in the recesses of the landing sites, if necessary, give the required bend in accordance with the spatial orientation of the levers and fasten with screws. If the levers are parallel or at a small angle, mini-cards are used to connect the devices.

Before installing the compensator, the antiseptic pad is impregnated with a disinfectant solution, the compensator is put on the shutter by direct pulling, excluding rotational movements, until the frame is in the shutter opening, the clamp is put on the splines of the neck with rotation around the axis and the voltage of the spiral. The compensator additionally acts as a cover for the shutter and prevents the penetration of infection through the barrel into the affected area.

For remote manipulations in the lesion, sinuses, intraosseous cavity neoplasms of the jaws, etc., the anchor device is installed with penetration into the cavity, the legs are released and fixed with a sleeve. The rod is rotated around the axis until the keys come out of the angular grooves and removed from the core channel, through this free channel a tube of instrument (catheter, fiber optics, etc.) is introduced into the cavity.

Thus, the claimed device anchor allows, at the cost of minimal additional trauma, to ensure reliable fixation of bone fragments in the resorption conditions throughout the consolidation period, an externally installed metal string with shape memory allows comfortable and safe dynamic compression at the junction of the fragments with the elastic stress of the immobilization system, at the same time, autonomous functioning according to the form restoration program is combined with the possibility of additional regulation of work ak a single device, and the entire immobilization system and dismantling after fracture union does not cause injury to the surrounding tissue. In addition, the cavity anchor allows you to conveniently and quickly, if necessary, provide access to the pathological focus for drug delivery, the implementation of endoscopic monitoring, histological diagnosis and other remote medical and diagnostic procedures.

The claimed method allows to improve the aesthetic results of the treatment of maxillofacial injuries, preventing the development of scars and trophic complications associated with damage to blood vessels and nerve trunks, as well as to provide an economic effect by optimizing the treatment process and reducing the patient’s hospital stay ..

Literature

1. Vernadsky Yu.I. Traumatology and reconstructive surgery of the maxillofacial region. / Yu.I. Vernadsky. - M .: Medicine, 1999 .-- 444 p.

2. Gunter V.E. Shape memory alloys in medicine. / V.E. Gunter, V.V. Kotenko, M.Z. Mirgazizov. Tomsk: 1986.

3. Semennikov V. I. Optimization of methods for fixing bone fragments of the facial skull and their clinical and biomechanical assessment: author. diss. ... Dr. honey. sciences. / IN AND. Semennikov, - Omsk, 2004 .-- 42 p.

4. Sysolyatin P.G. Super-elastic implants with shape memory in maxillofacial surgery, traumatology, orthopedics and neurosurgery. Guide for practitioners. / P.G. Sysolyatin, V.P. Pushkarey, A.A. Ilyin // Tomsk. - TSU. - 1995 .-- 224 p.

5. H.G. Luhr, Entwicklung der modemen Osteosynthese, Mund Kiefer GesichtsChir, 2000: S.84-90.

6. New encyclopedic dictionary. - M .: Big Russian Encyclopedia, 2002. - P.51, - P.1422.

Claims (3)

1. An anchor fixation method for bone fragments with stringing, characterized in that the string used is made of metal with shape memory, at least two anchor devices are reversibly jammed in the fragments, connected by an elastic arc and pulled together by a metal string with shape memory. 2. An anchor device containing a barrel, a core, characterized in that it has a shutter, a sleeve and a compensator, the barrel is made in the form of a tube with levers, a neck and an intraosseous leg, the levers have holes for screws for fastening the elastic arch, the intraosseous leg has a thread and longitudinal slots in which are placed on the axes of the foot, the latter are connected by a spring and mounted movably, the core is mounted coaxially in the barrel, the bolt is threadedly connected to the neck of the barrel for rotation and allows the core to move along the axis of the trunk and fixes the position of the core along the axis of the trunk, the movement of the core provides rotation of the foot around the axis with the foot extending from the lumen of the trunk and picking up with the foot of the bone fragment, when lifting the core, the spring tension returns the foot to the lumen of the trunk, the sleeve has a bed for the string and has the ability to twist , lowering along the leg and abutting its base on the bone fragment, the compensator ensures the transmission of the rotational force to the shutter in the direction of twisting. 3. The device according to claim 2, characterized in that it has a removable metal core with shape memory, the core is made in the form of a tube and carries a removable metal core with shape memory, the barrel lever has a landing pad.

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