RU2452419C2 - Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity - Google Patents

Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity Download PDF

Info

Publication number
RU2452419C2
RU2452419C2 RU2010124786/14A RU2010124786A RU2452419C2 RU 2452419 C2 RU2452419 C2 RU 2452419C2 RU 2010124786/14 A RU2010124786/14 A RU 2010124786/14A RU 2010124786 A RU2010124786 A RU 2010124786A RU 2452419 C2 RU2452419 C2 RU 2452419C2
Authority
RU
Russia
Prior art keywords
rods
plate
supports
holes
bars
Prior art date
Application number
RU2010124786/14A
Other languages
Russian (ru)
Other versions
RU2010124786A (en
Inventor
Елена Геннадьевна Музина (RU)
Елена Геннадьевна Музина
Алексей Петрович Скворцов (RU)
Алексей Петрович Скворцов
Original Assignee
Государственное учреждение здравоохранения "Республиканская клиническая больница Министерства здравоохранения Республики Татарстан"
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Государственное учреждение здравоохранения "Республиканская клиническая больница Министерства здравоохранения Республики Татарстан" filed Critical Государственное учреждение здравоохранения "Республиканская клиническая больница Министерства здравоохранения Республики Татарстан"
Priority to RU2010124786/14A priority Critical patent/RU2452419C2/en
Publication of RU2010124786A publication Critical patent/RU2010124786A/en
Application granted granted Critical
Publication of RU2452419C2 publication Critical patent/RU2452419C2/en

Links

Images

Abstract

FIELD: medicine.
SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics and is intended for elongation of hip bone in children and teenagers with possibility to restore biomechanical interrelationships of extremity segments. Device contains supports in form of arch-shaped plates, thread bars, connecting supports, intraosseous rods and rod-fixers. Arch-shaped plates are bent on radius in their own plane, and are bent away in said plane in form of protrusions from end parts of plate towards its convexity. Protrusions and end parts of plate are provided with holes with bilateral countersunk. Along plate made are holes located on radius. Rod-fixers are made in form of prism, for installation in them of thread rods, with possibility to fix the latter with nuts. On lateral surface of prism installed it square boss for fixation of rod-fixers by means of screw with washer in support. Holes along plate are made in form of arch-shaped slots. Plate arches and said slots are arches of circumferences whose centre coincides with hip axis. Holes located in end parts of plate are intended for medial thread bars. Holes in protrusions have spherical countersunk and are intended for lateral thread bars. There are two pairs of bars in apparatus. Each of medial pair of bars consists of two bars, connected by means of hinge, with possibility of regulation and fixation in the place of junction with bolt with nut. Lateral bars are made one-piece and are connected with supports by means of nuts which have spherical contact surfaces. Medial bars are connected with supports by means or ordinary nuts.
EFFECT: invention ensures elongation of hip bone with reconstruction of correct interrelationship of low extremity segments in sagittal and frontal planes, without additional surgery, with reduction of trauma, with increase of patient's comfort for treatment period, with improvement of treatment results.
2 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended to lengthen the femur in children and adolescents with the possibility of restoring the biomechanical relationships of limb segments.

Currently, the extension of the femur is carried out using external fixation devices, differing in the way they are fixed on the limbs, which can be rod, spoke and spoke. Conventionally, all methods include the use of apparatuses consisting of supports placed on each bone fragment, subsequent osteotomy or corticotomy, and distraction in the apparatus for 4-5 days at a rate of 0.25 mm 4 times a day.

External fixation devices for lengthening the femur consist of annular and semi-annular supports connected by threaded rods that are fixed with rods or knitting needles, or use a combination of these methods. If these devices are placed on the proximal femur, this causes considerable inconvenience for the patient, since the bulky proximal arches makes walking difficult, and without additional devices it is impossible to conveniently place the patient on the bed. V. Golyakhovsky and V. Frenkel [1] for the first time proposed the use of sectoral supports in the apparatus, which significantly increases the “quality of life” of the patient in the postoperative period. However, the apparatus used by them contains many structural units and is unnecessarily cumbersome, so it finds discreet use in children's practice.

These shortcomings are deprived of rod compression-distraction apparatuses of external fixation. A known apparatus for the treatment of fractures of long tubular bones [2] is the closest to the claimed apparatus, it is taken as a prototype. Due to its small size and weight, this device is convenient for the patient, its application eliminates damage to the neurovascular structures, takes a little time for the surgeon, and allows the development of adjacent joints throughout the course of treatment. Sufficient rigidity of the structure allows you to fully load the operated limb, which contribute to the prevention of osteoporosis and muscle atrophy. However, this apparatus is not sufficiently controllable and does not allow controlling the shape of the regenerate in the distraction period. It is all the more impossible to restore the mechanical and anatomical axis of a limb with its help, i.e. restore the correct relationship of the segments of the lower limb in the sagittal and frontal plane, which is often broken after lengthening of these segments [3].

The invention consists in a combination of essential features sufficient to achieve the desired technical result, consisting in lengthening of the femur with the restoration of the correct relationship of the segments of the lower limb in the sagittal and frontal planes, without additional surgical intervention, while reducing trauma, with increasing comfort for the patient during treatment with improved treatment outcomes.

The essence of the device for lengthening the femur with the simultaneous restoration of the biomechanical axis of the limb is that it contains supports in the form of arched plates, curved along the radius in its own plane, and bent in this plane in the form of protrusions from the end sections of the plate towards its convexity. The protrusions and end sections of the plate are equipped with openings with double-sided countersink, and along the plate there are holes arranged along the radius. The device contains threaded rods connecting these supports, intraosseous rods, and rod fixators in the form of a prism, for installing threaded rods in them, with the possibility of fixing the latter with nuts. A square boss is mounted on the side surface of the prism to fix the rod fixators in the support. The holes along the plate are made in the form of arched grooves. The arcs of the plate and the mentioned grooves are arcs of circles whose center coincides with the axis of the thigh. The holes located in the end sections of the plate are designed for medial threaded rods, and the holes in the protrusions have a spherical countersink and are designed for lateral threaded rods. The rods in the apparatus are two pairs. Each of the medial pairs of rods consists of two rods connected by a hinge, with the possibility of regulation and fixation at the junction with a bolt and nut. The lateral rods are made integral, and connected to the supports with nuts with spherical contact surfaces, while the medial rods are connected to the supports with ordinary nuts.

The implementation of the plates and the mentioned grooves for the installation of rod fixators, in the form of circular arcs, the center of the radius of which coincides with the axis of the thigh, provides the direction of the distraction force along the axis of the elongated thigh and, in the clinical aspect, ensures the formation of a linear regenerate.

The holes in the projections of the supports intended for installation of lateral threaded rods in them have a spherical countersink, which provides, when interacting with the spherical contact surface of the nut, the possibility of tilting the rod relative to the support at an angle of 15-20 °, sufficient to restore the biomechanical axis limbs in both the frontal and sagittal planes. The support of the supports on the rods with spherical nuts ensures the rotation of one support relative to the other, without additional hinges, since the contact between the support and each nut does not occur on a plane, as with ordinary nuts, but on the surface of the spherical chamfer and the ball surface of the nut, which significantly reduces the weight of the structure and makes it more technologically advanced.

The implementation of each of the medial pair of rods from two rods connected by a hinge, provides the creation of a given distraction regenerate, with the necessary spatial angles. A regenerate of this form is necessary to restore the biomechanical axis of the lower limb, as well as to prevent the development of varus deformity of the distraction regenerate. The use of sectoral supports (plates bent along the radius in their own plane) to lengthen the segments of the limbs, rather than ring supports, as in the Ilizarov apparatus, in the process of lengthening the segments, as a rule, leads to the appearance of varus deformation of the apparatus, associated with an increase in distraction efforts. This deformation of the entire structure is manifested by the bending of the distraction rods connecting the sectoral supports under the action of the adductors of the thigh, which causes a similar deformation of the regenerate.

The connection of each of the medial pair of rods with hinges, with the possibility of regulation and fixing at the junction with a bolt and nut, provides the ability to adjust and fix the angle between the component rods, and hence the spatial angles of the distraction regenerate, and the distraction period occurs with the fixed position of the hinges. In the correction mode of the biomechanical axis of the lower extremity, as well as to prevent the development of varus deformity of the distraction regenerate, the hinge pairs are relaxed, and the correction is performed by working on the spherical nuts of the pair of lateral rods.

The connection of the medial rods to the supports with ordinary nuts allows maintaining parallelism of the supports during the distraction period, provided that the distraction is uniform across both pairs of rods.

The device is illustrated in the illustrations. Figure 1 shows the apparatus superimposed on the femur; figure 2 - apparatus with formed distraction regenerate.

The apparatus comprises supports 1 made in the form of plates bent radially in their own plane and bent in this plane in the form of protrusions 2 from the end sections of the plate towards its convexity. The supports of the apparatus 1 are interconnected by means of threaded rods lateral 3, with respect to the thigh, and medial - 4. The lateral rods 3 are located in the holes located in the protrusions of the supports 1 having a spherical countersink and are fixed in them by means of nuts 5 having spherical contact surface. The threaded medial rods 4, made of two rods, are connected by a hinge 6. The hinge 6 has the ability to adjust and fix with a bolt 7 in the nut 8. The medial rods 4 are installed in the holes of the end sections of the plates and are connected to the supports 1 by the nuts 9. The device is fixed on the femur by intraosseous rods 10-13.

The method is as follows.

Before the operation, in order to identify the anatomical shortening of the femur, X-rays of both lower extremities are made in direct projection on one film. An intraosseous rod 10 is inserted into the proximal femur from the lateral side, strictly in the frontal plane, at an angle of 90 ° to the bone, so that it is located below the growth zone of the greater trochanter, but above the corticotomy line. Accordingly, in the distal femur, the intraosseous rod 11 is inserted below the corticotomy line, in the same plane, but above the growth zone of the femoral condyles. After installing the distal and proximal supports on the intraosseous rods 10 and 11, the supports are interconnected using two pairs of threaded rods: lateral 3 and medial 4. The medial rods 4 are made integral, each of the two rods connected by a hinge 6, with the possibility of regulation and fixation at the junction of the bolt 7 in the nut 8. The installation of these staples is made so that the hinge is located exactly opposite the line of the proposed corticotomy. Radiography of the thigh is performed in two planes: anterior-posterior and lateral projections. The images determine the position of the apparatus relative to the axis of the thigh and, if necessary, center the apparatus so that the latter is strictly parallel to the axis of the femur in two planes. After that, the introduction of the rods 12 and 13, lower or higher than the installed rods 10 and 11, with a spatial "slant." The rods 12 and 13 are carried into the bone at a different angle than the right angle, and are fixed on the proximal and distal supports. This introduction of the rods achieves sufficient structural rigidity, while maintaining a parallel arrangement of the apparatus relative to the axis of the femur. This technique is achieved by making plates and grooves for installing rod fixators in the form of arcs of circles, the center of which coincides with the axis of the thigh, which ensures the direction of the distraction force along the axis of the elongated thigh.

Through an incision in the skin and soft tissues, they access the surface of the femur and perform its corticotomy in the middle third - upper third. At the final stage of the operation, the wound is sutured and aseptic dressings are applied. Postoperatively, 5-6 day dosage distraction carried by lateral and medial 4 3 bars apparatus producing nuts 5 1/4 turn to 4 times a day at regular intervals. This corresponds to an extension of the limb by 1 mm per day. When a distraction regenerate is formed, its varus deformation inevitably arises to one degree or another, the magnitude of which is proportional to the magnitude of elongation. To avoid this, maintain compression on the lateral rods 3. At the end of the formation of the distraction regenerate 14, X-ray is performed to determine the biomechanical axis of the limb, and, if necessary, by varying or valgizing the bone regenerate at an angle depending on the length of the regenerate formed, due to relaxation or tightening the spherical nuts 5 on lateralized rods 3. Correction in the sagittal plane is carried out by turning the hinges 6 of the medial rods 4, and work g ykami 5 and 9 on the medial and lateral bars 4 3 than is provided by the rotation of both supports. After achieving the correct relationship of the segments of the lower limb in the frontal and sagittal planes, the device is stabilized.

The proposed apparatus allows for lengthening of the femur with simultaneous restoration of the biomechanical axis of the limb in the frontal and sagittal planes, which positively affects the condition of adjacent joints, prevents joint arthrosis and forms a correct gait. Thanks to the hinges installed between the supports at the level of the osteotomy on the medial rods, the need for remounting the external fixation apparatus, which usually requires repeated anesthesia, is eliminated.

Information sources

1. V. Golyakhovsky, V. Frenkel Manual on transosseous osteosynthesis using the Ilizarov method. // M .: "Binom" and others, - 1999, p. 166-167.

2. RF patent No. 2201168, А61В17 / 66, BI No. 9, 2003.

3. A.V. Popkov, D. A. Popkov. Some questions of biomechanics of operative hip lengthening. // The genius of orthopedics. - 1997. - No. 1. - S.24-26.

4. Passport A. 101.00.00.00 PS for a set of compression and distraction apparatus G. A. Ilizarov for the upper limb, lower leg and thigh, Gudermes, 1991, pp. 9-11.

Claims (1)

  1. A device for extending the femur with simultaneous restoration of the biomechanical axis of the limb, containing supports in the form of arched plates curved along the radius in its own plane and bent in this plane in the form of protrusions from the end sections of the plate to the side of its convexity, while the protrusions and end sections of the plate are equipped holes with a double-sided countersink, and along the plate there are holes placed along the radius, threaded rods connecting these supports, intraosseous rods and rod fixators in the form of isms, for installing threaded rods in them, with the possibility of fixing the latter with nuts, a square boss is installed on the side surface of the prism for fixing the rod fixators with a screw and washer in the support, characterized in that the holes along the plate are made in the form of arcuate grooves, and the plate arcs and the mentioned grooves are arcs of circles whose center coincides with the axis of the thigh, the holes located in the end sections of the plate are designed for medial threaded rods, and the holes in the protrusions have a spherical zen They are designed for lateral, threaded rods, rods in the apparatus for two pairs, each of the medial pair of rods consisting of two rods connected by a hinge, with the possibility of regulation and fixing at the junction with a bolt and nut, lateral rods are made integral and connected to supports nuts having spherical contact surfaces, while the medial rods are connected to the supports with ordinary nuts.
RU2010124786/14A 2010-06-16 2010-06-16 Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity RU2452419C2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
RU2010124786/14A RU2452419C2 (en) 2010-06-16 2010-06-16 Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
RU2010124786/14A RU2452419C2 (en) 2010-06-16 2010-06-16 Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity

Publications (2)

Publication Number Publication Date
RU2010124786A RU2010124786A (en) 2011-12-27
RU2452419C2 true RU2452419C2 (en) 2012-06-10

Family

ID=45782122

Family Applications (1)

Application Number Title Priority Date Filing Date
RU2010124786/14A RU2452419C2 (en) 2010-06-16 2010-06-16 Device for hip joint elongation with simultaneous reconstruction of biomechanical axis of extremity

Country Status (1)

Country Link
RU (1) RU2452419C2 (en)

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU850058A1 (en) * 1969-02-11 1981-07-30 за витель Г. М.Ройко Compression-distraction apparatus
DE4428518A1 (en) * 1994-08-11 1996-02-22 Fraunhofer Ges Forschung Fixation ring for bone fractures
RU2058760C1 (en) * 1992-11-11 1996-04-27 Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А. Илизарова Method for elimination of periarthric deformity of extremity
US6102911A (en) * 1997-02-13 2000-08-15 Orthofix S.R.L. Orthopaedic apparatus, particularly for the surgical correction of bone deformities
RU2192198C2 (en) * 2000-07-26 2002-11-10 Научно-исследовательский центр Татарстана "Восстановительная травматология и ортопедия" Apparatus for elimination of bone deformation
RU2201168C2 (en) * 2001-02-28 2003-03-27 Научно-исследовательский центр Татарстана "Восстановительная травматология и ортопедия" Apparatus for treating long tubular bone fractures
US7575575B2 (en) * 2005-03-18 2009-08-18 Ron Anthon Olsen Adjustable splint for osteosynthesis with modular components
US7645279B1 (en) * 2003-07-25 2010-01-12 Haupt Bruce F Bone fixation method

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU850058A1 (en) * 1969-02-11 1981-07-30 за витель Г. М.Ройко Compression-distraction apparatus
RU2058760C1 (en) * 1992-11-11 1996-04-27 Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А. Илизарова Method for elimination of periarthric deformity of extremity
DE4428518A1 (en) * 1994-08-11 1996-02-22 Fraunhofer Ges Forschung Fixation ring for bone fractures
US6102911A (en) * 1997-02-13 2000-08-15 Orthofix S.R.L. Orthopaedic apparatus, particularly for the surgical correction of bone deformities
RU2192198C2 (en) * 2000-07-26 2002-11-10 Научно-исследовательский центр Татарстана "Восстановительная травматология и ортопедия" Apparatus for elimination of bone deformation
RU2201168C2 (en) * 2001-02-28 2003-03-27 Научно-исследовательский центр Татарстана "Восстановительная травматология и ортопедия" Apparatus for treating long tubular bone fractures
US7645279B1 (en) * 2003-07-25 2010-01-12 Haupt Bruce F Bone fixation method
US7575575B2 (en) * 2005-03-18 2009-08-18 Ron Anthon Olsen Adjustable splint for osteosynthesis with modular components

Also Published As

Publication number Publication date
RU2010124786A (en) 2011-12-27

Similar Documents

Publication Publication Date Title
Sirkin et al. The treatment of pilon fractures
Cole et al. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia
Rozbruch et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison
Johnson et al. Human bone morphogenetic protein allografting for reconstruction of femoral nonunion
Helfet et al. Minimally invasive plate osteosynthesis of distal fractures of the tibia
Kim et al. Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates
Fragomen et al. The mechanics of external fixation
Ring et al. Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis
Charnley Positive pressure in arthrodesis of the knee joint
De Bastiani et al. The treatment of fractures with a dynamic axial fixator
JP5539375B2 (en) Fixed plate used in the rapidus approach
Borens et al. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases
Ali et al. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator: biomechanical study and operative technique
Gausepohl et al. Principles of external fixation and supplementary techniques in distal radius fractures
De Bastiani et al. Chondrodiatasis-controlled symmetrical distraction of the epiphyseal plate. Limb lengthening in children
Dobbs et al. Use of an intramedullary rod for treatment of congenital pseudarthrosis of the tibia: a long-term follow-up study
Rozbruch et al. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame
Arazi et al. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur
Habernek et al. Comparison of ender nails, dynamic hip screws, and Gamma nails in the treatment of peritrochanteric femoral fractures
Damsin et al. Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique
Pennig et al. Transarticular fixation with the capacity for motion in fracture dislocations of the elbow
Fadel et al. The Taylor spatial frame for deformity correction in the lower limbs
Chen et al. Ankle arthrodesis with cross-screw fixation: good results in 36/40 cases followed 3-7 years
Murphy et al. The small pin circular fixator for proximal tibial fractures with soft tissue compromise
Huang et al. Indirect reduction and bridge plating of supracondylar fractures of the femur

Legal Events

Date Code Title Description
MM4A The patent is invalid due to non-payment of fees

Effective date: 20120617