RU2477983C2 - Intra-articular osteosynthesis guide pin - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and may be used in treating articular diseases and injuries with the use of transplants, e.g. chronic recurrent shoulder instability accompanied by formation of a bone defect of an articular process of shoulder blade. A guide pin comprises a body and a guide element with through holes. A handle is fixed on one end of the body. The body is bent in the form of a plate a central part of which has a flat surface extended by an articular scoop bent by a surface of articular head on the end opposite to the handle. The guiding element is fixed in the central part of the plate on its flat surface and has through holes parallel to each other and to the central flat part of the body, and used for inserting osteosynthesis pins and screws passing through the body of the guiding elements, a transplant and a source bone.

EFFECT: invention enables higher accuracy, lower number of injuries accompanying transplant insertion, providing more reliable fixation of a free bone auto- or homotransplant to the reconstructed joint defect, maximally preserving an articular surface congruence that shall lead to further probability of developing arthrosis deformans.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of diseases and injuries of joints using grafts, for example, chronic recurrent instability of the shoulder joint, accompanied by the formation of a bone defect in the articular process of the scapula.

A device [1] is known for providing accurate insertion of transosseous elements into the subchondral region of the proximal tibia, and also as a guide for osteotomy of the same bone. This device is used in conjunction with the Ilizarov apparatus, which serves as a support. The main field of application of the known device is corrective high (supra tubercular) osteotomy of the tibia with deforming arthrosis of the knee joint, accompanied by varus deformity. The described device operates as follows. The Ilizarov apparatus is imposed, thus forming a basic transosseous support, for subsequent fixation of osteotomized fragments of the tibia. Then, a known guide device is attached to the proximal ring of the Ilizarov apparatus so that the spokes and screws through the guide holes pass through the bone parallel to the subchondral plate of the tibia. In this case, the indicated position is controlled using an electron-optical converter (EOC). Then, through the slot in the guide arc, an osteotome is carried out and an osteotomy is performed. The locking screws are loosened, the arc-guide is dismantled, the skin is sutured, and the remaining spokes are mounted in the third (proximal) support of the Ilizarov apparatus. After that, the varus deformity is eliminated by wedging of bone fragments and bone fragments are fixed in the supports of the apparatus with rods in a corrected position.

Closest to the proposed device is a guide designed to make holes in the bone tissue in any location, that is, it is universal [2]. The known device allows you to adjust the direction of the drill when drilling holes in the bone with the subsequent connection of bone fragments and their further immobilization (cannulated screws, plate, etc.). The known guide is a device having a main unit made in the form of a hollow cylinder with holes located around its circumference. The device is equipped with removable bushings (conductors) of the same diameter with pointed bevel teeth to prevent slipping from the surface of the bone during drilling. The bushings have the ability to mobile rearrange and maintain the accuracy of the intervals between the holes. The holes on the main unit are made in such a way that their location provides the introduction of fixing screws in the correct axial direction and compression of the connected bone fragments without much stress. The known guide has a handle connected to the main block to create manual compression between the main block and the reconstructed bone surface at the time of its drilling.

However, the known device has significant disadvantages, namely:

- It does not allow to fix and hold a free bone graft congruently with respect to the reconstructed articular surface.

- Does not have holes for diafixing (temporary) spokes and holes for the drill of the required diameter, forming channels for the introduction of fixing screws.

- The handle-holder is designed in such a way that it limits the view of the surgical wound in the joint area and does not allow to exert sufficient physical effort to compress between the bone graft and the perceiving bone bed at the time of its diafixation or fixation.

- The wide rigid frame of the main unit does not provide complete congruency in accordance with the anatomical bends of the reconstructed bone, which leads to the instability of this device when it is used.

- Due to the low stability of this device, it is not possible to prevent deviations for perpendicular drilling holes in the bone.

- It does not allow temporary fixation of the graft to the guide outside the surgical field and to reduce joint trauma during fixation of the graft to the perceiving bone bed.

Based on the existing level of known guide designs used for intraarticular osteosynthesis and elimination of their shortcomings, the task was to increase the accuracy of the installation and increase the reliability of atraumatic fixation of a free bone graft when replacing a bone tissue defect, preserving the congruence of the reconstructed articular surface as much as possible, which subsequently reduces the likelihood of developing deforming arthrosis and other joint diseases.

The problem is solved by using the proposed guide for osteosynthesis during surgical intervention in the treatment of diseases and joint injuries.

The guide for intra-articular osteosynthesis comprises a housing 1, with a handle 2 and a guiding element 5 with through holes 6 mounted on the housing 1. New in the design of the proposed device is that the housing 1 is ergonomically bent and made in the form of a plate, the central part of which has a flat surface 4 passing at the end opposite the handle 2, into the joint spoon 3, curved in accordance with the surface of the head of the joint. In this case, the guide element 5 is mounted in the central part of the plate on its flat surface 4 and has through holes 6 for introducing spokes 9 and screws 10 for osteosynthesis parallel to each other and the central flat part 4 of the housing 1, which transplant 7 and maternal bone 8.

We explain the essential distinguishing features of the proposed device:

- Preliminary fixation of the bone autograft or homograft in the guide allows you to manipulate it [graft] deep in the wound without the risk of falling out of the wound, impaired aseptic surgery, and significantly reduce the trauma of osteosynthesis.

- The presence of a curved end scapula - the joint spoon, repeating the contour of the joint surface of the joint, allows, firstly, to avoid the biasing effect of the head of the joint on the transplant being installed and, secondly, to install the graft so that there is no bias between it and the receiving bone bed in width, for example, in the form of a "step".

- The shape of the handle and its position relative to the main guide element allow you to maintain a good overview of the surgical wound and, at the right time, perform manual compression between the graft and the perceiving reconstructed bone bed.

Patent studies on subclasses А61В 17/56 and analysis of scientific and medical information reflecting the current level of treatment of intraarticular deformities did not reveal structures identical to the proposed one. Thus, the proposed device is new.

The interconnection and interaction of essential structural elements when using a guide for intraarticular osteosynthesis provides a new medical result in solving the task, namely, to increase accuracy, reduce the morbidity of the transplant installation, increase the reliability of fixation of a free bone auto or homograft to a reconstructed joint defect, while preserving as much as possible congruence of the articular surface, which will reduce the likelihood of deforming in the future joint arthrosis of the joint. Thus, the proposed technical solution has an inventive step.

The proposed device is intended for specialists who are familiar with basic reconstructive interventions on the capsule-ligamentous apparatus of the joint and the basic methods of immersion osteosynthesis, that is, specialists in the trauma and orthopedic departments of hospitals at the city, regional and republican levels, the guide can be played repeatedly.

The essence of the design of the proposed device is illustrated by drawings, where:

Figure 1 - General view of the guide for intraarticular osteosynthesis;

Figure 2 is a side view of the guide with a transplant and a temporarily retaining spoke;

Figure 3 is a view of the guide inserted into the joint cavity with the graft with a fixed spoke passing through the holes of the guide element, the graft and the mother bone;

Figure 4 - view of the guide with a graft mounted in the mother bed at the stage of osteosynthesis with screws;

5 is a final view of osteosynthesis using a screw passing through the graft and osteoarticular defect.

The essence of the design of the proposed "Guide for intraarticular osteosynthesis" is the following.

The device comprises a curved body 1, made in the form of a curved plate with a handle 2. On the side of the body 1, opposite the handle 2, there is a joint spoon 3, curved in accordance with the articular surface of the head of the joint. The housing 1 in the central part has a flat surface 4 on which the guide element 5 is mounted. The guide element 5 has through holes parallel to each other and the central flat surface 4 of the housing 1 of the hole 6 for introducing the spokes 9 and screws 10 for osteosynthesis that pass through the graft 7 and maternal bone 8. The guide element 5 has the shape of a rectangular parallelepiped (see the appendix to the description of figures 1, 2).

Apply the proposed "Guide for intraarticular osteosynthesis" as follows.

Using the proposed device is presented as an example of surgical treatment of a habitual dislocation of the shoulder with a defect in the articular process of the scapula.

Surgical treatment of a habitual dislocation of the shoulder includes access to the shoulder joint, partial dissection of the deltoid muscle, transverse subperiosteal dissection of the tendon of the subscapularis muscle with the formation of an arthrotomy entrance along the front surface of the shoulder joint in the form of a window. After accessing the anteroposterior edge of the articular process of the scapula with a sharp raspator, refresh it and determine the absolute dimensions of the defect and, accordingly, the dimensions of the proposed free bone auto- or homograft 7. As a rule, the used graft 7 has the form of a rectangular parallelepiped with dimensions corresponding to the replaced defect bone tissue 8. It is this form of transplant 7 that will subsequently be a continuation of the missing articular surface of the anterior-lower edge of the articular cane scapula. The obtained free bone auto- or pre-prepared homograft is modeled with an oscillatory saw so that its end face matches the size of the perceptual bone bed of the articular process of the scapula. The finished graft 7 (see the appendix to the description of FIG. 2) is fixed in the central part of the body 1 on a flat surface 4 with the convex side to the distal end of the guide element 5. The concave side of the graft 7 is located on a flat platform 4 of the guide, repeating the curvature of the restored articular surface of the scapula. Holding the graft 7 and the guide in this position, Kirchner spokes 9 are inserted through small holes 6 using a standard drill outside the surgical wound in advance (see the appendix to the description of FIG. 2). After that, the graft 7 and the device are ready for the main stage of the operation. The Farabef hooks push apart the edges of the arthrotomy (tendon-muscle window in the rotational cuff of the shoulder no more than 35 × 25 mm in size) and set the guide so that the joint spoon 3 penetrates into the joint space (see the appendix to the description of figure 3) strictly according to natural curvature the articular surface of the scapula, and graft 7 was pressed firmly against a previously prepared perceptual bone bed of a scapular defect. After the surgeon is convinced that the transplant is installed in the correct position, the spokes 9 are inserted with a drill into the scapula to a depth of not more than 40 mm, providing reliable temporary fixation in conditions of limited visibility of the edges of the graft and the shoulder joint itself. After that, through the large holes 6 in the guide element 5, two parallel channels are formed with a drill through the transplant 7 and both cortical plates of the articular process of the scapula (see the appendix to the description of FIG. 4). Holding the graft with a standard Kocher clamp, the guide is removed from the surgical wound, leaving the graft fixed to the scapula. Two screws 10 are inserted through the prepared channels, thereby providing good compression between the graft 7 and the receiving bone bed (see the appendix to the description of FIG. 4). All temporarily fixing knitting needles 9 are removed, the joint is rinsed abundantly with saline and the wound is sutured in layers with drainage of the fake space. Intra-articular osteosynthesis is completed (see the appendix to the description of FIG. 5).

Thus, the proposed "Guide for intraarticular osteosynthesis" in comparison with other known designs provides the following advantages:

- preliminary fixation of the bone graft in the guide outside the surgical field allows atraumatic manipulation of it [the graft] deep in the wound without the risk of falling out of the wound and impairing aseptic intervention;

- the presence of a flat-curved end joint spoon that follows the contour of the joint surface allows, firstly, in conditions of limited visibility in the joint, to avoid the biasing effect of the head of the joint on the graft being installed and, secondly, to fix the graft so that between it and the perceiver there were no displacements in the maternal bed, thereby accelerating the process of repairing a bone defect and preventing repeated relapses of the joint dislocation and deforming arthrosis;

- ergonomically curved handle and its position relative to the main guide element allow you to maintain a sufficient overview of the surgical wound and at the right time to carry out manual compression between the graft and the receiving bone bed of the scapula.

Information sources

1. Device for osteotomy of the tibia: US Pat. 2340296 RF: MKI A61V 17/17, 17/56 / Vasiliev V.Yu., Tishkov N.V., Puseva M.E., Tkachenko A.V., Grishin M.M .; Applicant and patent holder Center reconstruction and restore. Surgery VSNS SB RAMS. - No. 2006143886/14; declared 12/11/06; publ. 12/10/08, bull. Number 34. - 5 p., Ill.

2. Drill setting guide for drilling holes in bones: Patent USA number 4,788,970: Int. C1. A61M 37/00 / Wlodzimierz Kara et al; Assignee: Huta Baildon, Katowice, Poland; Appl. No .: 33,410; Filed: Apr. 1, 1987; Date of patent: Dec.6, 1988.

Claims (1)

A guide for intra-articular osteosynthesis, comprising a body and a guiding element with through holes, a handle being fixed at one end of the body, characterized in that the body is curved and made in the form of a plate, the central part of which has a flat surface that passes at the end opposite the handle into the articular a spoon bent in accordance with the surface of the head of the joint, while the guide element is fixed in the central part of the plate on its flat surface and has through parallel to each other at the central and central flat part of the body of the hole for the introduction of knitting needles and screws for osteosynthesis, which pass through the body of the guide element, the graft and the mother bone.

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