RU2523134C2 - Method for acromial osteotomy and device for implementing it - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of invention refers to traumatology and orthopaedics and can be used for acromial osteotomy. After separating, the acromial process is placed between a body of a device and a protective element. Pins are inserted into the acromial process through holes in guide cones in an auxiliary unit of the device, a depth of insertion of which into the acromial process makes no more than 25 mm. Before the osteotomy, the wires are partially brought out keeping the depth of insertion into the acromial process no more than 5 mm. Through pin holes in the body, counter passages are created in the acromial process wherein the pins are inserted for final fixation of the device on the acromial process. That is followed by an osteotomy parallel with an edge of the acromial process, the main stage of the intervention within a subcoracoid space; thereafter, a dissected fragment of the acromial process, pinned in the auxiliary unit is adapted to a parent bed. An osteosynthesis of a bone shaft and dissected fragment of the acromial process is performed.

EFFECT: group of inventions enables reducing a risk of rotator shoulder muscle injuries, shortening a rehabilitation period.

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Description

The proposed method and device relate to the field of medicine, namely to traumatology and orthopedics, and can be used for bone-plastic access to the fake shoulder space and subsequent restoration of the acromial process of the scapula after surgical treatment of injuries of the rotational cuff of the shoulder, when performing revisions of the subacromial space .

Closest to the proposed is a method of osteotomy of the acromial process of the scapula [1]. The essence of the known method is that an arcuate skin incision is performed in the projection of the acromial process. Then, the osteotomy of the acromial process from front to back is performed with a manual osteotome, departing from the outer edge of the process 4-6 mm in a plane close to perpendicular to the plane of the process itself. The bone fragment with the middle portion of the deltoid muscle attached to it is folded outwards and lowered distally, giving access to the sub-falt region. After the main stage of the surgical intervention is completed, osteosynthesis of the previously dissected acromial process of the scapula is performed using transossal sutures.

A device for osteotomy, which has some common structural elements with the proposed, but cannot be used in the treatment of injuries of the shoulder joint [2]. The known device is used when exposing the undertrochanteric region and the greater trochanter of the thigh, after which the fixing plate of the device is installed in the undertrochanteric region using two screws on the femur and the guide device is fixed. The brackets are fixed with screws at an angle corresponding to the cervical-diaphyseal angle, measured in advance and set on the goniometer scale (on the goniometer scale, divisions are made for the corresponding values of the cervical-diaphyseal angle). The angle is determined before surgery by x-ray of the hip joint in direct projection. The adapters of the device are fixed with screws so that the slit guide is located at a distance of 10-12 mm outward from the place of attachment of the capsule of the hip joint on the surface of the femur, and then they are fixed with screws. With this installation of the guide device, the slotted saw guide takes up a position perpendicular to the axis of the femoral neck. After that, an oscillating saw performs an alternate osteotomy in the posterior plane, rotate the head along the axis of the neck by the required angle, perform osteosynthesis, then the wound is sutured in layers.

However, the known method of osteotomy of the acromial process of the scapula used to form osteoplastic access to the fake space, and the device for its implementation have significant disadvantages, namely:

- an osteotomy of the acromial process using the “free hand” method using a manual osteotome can lead to the formation of an osteotomy line (not parallel to the free edge of the acromial process of the scapula and not perpendicular to the plane of the acromial process of the scapula);

- the absence of protective elements when performing an osteotomy can lead to accidental damage to the adjacent tendons of the rotational cuff of the shoulder;

- no guide holes or marks are provided to facilitate the restoration of the integrity of the acromial process of the scapula after the end of the main stage of surgery;

- fixation of the cut off bone fragment of the acromial process of the scapula is carried out by transossal sutures, which together with the non-programmable line of osteotomy can lead to inaccurate reposition and unstable fixation of the fragment and increase the risk of nonunion;

- the use of a known device for osteotomy of the acromial process of the scapula is impossible due to the limited indications for its use (transverse rotational femur osteotomy in a given area), design features that do not allow the use of the known device for osteotomy of the acromial process of the scapula.

Based on the existing level of technology for osteotomy and osteosynthesis of the acromial process of the scapula, as well as to eliminate the disadvantages of the known methods and devices, the task was to increase the accuracy of osteotomy and reduce the invasiveness of surgical intervention, to ensure the subsequent restoration of the integrity of the acromial process of the scapula when performing bone-plastic access to the fake space of the shoulder joint, which will prevent the risk of damage rotationally cuff, and also reduce the duration of post-operative rehabilitation.

The problem is solved as follows.

Performing an osteotomy of the acromial process of the scapula includes the selection of the acromial process of the scapula and its dissection, departing from its outer edge. Moving the cut bone fragment outward and releasing distally, opening access to the sub-falt region.

New in the proposed method is that after the allocation of the acromial process of the scapula, it is placed between the body of the proposed device and the protective element. Then, spokes are introduced into the acromial process of the scapula through openings in the guide cones in the auxiliary unit of the device, the immersion depth of which in the acromial process of the scapula is not more than 25 mm. Before performing an osteotomy, the knitting needles are partially brought out, leaving the immersion depth in the acromial process of the scapula not more than 5 mm. Through openings for pins in the device body, oncoming channels are made in the acromial process of the scapula, into which pins are inserted for final fixation of the device on the acromial process of the scapula. After that, an osteotomy is performed parallel to the edge of the acromial process of the scapula and the main stage of surgery in the subclavicular region is performed. The cut off fragment of the acromial process of the scapula fixed with knitting needles in the auxiliary unit of the proposed device is adapted to the mother bed, the auxiliary unit and the needles are removed and osteosynthesis of the body and the cut off bone fragment of the acromial process of the scapula is performed.

A device for implementing the method of osteotomy of the acromial process of the scapula contains a body with fixing elements and a slit guide for introducing the osteotome.

New in the design of the proposed device is that the housing has a handle, an auxiliary unit and a protective element with a rounded end, made in one piece with the housing, and between them there is a longitudinal recess. The auxiliary unit is fixed to the housing by a threaded rod with a wing nut.

Holes for pins and a slit guide for osteotomy are made on the upper surface of the housing, and on the side surface of the housing there is a central threaded rod and cotter pins, on which the auxiliary unit of the device is mounted. The auxiliary unit has a central non-threaded hole and holes for cotter pins. In addition, at the base of the auxiliary unit there are guide cones with holes into which fixing spokes with marks are inserted.

We explain the essential distinguishing features of the proposed method of osteotomy of the acromial process of the scapula and device for its implementation.

The allocation of the acromial process of the scapula, its location between the body of the proposed device and the protective element allows you to minimize the likelihood of accidental damage to the adjacent tendons of the rotational cuff of the shoulder.

The introduction of knitting needles into the acromial process of the scapula through the holes in the guide cones in the auxiliary unit of the proposed device, the immersion depth of which in the acromial process of the scapula is not more than 25 mm, as well as the presence of mutually parallel channels of the indicated depth provides the subsequent more accurate osteosynthesis of the cut off fragment of the acromial process of the scapula.

Partial knitting of knitting needles outside before an osteotomy, leaving the depth of immersion in the acromial process of the scapula not more than 5 mm, is necessary for the osteotome or oscillating saw to completely pass through the acromial process of the scapula in order to perform an osteotomy.

The implementation of the oncoming channels in the acromial process of the scapula through the holes in the upper part of the body, into which the pins with the hinge-limiter are then inserted for the final fixation of the device on the acromial process of the scapula, is necessary for stable fixation of the device on the acromial process of the scapula during osteotomy. Performing an osteotomy parallel to the edge of the acromial process of the scapula allows you to form smooth and congruent surfaces on the cut-off fragment and body of the acromial process of the scapula, providing greater accuracy and ease of subsequent reposition of the acromial process of the scapula.

Fixing the cut off fragment of the acromial process of the scapula with knitting needles in the auxiliary unit of the proposed device, its adaptation to the mother bed, the subsequent removal of the auxiliary unit of the device and knitting needles, performing osteosynthesis of the body and the cut off bone fragment of the acromial process of the scapula, ensures the accuracy of the reposition of the cut fragment to the mother bed.

The equipment of the proposed device for implementing the method of osteotomy of the acromial process of the scapula, in addition to the body, the handle, the auxiliary unit and the protective element with a rounded end, made in one piece with the body, and the presence of a longitudinal opening between them allows you to perform osteotomy of the acromial process of the scapula with a minimum probability of accidental damage to adjacent tendons of the rotator cuff of the shoulder.

The installation of the auxiliary unit to the device body using a threaded rod with a wing nut increases the stability of the fixation of the device to the acromial process of the scapula and the correct location of the acromial process of the scapula between the body and the protective part of the proposed device.

The implementation of holes on the upper surface of the housing for pins and a slit guide for osteotomy, as well as the presence on the side surface of the housing of a central threaded rod and cotter pins on which the auxiliary unit of the device is mounted, ensures that there is no mobility between the auxiliary unit and the device body.

The auxiliary unit has a central non-threaded hole and holes for cotter pins. In addition, guide cones with holes are introduced at the base of the auxiliary unit, into which fixing spokes with marks are inserted, during which two parallel channels with a depth of not more than 25 mm are formed in the acromial process of the scapula for subsequent more accurate and easy osteosynthesis of the cut off acromial process of the scapula.

Patent studies on subclasses A61B 17/56 and analysis of scientific and medical information reflecting the current level of osteotomy of the acromial process of the scapula did not reveal methods and devices identical to those proposed. Thus, the proposed method of osteotomy of the acromial process of the scapula and a device for its implementation are new.

The sequence and interconnection of the methods of the proposed method and device for its implementation ensure the achievement of a new technological medical result in solving the problem, namely: improving the accuracy of osteotomy and reducing the morbidity of surgical intervention, ensuring the subsequent restoration of the integrity of the acromial process of the scapula when performing bone-plastic access to the fake the space of the shoulder joint, which will prevent the risk of damage to cuffs of the shoulder, as well as reduce the duration of postoperative rehabilitation. Thus, the proposed technical solution has an inventive step.

The technology is intended for specialists who are familiar with basic reconstructive interventions on the capsule-ligamentous apparatus of the shoulder joint and the main methods of immersion osteosynthesis, i.e. specialists of traumatology and orthopedic departments of hospitals at the city, regional and republican levels, and can also be reproduced repeatedly. The manufacture of the device can be mastered by the medical industry and greatly facilitate the work of the surgeon and patient safety.

The essence of the proposed device for performing an osteotomy of the acromial process of the scapula is illustrated by drawings:

Figure 1 - General view of the device;

Figure 2 - the body of the device for osteotomy;

Figure 3 - auxiliary unit.

A device for performing an osteotomy of the acromial process of the scapula contains a housing 1, a handle 2, an auxiliary unit 5 and a protective element 4. The housing 1 is made in the form of a parallelepiped. One of the sides of the housing 1 has a cut in an oblique direction with a hole 18 in which the handle 2 is fixed with a screw 3. At the base of the housing 1 there is a protective element 4 in the form of an elongated plate made in one piece with the housing 1 and connected to the housing 1 from the saw cut on the side with the hole 18. The protective element 4 is parallel to the axis of the housing 1 and has a rounded end. Between the housing 1 and the protective element 4 there is a longitudinal recess in which the acromial process of the scapula is located during operation with this device. The handle 2 is attached to the housing 1 and is divided into two functional parts: a handle having an ergonomic shape that provides a comfortable hold of the handle 2 by the surgeon’s hand, and the other part fixedly fixed to the handle at an angle of 135 degrees, in the form of a cylinder with a thread and an internal diameter matching with the diameter of the fixing screw 3. In the center of the front surface of the housing 1, a central threaded rod 8 with a wing nut 9 is fixed. Equidistant from the central threaded rod 8 there are cotter pins 6 of the housing 1 in the form of protruding cylinders, the diameter of which is equal to the diameter of the holes 7 for the cotter pins 6 in the auxiliary unit 5. In the center of the auxiliary unit 5, a central non-threaded hole 10 is made. The auxiliary unit 5 is attached to the housing 1 by means of cotter pins 6 and the central threaded rod 8, rigidly fixed to the housing 1 with a nut - lamb 9. At the base of the auxiliary unit 5, guide cones 11 are made with holes 12 into which fixing spokes 13 with marks are inserted.

On the upper surface of the housing 1 there are holes 14 for pins 15, which are introduced into the channels formed through the entire thickness of the housing 1 in a mutually oblique direction, the depth of introduction of the pins 15 is regulated by the hinge limiter 16. In addition, there is a slot guide 17 on the upper surface of the housing 1 for osteotomy.

The essence of the proposed "Method of osteotomy of the acromial process of the scapula using the proposed device for its implementation" is as follows.

Before the operation, the device for osteotomy of the acromial process of the scapula is assembled. Attach the handle 2 with the fixing screw 3 inserted into the threaded hole 18 on the side surface of the housing 1.

An arcuate skin incision is performed in the projection of the acromial process of the scapula. After isolating the acromial process of the scapula, the casing 1 is held, held by the handle 2, so that the acromial process of the scapula is located between the casing 1 and the protective element 4 with a rounded end to reduce trauma to structures adjacent to the acromial process during the holding of the protective element 4 into the fake space of the shoulder joint.

Then, the auxiliary unit 5 of the device is installed on the housing 1 so that the cotter pins 6 on the side surface of the housing 1 enter the corresponding holes 7 in the auxiliary unit 5, and the central threaded rod 8 of the housing 1 enters the corresponding central non-threaded hole 10 of the auxiliary unit 5. Guide cones 11 auxiliary unit 5 with longitudinal holes 12 with their pointed ends at the time of tightening the wing nut 9 on the central threaded rod 8 of the housing 1 is pressed tightly against the edge of the acromial process a blade located in that moment between the housing 1 and the protective element 4 protruding.

Through the longitudinal holes 12 in the guide cones 11 of the auxiliary unit 5, two spokes 13 are drawn into the acromial process of the scapula using a drill to a depth corresponding to mark No. 1. The distance from the sharp end of the spoke corresponds to the sum of the lengths of the longitudinal holes 12 of the guide cone 11 of the auxiliary unit 5 and the immersion depth in the acromial process of the scapula not more than 25 mm. And then the needle 13 is displayed in the opposite direction to the mark number 2. The distance from the sharp end of the spoke corresponds to the sum of the lengths of the longitudinal hole 12 in the guide cone 11 of the auxiliary unit 5 and the immersion depth in the acromial process of the scapula not more than 5 mm. In this position, the spokes 13 do not create obstacles for performing an osteotomy and carry out additional stabilization of the entire system.

Through the holes 14 under the pins 15 on the upper surface of the housing 1 using a drill, drill channels in a mutually oblique direction in the acromial process of the scapula. Then, pins 15 having a hilt limiter 16 are introduced into the holes 14. The distance from the sharp end of the pin 15 to the hilt limiter 16 corresponds to the sum of the lengths of the oblique channel in the housing 1 and the channel drilled in the acromial process of the scapula. The introduction of pins 15 carry out the final stabilization of the entire guide system of the proposed device on the acromial process of the scapula. With this installation, the slit guide 17 for osteotomy is located strictly parallel to the edge of the acromial process of the scapula, departing from it by a distance of at least 5 mm and strictly perpendicular to the plane of the acromial process.

After that, an oscillating saw produces an osteotomy of the acromial process of the scapula. The criterion for the passage of the saw blade through the acromial process of the scapula is the contact of the cutting edge of the saw blade with the protective element 4 of the proposed device for osteotomy. At the end of the osteotomy of the acromial process of the scapula, the wing nut 9 is unscrewed from the central threaded rod 8 on the housing 1, the auxiliary unit 5 is removed from the cotter pins 6 and it is removed outward with the cut off fragment of the acromial process of the scapula fixed to it using previously installed spokes 13.

The pins 15 with the hinge limiter 16 are removed from the holes 14 of the housing 1, after which the handle 1 is removed from the area of surgical intervention using the handle 2. As a result, we get wide and convenient access to the area of surgical intervention. Perform the main stage of surgical intervention in the subclavicular region of the shoulder joint.

At the end of the main stage of the surgical intervention, they begin to restore the integrity of the acromial process of the scapula. A fragment of the acromial process with an auxiliary unit 5 fixed to it using knitting needles 13 is adapted to the mother bed of the acromial process of the scapula. Moreover, in order for the adaptation to be performed with maximum accuracy, the diafixing needles are inserted with 13 hands into the previously formed channels in the acromial process of the scapula, the depth of which is not more than 25 mm.

Auxiliary block 5 is removed so as not to disrupt the adaptation of the bone fragments of the acromial process of the scapula. In this position, the cut-off fragment of the acromial process is fixed only by two parallel knitting needles 13. The osteosynthesis of the fragment and body of the acromial process of the scapula is cannulated by cannulated compression screws according to known technology. After the performed osteosynthesis with screws, the spokes 13 are removed. Complete the operation by washing and suturing the wound.

Thus, the proposed "Method of osteotomy of the acromial process of the scapula and device for its implementation" in comparison with the known technologies for performing osteotomy, can improve the accuracy of the osteotomy to reduce the invasiveness of the surgical intervention, to ensure subsequent restoration of the integrity of the acromial process of the scapula when performing bone-plastic access to the fake space shoulder joint, prevent the risk of damage to the rotational cuff of the shoulder, and also reduce postoperative rehabilitation.

Information sources

1. Detlef von T., Toufick N. Atlas orthopadsch-chirurgischer Operationsschnitte und Zugangswege. 3. Auflage. P.34-36.

2. A guide device for osteotomy: AS USSR 1505528: MKI A61B 17/58 / Divakov MG; applicant and patentee Vitebsk Medical Institute. - declared. 01/13/88; publ. 09/07/89. Bull. No. 33.

Claims (4)

1. The method of osteotomy of the acromial process of the scapula, including the selection of the acromial process of the scapula and its dissection, departing from its outer edge, moving the cut bone fragment outward and releasing distally, opening up access to the fake region, characterized in that the device according to claim 2, is used, after isolation of the acromial process of the scapula, it is placed between the device body and the protective element, then spokes are introduced into the acromial process of the scapula through the holes in the guide cones in the help unit of the device, the immersion depth of which in the acromial process of the scapula is not more than 25 mm, before performing an osteotomy, the needles are partially brought out, leaving the immersion depth in the acromial process of the scapula of not more than 5 mm, after which oncoming channels pass into the device’s casing the acromial process of the scapula, into which the pins are inserted for the final fixation of the device on the acromial process of the scapula, after which an osteotomy is made parallel to the edge of the acromial process scapulae, perform the main stage of surgical intervention in the area of the subclavicular space, after which the cut off fragment of the acromial process of the scapula, fixed with knitting needles in the auxiliary unit of the device, is adapted to the mother bed, the auxiliary unit and knitting needles are removed and osteosynthesis of the body and the cut off bone fragment of the acromial process of the scapula is performed. 2. A device for implementing the method of osteotomy of the acromial process of the scapula, comprising a body having a handle, an auxiliary unit and a protective element with a rounded end, made in one piece with the body with a longitudinal recess between them, and the auxiliary unit is fixed to the body by a threaded rod with a wing nut , holes for pins and a slit guide for introducing an osteotome are made on the upper surface of the body, guide cones with holes for introducing a fix are made in the base of the auxiliary unit ruyuschih spokes with labels. 3. The device according to claim 2, characterized in that on the side surface of the housing there is a central threaded rod and cotter pins on which the auxiliary unit of the device is mounted. 4. The device according to claim 2, characterized in that the auxiliary unit has a central non-threaded hole and holes for cotter pins.

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