RU2555108C2 - Method for subchondral strained reinforcement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to traumatology and orthopaedics and is applicable for subchondral strained reinforcement. The first version: one end of at least two pins is inserted subchondrally through articular surface fragments above a bone defect up to its cortical layer. The mechanical strain is generated in the pin; an arched curve is formed at an outer end of each pin, whereas a free linear segment of the pin thereafter is inclined by 45-60 degrees to a long axis of the bone, and then pressed to the bone with a clamp element by means of screws. The second version: one end of each pin is brought until it comes out from the opposite side of the bone, and a support pad is formed thereon; each pin is pulled up to contact the support pad to the opposite cortical layer of the bone; the pin is pulled up by its outer end; that is ensured by forming the arched curve of the pin at the end of each pin opposite the support pad and fixing it by at least two loops around the axis of the pin rod; the arched curve is bent to the bone, whereas the free linear segment of the pin end is placed on the surface of the bone surface for fixation thereto.

EFFECT: group of inventions enables preventing the secondary fragment displacement.

3 cl, 8 dwg

Description

The invention relates to medicine, in particular for use in traumatology, namely, it is intended for fixation of comminuted compression fractures of the articular surfaces of bones.

A known device for transosseous osteosynthesis, containing supports in the form of arcs and rings with mounted spokes, interconnected by threaded rods and forming blocks for fixing the proximal and distal fragments, distractors and nodes for adjusting and fixing the position of the supports and knitting needles, made in the form of connected strips, sliders and washers, which is equipped with an additional ring installed between the blocks of the proximal and distal fragments and connected to them by means of distractors, and the nodes for adjusting and fixing the position of the supports the spokes are located on the additional ring, while the straps are equipped with a flange with a threaded hole on the end, the axis of which coincides with the plane of the surface of the strips, the sliders are made in the form of brackets with threaded ends, and the washers have a prismatic groove tangent to the hole (A.S. SU No. 1055499. Published on 11/23/1983).

However, the design of the known apparatus and the method of its use do not provide for the possibility of creating a damping intense compression of the joint fragments of the articular ends by means of a combination of spoke-pin fixation and preventing their secondary displacement after surgery.

A known method of transosseous osteosynthesis of lower leg bones, in which an external fixation apparatus is applied. To do this, conduct and fix in the conductors installed in the holes of the rings, two spokes through the metaphysical divisions of the tibia above the fracture level - in the positions of the corridors 8 and 10.5, below the fracture level - in the positions of the corridors 8 and 10. Connect the reposition unit to the rings , consisting of two intermediate rings connected using telescopic rods and mounted on each of them sliders having holes with transosseous elements placed in them, which are inserted into bone fragments in the positions of corridor 1-2. At the same time, screw rods-screws are used as transosseous elements, which are parafractically inserted into bone fragments through both of their cortical layers perpendicular to the fracture line. The tibial fragments are repositioned and the external fixation apparatus is stabilized (patent RU No. 2475200. Publ. 02.20.2013).

However, the known method involves the use of an external fixation device, which increases the treatment time, while the treatment is quite expensive.

A known method of surgical treatment of fractures of the proximal humerus with strained needles, which consists in the open elimination of dislocation and reposition of fragments. In this case, osteosynthesis is performed with strained knitting needles. Cortical holes in the humerus are drilled with a 2 mm drill from the head of the humerus into the intramedullary canal, a 1.8 mm needle is inserted behind the fracture line through the cortical hole. Then drill another hole from top to bottom in the head of the humerus in the intramedullary canal. The protruding end of the knitting needle is bent and inserted through the head of the humerus into the hole. The needle is hammered all the way. Similarly, the first knitting needle is inserted with other knitting needles necessary for rigid fixation. The minimum of knitting needles for rigid fixation is two. Then produce additional immobilization of the damaged limb in the discharge bus (patent RU No. 2483688 RU. Publ. 10.06.2013,).

However, the known method of treatment requires, after its implementation, additional fixation in the discharge bus, which leads to certain inconveniences for the patient.

A known method of surgical treatment of comminuted fractures of the proximal humerus with strained needles, in which the dislocated large and / or small tubercles are fixed without exposing the fracture site by introducing Kirchner spokes through the perforation holes in the external cortical layer of the humerus of the humerus, is intramedullary. The spokes are passed through the tubercles, brought to the surface of the shoulder, bend their peripheral ends, giving them the shape of an anchor. They produce traction and bend the central ends of the spokes on the surface of the humerus so that the peripheral ends of the spokes fit the contours of the tubercles (patent RU No. 2357692. Publ. 10.06.2009).

However, when using the known method, there is no possibility of creating a damping stress compression of the combined fragments by means of a combination of spoke-pin fixation and obstacles to their secondary displacement after surgery.

There is a method of closed osteosynthesis of acetabular fractures, in which a 1 cm skin puncture is made in the area of the sciatic tuber, then under the X-ray control of the tube, a 2 mm thread is closed through a skin puncture through the ischial branch through the fracture line extraarticularly into the ilium. A channel is formed along the spoke with a cannulated drill and osteosynthesis is performed using a screw of the required length with a diameter of 7.3 mm. The next step is also closed under the control of the image intensifier through the body of the ilium 2 cm above the level of the acetabulum with a needle with a cut into the body of the pubic bone of the damaged side. Through a puncture of the skin 1 cm into the body of the pubic bone of the injured side, a screw of the required length with a diameter of 4.5 mm is drawn. The screws are tightened until inter-fragment compression is achieved (RU patent No. 2322427. Publ. June 27, 2008).

However, despite the fact that the known method provides reliable fixation, consolidation of the fracture, reduction of trauma, the elimination of postoperative complications, reduction of treatment time, it does not allow to create a damping stressful compression of the combined fragments by means of a spoke-pin fixation and prevent their secondary displacement after surgery.

A known method of performing intense closed osteosynthesis of fractures of the surgical neck of the humerus, in which a hole is made in the diaphysis of the humerus, is introduced through the hole in series of spokes tangentially to the opposite cortical and through the fracture zone into the head of the humerus. The ends of the spokes are brought out of the head contour. Bite the ends of the spokes at a distance equal to three diameters of the head. Select a bending point at a distance equal to one and a half diameters of the head. Bend at the specified point to the needles to complete convergence. The planes formed by the curved ends of the spokes are arranged mutually perpendicular to each other. Closed oriented knitting needles with curved ends back to the bone. Bite off 2 cm from the diaphysis of the humerus introduced into the hole in the diaphysis of the spokes, bend them in the proximal direction and have the ends of the spokes tangent to the diaphysis (patent RU No. 2231987. Publ. 07.07.2004).

However, when using the known method, there is no possibility of creating a damping stress compression of the combined fragments by means of a combination of spoke-pin fixation and obstacles to their secondary displacement after surgery.

The present invention is the creation of a damping tight fixation of the combined fragments of the articular surface and obstacles to their secondary displacement after surgery, the result of which is the reduction of treatment time and its low cost.

The problem is solved in that in the method of subchondral tensile reinforcement, including the introduction of spokes through the fracture zone, bending their outer ends, one end of the spokes, at least two, is introduced subchondrally through fragments of the articular surface above the area of the bone defect to its cortical layer, then create mechanical stress, for this purpose an arcuate bend is formed at the outer end of each spoke, and the free linear portion of the spoke after it is deflected by an angle of 45-60 degrees with respect to the longitudinal axis of the bone and izhimayut bone pressing element by means of screws.

In an embodiment of the method for impression fractures in the middle part of the metaphysis, it is advisable to carry one end of each spoke to the exit from the opposite side of the bone and form a thrust pad on it, then pull each of the spokes until the thrust pad contacts the opposite cortical layer of the bone, tension the knitting needles the outer end, for this purpose, at the end of each knitting needle, opposite the thrust pad, to form an arcuate bend of the knitting needle, fix it, at least two, with loops around the axis of the shaft of the knitting needle, arcs bend the shaped bend to the bone, and position the free linear portion of the end of the spoke longitudinally to the bone to fix it to it.

It is advisable to expand the range of use of the method as a clamping element to use an external fixation device.

The present invention is illustrated by a detailed description, diagrams in which:

Figure 1 - illustrates the introduction of spokes into the bone fragments of the articular ends according to the invention;

Figure 2 - shows the creation of mechanical stress in each spoke, the creation of a point abutting against the bone tissue and the clamping element, and the fixation of the free straight end of each spoke in the clamping element, the same as in figure 1;

Figure 3 - characterizes the holding of each spoke with the exit of one of the ends on the opposite side of the channel and the formation of a thrust pad according to the invention;

Figure 4 - shows the direction of tension of the spokes;

Figure 5 - characterizes the arcuate bend and the linear section on the free end of the spokes for its pressing against the bone in the longitudinal direction;

6 - illustrates the formed arcuate section, at least two loops around the core of the knitting needle, a free rectilinear section of the end of the spoke located longitudinally to the bone for fixing it to it.

Figa and b are copies of x-ray of the patient upon admission to treatment with a diagnosis of Compression fracture of the external condyle of the tibia;

Figa and b are copies of x-rays of the patient after surgery. The present invention is used as follows.

For the implementation of osteosynthesis by means of a clamping element and the creation of mechanical tension in the spokes 1, at least two spokes 1 are introduced subchondrally through the fragments 2 of the articular surface, above the region of the bone defect 3 (Figure 1). The ends of each spoke 1 are inserted to the opposite cortical layer of the bone without leaving it. Thus, a rigid seal of the distal end of each spoke 1 is formed. The outer ends of each spoke 1 are bent in an arc-like manner, forming an arcuate bend and a fulcrum 4. The free linear portion 1a of each spoke 1 is deflected upward by an angle of 45-60 ° with respect to the longitudinal axis of the bone.

After that, the free linear sections 1a of the ends of each spoke 1 and the support point 4 are pressed against the bone with the defect 3 by means of screws 5a (Figure 2).

As the clamping element 5 can be used a osseous plate, approved for use in clinical practice. The clamping element is fixed with rods 5a to the bone.

The pivot point 4, depending on the clinical situation, will be located either on the outer cortical layer of the bone, or on the clamping element. After pressing the previously arched, curved, free linear portion of the end 1a of the spoke 1, mechanical stress arises in it due to the arcuate bending of the spoke 1. In this case, an inverse force arises to displace the fragments of the articular surface, which prevents their secondary displacement. In addition, under dynamic loading, the stressed spoke 1 will deform slightly with the fragments and tend to return them to their original position due to the properties of mechanical stress, in particular elasticity.

In an embodiment of the method of subchondral strained reinforcement, the spoke 1 is passed through the bone (Fig. 3). Its distal end is bent to form a thrust pad 6. After that, the needle 1 is pulled back until the thrust pad contacts the opposite cortical bone layer using one of the known devices 9 approved for use in clinical practice (Figure 4). Then the linear free end of the spokes 1 arcuate bend to obtain a bend 8 (Figure 5). In this case, the free linear end 7 of the spoke 1 is positioned longitudinally to the bone 1. Using pliers, wind the loops, at least two, around the axis of the pin shaft (Fig. 6). With each loop made, the mechanical stress increases by tensioning the spoke 1. At the same time, the loops fix it in a tension state. After reaching the necessary tension of the spoke 1, its arcuate curved end 8 is bent to the bone.

In addition, an external fixation apparatus, namely, an apparatus for axial fixation of the calcaneus described in RU patent No. 119993, can be used as a clamping device.

A clinical example of the method.

Patient S. Age 62 years.

Diagnosis: Compression fracture of the external condyle of the right tibia with displacement (Figa, b).

Operation on the 8th day after the injury: Osteosynthesis of the fracture of the external condyle of the tibia with a plate with subchondral reinforcement by strained knitting needles.

Operation Technique.

Under spinal anesthesia, access to the tibia was performed. Fracture area highlighted. An autograft from the iliac wing was taken according to the standard method. The fracture was repositioned, a bone autograft was placed under the fragments of the articular surface. Through the fragments of the 2 articular surface, three spokes 1 were conducted subchondrally (Fig. 8a, b). The outer ends of each spoke are bent in an arcuate fashion to form an arcuate bend. The free linear portion 1a of each spoke 1 is deflected upward by an angle of 45-60 ° with respect to the longitudinal axis of the bone.

After that, the free linear sections 1a of the ends of each spoke are pressed with a plate 5 and screws 5a to the bone. As a result of deformation of the spoke 1, a fulcrum 4 for the spoke is formed on the adjacent cortical bone layer, and a stressed structure of the spoke 1 is formed.

After that, the remaining screws 5a are inserted through the plate 5, which are necessary for fixing large fragments of the tibia.

After the operation, a full range of movements was noted, the pain syndrome quickly passed. Partial load walking without additional immobilization.

Fracture healed after 3 months. Allowed full load. The metalwork was removed after 1 year at the request of the patient.

The outcome was a full range of motion in the knee joint. The patient did not show any particular complaints.

The proposed method of subchondral stress reinforcement allows you to create a damping mechanical stress compression of the combined fragments through a combination of spoke-pin fixation and prevent their secondary displacement after surgery. In addition, it allows to reduce the treatment time, stay in stationary conditions and has a low cost.

Claims (3)

1. The method of subchondral tensile reinforcement, including the introduction of spokes through the fracture zone, bending their outer ends, characterized in that one end of the spokes, at least two, is introduced subchondrally through fragments of the articular surface above the area of the bone defect to its cortical layer, then created in the spoke mechanical stress, for this, an arcuate bend is formed at the outer end of each spoke, and the free linear portion of the spoke after it is deflected at an angle of 45-60 degrees with respect to the longitudinal axis of the bone, after this clamp t presser member to the bone using screws. 2. The method of subchondral tensile reinforcement, including the introduction of spokes through the fracture zone, bending their outer ends, characterized in that one end of each spoke is carried out before exiting from the opposite side of the bone and a thrust pad is formed on it, then each of the spokes is pulled to the contact of the thrust pad with the opposite cortical layer of the bone, the needle is tensioned at its outer end, for this purpose, at the end of each spoke, opposite the thrust pad, an arched bend of the spoke is formed, fix it, at least two loops around the axis of the spoke rod, the arcuate bends to the bending of the bone and the free end of the linear portion of the spokes is positioned on the bone surface for fixing it thereto. 3. The method according to p. 1, characterized in that the external fixation apparatus is used as the clamping element.

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