RU2596089C1 - Method for minimally invasive osteosynthesis floating fractures of ribs and device therefor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to traumatology and orthopaedics and can be used for minimally invasive osteosynthesis floating fractures of ribs. Line is made wit paint on skin along rib. At tube at marked line, a scalpel is used to puncture at level of proximal fragment, middle floating segment and distal fragment of ribs. Holes are drilled through rib and introduced into them rods on whole thickness of rib. Nuts are screwed on screw part of rod. Plate is placed on rods through slots in plate, which is lowered to nuts. Other nuts are turned from above. If necessary to lift bone fragment, upper nut is turned with loosening of lower nut, and for lowering lower nut is turned, by manipulating plate, thus establishing reducing balance of bone fragments. Nuts on rod are fixed tightly to plate. Broken ribs are fixed through one. Device for minimally invasive osteosynthesis of floating fractures of ribs includes plate, which is transversally bent with radius equal to width of plate, and on length is bent in form of ribs by 120 degrees, in centre of longitudinal axis of plate there are slots for introduction of rods with diameter equal to slot; rod having a square shape on top for use of cap key with screwing rod in rib bone fragment, then on shaft of rod there is a screw thread for nuts and below, to rod end, threaded with greater thread pitch, end of rod is blunt; two nuts arranged on screw thread of rod to allow movement of plate upwards or downwards during reposition of bone fragments of rib and fixed tightly to plate when reposition is achieved.

EFFECT: group of inventions enables to reduce injuries, provides reliable fixation, recovering respiratory function.

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Description

The invention relates to medicine and medical equipment, namely to traumatology-orthopedics, and is intended for the treatment of fractures of ribs, especially floating.

A known method of surgical treatment of complicated fractures of the ribs.

Pronskikh Al.A., Agadzhanyan A.V., Pronskikh A.A. OPERATIONAL RESTORATION OF THE BREAST CELL CARCOSITY AS PREVENTION OF RESPIRATORY COMPLICATIONS IN PATIENTS WITH SEVERE CLOSED INJURY BREAST IN POLITRAUMA. Materials of the conference “Modern principles and technologies of osteosynthesis of bones of limbs, pelvis and spine, 2015, P. 78.

“... after the injury, an operative restoration of the chest carcass was carried out by open reduction, osteosynthesis of floating rib fractures under the control of endovideo thoracoscopy with original angular-stability fixative plates”.

The most serious drawback of this method of treatment is surgery on the chest at the time of the shock state. As a rule, terminal fractures occur during severe compressive traumatic effects. The latter cause multiple fractures of the ribs and at different levels. If you try to openly repair and synthesize fragments, then this will be a serious additional trauma, exacerbating the already shock state. Therefore, we consider the implementation of open osteosynthesis in this situation unacceptable.

An operation is proposed on the website www.f-med.ru/surgeri/osteosintes.php

Rib osteosynthesis in multiple fractures is also known. Operation. "one. Access. Having determined the location of the fractures by palpation and comparing them with radiographs, the surgeon makes a small incision 8 cm long above the fracture along the rib. Having exposed the broken portion of the rib, small fragments of it are removed, the anterior sheet of the periosteum is longitudinally incised, and the posterior sheet of the periosteum is cut off by 3 cm from both sides of the fracture with a rasp (first straight and then rib).

2. Stitching of fragments of the ribs produced by the apparatus SRKCH-22. After removing the device from the wound, the surgeon passes it to his sister for the next charge with brackets. If the first time it was not possible to firmly connect the ends of the broken rib, then re-stitch the device in the same place.

3. Wound closure. First, periosteum leaves are sewn over the rib along with intercostal muscles with catgut interrupted sutures (catgut No. 3). Then, the fascia with subcutaneous tissue is sutured with the same sutures. Separate interrupted silk sutures are applied to the skin (silk No. 3). Having processed the skin around the wound, they move to another part of the same rib to the site of the second fracture or to the next broken rib. To reduce the morbidity and reduce the duration of the operation, usually not all broken ribs are stitched, but after one, for example: the third, fifth, seventh. This is enough to fix the entire floating portion of the chest wall.

The operation is completed after suturing of the last ribs of the rib designated for fixation. ”

This operation is less traumatic, although it is also dangerous for a patient with severe multiple fracture of the ribs.

Analogue (prototype). Kazarezov M.V. et al. Patent 2529702, 2013 “Device for lockable osteosynthesis of diaphyseal fractures of tubular bones” “... the plate is transversely curved with a bend radius equal to the width of the plate, and its edges are pointed along, with serrated cutting, at both ends of the plate, in the middle ( on the top of the transverse bend) - holes made with an inclination towards the center of the plate with a threaded thread, and along the plate, in the center - cuts at both ends, separated by a solid body of the plate by ¼ its length, in the slots of the plate there are screw cuts throughout, closely adjacent to each other, with a number depending on the length of the slots for introducing a fixing screw with a head, on which there is a cylindrical thread matching the thread of the slot of the plate equal to the diameter of the screw head for screwing the head into the plate. "

The device is shown as an analogue to illustrate the possibilities of increasing the strength of the plate when carrying out reponing actions with fragments of the ribs.

Prototype. Gorevich I.I. Patent 2234275. A method for the surgical treatment of floating rib fractures, including osteosynthesis, characterized in that osteosynthesis is performed by periosteal holding crossed needles through injured ribs, the ends of the spokes brought out over the skin are fixed with spokes with the ends of the rods, the ends of the rods being fixed in the center direction around the circumference of the lateral the surface of the cylinder and produce tension spokes.

Holding spokes fragments difficult, especially loosening when breathing.

Closer to the proposed is a "Device for the treatment of fractures of the ribs", Kazarezov M.V., Koroleva A.M., Kozhevnikov V.A., Kazarezov A.M. Etudes of Plastic Surgery, Novosibirsk - 1996. - P. 3.

“It is a plate curved in the shape of a rib with an internal threaded thread, equipped with five rods with multi-step cutting: with a small step above and a larger step from below. By manipulating the rods, it is possible to repair the broken rib and stabilize in the desired position. When screwing the screw, first into the rib, and then simultaneously into the plate, the fragment of the rib rises, and if necessary, falls down and is installed in the given position. "

Disadvantages; 1. At the same time, screwing the screw into the rib and plate, the reposition process is uncontrollable, as a result, the possibilities of comparing fragments are limited.

2. The internal threading in the plate does not allow the turn of the screw to enter and to screw the top of the screw into the plate and to manipulate the fragment of the rib.

3. The continuous longitudinal slot of the plate weakens its strength properties.

Table of claimed designs

1. ANALOGUE. OPERATIONAL RESTORATION OF THE BREAST CELL CARCOSITY AS PREVENTION OF RESPIRATORY COMPLICATIONS IN PATIENTS WITH SEVERE CLOSED INJURY BREAST IN POLITRAUMA. Using open reposition of rib fragments and osteosynthesis with angularly stable plates

2. The analogue. Osteosynthesis of ribs during multiple fractures. Open reduction and suture of fragments by wire or using the RSCh-22 apparatus.

3. Analogue (prototype)

A method for the surgical treatment of floating rib fractures.

4. "Device for osseous blocked osteosynthesis of diaphyseal fractures of tubular bones"

5. The analogue. Prototype. Device for treating rib fractures.

The achievement of the following technical result when using the closest analogues is facilitated by the fact that in the synthesis of fragments of ribs using rod clamps, the fixing properties of the plate, fixed by nuts located on the rods screwed into the fragments of the rib, matter.

The objective of the invention is to improve the quality of treatment of patients by using minimally invasive osteosynthesis using rods with a threaded thread for screwing into a bone (rib) and a screw thread for holding a transversely curved plate with reponitive actions of nuts on both sides of the plate.

The claimed invention: "A method for minimally invasive osteosynthesis of floating rib fractures and a device for its implementation" (reflected further in the text of the description of the invention).

A preliminary version of the claims

Method for minimally invasive osteosynthesis of floating rib fractures and device for its implementation

Method for minimally invasive osteosynthesis of floating rib fractures: after injury, surgical repair of the chest frame by open reposition, osteosynthesis of floating rib fractures under the control of endovideo thoracoscopy with original fixators - plates with angular stability, or with an SRKCh-22 device, or with an intraosseous reposition of needles, or with multilevel thread with simultaneous screwing into the rib and plate, characterized in that under the image intensifier puncture with a scalpel on exactly the proximal fragment, the middle floating segment and the distal fragment of the rib, drill holes through the rib and insert the rods into them over the entire thickness of the rib, screw the nuts on the screw part of the rod and put the plate on the screws through the slot in the plate, which is lowered to the nuts, and screwed on top other nuts, if necessary, raise the bone fragment, tighten the upper nut with the weakening of the lower one, and to lower it, unscrew the lower nut, manipulating the plate, thus installing a repon avnovesie bone fragments; if necessary, screw in additional rods, it is enough to fix the broken ribs through one.

A device for minimally invasive osteosynthesis of floating rib fractures is presented in the form of intersecting spokes through injured ribs, the ends of the spokes brought out over the skin are fixed with spokes with the ends of the rods or in the form of a plate curved in the shape of a rib with an internal threaded thread, equipped with five rods with multi-step cutting: with small above and larger - below, characterized in that they use a plate that is transversely curved with a bend radius equal to the width of the plate, and chest-curved in length th cell (ribs) by 120 degrees, its fragmentary slot in the center of the length for the introduction of rods with a diameter equal to the slot; the rod at the top has a square shape for using the socket wrench when screwing the rod into the bone fragment of the rib, then on the shaft of the rod there is a screw thread for nuts, and below, to the end of the rod, a threaded thread with a large thread pitch and with a blunt end of the rod; on the upper screw thread there are two nuts, with the help of which the plate is moved up or down in the process of repositioning the bone fragments of the rib, and when the reposition is achieved, the nuts on the shaft are fixed tightly to the plate.

Technical result

The technical result of the present invention is the implementation of the operational and functional properties of the device for osteosynthesis: less traumatic reposition, ensuring reliable fixation, and most importantly, the restoration of the respiratory function of patients with damage to the chest frame.

Justification of compliance of the invention with the criterion of "inventive step".

No signs are known from the prior art:

1. A method for the elimination of flotation of rib fragments with the provision of skeleton chest structure with gentle techniques and devices.

2. The ability to reposition bone fragments without visualization and opening at the fracture level.

3. The simplicity of the device allows for use in the field in the early stages of providing assistance to victims.

4. Reliability of the synthesis of floating fragments.

5. The transverse curvature of the plate provides strength properties during reponious manipulations with nuts on the rod.

The proposed device is presented in FIG. 1, FIG. 2

FIG. 1. The method of minimally invasive osteosynthesis of floating rib fractures and a device for its implementation.

FIG. 2. A method for minimally invasive osteosynthesis of floating rib fractures and a device for its implementation.

Thus, the proposed device for minimally invasive osteosynthesis of floating rib fractures consists of a plate - 1, bent laterally with a bending radius equal to the width of the plate, to ensure strength during repositional measures; the plate is curved in the shape of a rib along a long line at an angle equal to 120 degrees - 3, with fragmentary slots - 2. At the same time, there are rods - 4 with individual features: a vertex in the form of a square - 5 for a socket wrench, for manipulating the screw screw into the rib or reverse unscrewing and then down on a small screw thread - 8 for nuts located above and below the plate, in the process of reponing movements of it to hold the floating fragments of the ribs relative to the proximal and distal stays in a stable position of fragments of ribs - 7, then down to the threadless space - 9, in the lowest part of the thread - 10 for insertion into the rib tissue.

Variant of use of the proposed device.

A device for minimally invasive osteosynthesis of floating rib fractures can be schematically applied as follows:

- Lay the patient in an elevated position with a turn on the opposite side.

- Draw a line with coloring matter along the located damaged rib.

- Select and simulate the necessary device - plate - 1.

- Make several punctures of soft tissues up to the rib with a scalpel along the indicated line, along the broken rib and through the created holes penetrate to the bone and drill holes in it.

- Screw the rods - 4 onto the rib thickness - 7 with the lower threaded part - 10 until the thread is completed.

- Screw the bottom nuts - 6 to the threadless level of the rod - 9 and place them through the slots - 2 plate - 1 with penetration through it and screwing on top of the nut - 6.

- Perform reponitive actions using nuts - 6, lowering or raising the plate - 1, with a change in the position of the floating fragments - 7. X-ray control of the position of the fragments and additional fixing of the plate by tightening the nuts tightly.

- Active breathing exercises on the second day after surgery.

Result:

- A chest frame is created and active respiratory movements are provided to prevent pulmonary complications.

- Reduces or eliminates the need for mechanical ventilation.

- Pulmonary complications characteristic of severe chest injuries are reduced or eliminated.

- Provides early and full rehabilitation of victims.

- A satisfactory quality of life is maintained during the treatment period.

- Provides a functionally stable fixation of fragments.

- The terms of inpatient treatment of victims are reduced.

Claims (3)

1. A method for minimally invasive osteosynthesis of floating rib fractures, including osteosynthesis using a plate, characterized in that the patient is placed in an elevated position on the opposite side, a line is drawn on the skin along the rib with paint; under the image intensifier line, along the marked line, punctures are made with a scalpel at the level of the proximal fragment, the middle floating segment and the distal fragment of the rib, drill holes through the rib and insert the rods into them over the entire thickness of the rib, screw the nuts on the screw part of the rod and lay the plate on the rods through the slots in the plate , which is lowered to the nuts, and other nuts are screwed on top, if necessary to raise the bone fragment, screw the upper nut with the loosening of the lower one, and to lower it, unscrew the lower nut, mani By pooling the plate, this establishes the rebalancing balance of the bone fragments, the nuts on the shaft are fixed tightly to the plate, and the broken ribs are fixed through one. 2. The method according to claim 1, characterized in that, if necessary, screw additional rods. 3. A device for minimally invasive osteosynthesis of floating rib fractures, including a plate that is transversely curved with a bend radius equal to the width of the plate and curved along the length of the rib by 120 degrees, slots are located in the center of the plate length for the rods to be inserted with a diameter equal to the slots; a rod having a square shape at the top for using the socket wrench when screwing the rod into the bone fragment of the rib, then on the shaft of the rod there is a screw thread for nuts, and below, to the end of the rod, a threaded thread with a large thread pitch, the end of the rod is blunt; two nuts located on the screw thread of the rod, with the possibility of ensuring the movement of the plate up or down during the reposition of bone fragments of the ribs and with the possibility of fixing tightly to the plate when reposition is achieved.

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