RU2605497C2 - External holding system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. System comprises support plate, reconstructive console adaptor, spokes cylindrical and prismatic washers, connecting locking screws, connecting shortened screws and cortical screws. On support plate by means of connecting locking screws and shortened screws, prismatic and cylindrical washers spokes are fixed at one end in console, reconstructive console adaptor is fixed at opposite end. Connecting locking screws and connecting shortened screws have head and section adjacent to head with taper thread. Cylindrical washer has central hole, and at least one groove for spokes on one of end surfaces. Prismatic washer is made with holes arranged along its longitudinal axis, and on one of surfaces with notches for spokes. Holes in washers are intended for connecting locking screws or connecting shortened screws. Support plate is made stepped with evenly spaced holes, made of two joint holes, one of said oval holes for cortical screws and second one is conical with thread for connecting locking screws or connecting shortened screws. Reconstructive console adapter is made in form of stepped plates. One stage of plate is shaped in form of polyhedrons connected by links with possibility to break away and it is equipped with holes with taper thread. Other stage of plate for attachment to stage of support plate is prismatic and it is equipped with slot with limiters. Each limiter is made in form of rounded ledges, by means of which cells-holes are formed, each of cells-holes is provided with taper thread.

EFFECT: invention provides possibility of damping dynamic fixation of bone fragments.

3 cl, 10 dwg

Description

The invention relates to medicine, in particular to medical equipment, namely to surgical devices for the treatment of the human musculoskeletal system located along the bone and intended for osteosynthesis of bone fragments, namely it is used in traumatology for the treatment of various injuries of bones and joints.

The known method of osteosynthesis, including the use of plates with angular stability LCP together with plates LISS and PHILOS, which contains the bone plates, plates with angular stability, screws, locking screws (E. Gautier, C. Sommer. The main recommendations for the clinical use of the LCP system // MARGO ANTERION /. - No. 1-2. - 2004. - S. 3-14).

A device for osteosynthesis and fixation of the bone is known, having a bone plate (12) including an edge, a protrusion, an edge, a threaded protrusion, a threaded rod, a threaded edge or a threaded hole (16), as well as a bone screw provided with a head. The leveling sleeve (4) has a single-thread external thread and is screwed into the edge, protrusion, edge, threaded protrusion, threaded rod, threaded edge or threaded hole. There is a bone screw head in the alignment sleeve. The leveling sleeve is screwed in with an internal thread. The threaded hole includes a multi-thread internal thread (18) (DE 102010042930 (A1) - 2012-04-26).

An adjustable bone plate is known which is longitudinally curved, including a description of the use as a first plate having an end defined by at least two spaced teeth and an end having means for attaching the plate to the body structure, i.e. to the bone; and a second plate having an end defined by at least two straight holes for introducing the teeth, and an end having means for attaching the plate to the body structure, i.e. to the bone; and a locking assembly for blocking the teeth in the holes and fixing the plate along the entire length (EP 1807011 (A1) - 2007-07-18).

A bone plate is known and a method for its use for reposition of bone fractures, this bone plate has a longitudinal axis, a bone plate, includes an upper surface, a lower surface, a first opening for introducing the head of the first bone anchor. The first hole is configured and adapted to fix the shaft of the first bone anchor along the first axis. The second hole is located at a distance from the first hole along the longitudinal axis. The second hole serves to introduce the head of the second bone anchor, it is configured and adapted to fix the rod of the second bone anchor along the second axis. The first hole and the second hole are configured so that the first axis and the second axis define one plane and intersect at a point below the bottom surface. The rods of the first and second bone anchors can touch each other or almost touch at the point of intersection, so that the first and second bone anchors form a ligament (EP 1633260 (A2) - 2006-03-15).

A known bone plate (1), which has an upper side (2), a lower side (3) facing the bone, a first end (11), a second end (12) and several holes (4) located between both ends (11, 12 ) and connecting the upper side (2) with the lower side (3), these holes serve to insert bone screws. Two of the aforementioned holes of the plate (4) are created by combining two partially overlapping drilled holes (5, 6) of different types. The first (5) of the two holes is round and cylindrical, having an internal thread (7) and a cylindrical axis (9). The second drilled hole (6) has a conical axis (10) and tapers from the upper side (2) to the lower side (3) in the form of a truncated cone. The named second drilled hole (6) has an internal thread (8). The cylindrical axis (9) is located at a distance A from the conical axis (10), which is not equal to zero (EP 1677693 (A1) - 2006-07-12).

Known bone plate (1) for osteosynthesis, which has an upper surface (2), a lower surface (3) on the side of the bone and several holes (5) connecting the above upper and lower surfaces (2; 3), these holes are located along the longitudinal axis (4) plates and have central axes (6) for insertion of bone screws (10). In two of these holes (5), a department (8) is created in the form of a hollow cone, which extends beyond the bottom surface (3) and which is concentric with respect to the central axis (6). The bone plate provides angular and axial stability, even if the plate is relatively thin (EP 1294298 (A1) - 2003-03-26).

A known bone plate and a bone plate system containing a plate equipped with holes for installing screws (WO 2012042592 (A1) - 2012-04-05).

A set of bone plates for orthopedic injury is known, which for the construction of a block of bone plates (100) for fixing a broken bone includes many plate elements (104, 116), a connecting element (108) for storing many plate elements in the desired configuration and many blocking elements (140 ) for attaching the plate elements to the connecting element (EP 1958580 (A1) - 2008-08-20).

Known bone plate with an elongated hole with a partial thread, which includes the upper part (1), the lower part (2) to create contact with the bone and several holes (4) created along the longitudinal axis of the plate (3) and connecting the upper part and the lower part (1) and (2) for holding bone screws (11). The diameter d _{1 of} at least one of these holes (4) is larger along the longitudinal axis of the plate (3) than the diameter d _q transverse to the longitudinal axis of the plate (3). At least one of these holes (4) has an internal thread (5). This internal thread (5) tightens the arc by at least 180 °. this bone plate can be applied as a compression plate, as well as the so-called internal system that does not cause risk (Patent CA No. 2367085 (A1), publ. 2007/08/07).

Known bone plate with dynamic compression, suitable for internal fixation and stabilization of bone fractures, includes: an elongated structure capable of shortening in the longitudinal direction and having at least two ends, a structure having at least two fixation points adapted for fixation to a broken bone with fixation points on the opposite side of the fracture. An elastic polymer cable stretches longitudinally and connects when tensioned to an elongated structure that can cause longitudinal contraction of the structure (WO 2007149325 (A2) - 2007-12-27).

However, the known bone plate has a complex structure and, in addition, there are no needles (thin rods) for reinforcing articular surfaces and creating dynamic fixation.

It is known to use UHN pins in the form of nails for osteosynthesis without drilling a channel with blocking and titanium flexible TEN pins, in which the tip is bent and acts as an “anchor” that allows you to hold the nail in the bone (A. A. Volna, A. B. Vladykin, Proximal fractures shoulder: the possibility of using pins // MARGO ANTERION /. - No. 5-6. - 2001. - S. 2-4). In addition, it relates to technologies for intramedullary osteosynthesis.

However, despite the simplicity of the design, the known technique of bone osteosynthesis does not allow to combine the use of knitting needles for reinforcing bone fragments and pins and does not allow creating the effect of damping dynamic fixation of bone fragments.

Known plate with angular stability for the proximal shoulder (LPHP), containing screws, cerclage wire (Plate with angular stability for the proximal humerus (LPHP) // MARGO ANTERION /. - No. 5-6. - 2001. - S. 13 -16).

However, the design of the known plate does not provide for the use of knitting needles for reinforcing bone fragments and pins and does not allow the creation of damping dynamic fixation of bone fragments.

Known adjustable osseous plate containing a means for fixing bone fragments, equipped with a means for moving bone fragments relative to each other and their fixation. Moreover, the adjustable osseous plate 22 contains two elements in the form of plates 24 and 26, equipped with one or more holes 28 into which bone screws 30 (or other fasteners) are installed, two elements in the form of plates 24 and 26 are interconnected with each other by means of rotary mechanical element 38 (Application No. US 2007276405 / Publ. 2007-11-29).

However, the known adjustable osseous plate does not allow damping dynamic fixation of bone fragments by reinforcing articular surfaces with beams from a combination of cantilever knitting needles and screws.

The basis of the invention is the creation of a damping dynamic fixation of bone fragments by combining the reinforcement of articular surfaces with beams of cantilever knitting needles and screws fixed to a bone plate, the result of which is manifested in the possibility of damping dynamic fixation of bone fragments.

The problem is solved in that the osseous fixation system containing the support plate, the cantilever reconstructive attachment, has spokes, cylindrical and prismatic washers, connecting locking screws, connecting shortened screws and cortical screws, while on the supporting plate by means of connecting locking screws and shortened screws, a prismatic and a cylindrical washer, spokes are cantileverly fixed at one end, a cantilever reconstructive attachment is fixed at the other end, connect Lockable screws and shortened connecting screws have a cap and a section adjacent to the cap with a tapered thread, a cylindrical washer is made with a central hole, and on one of the end surfaces with at least one groove for the spokes, a prismatic washer is made with holes located along its longitudinal axis, and on one of the surfaces with notches for knitting needles, holes in the washers are designed for locking interlocking screws or shortening connecting screws, the base plate is made stepwise with evenly spaced holes made of two combined holes, one of the mentioned oval holes for cortical screws, and the second conical with a thread for locking interlocking screws or shortened connecting screws, the console reconstructive attachment is made in the form of a stepped plate, while one step of the plate is made figured in the form of polyhedra, interconnected by jumpers for the possibility of breaking off and equipped with holes with a tapered thread, and another step for replication to the step of the base plate is made prismatic and equipped with a groove with stops, each stopper made in the form of rounded protrusions, through which formed cell holes, each of the cell holes is equipped with a tapered thread.

It is advisable, for convenience and strength, to fix the cantilever ends of the knitting needles on one of the surfaces of the prismatic washer parallel to the one and the other sides of the prism, forming protrusions.

It is advisable to maintain the strength of the cylindrical washer and the convenience of fixing the cantilever ends of the spokes on the end surface of the cylindrical washer to make no more than four grooves located in mutually perpendicular planes.

The invention is illustrated by a detailed description, a specific example of its use and schemes in which:

FIG. 1 characterizes an embodiment of the osseous fixation system according to the invention;

FIG. 2 illustrates a connecting element made in the form of a screw;

FIG. 3 illustrates a connecting element made in the form of a screw equipped with a neck;

FIG. 4 shows a shortened compression bolt;

FIG. 5 characterizes cylindrical washers equipped with one groove and four, located opposite each other on opposite sides of the central hole;

FIG. 6 shows a prismatic washer, one side of which is made with notches located in mutually opposite directions and forming protrusions;

FIG. 7 illustrates a cantilever reconstructive attachment in the form of a stepped plate, one step of which is equipped with threaded holes, and the other has a rectangular shaped groove equipped with limiters in the form of rounded protrusions forming several threaded holes;

FIG. 8 shows a support plate made shortened by their two steps, equipped with one connecting curly hole;

FIG. 9 shows a lockable screw with a thread on the head;

FIG. 10 shows a cortical screw.

Bone fixation system 1 contains a set of standard sizes of supports made in the form of support plates, washers, attachments, connecting elements, and knitting needles (Fig. 1). In this case, in each set, the support plate 2 is made in the form of a stepped prism having a step 3 higher in height and a step 4 smaller in height. Step 3 is equipped with evenly spaced connecting holes 5 of complex shape made of two connected holes, one of which has a tapered thread and the other has no thread, but is made in the form of an oval shape, the number of which depends on the length of the step 3. Step 4 is equipped with a hole 6 , the implementation of which is similar to the hole 5. The washers 7 are cylindrical, on one of the end surfaces of which no more than four grooves 8 are made (Fig. 1, 5). In addition, the washers 9 are made prismatic and equipped with holes located along its longitudinal axis (Fig. 1, 6). Notches 10 are made on one of the surfaces of each washer 9. The latter are made in mutually opposite directions parallel to one and the other sides of the prism, forming protrusions. Console reconstructive prefix 11 is made in the form of a stepped plate, which consists of protrusions (steps) 12 connected by prismatic jumpers. One of the sides of such a jumper is equal to the side of the hexagon. Moreover, each protrusion 12 of the cantilevered reconstruction plate 11 is made shaped, in particular in the form of a hexagonal prism. Each protrusion 12 is equipped with a cylindrical hole 13. The latter are located evenly along the axis of the reconstruction plate 11 (Fig. 1, 7). The reconstructive plate 11 may have protrusions 12 from one or more. The number of protrusions 12 depends on the treatment task. Another stage 14 is made prismatic and equipped with a rectangular figured groove 15. The latter is divided by several stops in the form of rounded protrusions, forming several holes with threads. The height of the step 14 is two times less than the height of the reconstruction plate 11. In addition, on the base plate 2 by means of a cylindrical 7 and prismatic 9 washers, spokes 16 are cantilevered at one end (Fig. 1). A cantilever reconstructive attachment 11 is fixed at the other end by means of a stage 14 and a fastening connecting element 17. Cortical screws 23 are placed on the support plate 2 in the connecting holes 5. Lockable screws 22 are placed on the supporting plate 2 in the connecting holes 24.

Lockable screws 17, 18 (hereinafter referred to as connecting elements) and shortened connecting screws 21 (hereinafter referred to as connecting elements) have a cap and a conical portion adjacent to the cap, equipped with a thread (Figs. 2, 3, 4, 9).

In the middle part of the plate with a washer 7 and a compression connecting screw 21 to the plate 2, a spoke is fixed.

For ease of use when performing surgical intervention, it is advisable to make each connecting hole 5 in the base plate 1 shaped, from interconnected holes having different diameters. In this case, one of these holes has a tapered thread 24 corresponding to a thread in the tapered part of the elements 17, 22, 21, 18 (Fig. 1, 8).

It is advisable in the system that each of the connecting element 17, 18 is made in the form of a compression screw to prevent the bone fragment from escaping from the cortical layer and fixation strength (Fig. 2, 3, 4, 9).

It is advisable for convenience and strength of fixing the cantilever ends of the knitting needles 16 of the notch on one of the surfaces of the prismatic washer 9 to be arranged in mutually opposite directions parallel to the one and the other sides of the prism, forming protrusions 10 (Fig. 1, 6).

It is advisable to maintain the strength of the cylindrical washer 7 and the convenience of fixing the cantilever ends of the spokes 16 on the end surface of the cylindrical washer to make no more than four grooves 8 located in mutually perpendicular planes (Fig. 5).

In an embodiment, it is advisable to connect the connecting elements 17, 18 in the form of shortened compression screws, which will prevent migration in the postoperative period (Fig. 4).

For self-regulation for the location of the holes on the base plate 2 due to the slipping of the connecting element (screw) 17, 18 and its exact location in the figured groove 15 of the console reconstructive console 14, the figured groove 15 is equipped with stops 19, which, if necessary, are made in the form of rounded protrusions (Fig. 7). These stops divide the figured groove 15 into several half-openings having a tapered thread corresponding to the thread of the tapered part of the elements 21, 17, 18.

For the variability of the selection of the diameter of the spokes, it is advisable to each connecting element 17, 18 in the form of a screw to perform with the neck 20 (Fig. 3).

Bone fixation system is used as follows.

In the operating room under anesthesia, a support plate 2 is attached along the bone fragment (Fig. 1). To do this, use connecting curly holes 5, which are obtained by connecting two holes of different diameters. In this case, one of them is smooth and oval, and the other with an internal thread 24, corresponding to the thread on the conical part of the elements 21, 9, 17, 18. Connecting elements 17, 18, 21, 9, which can be used either, are placed in the holes 24 compression or lockable screws. In another oval part of the holes 5 are placed screws 10, which are used as cortical screws. In addition, if necessary, washers 7 or an additional cantilever reconstruction plate 11 are used. Each of the connecting elements 17, 18 at the end at the head is performed depending on the treatment tasks and the difficulty of securing to the neck 20 (Fig. 3). The connecting elements 17, 18, screwing their threads into the threads of the holes 24 of the support plate 2, are pressed against the last washer 7 or the cantilever reconstruction plate 11, while the connecting element 18 acts as a locking screw (Fig. 1). Depending on the medical task, a shortened connecting element 21 is used to fix the supporting platinum 2 (Fig. 4). Then, one ends of the spokes 16 are inserted into the bone tissue for reinforcing the articular surfaces or fixing bone fragments (Fig. 1). The free ends of the spokes 16 are fixed with a prismatic 9 washer and cylindrical washers 7 to the step 3 of the support plate 2 or the holes of the cantilever reconstruction plate 11. At the same time, the free end of each spoke is placed in one of the grooves 8 of the cylindrical washer 7, which can be from one to four, and in the notches 10 of the prismatic washer 9 (Fig. 5, 6).

The design of the support plate 2, in particular the stage 4, allows the step 14 of the cantilever reconstruction plate 11 to be fixed in the cylindrical part equipped with a thread 24 of the figured hole 5 (Fig. 1). Step 14 has a prismatic shape and a rectangular figured groove 15. Moreover, for independent adjustment to the required location of the connecting element 17 and its fixation, the figured groove 15 is equipped with limiters 19 (Fig. 7). Each of the stops 19 is made in the form of rounded protrusions forming a cell-holes. In addition, each of the three cell-holes has a thread corresponding to the thread of the conical part of the element 17, 18, 21, 22 (Fig. 2-4). The stage 12 of the cantilevered reconstruction plate 11 is made shaped, in the form of 3 (several) hexagonal prisms that connect the prismatic bridges, one of the sides of such a bridge is equal to the side of the hexagon. Hexagonal steps 12 are equipped with connecting holes that are uniformly axially spaced relative to each other 13. The connection of the support plate 2 and the cantilever reconstructive console 11 using the steps 4 and 14, respectively, allows the support plate 2 and the cantilever reconstructive console 11 to be assembled with a minimum vertical size (Fig. one). If necessary, depending on the treatment tasks, due to the prismatic sections, the cantilever reconstructive prefix 11 can be bent to reduce its length or bent at the required angle to fix the bone fragment.

Clinical use of osseous fixation system.

After the diagnosis is made, an individual set of the required number of standard sizes of parts is preliminarily prepared: base plate 2, cylindrical washers 7 and prismatic 9, connecting elements: screws / bolts, including shortened ones, 17 and 18, 21 of the console reconstructive attachment 11 and spokes 16, planned for layout design on the limbs of the patient during surgery.

In the operating room under anesthesia, surgery is performed.

After opening the area of interest, in particular the articular surface, put the support plate 2 on the bone in the periarticular region, fix the support plate 2 on the bone using the connecting elements in the form of screws 22, 23 inserted into the bone fragment. One end of each spoke 16 is inserted into the damaged articular end of the bone or its fragments, placing the needles 16 at an angle to each other. The free ends of the spokes 16 are fixed by pressing them to the plate 2 with cylindrical washers 7 or washers 9, by means of connecting elements 18 and one of the connecting holes 5. In this case, the spoke 16 is elastically deformed due to its position in the bone and pressing the free end 7 of the bone. Such a fixation creates a damper tensile structure that stimulates internal stresses in the bone during fixation. The spokes 16 can be fixed without creating tension. Moreover, due to their multidirectional location in the bone, bone fragments are fixed.

The proposed osseous fixation system allows the reinforcement of articular surfaces and bone fragments with needles, carried out in different directions and strained or stretched using this system; fixing them to a bone plate superimposed on one of the bone fragments. This connection allows you to create a damping dynamic fixation of bone fragments through the use of fixation elements in the form of a console mounted on the bone plate by means of connecting elements.

The proposed osseous fixation system expands the fixation capabilities of the known osseous fixators depending on the treatment tasks, allows more reliable fixation of comminuted, intraarticular fractures and fragments of various sizes by changing the shape of the osseous system by a combination of its various elements.

The proposed system with the movement of the limb and dynamic loads on its fragments allows you to create a deformation of the spokes, causing micromotion at the fracture level and stimulating osteogenesis.

The proposed bone system is simple to manufacture, has a low cost and is simple when used in the process of surgical intervention in the treatment of various injuries and diseases of bone tissue and articular ends.

In addition, the proposed osseous fixation system is universal, can be easily transformed depending on the medical tasks and the capabilities of the medical institution and has a minimum size.

Claims (3)

1. Bone fixation system containing a base plate, a cantilever reconstructive attachment, characterized in that it has spokes cylindrical and prismatic washers, connecting locking screws, connecting shortened screws and cortical screws, while on the supporting plate through connecting locking screws and shortened screws, prismatic and a cylindrical washer, spokes are cantileverly fixed at one end, a cantilever reconstructive attachment is fixed at the other end, The threaded screws and the shortened connecting screws have a cap and a section adjacent to the cap with a tapered thread, a cylindrical washer is made with a central hole, and on one of the end surfaces with at least one groove for the spokes, the prismatic washer is made with holes located along its longitudinal axis, and on one of the surfaces with notches for knitting needles, the holes in the washers are designed for locking interlocking screws or shortening connecting screws, the base plate is made stepped with uniformly distributed with openings made of two combined openings, one of the said oval-shaped openings for cortical screws and the second tapered with a thread for lockable connecting screws or shortened connecting screws, the cantilever reconstructive attachment is made in the form of a stepped plate, while one step of the plate is made figured in in the form of polyhedra, interconnected by jumpers for the possibility of breaking, and equipped with holes with a tapered thread, and another step for attaching to the The foam of the base plate is prismatic and equipped with a groove with stoppers, each stopper being made in the form of rounded protrusions by means of which hole cells are formed, each of the hole cells is equipped with a conical thread. 2. The system according to claim 1, characterized in that the notches on one of the surfaces of the prismatic washer are parallel to one or the other side of the prism, forming protrusions. 3. The system according to claim 1, characterized in that on the end surface of the cylindrical washer there are no more than four grooves located in mutually perpendicular planes.

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