RU2637921C1 - Tool for squint treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: squint treatment tool includes a handle and a working portion perpendicular to it, at the end of which there is a rounded protrusion. The inner surface of the protrusion facing the handle is formed at an angle of less than 90°, the height of the protrusion narrowing to the top is not less than 1.5 mm, and the length of the bent working portion is less than 5 mm.

EFFECT: application of this invention will improve the efficiency of operations performed with squinting.

3 dwg, 1 ex

Description

The invention relates to medicine, namely to ophthalmology, and can be used in the surgical treatment of strabismus.

Known widely used in ophthalmic practice is a tool for treating strabismus (Catalog RTO "MEDTEKHNIKA" mod. E-5121, p. 87), containing a handle and a working part made perpendicular to it, at the end of which a rounded protrusion is placed.

A disadvantage of the known tool is the lack of effectiveness of the operation using this tool due to the possibility of sliding the selected muscle from the working part of the tool. The muscle has the ability to freely move in both directions along the working part of the instrument due to the length of the working part, which does not provide a fixed position of the muscle. In addition, the outward-curved end of the working part does not hold the muscle on the working part before surgical manipulation, but can contribute to its sliding. Since, in addition to muscle retention, it must first be isolated, when using a known tool for this, problems and difficulties arise due to the constructive implementation of the rounded protrusion at the free end of the working part of the tool.

The proposed tool solves the problem of creating a new tool for the treatment of squint of such a design that will improve the efficiency of operations using the inventive tool. An optimally selected length of the working part of the tool of not more than 5 mm allows the selected muscle to maintain a fixed position with the restriction of its movement along the working part of the tool. The implementation of the inner surface of the protrusion facing the handle at an angle of less than 90 °, as well as the selection of the height of the protrusion of at least 1.5 mm and its shape narrowed to the apex, facilitate the rapid and unhindered passage of the working part of the instrument under the muscle plane from one to the other edges and less traumatic release of the edge of the muscle from the subthenon capsule. In addition, the combination of features that make up the end of the working part of the instrument prevents involuntary muscle slipping, allows you to quickly and atraumatically free the edge of the muscle from the subten capsule, and at the same time unhindered to remove the muscle before further surgical manipulation, which helps to reduce the size and severity of the postoperative scar , reduces the time of the operation due to the convenience and speed of muscle allocation.

The proposed tool is convenient to use, it is reusable due to the ability to carry out pre-sterilization treatment and sterilization in any standard way. In addition, the use of the proposed tool allowed to reduce surgical access to the direct oculomotor muscles to 6 mm, which reduced the time of surgery and reduced the trauma of the operated tissues, thereby accelerating the rehabilitation process.

The specified technical result is achieved by the fact that in the strabismus treatment tool containing a handle and a working part made perpendicular to it, at the end of which there is a rounded protrusion, the inner surface of the protrusion facing the handle is made at an angle less than 90 °, the height of the protrusion not narrowed to the top less than 1.5 mm, and the length of the bent working part is not more than 5 mm.

The invention is illustrated by drawings, where

in FIG. 1 schematically shows the proposed tool for the treatment of strabismus;

in FIG. 2 - remote element I in FIG. one;

in FIG. 3 is a view A in FIG. one.

A tool for treating strabismus contains a handle 1 and a working part 2 made perpendicular to it. At the end of the working part 2 there is a rounded protrusion 3 narrowed to the apex at least 1.5 mm high. The inner surface of the protrusion 3, facing the handle 1, is made at an angle of less than 90 °. The length of the bent working part 2 of the tool is less than 5 mm.

A tool for treating strabismus is used as follows.

After the conjunctiva is cut in the projection of the attachment of the rectus oculomotor muscle 6 mm long, the tool for treating strabismus, holding the handle 1, is started from one edge of the muscle at the place of its attachment. The rounded shape of the protrusion 3 of the working part 2 of the tool allows you to freely pass under the muscle plane to its other edge, and the rounded protrusion 3 narrowed to the apex makes it possible to quickly and atraumatically free the edge of the muscle from the subtenon capsule. The selected muscle is located on the working part 2 of the tool. Then another instrument is likewise turned on the other side of the muscle, freeing it from the subthenon capsule. The muscle is stretched between two hooks, which in this case are the protrusions 3 of the working part of 2 tools for treating strabismus, by 4-12 mm, depending on the plan of operation. After this, surgical manipulation of the muscle is performed: strengthening or its weakening.

Clinical example. Patient K., 6 years old. Diagnosis: OU - Periodic divergent alternating strabismus. Myopia is moderate.

Visual acuity: OD - 0.1 sph (-4) = 1.0, OS - 0.15 sph (-3.5) = 1.0

The strabismus angle according to Hirschberg periodically is 30 °, it alternates, more often mows OD.

The nature of vision is simultaneous.

An operation has been performed on OD.

Under laryngeal anesthesia, a vertical incision of the conjunctiva and subthenon capsule was performed in the projection of the attachment of the external rectus oculomotor muscle 6 mm long. A tool for the treatment of strabismus, holding the handle 1, brought from one lower edge of the muscle at the place of attachment to the sclera. The rounded shape of the protrusion 3 of the working part 2 of the tool made it possible to freely pass under the muscle plane to its other edge, and the rounded protrusion 3 of the working part 2 of the tool narrowed to the top made it possible to quickly and atraumatically free the edge of the muscle from the subtenon capsule. The selected muscle was located on the working part 2 of the instrument. Then another instrument was likewise introduced on the other side of the muscle from the upper edge, freeing the muscle from the subthenon capsule. The muscle was stretched 7 mm between the two hooks, which in this case are the protrusions 3 of the working part of 2 tools for the treatment of strabismus. After that, the muscle was stratified along 2 parts by 7 mm from the place of attachment to the sclera. The lower part of the muscle was sutured at the attachment site and cut off, and the other part of the muscle was cut off, retreating 7 mm, and then these parts were sewn with polyglycolide thread 6/0.

Next, a vertical incision was made of the conjunctiva and subthenon capsule in the projection of the attachment of the internal rectus muscle 6 mm long. A tool for treating strabismus, holding the handle 1, brought from the lower edge of the muscle at the site of attachment to the sclera. The rounded shape of the protrusion 3 of the working part 2 of the tool made it possible to freely pass under the muscle plane to its other edge, and the rounded protrusion 3 of the working part 2 of the tool narrowed to the top made it possible to quickly and atraumatically free the edge of the muscle from the subtenon capsule. The selected muscle was located on the working part 2 of the instrument. Then another tool was similarly brought in from the upper edge of the muscle, freeing the muscle from the subthenon capsule. The muscle was stretched 5 mm between two hooks, which in this case are the protrusions 3 of the working part of 2 tools for the treatment of strabismus. Large vascular arcades were isolated and a 6/0 polyglycolide suture was sutured on the middle part of the muscle 4 mm wide 5 mm from the attachment point without stitching the vascular arcade, and this portion of the muscle was hemmed to the sclera 1 mm in front of the attachment point to the sclera in the center. Continuous stitches were placed on the conjunctiva with 8/0 polyglycolide thread.

After the operation, the position of the eyes is correct. OD - the eye is calm. Eye movements in full. Using the new proposed tool, 46 patients were operated on. No intraoperative and postoperative complications were detected.

Claims (1)

A tool for treating strabismus, comprising a handle and a working part perpendicular to it, at the end of which a rounded protrusion is placed, characterized in that the inner surface of the protrusion facing the handle is made at an angle of less than 90 °, the height of the protrusion to the top of the protrusion is at least 1, 5 mm, and the length of the bent working part is less than 5 mm.

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