RU2643296C2 - Compression-distraction apparatus for eliminating the deformation of the skull, mainly resulting from premature atresia of the cranial sutures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Compression-distraction apparatus for eliminating the deformation of the skull, mainly resulting from premature atresia of the cranial sutures, includes a pair of plates, one is intended to be connected to the fixed part of the skull, and the other – for connection to the movable part of the skull, each of which has a transverse projection on the side opposite to the side intended to contact with the parts of the skull. Each transverse projection has a screw-threaded through-hole oriented along the plate and a pair of lead screws, facing each other, ends of which are connected by a hinge coupling. One lead screw has a right-hand thread and cooperates with a transverse projection of one plate by means of the screw-threaded through-hole, another lead screw has a left-hand thread and cooperates with a transverse projection of other plate by means of the screw-threaded through-hole. One of the plates, designed to connect to the part of the skull, and the lead screw, designed to connect with it, are interconnected by means of the transverse projection in the form of a tab having, on one side at the end, a projection for rigid attachment to the plate, and, on the other side, the through-hole with screw-thread for screwing the lead screw, and the other plate intended to be connected to another part of the skull and a lead screw for connecting to it, are interconnected by means of a transverse projection fixed on this plate, made of a composite, and comprising a cylinder-shaped body with a through transverse hole with a screw thread inside for screwing the lead screw, and transverse fence rigidly fixed to the plate. Cylindrical body is arranged to pivot about its longitudinal axis in a transverse fence. Transverse fence is made with the possibility of turning the lead screw.

EFFECT: invention provides an increased distraction length (id es, an increased distance to which the movable part of the skull relative to the fixed part of the skull can be displaced) and the absence of undesirable complications caused by the displacement of the axes of the propellers relative to each other (prevention of wedging the axis in the thread and preventing displacement of the compression-distraction apparatus relative to the bone).

4 cl, 36 dwg

Description

The claimed invention relates to the field of neurosurgery, in particular to children's neurosurgery, and is intended for the treatment of mainly children with severe craniocerebral imbalance (mismatch of intracranial volume to the volume of brain tissue) for a gradual phased increase in intracranial volume by extension of the occipital region.

There are a number of pathologies associated with premature fusion of sutures between the bones of the cranial vault in young children. This is associated with severe disability of children due to the fact that the growing brain is "not enough space" in the cranial cavity. Since the cranial vault is not formed correctly, has insufficient volume, and the brain grows rapidly in early childhood, increased intracranial pressure arises due to an external mechanical restriction on brain growth. Clinically, this is manifested by a delay in the psychomotor development of the child, a decrease in vision up to blindness, periodic headaches, and vomiting. All of the above are signs of craniocerebral imbalance (hereinafter - CD).

To eliminate CD, a number of operations are proposed aimed at surgical increase in intracranial volume due to reconstruction of the bones of the cranial vault. In this case, the skull is “disassembled” and then reassembled with a “large volume”. At the same time, the parts of the skull are “cut out” at the same time that are moved away at a certain distance from the remaining part of the skull (see NEUROSURGERY 2000, Craniosynostosis John A. Jane, Jr, Aaron S. Dumont, Kant Y.K. Lin and John A. Jane Sr). Accordingly, while the volume of the skull increases.

These operations have several disadvantages:

- An increase in intracranial volume after surgery does not always correspond to the planned;

- A simultaneous surgical enlargement of the cranial cavity often leads to the fact that, due to the significant gap between the edges of the wound, this wound cannot be closed due to the tension of the scalp (scalp refers to everything that covers the skull: skin, subcutaneous tissue, aponeurosis (tendon helmet);

- Often, due to the separation of the bone from the dura mater, “dead spaces” are formed inside the skull between the dura mater and the bones of the skull, which, in some cases, is filled with blood, cerebrospinal fluid (fluid washing the brain), which leads to the development of inflammation and is a risk factor for the development of infectious complications (meningitis, encephalitis);

- Increased invasiveness of the operation, which is due to the fact that the operations are associated with high blood loss requiring blood transfusion. For a child in the first year of life, weighing 10-15 kg, even minor blood loss is extremely dangerous due to the small volume of circulating blood.

To eliminate the above disadvantages, a method was proposed for the extension (distraction) of the occipital region using distraction apparatuses.

This method is as follows:

- First, the results of computer and magnetic resonance imaging of the skull are studied (hereinafter referred to as CT and MRI of the skull);

- According to the results of the study, computer simulation of the necessary increase in the volume of the skull for each specific case is performed;

- In the position of the child lying on his stomach, either drank or bites (with special nippers) the bones of the cranial vault at the border of the crown of the head and neck;

- A distraction apparatus is installed in the obtained gap between the bones and is fixed (attached) to the bones using microscrews;

- Then, by means of the apparatus, a gradual extension of the occipital region is carried out in the direction from the rest of the skull.

A compression-distraction apparatus implementing this method is known to eliminate skull deformation, mainly resulting from (premature) premature fusion of cranial sutures, including a pair of plates (otherwise called working sites), one designed to connect to the fixed part of the skull, and the other to connect with the movable part of the skull, each of which has a transverse protrusion from the side opposite to the side intended for contact with parts of the skull, with each transverse protrusion n has a through hole oriented along a plate with a screw thread and a pair of lead screws, the ends of which are connected to each other by an articulated sleeve, moreover, one lead screw has a right-hand thread and through a through hole with a screw thread interacts with the transverse protrusion of one plate, and the other lead screw has a left-hand thread and through a through hole with a screw thread interacts with the transverse protrusion of another plate (see prospectus of Cizeta S. r. L. DIVISIONE PRESIDI CHIRURGICI, DISTRATTORI CRANIALI, Italy, 2002).

Its disadvantages are:

- a small length of distraction (that is, a small distance by which the movable part of the skull can be offset relative to the fixed part of the skull),

- the possibility of undesirable complications caused by the displacement of the axes of the lead screws relative to each other (jamming of the axis in the thread, the displacement of the apparatus relative to the bone).

This is caused by the following circumstances.

As indicated earlier, the essence of the method is that first part of the cranial vault is separated at the vertex-nape border, and then several devices of Cizeta S. r are taken. L. and attach each apparatus to the skull so that one plate of each apparatus is rigidly attached to the fixed part of the skull, and the other is rigidly attached to the movable part of the skull. Then, using the right and left-hand threaded spindles connected at the ends by an articulated coupling, they begin to gradually move one plate away from the other together with the parts of the skull connected with them by rotating the spindles.

Since in this part the features of the claimed invention and the above closest analogue are the same, then to save figures, the applicant illustrates this in figures 6 and 7 of the claimed invention.

In FIG. 6, two apparatuses are shown at the initial stage after installation on the skull, and in almost every apparatus, the longitudinal axes of the lead screw 15 and the lead screw 16 coincide. Moreover, if we consider two devices at the initial stage, we can pay attention that the longitudinal axes of the lead screws are parallel.

When the spindles of each device rotate, the moving part of the skull is gradually removed from the fixed part.

The applicant considers it necessary to pay particular attention to the examination of the following disadvantage of the known device, which is detected by the gradual removal of parts of the skull.

If we look at each device separately, it can be seen that, with gradual removal, the longitudinal axis of one screw of the device starts to rotate relative to the longitudinal axis of the adjacent screw of the same device in a plane parallel to the plane of their plates in contact with the skull, clockwise or counterclockwise .

This is illustrated in FIG. 7, which shows two apparatuses at the final stage after sliding. As you can see, after moving, when the gap between the parts of the skull is filled with regenerate, the longitudinal axis of the rotary screw 16 of one device turned relative to the longitudinal axis of the screw 15 by an angle α clockwise (Fig. 7). In this case, the longitudinal axis of the rotary screw of the other apparatus turned relative to the longitudinal axis of the adjacent rotary screw counterclockwise (Fig. 7).

An unparalleled position of the longitudinal axes of the leadscrews can occur when the osteotomy line is formed in the apparatus installation area not in a straight line in the top view, but in an arc (see Fig. 6), or if the plates with protrusions on the skull are not properly fixed.

If the distraction length is small and the angle α is small, then the displacement of the axes will be compensated for by the selection of gaps between the moving parts of the apparatus (due to the selection of backlash).

However, with a considerable length of distraction, such a significant distortion of the lead screw mounted on the movable part of the skull inside its threaded through transverse hole will occur that it will either jam the threaded joint or tear off the plate connected to it from the movable part of the skull.

In FIG. 7 shows that although there was a rotation of the longitudinal axis of one screw relative to another, however, due to the claimed invention, jamming did not occur, since the lead screw is placed in the protrusion with the possibility of rotation around the vertical axis of the protrusion.

The objective of the claimed technical solution is to prevent the above undesirable complications caused by the displacement of the axes of the propellers relative to each other (preventing the axis from jamming in the thread, the displacement of the apparatus relative to the bone), and increasing the length of the distraction.

The technical result is achieved in that in a compression-distraction apparatus for eliminating cranial deformation, mainly resulting from premature fusion of cranial sutures, including a pair of plates, one is designed to connect to the fixed part of the skull, and the other to connect to the movable part of the skull, each which has a transverse protrusion from the side opposite the side intended for contact with parts of the skull, with each transverse protrusion oriented along the plates a through hole with a screw thread, and a pair of lead screws, the ends of which are connected to each other by an articulated coupling, moreover, one lead screw has a right-hand thread and through a through hole with a screw thread interacts with the transverse protrusion of one plate, and the other lead screw has a left-hand thread and through a through hole with a screw thread interacts with the transverse protrusion of another plate, according to the invention, one of the plates, designed to connect with a part of the skull, and the lead screw, designed Designed for connection with it, they are interconnected by means of a transverse protrusion, rigidly fixed to this plate, a lead screw is screwed into a through hole with a screw thread, and another plate, designed to connect to another part of the skull, and a lead screw, designed to connect with connected to each other by means of a transverse protrusion mounted rotatably on this plate about the longitudinal axis of this transverse protrusion, into the through hole of which is screwed x single screw.

This set of common essential features is the essence of the claimed invention. It is necessary and sufficient in all cases of its implementation.

Such a technical solution has the following advantages compared to the prototype:

- increased length of distraction (i.e. an increased distance by which the movable part of the skull can be offset relative to the fixed part of the skull),

- the absence of undesirable complications caused by the displacement of the axes of the lead screws relative to each other (preventing the axis from jamming in the thread and preventing the displacement of the compression-distraction apparatus relative to the bone).

In addition, in relation to the claimed device, the applicant considers it necessary to highlight the following development and / or refinement of its essential features related to particular cases of implementation or use.

Each device has two plates, each of which can be attached to both the fixed part of the skull and the movable part of the skull.

However, according to the applicant, it is advisable that the plate intended to be connected to the fixed part of the skull and the lead screw intended to be connected to it are interconnected by means of a transverse protrusion rigidly fixed to this plate, and the plate intended to be connected with the movable part of the skull, and the lead screw intended for connection with it would be interconnected by means of a transverse protrusion fixed with the possibility of rotation on this plate around the longitudinal axis transverse protrusion.

In the General case, the plate, designed to connect with part of the skull, and the spindle, designed to connect with it, can be interconnected by means of a transverse protrusion mounted rotatably on this plate around the longitudinal axis of this transverse protrusion, using various design solutions .

However, according to the applicant, the most appropriate design is that a transverse protrusion mounted rotatably on a plate around its longitudinal axis is made integral and comprises a cylindrical body with a through transverse hole with a screw thread inside for screwing in the lead screw and rigidly fixed to the plate a transverse enclosure, wherein the cylindrical body is rotatably disposed about its longitudinal axis in the transverse enclosure, wherein the transverse enclosure is configured to It is necessary to ensure rotation of the lead screw, in particular, the transverse guard may be a hollow cylinder, one end of which is equipped with a transverse plate and the other is closed by a lid, and through openings for the lead screw and its rotation are made in the side wall of the cylinder opposite each other.

This design is characterized by simplicity, reliability, ease of use and manufacturability in manufacturing.

The cover can be welded to the end of the cylinder, and can be mounted removably to repair the structure.

An important advantage of the invention is also that the details of the device can be prefabricated on conventional processing equipment used in the medical industry.

In addition to the above variants of the invention, numerous other modifications thereof are possible.

These and numerous other variations of the invention are covered by the following claims.

The invention is illustrated in the drawing.

In FIG. 1 shows the claimed compression-distraction apparatus for eliminating cranial deformation, mainly resulting from premature fusion of cranial sutures, axonometry;

In FIG. 2 is a perspective view of a distraction device;

In FIG. 3 is the same side view along arrow A in FIG. 2, partial longitudinal section;

In FIG. 4 shows a cross section BB in FIG. 2;

In FIG. 5 shows a cross-section BB in FIG. 2;

In FIG. 6 shows the installation of distraction devices on the patient’s skull relative to the osteotomy line at the initial stage of distraction, top view;

In FIG. 7 - the same, the gap at the end of the distraction, filled with bone regenerate;

In FIG. 8 depicts a separate plate 3 in FIG. 2, top view;

In FIG. 9 is the same side view along arrow D in FIG. 8;

In FIG. 10 shows plate 3, a perspective view;

In FIG. 11 shows separately the transverse protrusion 7 in FIG. 2, side view;

In FIG. 12 - same, bottom view along arrow D;

In FIG. 13 is the same, section EE of the transverse protrusion 7 in FIG. eleven;

In FIG. 14 shows separately plate 5 in FIG. 2, top view;

In FIG. 15 is the same, side view along arrow G in FIG. fourteen;

In FIG. 16 shows a plate 5, a perspective view;

In FIG. 17 depicts separately the transverse guard of the transverse protrusion 8 in FIG. 2, side view;

In FIG. 18 is the same, section II in FIG. 17;

In FIG. 19 is the same, section KK in FIG. 17;

In FIG. 20 depicts a separately cylindrical body of the transverse protrusion 8 in FIG. 2, side view;

In FIG. 21 is the same, section LL in FIG. twenty;

In FIG. 22 shows separately the cover of the transverse protrusion 8 in FIG. 2, side view;

In FIG. 23 is the same, view along arrow M in FIG. 22;

In FIG. 24 shows a node with a transverse protrusion 8, a plate 5 and a lead screw (see Fig. 2), the details of the node spaced in space, axonometric;

In FIG. 25 shows the spindle 15 of the transverse protrusion 7;

In FIG. 26 shows the lead screw 16 of the transverse protrusion 8;

In FIG. 27 shows the axis of the driveshaft 40, having at the end a hexagonal bulge 44 for a screwdriver to drive the driveshaft into rotation;

In FIG. 28 is a side view of a fork of a swivel coupling;

In FIG. 29 is the same, view along arrow H in FIG. 28;

In FIG. 30 is the same, a section along PP in FIG. 28;

In FIG. 31 shows a crosspiece of an articulated coupling, side view;

In FIG. 32 is the same, a section along PP in FIG. 31;

In FIG. 33 shows a pin of a swivel coupling, a perspective view;

In FIG. 33 shows the shaft of a swivel coupling, a perspective view;

In FIG. 34 shows a swivel coupling yoke, a perspective view;

In FIG. 35 depicts a variant of using a pair of the claimed compression-distraction apparatuses to eliminate cranial deformation, mainly resulting from premature fusion of cranial sutures, axonometry.

The compression-distraction apparatus 1 for eliminating the deformation of the skull 2, which was mainly the result of premature fusion of the cranial sutures, is illustrated by the example when the transverse protrusion, which is rotatably mounted, is mounted on a plate fixed to the movable part of the skull (Fig. 1). Although the opposite fixing is possible, when the transverse protrusion, mounted with the possibility of rotation, is mounted on a plate mounted on a fixed part of the skull, which is obvious and therefore not considered.

The device includes a pair of plates. The plate 3 is designed to connect with the fixed part 4 of the skull 2, and the plate 5 is designed to connect with the movable part 6 of the skull 2 (Fig. 1 - Fig. 3).

Each of the plates 3 and 5 have transverse protrusions 7 and 8, respectively, from side 9, opposite side 10, intended for contact with parts of the skull 2. That is, the plate 3, designed to connect with the fixed part 4 of the skull 2, has a transverse protrusion 7, and the plate 5 is designed to connect with the movable part 6 of the skull 2, has a transverse protrusion 8.

The transverse protrusion 7, rigidly mounted on the plate 3, intended for connection with the fixed part 4 of the skull 2, has a through hole 11 with screw thread 12 oriented along the plate 3 (Fig. 11 - Fig. 13). The transverse protrusion 8, mounted rotatably on the platinum 5, has a through hole 13 with a screw thread 14 oriented along the corresponding plate 5 (Fig. 4, Fig. 20 - Fig. 21, Fig. 24). The transverse protrusion 7, rigidly mounted on the plate 3, has a lead screw 15, which is screwed into its through hole 11 with a screw thread 12 (Fig. 1 - Fig. 3, Fig. 6), and the transverse protrusion 8, mounted rotatably on the plate 5 has a lead screw 16, which is screwed into the through hole 13 with a screw thread 14 (Fig. 1 - Fig. 4, Fig. 6 - Fig. 7, Fig. 17 - Fig. 21, Fig. 24).

The ends 17 and 18 of the lead screws facing each other, respectively 15 and 16, are connected by an articulated sleeve 19 (Fig. 2 - Fig. 3, Fig. 7).

In this case, one lead screw, namely the lead screw 15, has a right-hand thread and through a through hole 11 with a screw thread 12 interacts with the transverse protrusion 7 of one plate 3, and the other lead screw, namely the lead screw 16, has a left-hand thread and through holes 13 with a screw thread 14 interacts with the transverse protrusion 8 of another plate 5.

According to the claimed invention, one of the plates intended for connection with a part of the skull and the lead screw intended for connection with it are interconnected by means of a transverse protrusion rigidly fixed to this plate, the lead screw is screwed into the through hole with the screw thread, and the other a plate designed to connect with another part of the skull, and a lead screw designed to connect with it, are interconnected by means of a transverse protrusion mounted rotatably on this plate around the longitudinal axis of this transverse protrusion, into the through hole of which a screw is screwed in with a screw thread. We illustrate this in the figures. In the described case, the plate 3, designed to connect with the fixed part 4 of the skull 2, and the lead screw 15, designed to connect with it, are interconnected by means of a transverse protrusion 7, rigidly fixed to this plate 3 (Fig. 1, Fig. 6 - Fig. 7), and the plate 5, designed to connect with the movable part 6 of the skull 2, and the lead screw 16, designed to connect with it, are interconnected by means of a transverse protrusion 8, mounted rotatably on this plate around the longitudinal axis 20 this by pepper ledge (Fig. 1, Fig. 6 - Fig. 7, Fig. 24).

The design of the transverse protrusion 8, mounted rotatably on the plate 5 around its longitudinal axis 20, can be varied. The applicant has developed several of its designs.

However, in the Applicant's view, the design described in FIG. 24.

According to it, the transverse protrusion 8, mounted rotatably on the plate 5 around its longitudinal axis 20, is made integral and contains a cylindrical body 21 with a through transverse hole 22 with a screw thread 23 inside for screwing in the screw 16 and a transverse guard 24 rigidly fixed on the plate 5 moreover, the cylindrical body 21 is placed with the possibility of rotation around its longitudinal axis 20 in the transverse guard 24, for example, the volume is smaller than the size of the cavity 25 inside the transverse guard 24, and having t clearance from it, of, for example, 1 mm. In addition, the transverse guard 24 is configured to rotate the spindle 16 in a plane parallel to the surface of the plate 5. The direction of rotation is shown in FIG. 24 by the arrow indicated by 32. For this, the transverse guard 24 may, in particular, be a hollow cylinder 26, one end 27 of which is equipped with a transverse plate 28, and the other is closed by a lid 29, moreover, in the side wall of the cylinder 26 are made opposite to each other through holes 30 and 31 for the lead screw 16 and its rotation in a plane parallel to the surface of the plate 5. The cover 29 can be welded to the end face of the cylinder 26 or screwed to it, for example, using a screw connection. The direction of rotation of the lead screw 16 around its longitudinal axis is shown by the arrow indicated by 33.

In the manufacture of the transverse protrusion 8, first, the rectangular end face 27 of the cylinder 26 is inserted into the rectangular hole in the plate 5 and rigidly connected, for example, by laser welding. Then, a cylindrical body 21 is placed in the cavity 25 and fixed on top by a cover 29. After that, the lead screw 16 is screwed into the through transverse hole 22 with a screw thread 23 (Fig. 4, Fig. 24).

In the manufacture of the transverse protrusion 7 is first inserted with a rectangular end 57 into a rectangular hole 58 in the plate 3 and then rigidly connected, for example, by laser welding. After that, the lead screw 15 is screwed into the through transverse hole 11 with a screw thread 12 inside. In the assembled position, the plate 3 is rigidly connected to the transverse protrusion 7.

For fixing on the bones of the skull, each plate 3 and 5 have through holes 34 for, for example, screwing bone screws.

To facilitate the movement of parts of the skull at the ends of each plate, transverse protrusions 35 on the plate 3 and transverse protrusions 36 on the plate 5 are made, not coinciding in plan ((Fig. 2, Fig. 6-Fig. 7, Fig. 24).

The end of the lead screw 15 is connected by means of an articulated coupling 39 to a cardan shaft 40, consisting of axles 41 and 42 connected by an articulated coupling 43. Axis 42 has at its end a hexagonal thickening 44 for a screwdriver for driving into rotation.

As can be seen, the claimed device contains three articulated couplings:

- swivel coupling 19 for connecting the ends of the spindles 15 and 16,

an articulated sleeve 39 for connecting the end of the lead screw 15 to the end of the axis 41 of the driveshaft 40, and

- an articulated coupling 43 for connecting the ends of the axles 41 and 42 of the cardan shaft 40. By design, these articulated couplings are the same.

Since the designs of the three articulated couplings are the same, the applicant gives an explanation of the design of one of them, especially since they are not the subject of the invention.

In order not to clutter up the figures, the applicant explains the construction using the hinge clutch 43 as an example. In FIG. 5 shows a cross-section BB of this articulated coupling in FIG. 2. As noted earlier, similar designs have articulated couplings 19 and 39.

The articulated sleeve 43 comprises a spider 45 (FIG. 5, FIG. 31-FIG. 32), which is a cube-shaped body with through axial holes 46 and 47 intersecting within the cube-shaped body. In addition, the hinge clutch includes a rod 48 (Fig. 34), a pair of fingers 49 (Fig. 33) and a pair of forks 50 (Fig. 28-Fig. 30, Fig. 35). Each fork 50 consists of a pair of legs 51 with through holes 52 in each foot, made integrally with the base 53 with a through hole 54 in the base of the fork (Fig. 28-Fig. 30).

During assembly, the end of the axis 41 is first inserted into the through hole 54 in the base 53 of the plug 50 (FIG. 30). Then the axis 41 is rigidly attached to the plug 50, for example, by laser welding. Similar actions are done with another fork, to which an adjacent axis is attached. After that, the paws of both forks cover the cross and fix the connection using the rod 48 and fingers 49.

As you know, articulated couplings are well-known mechanisms that provide rotation of a pair of shafts, if possible the occurrence of misalignment of their longitudinal axes (see, for example, the Handbook of a mechanical engineering designer, authors V.I. Anuryev and others, 2nd edition, revised and supplemented, Mashgiz Moscow, 1963, pp. 321-323). For this reason, the applicant considers the description of this part sufficient, especially since it is well-known, is not the subject of the invention and any other design could be used instead, providing the function of transferring rotation from one axis to another, if possible misalignment of their longitudinal axes.

Note: instead of the axis 41, another part can be inserted and rigidly fastened into the through hole 54, for example, the end of the lead screw 15 or 16. Further assembly will be similar.

The use of compression-distraction apparatus 1 to eliminate the deformation of the skull 2 is as follows.

The proposed technical solution to the problem is illustrated by the example of using the claimed device for the operation. "Osteotomy of bones of the parieto-occipital region, installation of distraction apparatuses."

1. In preparation for surgery, the patient performs computed tomography (hereinafter referred to as CT) of the bones of the skull.

2. According to the data obtained during CT, a three-dimensional model of the patient’s skull is performed.

3. Based on this model, the osteotomy line, the distraction vector (the direction in which the occipital region of the skull extends), the location of the compression-distraction apparatuses, and their number are modeled (designed).

4. During the operation, the patient under anesthesia is given a supine position.

5. After processing the skin, a bicoronary skin incision is made (ie, an incision through the arch of the skull from ear to ear).

6. The skin flap of the occipital region is separated and reclined.

7. The line of osteotomy is determined and marked.

8. Two or more milling holes are made along the line of the osteotomy (the line along which the bone will be cut).

9. By using the made milling holes in the skull, bone is cut or bitten in accordance with the previously marked osteotomy line.

10. In the gap obtained between the bones of the skull obtained by osteotomy, compression-distraction apparatuses 1 are installed and fixed.

11. For this, the plate 3 is mounted on the fixed part 4 of the skull 2, and the plate 5 is mounted on the movable part 6 of the skull 2 so that the transverse protrusions 35 and 36 of these plates are in the gap 37 at the initial stage of distraction (Fig. 1, Fig. . 6).

12. Plates 3 and 5 are fixed (attached) to the bone through holes 34 using, for example, screws (that is, optional) (in the figures, the screws are not shown so as not to overload them).

13. The wounds are sutured in layers so that the propeller shaft 40 remains outside, and the plates 3 and 5 with the protrusions 7 and 8, respectively, are immersed under the skin. Aseptic dressings are applied to the head.

14. After 5-7 days, a panoramic x-ray of the bones of the skull of the lateral projection is performed in order to verify the position of the compression-distraction apparatus 1 according to the calculated positions.

15. After making sure that the compression-distraction apparatus 1 is located correctly, distraction begins according to a previously developed protocol, depending on the specific case.

16. For this, for example, for the case depicted in FIG. 1, one revolution of the driveshaft 40 is carried out using a special screwdriver, dressed with an end hexagonal cavity for a 6-sided thickening 44. For example, a rotation is performed 360 ° twice a day with an interval of 12 hours, daily for 40-70 days, depending from a specific case.

17. In this case, the plates 3 and 5 are gradually removed from each other, connected by an articulated sleeve 19 and, accordingly, the edges of parts 4 and 6 of the bone 2 are gradually disconnected. In this case, the occipital region of the patient is gradually extended from the main part of the skull 2.

18. As parts 4 and 6 of the skull 2 move apart, a bone regenerate 45 is formed between them in the gap 37.

19. At the same time, as the plates 3 and 5 move apart, the misalignment between the longitudinal axes of the lead screws 15 and 16 increases and the lead screw 16 rotates relative to the lead screw 15 as a result of rotation of the cylindrical body 21 inside the hollow cylinder 26. If there is no rotation (see prototype) there would be a misalignment of the lead screw 16 inside the thread 14 inside the through transverse hole 13, that is, the threaded connection would seize, or the entire plate 5 would tear apart from the movable part 6 of the skull 2.

20. After reaching the estimated width of the gap (the estimated length of the distraction), X-ray is taken in the lateral projections, making sure that the required length of the distraction is reached, stop further movement.

21. After 8-24 weeks (retention period - the period of ossification of bone regenerate 45 in the resulting gap 38) CT is performed.

22. After that, the compression-distraction apparatus 1 is removed under operating conditions under anesthesia from small skin incisions.

According to the applicant, during the operation, the number of compression-distraction devices necessary for its implementation (for example, two, or four, etc.) is determined in each case depending on the specific circumstances (Fig. 36).

According to the applicant, it is also important that in each device there is only one transverse protrusion fixed with the possibility of rotation on this plate around the longitudinal axis of this transverse protrusion, and the other protrusion must be rigidly fixed to the corresponding plate, since if both transverse protrusions are fixed with the possibility of rotation, this can lead to "folding" of the apparatus, which is unacceptable.

The invention is illustrated by clinical examples.

Example 1

Patient K., 8 months old, was admitted with a diagnosis of syndromic form of craniostenosis. Aper syndrome. Bilateral synostosis of the coronary suture. Brachycephaly. Hypoplasia of the occipital region. Multiple malformations.

Complaints of admission to deformity of the skull. Delayed mental and motor development.

An examination revealed that the child’s suffering is caused mainly by intracranial hypertension (increased intracranial pressure), as a result of cranio-cerebral imbalance due to premature closure of the coronary suture on both sides.

A standard operation was performed: osteotomy of the cranial bones, 2 compression-distraction apparatuses were installed according to this invention.

Performed distraction of the occipital region according to the protocol: the length of the distraction is 28 mm, with a frequency of 1 mm per day. The distraction suffered satisfactorily. Compression-distraction apparatuses were removed 12 weeks after completion of distraction.

With distraction, manifestations of intracranial hypertension (increased intracranial pressure) were completely resolved. The child quickly began to acquire psycho-motor skills. The shape of the skull has changed for the better, an occipital protrusion has formed.

This treatment illustrates an example of the use of the claimed invention.

Using the claimed device allowed:

1. Increase the length of distraction;

2. To prevent unwanted complications caused by the displacement of the axes of the propellers relative to each other (jamming of the axis in the thread, the displacement of the apparatus relative to the bone).

These and numerous other variations of the invention are covered by the following claims.

Claims (4)

1. Compression-distraction apparatus for eliminating cranial deformity, mainly resulting from premature fusion of cranial sutures, including a pair of plates, one designed to connect to the fixed part of the skull, and the other to connect to the movable part of the skull, each of which has a transverse protrusion from the side opposite to the side intended for contact with parts of the skull, with each transverse protrusion has a through hole oriented along the plate with a screw thread and steam spindles, the ends of which are connected to each other by an articulated coupling, moreover, one spindle has a right-hand thread and through a through hole with a screw thread interacts with the transverse protrusion of one plate, and the other spindle has a left-hand thread and interacts with a through hole with a screw thread transverse protrusion of another plate, characterized in that one of the plates, designed to connect with a part of the skull, and the lead screw, designed to connect with it, are connected between by means of a transverse protrusion in the form of an eye, having a protrusion on one side for rigid fixation on the plate, and on the other a through hole with a screw thread for screwing in the lead screw, and another plate intended for connection with the other part of the skull and the lead screw intended for connection with it are interconnected by means of a transverse protrusion fixed on this plate, made integral and containing a cylindrical body with a through transverse hole with a screw thread in utri for screwing the screw shaft and is rigidly fixed to the plate transverse rail, wherein the cylinder-like body is arranged rotatably about its longitudinal axis in the cross fence, wherein the cross rail is arranged to provide rotation of the lead screw. 2. The device according to p. 1, characterized in that the plate intended for connection with the fixed part of the skull and the screw screw intended for connection with it are interconnected by means of a transverse protrusion in the form of an eyelet having, on one side, an end face of a rectangular shape a protrusion for rigid fixing on the plate, and on the other a through hole with a screw thread for screwing in the lead screw, and the plate intended for connection with the movable part of the skull, and the lead screw intended for connection with it, with are interconnected by means of a transverse protrusion made integral and containing a cylindrical body with a through transverse hole with a screw thread inside for screwing in the lead screw, and a transverse guard rigidly fixed on the plate, the cylindrical body being rotatably mounted around its longitudinal axis in the transverse guard, the transverse fence is configured to provide rotation of the lead screw. 3. The device according to any one of paragraphs. 1 and 2, characterized in that the transverse fence is a hollow cylinder, one end of which is equipped with a transverse plate, and the other is closed by a lid, and through openings for the lead screw and its rotation are made in the side wall of the cylinder opposite each other. 4. The device according to claim 3, characterized in that the cap is welded to the end of the cylinder.

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