RU2687602C1 - Device for twisting wire cerclage - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: wire cerclage swirling device represents parts of the Ilizarov apparatus set, namely, a rod with a threaded and smooth end. Smooth end of rod is fixed in drill cartridge. Chamfered grooves are formed on the threaded end of rod during 20–30 mm on both sides. At the end of the rod two nuts are installed, from which the extreme nut forms two grooves with grooved recesses of this rod, into which both ends of cerclage wire are introduced with diameter, which is inferior to diameter of slots. Second nut, located farther than first nut 15–30 mm, is screwed in the direction of the first nut and by these counter-positioning fixing the ends of the cerclage wire, after that, twisting of the ends of the cerclage wire is performed by imparting rotary motion to the drill cartridge in one direction or the other and the spinning end is bitten off and bent.EFFECT: invention provides higher clinical effectiveness in orthopedic traumatology patients undergoing a surgical procedure using a wire cerclage.1 cl, 4 dwg

Description

The invention relates to medical equipment, namely to devices used in operative traumatology and orthopedics.

During orthopedic and traumatologic operations, for example, during the submersible osteosynthesis of long tubular bones, a wire cerclage is often used. So, when oblique, spiral and longitudinal fracture line, fixing a bone fragment to his bed or at a transverse fracture line or osteotomy during osteosynthesis according to Weber, to enhance the mutual adaptation between the bone fragments, around them conduct cerklyazhly, the ends of which are twisted with pliers, needle holders or clamps with rigid jaws (Fig. 1, a). In this case, twist the ends of the wire cerclage regulate the degree of mutual adaptation of bone fragments. For the same purpose, you can use various options for a metal tape, for example, Putti tape (Fig. 1, b), a combination of wire cerclage with brackets (Fig. 1, c), the use of special plates without holes for fixing bone fragments using cerclages (Fig . 1, d).

Criticism of analogues

A common disadvantage of all the listed analogues is that in order to carry out adequate tightening and twisting of the wire cerclage or metal tape, it is necessary to tighten their ends in both directions perpendicular to the surgical wound, grab the pliers or needle holders and twist in one direction or the other. This delays the time of the operation and dictates the need for a wider surgical approach with an increase in the morbidity, laboriousness and duration of the surgical intervention.

Prototype

As a prototype of the proposed device, we have selected a wire cerklage for osteosynthesis (Fig. 1, a), described in many manuals, including the monograph by A.Yu. Nabokov Modern Osteosynthesis (Moscow: Medical Information Agency LLC, 2007. - 400 p.). The essence of the prototype device and its application lies in the fact that with oblique, spiral and longitudinal fracture lines, as well as with a transverse fracture line or osteotomy during Weber osteosynthesis or when fixing a bone fragment to its bed, to enhance the mutual adaptation of bone fragments around the bones conduct the wire for osteosynthesis, with a diameter of 0.5 to 2.0 mm, the ends of which are twisted with pliers or other tools with rigid jaws (Fig. 1, a). At the same time, by twisting the ends of the wire cerclage, they regulate the degree of mutual adaptation of the bone fragments and, thus, ensure the stability of the osteosynthesis.

Criticism of the prototype

The use of wire cerclage in operative traumatology and orthopedics involves stretching the ends of the wire in both directions perpendicular to the surgical wound, seizing them with pliers or needle holders and performing a twist in one direction or the other. This, in turn, has the following disadvantages:

- the increase in the complexity and duration of surgical intervention, due to the need to seize the pliers or needle holders of the ends of the wire and perform the twist ends of the wire cerclage in one direction or another;

- an increase in the trauma of surgical intervention, due to the forced expansion of surgical access and an increase in the length of skeletization, and, consequently, a decrease in vascularization of bone fragments. This slows wound healing, worsens the conditions of reparative osteogenesis, delays and reduces the effectiveness of treatment and increases the risk of postoperative complications.

The purpose of the invention is to increase the effectiveness of the treatment of trauma and orthopedic patients in need of surgical manual using wire cerclage.

Summary of Invention

A device is proposed for twisting a wire cerclage, characterized in that it consists of the details of the Ilizarov apparatus (Fig. 2, a), namely the rod (pos. 1) with the threaded (pos. 2) and smooth (pos. 3) end, the smooth end (pos. 3) of which is fixed in the drill chuck (Fig. 2, b, pos. 4), and on the threaded end (Fig. 2, a, pos. 2), the rods are formed on both sides for 20-30 mm using a file or a circular saw ("grinder"), bevelled grooved recesses (Fig. 2, c, pos. 5). At the threaded end (pos. 2), the rods install two nuts (pos. 6 and pos.7), of which the extreme nut (Fig. 3, a, pos. 6) forms with grooved recesses (pos. 5) of this rod two grooves (Fig. 3, a, pos. 8), into which both ends of the cerclage wire (pos. 9) are inserted, with a diameter inferior to the diameter of the grooves (pos. 8), and the second nut (pos. 7) located further than the first nut ( position 6) 15-30 mm, screw in the direction of the first nut (position 6) and with this counter-locking fix the ends of the cerclave wire (position 9), after which they twist the ends (FIG. 3, b, position 10) se From the wire (pos. 9) on the bone (pos.11), by turning the drill chuck (fig. 2, b, pos. 4) to one side or the other and the end of the twist (fig. 3, b, pos. 10), they bite and bend over.

An example of the application of the invention

As an example of the application of the proposed device, we give the following observation. Patient M., 78 years old, entered the Republican Orthopedic and Traumatology Center (ROTC) in Makhachkala 09/26/17 with a diagnosis: Closed comminuted fracture of the upper third of the left humerus with displacement of fragments; Systemic osteoporosis; Associated coronary artery disease and GB.

From the anamnesis: household injury when falling a day before entering the ROTC. He was treated at the TsRB of the Kasumkent district of the Republic of Dagestan, where, after an attempt of closed reposition of the bone fragments, a plaster splint was applied to the Turner.

On the control radiographs, there was a gross displacement of the bone fragments (Fig. 4, a), and therefore, on September 29, 17, the operation was performed: POSTAL osteosynthesis of the comminuted fracture of the upper third of the left humerus with an angularly stable plate. In the position of the patient on his back with a roller under the left shoulder blade, a longitudinal skin incision was made from the level of the humeral head down, 13-14 cm long. The subcutaneous tissue and fascia were cut; at the top of the wound, the incision is deepened between the longitudinally split anterior portion of the deltoid and biceps muscles, and distal, the abdomen of the brachial muscle is longitudinally split with subperiosteal abduction to the sides. The zone of oblique fracture with hematoma evacuation and elimination of soft tissue interposition is exposed. The pointed ends of both bone fragments and the wedge-shaped fragment are economically mobilized and repaired with provisional fixation of their x-ray wire as follows. The cerclage wire, with a diameter of 1 mm and a length of 130-140 mm, is wound up at the ends of the bone and around the bone is pulled back, and its ends are inserted into the slots of the device, which is a bar from the Ilizarov apparatus, 150 mm long, with a smooth end fixed in the drill chuck . The other end of this bar for 20 mm on both sides has a chamfered grooves and two nuts, formed by a circular saw ("grinder") and two nuts, the extreme one of which forms two grooves with these grooved grooves. In these grooves and entered the ends of the cerclage wire, which are secured by twisting the second nut in the direction of the first nut. With this controversy, the ends of the cage wire were fixed, after which the wire was twisted clockwise by spinning the drill chuck. As the degree of twisting of the cervix wire increased, the reposition and strengthening of the mutual adaptation of the bone fragments occurred, and the end of the twist was bitten with nippers and turned away from the intended position of the plate. The use of cerclage made it possible to reposition and retain the bone fragments less laboriously and with higher quality and to do without provisional fixation with their needles, accompanied by perforation and weakening of the mechanical strength of the bone fragments already weakened due to osteoporosis. A simulated 15-centimeter plate with an angular stability under 5-millimeter self-cutting locking screws with preliminary reaming of the bone channels with a 4.5-mm drill and bicortical fixation of the screws are laid along the anterior-outer surface of the repaired bone fragments. All screws were blocked by screwing the threads of their caps into the threads of the plate holes. Osteosynthesis is consistent and stable, and its strength margin far exceeded the need to leave wire cerclage. Therefore, the cerclage was removed, for which, on one side of the twist knot, the wire was cut with wire cutters and removed with a pliers for twisting the knot. The wound cavity is washed with a solution of hydrogen peroxide and novocaine and sutured in layers, leaving the perforated tubular drainage. Aseptic wound label applied. On control radiographs, the position of the bone fragments is satisfactory (Fig. 4, b). Postoperative wound healed by first intention. The patient was discharged for outpatient treatment on 9/10/17, the result of treatment is regarded as good.

Signs of the device, the distinctive features of the prototype:

- the device consists of the details of the Ilizarov apparatus (Fig. 2, a), namely the rod (pos. 1), 100-170 mm long with smooth (pos. 3) and threaded (pos. 2) ends and two nuts (pos 6 and 7);

- on the threaded end of the rod (pos. 2) for 20-30 mm on both sides with a file or a circular saw form bevelled grooved recesses (Fig. 2, a, b, pos. 5);

- two nuts are screwed onto the threaded end of the bar, the extreme of which (pos. 6) with grooved recesses (pos. 5) forms two manholes (Fig. 2, a and Fig. 3, a, pos. 8);

- the smooth end of the rod (pos. 3) is fixed in the drill chuck (Fig. 2, b, pos. 4);

- in both slots (Fig. 3, a, pos. 8), formed by an extreme nut (pos. 6) and two fluted grooves (pos. 5), enter both ends of the cerclage wire (Fig. 3, a, b, pos. 9), the diameter of which is inferior to the diameter of the grooves (pos. 8);

- the second nut (pos. 7), located 15–30 mm further than the first nut (pos. 6), is screwed in the direction of the first nut and the counter wire is fixed with this counter-locking (Fig. 3, a, pos. 9);

- give the drill chuck (fig. 2, b, pos. 4) a rotational movement, which is what makes the twist (fig. 3, 6, pos. 10) of the tips of the serpentro wire (pos. 9) in one direction or the other, and the end of the twist (pos. 10) bite and bend.

The technical result (advantages over the prototype) device for twisting wire cerklyazha:

- a significant reduction in the complexity and duration of surgical intervention, due to the lack of need to seize the pliers or needle holder of the ends of the wire and perform their twist;

- a significant reduction in the morbidity of surgical intervention, due to the reduction of surgical access and the length of skeletonization of bone fragments. This improves the vascularization of the fracture zone, wound healing and reparative osteogenesis, and, therefore, reduces the time and increases the effectiveness of treatment, and also minimizes the risk of postoperative complications;

- the possibility of reducing the length of the operating wound and the degree of stretching of the soft tissues, which, in addition to improving the conditions for their subsequent healing, reduces the risk of iatrogenic traumatic neuritis, for example, traction neuritis of the radial nerve, which is a frequent serious complication of the osteal osteosynthesis of the humerus;

- the possibility of wider use of wire cerclage for reposition and provision fixation of bone fragments during the operation of osteosynthesis - until the final metalwork is established, after which cerclages are removed. This allows less time-consuming and better reposit and retain the bone fragments and do without the provisional fixation of their needles, accompanied by perforation and weakening of the mechanical strength of the bone tissue;

- no need to search for material for the manufacture of the device, since A set of Ilizarov apparatus parts is included in the range of osteosynthesis means for any trauma and orthopedic department.

Thus, the proposed device allows to significantly improve the quality of traumatologic-orthopedic operations using wire cerclage.

List of sources of information:

1) Boychee B. Operative Orthopedics and Traumatology / B. Boychev, B. Conforti, K. Chokanov. - "Medicine and Physical Education", - 2nd ed., Pererab. and add. - DI - Sofia, 1958. - 832 p .;

2) Burykh MP General principles of surgical technology / M.P. Brown. - A guide for surgeons. - Rostov n / A: publishing house "Phoenix", 1999. - 544 p .;

3) Tartan G.E. Operative surgery and topographic anatomy / G.E. Ostroverkhov, Yu.M. Bomash, D.N. Lubotsky - M: LLC Medical Information Agency, 2005. - 736 p .;

4) Movshovich I.A. Operative Orthopedics: (A Guide for Physicians) / I.A. Movshovich - 2nd ed., Pererab. and add. - M .: Medicine, 1994. - 448 p .;

5) Muller M.E. Guide to internal osteosynthesis: Trans. with him. / M.E. Müller, M. Allgäver, R. Schneider, H. Willinger. - 3rd ed. and add. - M .: Publishing house AdMarginem, 1996. - 750 p .;

6) Traumatology: national leadership / ed. G.P. Kotelnikova, S.P. Mironov. - M .: GEOTAR-Media, (Series "National guidelines"), 2008. - 808 p .;

7) Nabokov A.Yu. Modern osteosynthesis / A.Yu. Nabokov. - M .: Medical Information Agency LLC, 2007. - 400 p. - device prototype.

Claims (1)

Device for twisting wire cerclage, representing the details of a set of Ilizarov apparatus, namely rod with a threaded and smooth end, the smooth end of which is fixed in the drill chuck, and on the threaded end of the rod for 20-30 mm on both sides form sloping grooved grooves, at the end of the rod, two nuts are installed, of which the extreme nut forms with grooved grooves of the rod two grooves, into which both ends of the serrated wire with a diameter smaller than the diameter of the grooves are inserted, and the second nut is located th on the first nut to 15-30 mm, is screwed to the side of the first nut and counter it zakontrogaivaniem serklyazhnoy fixed ends of the wire, followed by twisting the ends of the wire serklyazhnoy imparting rotational motion of the drill chuck in one direction or another, and the end of the spin skusyvayut and folded.

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