RU2692726C1 - Reposition-fixing support ring for surgical treatment of displaced polyfragmental fractures of cotyloid cavity - Google Patents

Abstract

FIELD: medicine; medical equipment.SUBSTANCE: invention refers to medicine. Reposition-fixation support ring for surgical treatment of shifted poly-fragmentary acetabular fractures has a concave shape and holes for inserting screws, has the shape of a hemisphere, external and internal surfaces, two rows of holes in the hemisphere and three flanges with holes for insertion of fixing screws. Flanges are located on the external surface of the hemisphere so that when the ring is placed in the cotyloid cavity two of them are located on the same line connecting the middle of the junction point of the ischial bone and the lower edge of the cotyloid cavity and the inferior spine of iliac bone. First of two flanges is located on that part of external surface of hemisphere of ring, which corresponds to place of upper edge of cotyloid cavity. Second of the two flanges is located on that part of external surface of the hemisphere of the ring, which corresponds to the junction of the ischial bone and the lower edge of the cotyloid cavity. Third flange on ring is located on that part of outer surface of hemisphere, which corresponds to confluence of anterior edge of cotyloid cavity and horizontal branch of pubic bone and is on line connecting midpoint of confluence of front edge of cotyloid cavity and horizontal branch of pubic bone and posterior lower spine of iliac bone. Plane of the first flange is at an angle to the plane of the ring inlet. Plane of the second and third flanges of the ring is in the same plane as the plane of the ring inlet. Holes of three flanges allow additionally fixing fragments of cotyloid cavity to reposition-fixing support ring. At the ring, the first row of holes is located on one line along the edge of the ring entrance, from the edge to the center, and the second row of holes is located on one line, from the first row in the direction towards the hemisphere center. Holes of the second row are located relative to holes of the first row in staggered order. Three groups of holes consisting of two holes of the first row and from one hole of the second row are located opposite each of three flanges, at that, holes of the second row of each of three groups of holes are located on one line of location of corresponding flanges. Ring has holes for screws with smaller diameter for fixation of small intermediate fragments located between the holes at the level of the first and the second rows of holes in those parts of the ring, where it contacts with the front and back columns, and the front and back edges of the cotyloid cavity and closer to the center from second row of holes.EFFECT: invention provides reliable fixation of fragments of cotyloid cavity to support ring, as well as provides possibility of reparation and fixing of intermittent fragments of cotyloid cavity.1 cl, 18 dwg

Description

The repositioning-fixation support ring refers to medicine, namely for the surgical treatment of displaced acetabular fractures, hip joint endoprosthetics, experimental medicine, and biomechanics.

Several devices have been proposed that are implanted into the acetabulum in order to restore its support and biomechanics for defects of the acetabulum of various origins, namely, for defects caused by the development of osteolysis after hip arthroplasty, and for traumatic defects (Fig. 1, 2, 3).

The closest solution to the problem of treatment of displaced acetabular fractures can be achieved by using the Muller ring (Fig. 1), which (which - if we are talking about all three rings - Figs 1, 2, 3) allows you to insert screws into the acetabulum fragments. However, these devices do not allow screws to be inserted into the bone mass of the acetabulum at an acute angle, and the arrangement of the screw insertion holes does not allow concentrating the efforts of fixing various fragments of the acetabulum taking into account the classification of acetabular fractures (Fig. 13) (Muller ME, Allgover M., Schneider R., Willinger X. Guidelines for internal osteosynthesis. - M., 1996. - 756 c).

The technical result is the development of a reposition-fixation support ring for the surgical treatment of displaced polyfragmentary fractures of the acetabulum.

The technical result is ensured by the fact that it has the shape of a hemisphere, an outer and an inner surface, two rows of holes in the hemisphere and three flanges with holes for insertion of fixing screws,

the flanges are located on the outer surface of the hemisphere so that when the ring is installed in the acetabulum, two of them are on the same line connecting the middle of the place of fusion of the ischial bone and the lower edge of the acetabulum and the anterior lower iliac bone,

the first of two flanges is located on that part of the outer surface of the hemisphere of the ring, which corresponds to the place of the upper edge of the acetabulum, and the second of the two flanges is located on that part of the outer surface of the hemisphere of the ring, which corresponds to the place of confluence of the ischial bone and the lower edge of the acetabulum bones, and the third flange on the ring is located on that part of the outer surface of the hemisphere, which corresponds to the confluence of the front edge of the acetabulum and the horizontal branch of the lunar bone and stored on the line connecting the middle junction of the front edge of the acetabulum and the horizontal branch of the pubic bone, and a rear lower iliac spine,

and the plane of the first flange is at an angle with respect to the plane of the ring entrance, the plane of the second and third flanges of the ring is in the same plane with the plane of the ring entrance,

at the same time, the holes of the three flanges make it possible to additionally fix the acetabular fragments to the reposition-fixation support ring,

and in the ring, the first row of holes is located on the same line along the edge of the ring entrance, some distance from the edge towards the center, and the second row of holes is located on one line, some distance from the first row towards the center of the hemisphere,

and, the holes of the second row are located in relation to the holes of the first row in a staggered manner,

moreover, three groups of holes consisting of two holes of the first and one hole of the second row are located opposite each of the three flanges, while the holes of the second row of each of the three groups of holes are located on the same line of the location of the corresponding flanges,

the ring has holes with screws with a smaller diameter for fixing small intermediate fragments located between the holes at the level of the first and second rows of holes in those parts of the ring where it contacts the front and rear columns and the front and rear edges of the acetabulum and closer to centered on the second row of holes. The invention is illustrated by the following figures.

FIG. 1. A photo of the acetabular strengthening ring ME is presented. Muller (ME Muller).

FIG. 2. A photo of an acetabular strengthening ring with a hook from Protek, Switzerland (PROTEK) is presented.

FIG. 3. A photo of the acetabular burch-Schneider strengthening ring (N.V. Burch - R. Schneider) is presented.

FIG. 4. A photo of the outer surface of the reposition-fixation support ring is presented. 1 - outer surface of the ring hemisphere; 3 - the first flange of the support ring; 4 - the second flange of the support ring; 5 - the third flange of the support ring; 6 - openings of the second row located on the longitudinal spine of the corresponding flanges; 7 - openings of the first row; 8 - holes of the second row; 9 - flange holes; 10 - hole for revision and manipulation at the bottom of the acetabulum; 11 - holes of smaller diameter; 12 - the line of the longitudinal axis of the location of the first and second flanges; 13 - the line of the longitudinal axis of the third flange.

FIG. 5. A photo of the inner surface of the reposition-fixation support ring for the surgical treatment of displaced acetabular fractures is presented. 2 - the inner surface of the ring hemisphere; 3 - the first flange of the support ring; 4 - the second flange of the support ring;

5 - the third flange of the support ring; 6 - openings of the second row located on the longitudinal spine of the corresponding flanges; 7 - openings of the first row; 8 - holes of the second row; 9 - flange holes; 10 - hole for revision and manipulation at the bottom of the acetabulum; 11 - holes of smaller diameter; 12 - the line of the longitudinal axis of the location of the first and second flanges; 13 - the line of the longitudinal axis of the third flange; 14 - edge of the ring wall; 15 - a group of holes consisting of two holes of the first and one hole of the second row, located opposite each of the three flanges; 16 - planes of flanges.

FIG. 6. A photo of the outer surface of the reposition-fixation support ring is shown, with the deviation of the deflection angle of the plane of the first flange (3) with respect to the outer surface of the ring (1). 16-plane flanges; 17 - the line denoting the plane of the entrance to the inner surface of the support ring; 18 is a line indicating the deviation of the plane of the first flange (3) relative to the line of the plane of entry into the inner surface of the support ring (17); 19 is a line indicating the angle of inclination of the outer surface of the ring; 20 is the deflection angle of the plane of the first flange with respect to the line denoting the plane of entry into the inner surface of the support ring (17); 21 is the deflection angle of the plane of the first flange with respect to the line indicating the angle of inclination of the outer surface of the ring (19).

FIG. 7. A photo of the outer surface of the reposition-fixation support ring (1) is shown by deducing the deviation angle (23) of the line (22) of the plane (16) of the first flange (3) with respect to the line indicating the plane of entry into the inner surface of the support ring (17).

FIG. 8. Presents a photo of the right Ilium. 24 - the right iliac bone; 25 - posterior lower spine of the ilium; 26 - anterior lower spine of the Ilium; 27 - the upper edge of the acetabulum; 28 - lower edge of the acetabulum; 29 - ischium; 30 - the middle of the confluence of the sciatic bone and the lower edge (28) of the acetabulum (34); 31 - anterior margin of the acetabulum; 32 - the middle of the confluence of the front edge (31) of the acetabulum and the horizontal branch of the right pubic bone (33); 34 - acetabulum; 35 is a line connecting the middle of the confluence of the ischial bone and the lower edge of the acetabulum of the right iliac bone, on the one hand, and the anterior lower spine (26) of the right iliac bone on the other.

FIG. 9. Presents a photo of the right reposition-fixation support ring set by the acetabulum of the right iliac bone. 3 - the first flange of the support ring; 4 - the second flange of the support ring; 5 - the third flange of the support ring; 24 - the right iliac bone; 25 - posterior lower spine of the ilium; 26 - anterior lower spine of the Ilium; 27 - the upper edge of the acetabulum; 28 - lower edge of the acetabulum; 29 - ischium; 30 - the middle of the confluence of the ischium and the lower edge of the acetabulum (34); 31 - anterior margin of the acetabulum; 32 - the middle of the confluence of the front edge (31) of the acetabulum and the horizontal branch of the right pubic bone (33); 34 - acetabulum; 35 is a line connecting the middle of the confluence of the ischial bone and the lower edge of the acetabulum of the right iliac bone, on the one hand, and the anterior lower spine (26) of the right iliac bone on the other; 36 - the line designating the longitudinal axis of the horizontal branch of the pubic bone.

FIG. 10. A photo of the acetabular fracture scheme B2.2 according to the AO / ASIF international classification is presented. 24 - the right iliac bone; 37 - line of transverse acetabular fracture; 40 - pelvic posterior column; 38 - the line of fracture of the pelvic posterior column; 39 - fracture line of the anterior column of the pelvis; 40 - posterior column of the acetabulum; 41 - anterior column of the acetabulum; 42 - the main fragment of the damaged acetabulum associated with the ileum (24).

FIG. 11. A photo of a mock-up of the right iliac bone with modeling of acetabular fracture B2.2 according to the AO / ASIF international classification with a diastasis between fragments is presented. 24 - the right iliac bone; 40 - posterior column of the acetabulum; 41 - anterior column of the acetabulum; 42 - the main fragment of the damaged acetabulum associated with the ileum (24).

FIG. 12. Presents a photo of the mock of the right Ilium with modeling of the reposition of acetabular fragments. 24 - the right iliac bone; 37 - line of transverse acetabular fracture; 37-back pelvic column; 38 - the line of fracture of the pelvic posterior column; 39 - fracture line of the anterior column of the pelvis; 40 - posterior column of the acetabulum; 41-front column of the acetabulum; 42 - the main fragment of the damaged acetabulum associated with the ileum (24).

FIG. 13. A photo of a mock-up of the right Ilium with fastened acetabular fragments fixed with a reposition-fixation support ring and fixing screws is presented. 3 - the first flange of the support ring; 4 - the second flange of the support ring; 5 - the third flange of the support ring; 24 - the right iliac bone; 26 - anterior lower spine of the Ilium; 27 - the upper edge of the acetabulum; 28 - lower edge of the acetabulum; 29 - ischium; 30 - the middle of the confluence of the ischium and the lower edge of the acetabulum (34); 31 - anterior margin of the acetabulum; 32 - the middle of the confluence of the front edge (31) of the acetabulum and the horizontal branch of the right pubic bone (33); 43 - locking screws.

FIG. 14. A photo of a mock-up of the right Ilium with fastened acetabular fragments fixed with a reposition-fixation support ring and fixing screws is presented. 3 - the first flange of the support ring; 4 - the second flange of the support ring; 5 - the third flange of the support ring; 11 - holes of smaller diameter; 24 - the right iliac bone; 26 - anterior lower spine of the Ilium; 27 - the upper edge of the acetabulum; 28 - lower edge of the acetabulum; 29 - ischium; 30 - the middle of the confluence of the ischium and the lower edge of the acetabulum (34); 31 - anterior margin of the acetabulum; 32 - the middle of the confluence of the front edge (31) of the acetabulum and the horizontal branch of the right pubic bone (33); 43 - locking screws; 44 - small locking screws inserted through the small holes of the ring (11).

FIG. 15. A photo is presented with outlines of the cut and contour of the large skewer.

FIG. 16. A photo of the incision of the skin and muscle of the fascating fascia of the thigh along the outer surface of the left spit is presented.

FIG. 17. A photo of a simulation of the acetabulum B2.2 fracture fracture according to the AO / ASIF international classification by means of the acetabulum osteotomy is presented. 37 - line of transverse acetabular fracture; 40 - pelvic posterior column; 38 - the line of fracture of the pelvic posterior column; 39 - fracture line of the anterior column of the pelvis; 40 - posterior column of the acetabulum; 41 - anterior column of the acetabulum; 42 - the main fragment of the damaged acetabulum associated with the ileum.

FIG. 18. A photo with a reposition-fixation support ring with screws (43) and small screws (44) inserted into the acetabulum is presented. 3 - the first flange of the support ring; 5 - the third flange of the support ring; 9 - flange holes.

The device has the shape of a hemisphere (Fig. 4), an outer (Fig. 4-1) and an inner (Fig. 5-2) surface, two rows of holes in the hemisphere (Fig. 4 - 6, 7, 8; Fig. 5 - 6 , 7, 8) and three flanges on the outer surface of the hemisphere (Fig. 4 - 3, 4, 5; Fig. 5 - 3, 4, 5) with holes for insertion of fixing screws (Fig. 4 - 9; Fig. 5 - 9) and technical hole (Fig. 4 - 10; Fig. 5 - 10), while the flanges are located on the outer surface of the hemisphere so that when you install the right ring in the acetabulum (Fig. 6 - 33) right (Fig. 6 , 7-13) Ilium, two of them, the first and second (Fig. 4, 3, 4, fig 5 - 3, 4), are on the same line (Fig. 6, 7 - 14) connecting the middle of the confluence (Fig. 6, 7 - 16) of the ischium (Fig. 6, 7 - 15) and the lower edge ( Fig. 6, 7 - 17) of the acetabulum (Fig. 6 - 33) of the right iliac bone (Fig. 6, 7 - 13) the anterior lower spine (Fig. 6, 7 - 18) of the right iliac bone (Fig. 6, 7 - 13), in this case, the first (Fig. 4, 5 - 3) of the two flanges is located on that part of the outer surface of the ring hemisphere, which corresponds to the place of the upper edge (Fig. 6, 7 - 19) of the acetabulum (Fig. 6 - 33), and the second (Fig. 6, 7 - 4) of two flanges is located on that part of the outer surface of the hemisphere of the ring, which corresponds to the place of confluence of the ischial bone (Fig. 6, 7 - 15) and the lower edge (Fig. 6, 7 - 15) of the acetabulum (Fig. 6 - 33), and the third flange (Fig. 6, 7 - 5) on the right ring is located on that part of the outer surface of the hemisphere, which corresponds to the middle of the confluence (Fig. 6, 7 - 20) of the front edge (Fig. 6, 7 - 21) of the acetabulum and the horizontal branch of the right pubic bone (Fig. 6, 7 - 22) and is on the line (Fig. 6, 7 - 23), s Connecting the middle of the confluence (Fig. 6, 7 - 20) of the front edge (Fig. 6, 7 - 21) of the right acetabulum (Fig. 6 - 33) and the horizontal branch of the right pubic bone (Fig. 6 - 22), and the back the lower spine of the right iliac bone (Fig. 6, 7-24), and the plane of the first flange (Fig. 4, 5, 9 - 25), is at an angle (Fig. 8 - 27) indicated by a line (26 - Fig. 8 ) with respect to the entrance plane of the ring (FIG. 8 - 28), and the plane of the first flange (Fig. 4, 5, 9 - 25) is at an angle (Fig. 9-29) to the outer surface of the ring hemisphere (Fig. 9-30), the plane of the second (Fig. 10 - 4, 5) and the third (Fig. 10 - 4, 5) ring flanges are in the same plane with the entrance plane (Fig. 10-28) rings, besides the flanges can be bent using tools to adapt to the surface of the corresponding bone , with the holes of the three flanges (Fig. 4, 5 - 9) allow you to additionally fix the acetabular fragments to the reposition-fixation support ring, which enhances fixation These possibilities of the ring, while in the right ring the first row of holes (Fig. 4, 5, 7, 9 - 7) is located on the same line along the edge (Fig. 5 - 31) of the entrance of the ring, some mm from the edge to the center, and the second row of holes (Figs. 4, 5, 7, 9–8) is located on the same line (Figs. 4, 5, 7, 9–8), departing from the first row in the direction to the center of the hemisphere (in the direction of the technical hole ) a few mm, and, the holes of the second row are located in relation to the holes of the first row in a checkerboard pattern (FIG. 4, 5, 7, 9 - 7, 8), with a group of holes (Fig. 5, 7 - 32) consisting of two holes of the first and one hole of the second row located opposite each of the three flanges (Fig. 4, 5 - 7, 8), with the holes of the second row (Fig. 4, 5 - 6) of each of the three groups of holes, corresponding to the three flanges, located on the same line (Fig. 4, 5 - 11) the location of the corresponding flanges (Fig. 4, 5), while the ring has holes for screws with a smaller diameter for fixing small intermediate fragments (Fig. 4, 5), located to the center from the second row of holes at the level n The second and second rows of holes, and in those parts of the ring where it contacts the front edge of the acetabulum (Fig. 4, 5) between the holes of the first and second row in those parts of the ring where it contacts the rear edge of the acetabulum (FIG. 4, 5).

The device works as follows

The operation of the device is described on the example of acetabular fracture B2.2 according to the AO / ASIF international classification (Fig. 10).

We simulate a fracture of the right acetabulum B2.2 according to the international classification AO / ASIF by osteotomy of the acetabulum with the creation of a diastasis between the fragments (Fig. 10, 12). At the next stage, we use the toolkit to bring the displaced fragments closer to each other, achieving the most accurate reposition (Fig. 12). Next, the right reposition-fixation support ring is installed in the right acetabulum so that the first flange (Fig. 9, 13 - 3) is above the upper edge of the right acetabulum (Fig. 9, 13 - 27), directly on the front lower spine (Fig 13-26) of the right ileum. The second flange (figs. 13-4) is placed at the confluence point (fig. 9, 13-30) of the ischial bone (fig. 14-29) and the posterior edge of the right acetabulum (fig. 9, 13-28). The third flange (Fig. 9, 13-5) is installed in the middle of the confluence (Fig. 13-32) of the front edge (Fig. 14 - 31) of the right acetabulum and the horizontal branch of the right pubic bone (Fig. 13-33). After this chisel we adapt the edges of the acetabulum to the plane of the flanges. Then the ring is fixed to the part of the articular surface of the main fragment (Fig. 12, 17 - 42) of the acetabulum, which is connected by the iliac bone by inserting screws (Fig. 13, 14 - 43) through a group of holes (Fig. 5-15) of the support ring (Fig. 13, 14 - 43). Next, we sequentially insert the screws (Fig. 13, 14 - 43) into the articular surface of the fragment of the posterior colonic column (Fig. 17-40) and the anterior column of the pelvis (Fig. 17 - 41) through the corresponding holes of the first and second row of the ring. Then with needles with the thread at the end, drawn through the small holes of the ring, we fix alternately the intermediate fragments of the acetabulum and pull them to the ring, and then fix these intermediate fragments with screws less than 4.5 mm. Next, screwing the screws alternately, we tighten the fragments of the posterior and anterior columns to the ring and thus, we first fix them and at the same time fix them to the ring. After that, we twist the screws of small diameter alternately and tighten the intermediate fragments of the acetabulum to the ring (Fig. 13, 14, 17 - 44). In the next stage, the ring is fixed with screws to the ilium by inserting screws through the holes of three flanges (Fig. 15-9), while the screw closest to the ring of the second flange (Fig. 13, 14, 18 - 9, 43) should be screwed into the stem ischial bone (Fig. 9, 13, 14, 18 - 43).

Experimental example

The operation of the device is described using the example of modeling acetabular fracture B2.2 according to the AO / ASIF international classification on corpse material with reposition and fixation of fragments by reposition-fixation support ring for surgical treatment of displaced acetabular fractures.

The corpse is laid on the right side. We perform a classic external-front access (Fig. 15, 16) used for endoprosthetics to the hip joint (Fig. 17). We carry out an osteotomy of the femoral neck, we remove the head of the femur, and remove the pinnacle region posteriorly.

We model acetabular fracture B2.2 according to the AO / ASIF international classification by osteotomy of the acetabulum (Fig. 17) with a diastasis between fragments. We perform using the toolkit to bring the displaced fragments closer to each other, seeking the most accurate reposition.

The left reposition-fixation support ring is installed in the left acetabulum so (Fig. 18) so that the first flange is located above the upper edge of the right acetabulum, directly on the anterior lower spine of the right Ilium. The second flange is located at the confluence (Fig. 18) of the ischium and the posterior edge of the right acetabulum. The third flange (fig. 18) is installed at the place of confluence of the front edge of the right acetabulum and the horizontal branch of the right pubic bone.

Then the ring is fixed to the articular surface of the main fragment of the acetabulum by inserting screws (Fig. 18-43) through a group of holes (Fig. 18-43) of the support ring.

After that, we consistently insert the screws through the articular surface of the fragment of the posterior column of the pelvis (Fig. 17-40) and the anterior column of the pelvis (Fig. 17-41) through the corresponding holes of the first and second row of the ring. Then, using needles with the thread at the end, carried out through the small holes of the ring, fix alternately the intermediate fragments of the acetabulum and pull them to the ring, and then fix these intermediate fragments with screws less than 4.5 mm (Fig. 18-44). Next, screwing the screws alternately, we tighten the back and front columns to the ring and thus perform the final reposition of the fragments and simultaneously fix to the ring (Fig. 18). After that, we twist the screws of small diameter alternately and tighten the intermediate fragments of the acetabulum to the ring (Fig. 18-44).

At the next stage, we introduce screws through all the free holes in the ring, thus fixing the reduction and strengthening the fixation of the fragments. Then the ring is fixed to the pelvis by inserting screws through the holes of the three flanges (Fig. 18).

Thus, the reposition-fixation support ring, right and left, for the surgical treatment of displaced acetabular fractures using standard access to the hip joint allows:

выполнять репозицию отломков вертлужной впадины;

perform reposition of acetabular fragments;

окончательную фиксацию отломков вертлужной впадины;

final fixation of acetabular fragments;

надежную фиксацию отломков вертлужной впадины к опорному кольцу за счет введения фиксирующих винтов в костную массу стенок вертлужной впадины под разными углами;

reliable fixation of fragments of the acetabulum to the support ring due to the introduction of fixing screws into the bone mass of the walls of the acetabulum at different angles;

наличие трех групп отверстий кольца, находящихся на линии продольной оси трех фланцев позволяет вводить как минимум по три винта в основную массу отломков, образованную слиянием стенок вертлужной впадины с подвздошной костью, горизонтальной ветвью лонной и седалищной костей, и надежно фиксировать все фрагменты вертлужной впадины;

the presence of three groups of ring holes located on the line of the longitudinal axis of the three flanges allows inserting at least three screws into the main mass of fragments formed by merging the walls of the acetabulum with the iliac bone, the horizontal branch of the pubic and sciatic bones, and reliably fix all fragments of the acetabulum;

наличие фланцев позволяет выполнять дополнительную вне вертлужной впадины фиксацию отломков вертлужной впадины к опорному кольцу, что повышает стабильность фиксации;

the presence of flanges allows additional fixation of acetabular fragments outside the acetabulum to the support ring, which increases the stability of fixation;

использование стандартного доступа к тазобедренному суставу позволяет выполнять репозицию всех отломков вертлужной впадины и ее колонн, манипулируя в пределах самой вертлужной впадины, не скелетируя отломки и не нарушая кровоснабжение центральных и промежуточных фрагментов.

The use of standard access to the hip joint allows reposition of all fragments of the acetabulum and its columns, manipulating within the acetabulum itself, without skeletonizing fragments and without disturbing the blood supply to the central and intermediate fragments.

наличие малых отверстий в кольце позволяет репонировать и фиксировать промежуточные отломки вертлужной впадины, что повышает качество репозиции отломков и восстановления анатомии вертлужной впадины, что важно для последующего ревизионного эндопротезирования тазобедренного сустава;

the presence of small holes in the ring allows reposition and fixation of the intermediate fragments of the acetabulum, which improves the quality of reposition of fragments and restoration of the anatomy of the acetabulum, which is important for subsequent revision hip arthroplasty

выполнить последующее эндопротезирование тазобедренного сустава,

perform subsequent hip arthroplasty,

в ранние сроки начинать активное восстановление движений в оперированном суставе объективно имеет место положительный лечебный эффект, заключающийся:

early to begin active recovery of movements in the operated joint objectively there is a positive therapeutic effect, which consists of:

- to reduce the time of surgery, because only one external access to the hip joint is used, consequently, in reducing blood loss;

- reducing tissue trauma by optimizing the performance of surgical intervention;

наличие раннего экономического эффекта, заключающегося в сокращении стоимости лечения за счет использования только одного наружно-переднего доступа к тазобедренному суставу, следовательно, и уменьшения расходного операционного материала.

the presence of an early economic effect, which consists in reducing the cost of treatment due to the use of only one external-front access to the hip joint, therefore, and reducing the expendable surgical material.

наличие долгосрочного экономического эффекта, заключающегося в ранней реабилитации пациента, сокращении времени нетрудоспособности, следовательно, и затрат на лечение.

the presence of long-term economic effect, consisting in the early rehabilitation of the patient, reducing the time of disability, and hence the cost of treatment.

присутствует социальный эффект за счет восстановления качества жизни пациента.

there is a social effect by restoring the patient’s quality of life.

Claims (9)

Repositional-fixation support ring for surgical treatment of displaced polyfragmentary fractures of the acetabulum, having a concave shape and holes for inserting screws, characterized in that it has the shape of a hemisphere, an outer and an inner surface, two rows of holes in the hemisphere and three flanges with holes for insertion of fixing screws , the flanges are located on the outer surface of the hemisphere so that when the ring is installed in the acetabulum, two of them are on the same line connecting the middle of the place of fusion of the ischial bone and the lower edge of the acetabulum and the anterior lower iliac bone, the first of the two flanges is located on that part of the outer surface of the hemisphere of the ring, which corresponds to the place of the upper edge of the acetabulum, and the second of the two flanges is located on that part of the outer surface of the hemisphere of the ring, which corresponds to the place of confluence of the ischial bone and the lower edge of the acetabulum and the third flange on the ring is located on that part of the outer surface of the hemisphere, which corresponds to the confluence of the front edge of the acetabulum and the horizontal branch of the pubic bone and is located on the line connecting the middle of the confluence of the anterior edge of the acetabulum and the horizontal branch of the pubic bone and the posterior lower spine of the Ilium, and the plane of the first flange is at an angle with respect to the plane of the ring entrance, the plane of the second and third flanges of the ring is in the same plane with the plane of the ring entrance, at the same time, the holes of the three flanges make it possible to additionally fix the acetabular fragments to the reposition-fixation support ring, and in the ring, the first row of holes is located on the same line along the edge of the ring entrance, some distance from the edge towards the center, and the second row of holes is located on one line, some distance from the first row towards the center of the hemisphere, and the holes of the second row are located in relation to the holes of the first row in a staggered manner, moreover, three groups of holes consisting of two holes of the first and one hole of the second row are located opposite each of the three flanges, while the holes of the second row of each of the three groups of holes are located on the same line of the location of the corresponding flanges, the ring has holes for screws with a smaller diameter for fixing small intermediate fragments located between the holes at the level of the first and second rows of holes in those parts of the ring where it contacts the front and rear columns and the front and rear edges of the acetabulum and closer to centered on the second row of holes.

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