RU2750518C1 - Device for clamping transosseous elements - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: device belongs to medical equipment, namely to instruments used in operative orthopedics and traumatology. The device for clamping transosseous elements is a knob for fastening rods, spokes, taps and cerclage wire, consists of a threaded sleeve with a transverse hole, brackets with a threaded shank, bolts and nuts from the Ilizarov apparatus. The clamp of the transosseous elements is made with the possibility of introducing the transosseous elements into the transverse hole of the threaded sleeve, one or both ends of which are made with the possibility of introducing the threaded shank of the bracket with T- or L-shaped fastened by counter screwing of the nuts in the hole of the bracket with a bolt, which is fixed by turning clockwise transosseous elements in the transverse hole of the threaded sleeve with the possibility of pressing and blocking the transosseous elements in a given position with the end surface of the threaded shank of one or two brackets.EFFECT: use of the invention makes it possible to increase the efficiency of treatment of patients with skeletal fractures, including long and short tubular bones, by optimizing open and closed intramedullary, extra-focal and extrafocal osteosynthesis.1 cl, 5 dwg, 1 ex

Description

The device belongs to medical equipment, namely to instruments used in operative orthopedics and traumatology.

Relevance. Osteosynthesis is a surgical intervention in the treatment of fractures of the bones of the skeleton with the achievement of reduction and fixation of bone fragments until the formation and maturation of callus. In this case, the role of provisional callus is played by the corresponding metal structures that perform the function of periosteal and endosteal callus. The absence or loss of stability of osteosynthesis can be a consequence of both imperfection of metal structures and surgical technique, and the absence of adequate conditions for the normal course of reparative osteogenesis. Therefore, during osteosynthesis, a balance must be maintained between the mechanical and biological conditions of fracture healing, which directly depends on the instrumentation, the quality of the metal structures used and the atraumatic nature of the surgical technique of intervention. In the system of osteosynthesis methods, screws, plates, pins, rods, nails, external fixation devices and wire cerclage are used as intraosseous implants for fixing fractures.

Analogs

In modern surgical traumatology and orthopedics, a wide range of implants for atraumatic minimally invasive osteosynthesis and the instruments necessary for their application are used. These are spoke, rod and hybrid external fixation devices, distractors, repositioning forceps, handles for repositioning bone fragments (joysticks - Shantz screws with special removable handles), bushings, taps, screwdrivers.

Criticism of analogues

A common disadvantage of all the given analogs is the narrow focus and specificity of each of them with the need for a wide inventory of auxiliary tools.

Prototype

As a prototype device for the proposed device, we have chosen a control handle (joystick) for reposition of bone fragments (Ankin L.N., Ankin N.L. Practical traumatology. European standards of diagnosis and treatment - M .: Kniga-plus, 2002. - 480 s; - S. 58-74; - prototype device), used in closed intramedullary osteosynthesis of long tubular bones, for example, the femur. The essence and application of this prototype device are as follows. The patient lies on the operating table on a healthy side, the injured limb is bent at the knee joint at an angle of 100 degrees. Reposition of bone fragments is performed using devices of an orthopedic table, a distractor, an external fixation device or Shants' rods, which are inserted into the bone fragments and used as control knobs - joysticks (Fig. 1). When bone fragments are repositioned, the Shants 'rods should be placed as close to the fracture as possible - the Shants' rod is inserted monocortically into the proximal fragment, and bicortically into the distal fragment, and with the help of two T-shaped handles, the fragments are repositioned under the control of an image intensifier (under X-ray control). After reduction, closed intramedullary osteosynthesis with blocking rods is performed.

Criticism of the prototype

T-shaped handles for Shants rods used as joysticks have the following disadvantages:

- too narrow focus and specialization with limited indications for use and the possibility of using only for reduction in the operation of intramedullary osteosynthesis of long bones;

- massiveness of the T-shaped handle for Shants rods;

- the complexity of the application with not always justifiably large expenditures of time;

- the problematic nature of the search and the complexity of manufacturing this device, which is not included in the register of traditionally used instruments in operative orthopedics and traumatology.

The purpose of the invention is to improve the efficiency of treatment of patients with skeletal fractures, including long and short tubular bones, by optimizing open and closed intramedullary, extra-focal and extrafocal osteosynthesis.

The essence of the invention

A device for clamping transosseous elements is proposed, which is a knob for fastening rods, spokes, taps and cerclage wire, and characterized in that it consists of parts of a standard set of the Ilizarov apparatus (Fig. 2), namely: a threaded sleeve (pos. 1) with a cross hole, brackets with a threaded shank (key 2), bolts (key 3), and nuts (key 4). In this case, the clamping of transosseous elements (Fig. 3), namely rods (pos. 5), spokes (pos. 6), taps (pos. 7) and cerclage wire (pos. 8), is carried out in this device (Fig. 4) , by introducing them (Fig. 5 a, b), for example, a rod (pos. 5), into the transverse hole of the threaded sleeve (pos. 1), into one or both ends of which the threaded shank of the bracket (pos. 2) is inserted with T - or L-shaped fixed counter-screwing of nuts (pos. 4) in the hole of the bracket (pos. 2) with a bolt (pos. 3), turning which clockwise (fig.5a) fix the transosseous elements, for example, a rod (pos. 5 ), in the transverse hole of the threaded sleeve (pos. 1) by pressing and blocking (fig. 5b) in a given position by the end surface of the threaded shank of one bracket (pos. 2). If it is necessary to enhance the reliability of fixation of the transosseous element, it is possible to insert the threaded shank of the second bracket (pos. 2) into the other end of the threaded sleeve (pos. 1), in the hole of which by counter-screwing the nuts (pos. 4) a T- or L-shaped bolt is fixed (pos. 3), by turning it clockwise, additional fixation of the transosseous element, for example, the rod (pos. 5), in the transverse hole of the threaded sleeve (pos. 1) is carried out by pressing and locking in a given position with the end surface of the threaded shank of the bracket (pos. 2). To remove the transosseous element from this device, in which it is fixed, it is necessary to perform a reverse rotation - that is, counterclockwise - of the bolt, T- or L-shaped fixed in the hole of the bracket by counter-screwing the nuts. In this case, in the transverse hole of the threaded sleeve, the transosseous element is unlocked due to the termination of its pressing by the end surface of the threaded shank of the bracket.

Application example of the device

As an example of the application of this device for clamping transosseous elements, we give the following observation. Patient M., 59 years old, was treated at the Republican Center of Orthopedics and Traumatology (RCTO) in Makhachkala from 04/12/2020 to 04/20/2020 with a diagnosis of Closed comminuted fracture of the middle third of the left humerus with displacement.

On April 14, 2020, the operation was performed in a planned manner: Extraural osteosynthesis of a comminuted fracture of the middle third of the left humerus with a plate. In the position of the patient on his back with the left upper limb retracted and laid on the table, an anterolateral longitudinal skin incision was made from the level of the shoulder neck downwards, 14-15 cm long. The fascia was dissected and along the fibers of the longitudinally split anterior portion of the deltoid and brachial muscles, the comminuted fracture zone was exposed middle third of the humerus. In the distal part of the access, visualization, economical isolation and abduction towards the radial nerve were performed. The bone fragments were repositioned with provisional fixation with a Kirschner wire. A low-contact plate with 12 holes for 3.5 mm screws was placed on the rehearsed bone fragments (with preliminary reaming of the canals in the bone with a 2.7 mm drill). At the same time, 3 screws were inserted into the proximal bone fragment, and 4 screws were inserted into the distal one with bicortical fixation of each of the screws. The bone splinter was placed and adequately retained on its bed by soft tissues and nylon cerclage. The provisional needle has been removed. Before screwing in the screws, to increase the metal-to-bone contact and better match the thread profile of the bone and screws, a tap was used, which was fixed in a wrench, consisting of parts of a standard set of the Ilizarov apparatus, namely: a threaded sleeve with a transverse hole, a bracket with threaded shank, bolt and nuts. In this case, the clamp of the tap in the wrench is carried out by introducing its end into the transverse hole of the threaded sleeve, into one end of which the threaded shank of the bracket is inserted with a T-shaped counter-screwing of the nuts in the hole of the bracket with a bolt, turning which clockwise fixes and locks the tap in the transverse hole the threaded sleeve by pressing it in a given position with the end surface of the threaded shank of the bracket. Osteosynthesis is stable. Passive movements in the left shoulder and elbow joints in full. The wound was washed with antiseptic solutions and sutured in layers. An aseptic dressing was applied to the wound. The control radiographs showed a satisfactory position of the bone fragments. The postoperative period was uneventful, the wound healed primarily. The patient was discharged for outpatient treatment with a recommendation to engage in dosed and increasing exercise therapy and to perform a control X-ray of the shoulder after 4 weeks. The result of the treatment was assessed as good.

Features of the invention that differ from the prototype

The design features (distinctive features of the prototype) of the device for clamping transosseous elements are:

- the device is a knob for fixing rods, knitting needles, taps and cerclage wire;

- the device consists of parts of a standard set of the Ilizarov apparatus, namely: a threaded sleeve with a transverse hole, brackets with a threaded shank, bolts and nuts;

- the diameter of the transosseous elements fixed in the device should not exceed the diameter of the transverse hole of the threaded sleeve, equal to 7 mm;

- the clamping of the transosseous elements in the device is carried out by introducing them into the transverse hole of the threaded sleeve, into one or both ends of which the threaded shank of the bracket is inserted with a T- or L-shaped counter-screwing of the nuts in the hole of the bracket with a bolt, turning which clockwise fix the transosseous elements ;

- fixation of transosseous elements in the transverse hole of the threaded sleeve is carried out by pressing and locking in a given position with the end surface of the threaded shank of the bracket;

- if it is necessary to enhance the reliability of fixation of the transosseous element, it is possible to insert the threaded shank of the second bracket into the other end of the threaded sleeve, in the hole of which, by counter screwing the nuts T- or L-shaped, a bolt is fixed, turning which clockwise performs additional fixation of the transosseous element in the transverse hole a threaded sleeve by pressing and locking in a predetermined position by the end surface of the threaded shank of the second bracket;

- to remove the transosseous element from the device, which is a knob, in which it is fixed, it is necessary to reverse the rotation of the bolt, T- or L-shaped fixed in the hole of the bracket by counter-screwing the nuts, counterclockwise. In this case, in the transverse hole of the threaded sleeve, the transosseous element is unlocked due to the termination of its pressing by the end surface of the threaded shank of the bracket.

The technical result (advantages over the prototype) of a device for clamping transosseous elements:

- efficiency, speed and simplicity of manufacturing the device, parts for which are usually available in any orthopedic and trauma department;

- the need and sufficiency for fastening the transosseous elements in the device for clockwise rotation of the bolt, T- or L-shaped fixed in the hole of the bracket by counter screwing the nuts, - as well as its reverse rotation counterclockwise to unblock and remove the transosseous elements from the device;

- a wide range of acceptability and indications for the use of the device: both for attaching transosseous elements and for manipulating them: use as a joystick, awl, tap, for manual osteoperforation with a knitting needle or a rod, as a device for twisting a wire, etc. .;

- if it is necessary to enhance the reliability of fixation of the transosseous element - a reserve possibility of introducing into the other end of the threaded sleeve the threaded shank of the second bracket, in the hole of which by counter screwing the nuts T- or L-shaped a bolt is fixed, turning which clockwise performs additional fixation of the transosseous element in the transverse the hole of the threaded sleeve by pressing and blocking in a given position with the end surface of the threaded shank of the bracket;

- the speed of blocking (clamping) and unblocking of the transosseous elements in the device by turning clockwise and counterclockwise a bolt, T- or L-shaped fixed in the hole of the bracket by counter-screwing the nuts;

- the possibility of adjusting the level of installation and dispensing the force of attachment of transosseous elements in the device;

- compact design, comfort and ergonomics of using the device during the osteosynthesis operation, due to the quickness and ease of fastening the transosseous elements in the device and unlocking and removing them;

- higher efficiency and versatility due to the possibility of using in different operations and on different segments and levels of both tubular and flat bones;

- a significant reduction in the labor intensity and duration of surgical intervention, due to the absence of the need to use wrenches when blocking and unblocking the transosseous elements in the device.

Thus, the proposed device makes it possible to increase the efficiency of treatment of orthopedic and traumatological patients in need of extramedullary, intramedullary or extrafocal osteosynthesis.

Information:

1) Boychev B., Konforti B., Chokanov K. Operative orthopedics and traumatology. - 2nd ed., Rev. and add. - CI "Medicine and Physical Education", - Sofia, 1958, - 832. - S. 84-92;

2) Movshovich I.A. Operative Orthopedics: (A Guide for Physicians). - 2nd ed., Rev. and add. - M .: Medicine, 1994 .-- 448 p. - S. 35-43;

3) Mueller M.E. Guide to internal osteosynthesis: Per. with him. / M.E. Müller, M. Allhover, R. Schneider, H. Willinger. - 3rd ed., Ext. and additional - M .: Publishing house AdMarginem, 1996. - 750 p .;

4) Burykh M.P. General principles of technology of surgical operations // Guide for surgeons. - Rostov n / a .: publishing house "Phoenix", 1999. - 544 p .;

5) Nabokov A.Yu. Modern osteosynthesis / M .: Medical Information Agency, 2007. - 400 p; - S. 17-46;

6) Traumatology and Orthopedics: A Guide for Physicians / Ed. N.V. Kornilov: in 4 volumes. - T. 1: General issues of traumatology and orthopedics. - SPb .: Hippocrates, 2006 .-- 624 p. - S. 303-388;

7) Ankin L.N., Ankin N.L. Practical traumatology. European standards of diagnosis and treatment - M .: Kniga-plus, 2002. - 480 p .; - S. 58-74; - prototype device.

Claims (1)

A device for clamping transosseous elements, which is a knob for fastening rods, spokes, taps and cerclage wire, consisting of a threaded sleeve with a transverse hole, brackets with a threaded shank, bolts and nuts from the Ilizarov apparatus, while the clamp of transosseous elements is made with the possibility of insertion transosseous elements into the transverse hole of the threaded sleeve, one or both ends of which are made with the possibility of inserting a threaded shank of the bracket with a T- or L-shaped counter-screwing of the nuts in the hole of the bracket with a bolt, turning clockwise to fix the transosseous elements in the transverse hole of the threaded sleeve with the possibility of pressing and blocking the transosseous elements in a given position by the end surface of the threaded shank of one or two brackets.

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