RU2752808C1 - Guide for latarjet operation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly to orthopedics, and can be used in open-ended operation of Latarjet. Guide for operation of Latarjet has handle and working part. Guide plate is a non-separable structure with hollow guides. Working part of guide consists of base, guiding device for articular process of blade, guides of cylinders for bone block and guide hole for provisory wire. Total length of guide makes 162.4 mm. Length of guide handle 130.4 mm, length of working part 32 mm, at 100.4 mm from beginning of working part handle has bend, which is 100-140°. Thickness of handle after bending towards working part is 5.60 mm, and width 16 mm, at that angle of inclination of working part relative to handle makes 120-150°. Along the handle rear surface there are grooves with radius of 0.85 mm to guide holes of the working part. Handle diameter extends from bend to handle beginning from 8 mm to 11.2 mm. Base has thickness of 5.6 mm and width of 12.35 mm; at the inlet holes of the cylinder guides there is a projection with radius of 1.5 mm at the base. Guide device for the articular process of the blade has the shape of a parabola with height of 27 mm and width of 16 mm, at that the thickness of parabola is 2.5 mm. Parallel to the rear part of the parabola there is a graduation scale of 10 to 24 mm with pitch of 1 mm. Guide cylinders are located at distance of 6 mm from each other and 6-8 mm from the guide device for the glenoid. Diameter of cylinders is 3.50 mm, are cannulated with hole diameter of 1.70 mm. Orifice for the tamper-operated wire is located between guide cylinders at equal distances from them of 3 mm and has diameter of 1.7 mm.EFFECT: use of the invention makes it possible to facilitate positioning and installation of the instrument, to control the position, to ensure stability during the canal, to accurately visualize the bone block, to reduce the time of setting the pins to a greater depth and to provide different angles of inclination.1 cl, 1 dwg

Description

The device relates to medicine, in particular to orthopedics, and can be used in Latarje surgery performed in an open way.

At the moment, several devices are known for the installation, positioning and fixation of the bone block of the coracoid process or free bone auto / allograft on the articular process of the scapula during the Latarje operation. Correct positioning of the bone block on the articular process of the scapula is a critical factor in the further survival of the graft and the development of osteoarthritis.

The most common device is the Parallel Drill Guide with 4, 6, 8 mm offsets from Arthrex (De Beer J, Burkhart S, Roberts C, et al. The Congruent-Arc Latarjet. Tech Shoulder Elbow Surg. 2009; 10 (2) : 62-67). This guide is an elongated metal block whose approximate dimensions are; length 90 mm, width 18 mm, height 5 mm) with two sleeves at one end for fixing the bone graft in it; a removable handle is also fixed to this block. The guide and sleeves have two cannulated holes for the guide wires. At the end of the guide, where the sleeves are located, there is a flat narrow projection on one edge, which is located along the articular surface of the articular process of the scapula and simplifies positioning of the graft. After osteotomy, the bone graft of the coracoid process is fixed in the guide sleeves, positioned on the anterior portion of the articular process in the antero-lower section, and the guide wires are passed along it. Then the guide is removed, leaving the graft fixed with wires to the articular process of the scapula. Holes for screws in the graft and the articular process of the scapula are made along the guide pins with a cannulated drill. Then, along the needles, using a cannulated screwdriver, the graft is fixed with two cannulated screws.

However, this device has drawbacks that the surgeon faces during practical use. The main block of the guide is relatively long - about 9 cm, which makes it difficult to use with a large array of soft tissues. This is due to the fact that it is not possible to set the block in parallel, the articular plane fails due to its conflict with soft tissues: skin, subcutaneous fat, muscles). Also, the disadvantage of this device is the presence of a flat protrusion for orientation along the articular surface of the articular process of the scapula and the formation of an off-set - the indent of the graft from the articular space. In practice, this guide protrusion interferes with the positioning of the graft and makes orientation difficult. In our opinion, it is easier and more convenient to position the graft under visual control. Another disadvantage of this guide is the removable fixation of the handle, which complicates the work, increases the risk of its falling. Also, the handle of the guide is awkward enough to be held in the hand.

A modification of the Parallel Drill Guide is a targeting device (RU 158950 U1 01/20/2016) for fixing the graft during the restoration of a bone defect in the articular process of the scapula. This device contains a rectangular shortened block with two parallel longitudinal holes and protruding bushings installed in them, having through holes for guiding spokes, a handle rigidly fixed to the block, consisting of two bases connected to each other and extending from both sides of the block at an angle of 45 ° having a bend at an angle of 45 °; oriented parallel to the block, the block being 40 mm long, 18 mm wide and 8 mm high. This device is devoid of a flat protrusion for positioning the graft and has a shortened block, which reduces the impact of soft tissues and facilitates its positioning. The use of this device allows to reduce trauma and shorten the operation time (RU 158950 U1 01/20/2016).

However, previously known devices have certain disadvantages. Namely, there remains the problem of precise positioning of the bone block on the articular process of the scapula depending on the inclination of the glenoid, the size of the bone block and the size of the defect.

The task of the present device is to eliminate the identified shortcomings of previously known devices and consists in facilitating the positioning and installation of the instrument, facilitating the position control, ensuring stability during the canal passage, and ensuring accurate visualization of the bone block.

The technical result of the claimed instrument is to facilitate positioning and installation of the instrument, facilitate position control, ensure stability during the canal, ensure accurate visualization of the bone block, reduce the time for setting the pins to great depths, and provide various angles of inclination.

The specified technical result is realized due to the following design features of the device. The guide is a non-separable design and consists of a handle (1) and a working part (2), with hollow guides. In this case, the total length of the tool is 162.4 mm. The length of the guide handle is 130.4 mm, the length of the working part is 32 mm. At a distance of 100.4 mm from the beginning of the working part, the handle has a bend, which is variable and ranges from 100 ° to 140 °, depending on the anatomical features of the patient. The thickness of the handle after bending towards the working part is 5.6 mm, the width of the handle after bending towards the working part is 16 mm. In this case, the angle of inclination of the working part relative to the handle is from 120 ° to 150 °, depending on the anatomical features of the patient. On the back surface of the handle, grooves with a radius of 0.85 mm are laid to the guide holes of the working part. The diameter of the handle expands from the bend to the beginning of the handle from 8 mm to 11.2 mm, respectively.

The working part of the guide consists of a base (3), a guide device for the articular process of the scapula (6), guide cylinders for the bone block (4) and a guide hole for the provisional wire. The base is 5.6mm thick and 12.35mm wide. There is a protrusion (5) with a radius of 1.5 mm at the inlet holes of the guide cylinders on the base. The guiding device for the articular process of the scapula has the form of a parabola with a height of 27 mm, a width of 16 mm, while the thickness of the parabola is 2.5 mm. On the back of the parabola there is a graduation scale from 10 to 24 mm in 1 mm increments. The guide cylinders are located at a distance of 6 mm from each other and 6-8 mm from the guide device for the articular process of the scapula. The diameter of the cylinders is 3.5 mm, are cannulated with a hole diameter of 1.7 mm. The hole for the provisional knitting needle is located between the guide cylinders at equal distances from them 3 mm, has a diameter of 1.7 mm.

The target can be made of titanium, medical steel, or other durable materials used in the manufacture of medical instruments.

The guide is illustrated by drawings with a particular case of the inclination angle of FIG. 1, where 1 is the handle; 2 - working part; 3 - base; 4 - guide cylinders for the bone block; 5 - ledge on the base; 6 - guiding device for the articular process of the scapula.

Examples of specific implementation.

Example 1.

The guide is a non-separable design and consists of a handle (1) and a working part (2), with hollow guides. In this case, the total length of the tool is 162.4 mm. The length of the guide handle is 130.4 mm, the length of the working part is 32 mm. At a distance of 100.4 mm from the beginning of the working part, the handle has a bend of 100 °. The thickness of the handle after bending towards the working part is 5.6 mm, the width of the handle after bending towards the working part is 16 mm. In this case, the angle of inclination of the working part relative to the handle is 120 °. On the back surface of the handle, grooves with a radius of 0.85 mm are laid to the guide holes of the working part. The diameter of the handle expands from the bend towards the beginning of the handle from 8 mm to 11.2 mm, respectively.

The working part of the guide consists of a base (3), a guide device for the articular process of the scapula (6), guide cylinders for the bone block (4) and a guide hole for the provisional wire. The base is 5.6mm thick and 12.35mm wide. There is a protrusion (5) with a radius of 1.5 mm at the inlet holes of the guide cylinders on the base. The guiding device for the articular process of the scapula has the form of a parabola with a height of 27 mm, a width of 16 mm, while the thickness of the parabola is 2.5 mm. On the back of the parabola there is a graduation scale from 10 to 24 mm in 1 mm increments. The guide cylinders are located at a distance of 6 mm from each other and 6 mm from the guide device for the articular process of the scapula. The cylinders have a diameter of 3.5 mm, cannulated with a hole diameter of 1.70 mm. The hole for the provisional knitting needle is located between the guide cylinders at equal distances from them 3 mm, has a diameter of 1.7 mm.

Example 2.

The guide is a non-separable design and consists of a handle (1) and a working part (2), with hollow guides. In this case, the total length of the tool is 162.4 mm. The length of the guide handle is 130.4 mm, the length of the working part is 32 mm. At a distance of 100.4 mm from the beginning of the working part, the handle has a bend of 140 °. The thickness of the handle after bending towards the working part is 5.6 mm, the width of the handle after bending towards the working part is 16 mm. In this case, the angle of inclination of the working part relative to the handle is 150 °. On the back surface of the handle, grooves with a radius of 0.85 mm are laid to the guide holes of the working part. The diameter of the handle expands from the bend towards the beginning of the handle from 8 mm to 11.2 mm, respectively.

The working part of the guide consists of a base (3), a guide device for the articular process of the scapula (6), guide cylinders for the bone block (4) and a guide hole for the provisional wire. The base is 5.6mm thick and 12.35mm wide. There is a protrusion (5) with a radius of 1.5 mm at the inlet holes of the guide cylinders on the base. The guiding device for the articular process of the scapula has the form of a parabola with a height of 27 mm, a width of 16 mm, while the thickness of the parabola is 2.5 mm. On the back of the parabola there is a graduation scale from 10 to 24 mm in 1 mm increments. The guide cylinders are located at a distance of 6 mm from each other and 8 mm from the guide device for the articular process of the scapula. The cylinders have a diameter of 3.5 mm, cannulated with a hole diameter of 1.70 mm. The hole for the provisional knitting needle is located between the guide cylinders at an equal distance from them 3 mm, has a diameter of 1.7 mm.

The advantages of the present invention are:

• Low profile design - facilitates positioning and installation;

• Additional hole for the fixing pin - facilitates position control and positioning; additional stability when conducting channels;

• Graduated parabolic guiding devices - provides accurate visualization of the bone block during placement, it is possible to control the gap when placing the block and checking the position;

• Support for the introduction of the needles on the base of the guide - provides quick installation of the needles at great depth;

• non-separable design provides additional rigidity of the structure;

• different off-sets and different angles of inclination of the working part, depending on the anatomical features of the patient.

Claims (1)

The guide for Latarje operation has a handle and a working part, which is different in that; that the guide is a non-separable structure with hollow guides, the working part of the guide consists of a base, a guide device for the articular process of the scapula, guide cylinders for the bone block and a guide hole for the provisional wire; the total length of the guide is 162.4 mm; the length of the guide handle is 130.4 mm, the length of the working part is 32 mm, at a distance of 100.4 mm from the beginning of the working part the handle has a bend of 100-140 °; the thickness of the handle after bending towards the working part is 5.60 mm, and the width is 16 mm, while the angle of inclination of the working part relative to the handle is 120-150º; grooves with a radius of 0.85 mm are laid along the back surface of the handle to the guide holes of the working part; the diameter of the handle expands from the bend towards the beginning of the handle from 8 mm to 11.2 mm, respectively; the base has a thickness of 5.6 mm and a width of 12.35 mm, at the inlet holes of the guide cylinders on the base there is a protrusion with a radius of 1.5 mm; the guiding device for the articular process of the scapula has the form of a parabola with a height of 27 mm and a width of 16 mm, while the thickness of the parabola is 2.5 mm; on the back of the parabola there is a graduation scale from 10 to 24 mm with a step of 1 mm, the guide cylinders are located at a distance of 6 mm from each other and 6-8 mm from the guide device for the glenoid, the diameter of the cylinders is 3.50 mm, are cannulated with a diameter holes 1.70 mm, the hole for the provisional knitting needle is located between the guide cylinders at an equal distance from them in 3 mm; has a diameter of 1.7 mm.

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