RU2756429C1 - Apparatus for open low-traumatic reposition of acetabular columns and fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: apparatus for open reposition of acetabular columns and fragments consists of a main wire, a fixing part thereof, a second wire and a conductor tube and a fastening screw. The main wire has a fixing part on one end thereof, connected with the wire undetachably so as to move relative to the wire and take the retracted position parallel to the main wire and the extended position perpendicular to the wire. A second wire is attached to one end of the fixing part, capable of changing the position of the fixing part. The conductor tube is double and consists of two conductor tubes, an external conductor tube with an internal diameter for passing a wire with a fixing part, an internal conductor tube and a rough outer surface section. The inner conductor tube has an inner diameter for passing a wire with a fixing part. The fastening screw has a longitudinal internal channel, the diameter whereof allows for passing a wire therethrough, and the screwdriver also has a longitudinal internal channel, the diameter whereof allows for passing a wire therethrough.

EFFECT: ensures execution of all the required elements of manipulation for maximally accurate open reposition of acetabular columns and fragments exactly from the side of the acetabulum, complying with the requirements for sparing reposition, preventing traumatisation of soft tissues associated with acetabular fragments and columns, allowing for reliable fixation of acetabular columns and fragments exactly from the side of the acetabulum, preventing secondary displacement of acetabular columns and fragments, contributing to early activation of the patient in the postoperative period with simultaneous sufficient increase in the quality of their life.

1 cl, 26 dwg

Description

A device for open, low-trauma reduction of columns and fragments of the acetabulum refers to medicine, namely to the surgical treatment of displaced acetabular fractures, hip arthroplasty, experimental medicine, and biomechanics.

For the reposition of fragments and columns of the acetabulum, a device is proposed [Buachidze O.Sh. and other Surgery of the hip joint, M., Medicine, 2002, 15-20.].

However, this device does not allow effectively and minimally traumatic to perform open reduction and fixation of columns and fragments of the acetabulum and has the following disadvantages:

- does not allow performing the necessary elements of manipulation for the most accurate reposition of the columns and acetabular fragments exactly from the side of the acetabulum,

- injures soft tissues associated with fragments and columns of the acetabulum,

- does not meet the requirements of sparing reduction,

- does not allow fixation of the columns and fragments of the acetabulum exactly from the side of the acetabulum.

The objective of the invention is to develop a device for open, low-traumatic reposition of columns and acetabular fragments.

The technical result of the invention is to ensure the implementation of all the necessary manipulation elements for the most accurate open reduction of the columns and fragments of the acetabulum exactly from the side of the acetabulum, which meets the requirements of a gentle reduction, preventing trauma to the soft tissues associated with fragments and columns of the acetabulum, allowing reliable fixation of the columns and fragments of the acetabulum exactly from the side of the acetabulum, preventing secondary displacement of the columns and fragments of the acetabulum, contributing to the early activation of the patient in the postoperative period with a simultaneous sufficient increase in the quality of his life.

The technical result is achieved by the fact that the proposed device for an open low-traumatic reposition of columns and fragments of the acetabulum, characterized by the fact that it consists of a main wire, its fixing part, a second wire, a guide tube and a fastening screw, while the main wire has at one end a fixing part, moreover, the fixing part is permanently connected by a wire in such a way that it can easily move relative to the wire, and take a position of adduction parallel to the wire and a withdrawal position perpendicular to the wire, and a second wire is attached to one end of the fixing part, which can change the position of the fixing part , and the conductor tube is double, and consists of two conductor tubes, an outer conductor tube, which has an inner diameter for conducting a wire with a fixing part and an inner conductor tube, and a section of a rough outer surface, and the inner conductor tube has an inner diameter for holding the wire with a fixing part, while the fastening screw has a longitudinal inner channel, the diameter of which allows the wire to pass through it, and the screwdriver also has a longitudinal inner channel, the diameter of which allows the wire to pass through it.

Among the essential features characterizing the proposed device for an open, low-traumatic reposition of columns and fragments of the acetabulum are:

- from the main wire and its fixing part,

- the second wire,

- conductor tubes,

- fastening screw,

- in this case, the main wire has a fixing part at one end, moreover, the fixing part is permanently connected by a wire in such a way that it can easily move relative to the wire, and take the position of adduction parallel to the wire, and withdrawal, perpendicular to the wire,

- a second wire is attached to one end of the fixing part, which can change the position of the fixing part,

- in this case, the conductor tube is double, and consists of two conductor tubes, an outer conductor tube, which has an inner diameter for conducting a wire with a fixing part and an inner conductor tube, and a section of a rough outer surface,

- the inner conductor tube has an inner diameter for conducting the wire with a fixing part,

- in this case, the fastening screw has a longitudinal inner channel, the diameter of which allows the wire to pass through it.

All the distinguishing features of the prototype device for an open, low-traumatic reposition of columns and acetabular fragments are necessary and sufficient to achieve the technical result.

Experimental studies of the proposed device for open, low-traumatic reposition of columns and acetabular fragments have shown its high efficiency. It was found that the proposed device for open, low-trauma reduction of the columns and fragments of the acetabulum during its use provided a necessary and sufficient degree of reliable fixation of the columns and fragments of the acetabulum, performing a gentle reduction, reliable fixation of the columns and fragments of the acetabulum to the reduction-fixation support ring, secondary displacement of the columns and fragments of the acetabulum.

A device for open, low-trauma reduction of columns and fragments of the acetabulum, characterized by the described set of essential features, possesses an inventive step, is new and industrially applicable.

The essence of the proposed device for open, sparing reduction of columns and acetabular fragments is illustrated by the following figures:

FIG. 1. Photo of bone holders Olier and Farabef is presented.

FIG. 2. Photo of Olier bone holder is presented

FIG. 3. Shown is a photo of the permanently connected main wire and the fixing part, and the second wire. 1 - main wire; 2 - fixing part in the reduced position; 3 - second wire.

FIG. 4. Shown is a photo of the permanently connected main wire and the fixing part, and the second wire in another projection. 1 - main wire; 2 - fixing part of the wire in the retracted position; 3 - second wire.

FIG. 5. A photo of the guide tube is presented. 4 - outer conductor tube; 5 - inner tube - conductor; 6 - a section of the outer rough surface of the conductor tube.

FIG. 6. Presented is a photo of the assembled conductor tube. 4 - outer conductor tube; 5 - inner tube - conductor; 6 - a section of the outer rough surface of the conductor tube.

FIG. 7. Shown is a photo of a conductor tube with a wire passed through it. 1 - main wire; 2 - fixing part of the wire in the retracted position; 3 - the second wire; 4 - outer conductor tube; 5 - inner tube - conductor.

FIG. 8. Shown is a photo of a conductor tube with a wire passed through it. 1 - main wire; 2 - fixing part in the reduced position; 3 - the second wire; 4 - outer conductor tube; 5 - inner tube - conductor.

FIG. 9. Shown is a photo of the wire and the fixing screw. 1 - wire; 7 - fixing screw.

FIG. 10. Shown is a photo of the mounting screw. 7 - fastening screw; 8 - longitudinal channel of the fastening screw.

FIG. 11. Shown is a photo of the fixing screw with wire. 1 - wire, passed through the longitudinal channel (8) of the fastening screw (7); 7 - fixing screw; 8 - longitudinal channel of the fastening screw.

FIG. 12. Presented is a photo of a screwdriver. 9 - screwdriver; 10 - longitudinal channel of the screwdriver.

FIG. 13. Presented is a photo of a screwdriver with a wire. 1 - wire; 9 - screwdriver.

FIG. 14. Shown is a photo of the mounting screw and screwdriver. 7 - fastening screw; 9 - screwdriver.

FIG. 15. Shown is a photo of the fixing screw, screwdriver and wire. 1 - wire passed through the longitudinal channel of the fastening screw and screwdriver; 7 - fastening screw; 9 - screwdriver.

FIG. 16. The photo of the scheme of the acetabular fracture of type B2.2 according to the international classification AO / ASIF is presented. 11 - pelvic bone; 12 - the main fragment of the acetabulum associated with the ilium. 13 - acetabulum; 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum.

FIG. 17. A photo of modeling an acetabular fracture of type B2.2 according to the international classification AO / ASIF by osteotomy of the acetabulum of a pelvic bone dummy with the creation of diastasis between the columns is presented. 11 - pelvic bone; 12- the main fragment of the acetabulum associated with the ilium. 13 - acetabulum; 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum.

FIG. 18. Shown is a photo with a repositioning-fixation ring installed in the acetabulum. 12- the main fragment of the acetabulum associated with the ilium. 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum; 16 - reposition-fixation ring; 17 - drilled hole in the posterior acetabular column.

FIG. 19. Shown is a photo with a reduction-fixation ring and a guide tube installed in the acetabulum. 4 - conductor tube inserted into the drilled channel; 12- the main fragment of the acetabulum associated with the ilium. 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum; 16 - reposition-fixation ring; 17 - drilled hole in the posterior acetabular column.

FIG. 20. Shown is a photo with a repositioning-fixation ring and wire installed in the acetabulum. 1 - the main wire, passed through the drilled channel of the posterior acetabular column; 12- the main fragment of the acetabulum associated with the ilium. 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum; 16 - reposition-fixation ring; 17 - drilled hole in the posterior acetabular column.

FIG. 21. Presented is a photo of the inner surface of the ischium (inner surface of the anterior column). 1 - main wire; 2 - fixing part of the wire in the reduced position; 3 - the second wire; 4 - outer conductor tube; 5 - inner tube conductor; 17 - drilled hole from the side of the inner surface of the ischium (posterior acetabular column); eighteen -. the inner surface of the ischium (inner surface of the posterior column).

FIG. 22. Shown is a photo of the inner surface of the ischium (inner surface of the posterior acetabular column). 1 - main wire; 2 - fixing part of the wire in the retracted position; 3 - the second wire; 4 - outer conductor tube; 5 - inner tube conductor; 17 - drilled hole from the side of the inner surface of the ischium (posterior acetabular column); 18 - the inner surface of the ischium (inner surface of the posterior column).

FIG. 23. Shown is a photo of the inner surface of the ischium (inner surface of the posterior column) with a wire and a fixing part. 1 - main wire; 1 - main wire; 2 - fixing part of the wire in the retracted position; 3 - the second wire; 17 - drilled hole from the side of the inner surface of the ischium (posterior acetabular column); 18 - the inner surface of the ischium (inner surface of the posterior column).

FIG. 24. Shown is a photo of the inner surface of the ischium (inner surface of the posterior column) with a wire and a fixing part. 1 - main wire; 2 - fixing part of the wire in the retracted position; 17 - drilled hole from the side of the inner surface of the ischium (posterior acetabular column); 18 - the inner surface of the ischium (inner surface of the posterior column).

FIG. 25. Shown is a photo with a repositioning-fixation ring, a fixing screw and a wire installed in the acetabulum. 1 - main wire, passed through the drilled channel of the posterior acetabular column and through the inner channel of the fastening screw; 7 - a fastening screw screwed into the drilled channel in the posterior acetabular column with a wire passed through the internal channel of the fastening screw; 12 - the main fragment of the acetabulum associated with the ilium. 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum; 16 - reposition-fixation ring; 17 - drilled hole in the posterior acetabular column.

FIG. 26. A photo is shown with a repositioning-fixation ring, a fixing screw, a screwdriver and a wire installed in the acetabulum. 1 - main wire, passed through the drilled channel of the posterior acetabular column, through the inner channel of the fastening screw and through the inner channel of the screwdriver; 7 - a fastening screw screwed into the drilled channel in the posterior acetabular column with a wire passed through the internal channel of the fastening screw; 9 - screwdriver; 12 - the main fragment of the acetabulum associated with the ilium. 14 - posterior column of the acetabulum; 15 - anterior column of the acetabulum; 16 - reposition-fixation ring; 17 - drilled hole in the posterior acetabular column.

The device for open low-trauma reduction of columns and fragments of the acetabulum contains the following elements consists of a main wire (Fig. 3-1, Fig. 4-1, Fig. 7-9-1, Fig. 11-1, Fig. 13-1, Fig. 15-1, Fig. 20-26-1), its fixing part (Fig. 3-2, Fig. 4-2, Fig. 7-8-2, Fig. 21-24-2),

the second wire (Fig. 3-3, Fig. 4-3, Fig. 7-8-3, Fig. 21-24-3) and the conductor tube (Fig. 5-8-4, Fig. 19-4, Fig. 21-22-4), a fixing screw (Fig. 9-11-7, Fig. 14-15-7, Fig. 25-26-7) and a screwdriver (Fig. 12-15-9, Fig. 26 -9), while the main wire (Fig. 3-1, Fig. 4-1, Fig. 7-9-1, Fig. 11-1, Fig. 13-1, Fig. 15-1, Fig. 20-26-1) has at one end a fixing part (Fig. 3-2, Fig. 4-2, Fig. 7-8-2, Fig. 21-24-2), moreover, the fixing part is permanently connected by a wire such in such a way that it can easily move relative to the wire, and take the position of the drive - parallel to the wire (Fig. 3-2, Fig. 8-2, Fig. 21-2), and the leads - perpendicular to the wire (Fig. 4-2, Fig. 7-2, Fig. 22-24-2), and a second wire is attached to one end of the fixing part (Fig. 3-3, Fig. 4-3, Fig. 7-8-3, Fig. 21-24-3 ), which can change the position of the fixing part, and the conductor tube is double, and consists of two conductor tubes, an outer conductor tube (Fig. 5-8-4, Fig. 19-4, Fig. 2 1-22-4), which has an inner diameter for conducting a wire with a fixing part and an inner conductor tube (Fig. 5-8-5, figs. 19-5, figs. 21-22-5), and a section of a rough outer surface (Fig. 5-6, Fig. 6-6), preventing sliding of the conductor tube, and the inner conductor tube has an inner diameter for conducting a wire with a fixing part, while the fastening the screw has a longitudinal internal channel (Fig. 10-8, Fig. 11, 15, Fig. 25), the diameter of which allows a wire to pass through it, and the screwdriver also has a longitudinal internal channel (Fig. 12-10, Fig. 13, 15 , Fig. 26), the diameter of which allows a wire to pass through it.

The implementation of the proposed device for open, low-trauma reduction of columns and acetabular fragments is illustrated by the following experimental example.

An experimental example is presented by the example of modeling a fracture of the acetabulum B2.2 according to the international classification AO / ASIF (Fig. 16-17). To do this, we simulate the fracture of the acetabulum B2.2 of the right pelvic bone (Fig. 16-1) according to the international classification AO / ASIF by osteotomy of the acetabulum with the creation of diastasis between the columns. At the next stage, we bring the displaced columns closer to each other, achieving the most accurate reposition. Next, we install in the acetabulum a repositioning-fixation support ring (Fig. 18-16) corresponding to the acetabulum (Fig. 16, 17-13) size and fix it with fixing screws to the main fragment (Fig. 16-20-12, Fig. 25-26-12) of the acetabulum (Fig. 16-17-13) associated with the ilium. Then, after the achieved reduction, we drill a through channel (Fig. 18-26-17) through the articular surface and the entire thickness of the bone wall of the posterior column (Fig. 16-20-14, 25-26-14), and, if necessary, the anterior column ( fig. 16-20-15, 25-26-15). Next, into the drilled channel, we introduce conductor tubes (Fig. 19-4.5; Fig. 21-24-4.5) with threaded wires (Fig. 21-22-4) so that their ends stand out of the drilled channel from the inner side the surface of the ischium (Figs. 21-22-18). Then, with the inner tube-guide, we press on the fixing part of the wire and transfer the fixing part of the wire (Fig. 21-24-2) to the retracted position (Fig. 21-24-2), due to which the fixing part is hooked onto the inner surface of the acetabulum column (from the side of the small pelvis) (Fig. 24-2). After that, we pull the main wire (Fig. 20-1) and achieve the maximum approximation of the column to the adjacent wall of the ring. Then, without weakening the wire pull (Fig. 20, 25-1), we pass it through the inner channel of the fastening screw (Fig. 25-7), and screw the latter into the drilled channel in the posterior acetabulum column (Fig. 25-17 ). Further, without weakening the wire pull, we pass the latter through the inner channel of the screwdriver (Fig. 26-9), and insert the screwdriver into the head of the fastening screw (Fig. 26-9) and without loosening the wire pull, screw the screw until the screw head stops into the wall rings.

Claims (3)

A device for open reduction of columns and fragments of the acetabulum, consisting of a main wire, its fixing part, a second wire and a guide tube and a fastening screw, while the main wire has a fixing part at one end, and the fixing part is permanently connected to the wire in such a way that it can move relative to the wire and take a position parallel to the main wire and a lead position perpendicular to the wire, and a second wire is attached to one end of the fixing part, which can change the position of the fixing part, and the guide tube is double and consists of two guide tubes: the outer guide tube, which has an inner diameter for conducting the wire with the fixing part, and inner conductor tube, and a section of rough outer surface, and the inner conductor tube has an inner diameter for conducting a wire with a fixing part, while the fastening screw has a longitudinal inner channel, the diameter of which allows a wire to be passed through it, and the screwdriver also has a longitudinal inner channel , the diameter of which allows a wire to pass through it.

Images