RU2779066C1 - Set of tools for adapting articulating surfaces in the defect of long tubular bones - Google Patents

Abstract

FIELD: medica technology.

SUBSTANCE: invention relates to medical technology, namely to a set of surgical instruments for traumatology and orthopedics, designed to provide mechanical processing of the ends of bone fragments. The set of tools for adapting articulating surfaces in the defect of long tubular bones includes three pairs of commensurate cutters equipped with working ends: a conical shape for processing bone fragments in the hypoplastic form of the defect, a cylindrical shape for processing bone fragments in the normoplastic form of the defect, a spherical shape for processing bone fragments in the hyperplastic form of the defect. Each pair of cutters contains one cutter with an outer working surface and one cutter with an inner working surface equipped with cutting edges. The transverse size of the working end of the cutters corresponds to the transverse size of the bone diaphysis. The working ends of cylindrical and spherical cutters from the end surface are made with a piercing point and with cutting edges for opening the medullary canal as the tool is immersed in the bone, the piercing point is made with a length of 10 mm.

EFFECT: use of the invention makes it possible to provide mechanical processing of tubular bone with minimal traumatization of tissues in the damaged segment of giving the closed ends a congruent shape, adapting the surfaces of the closed ends of fragments according to the geometric shape of the treated surface.

1 cl, 7 dwg

Description

Technical field

The technical solution relates to medicine, namely to sets of surgical instruments for traumatology and orthopedics, designed to provide mechanical processing of the ends of bone fragments.

The level of technology.

Pseudoarthrosis and hip defects in the structure of the consequences of injuries of long tubular bones occupy 3-4 place, being the cause of permanent disability in 10.7-30.8% of cases [Kaplan A.V. et al., 1973; Goridova L.D. et al., 1988; Balakina V.S., 1985; Yakunina L.N., 1989; Kuftyrev L.M., 1990; Borzunov D.Yu., 2004; G. Hierholzer et al., 1983; Hernigju P., 2002]. Concomitant processes and local complications in long bone defects create difficulties in the rehabilitation of the patient, and there is a need for long-term and multi-stage treatment.

The treatment of a formed false joint and a defect of a long tubular bone is presented exclusively on surgical intervention, which is based on the processing of the articulating surfaces of the bone, resection of non-congruent bones, opening of the medullary canal, removal of fibrous and cartilaginous tissues to ensure direct contact of the bone tissue.

To process the articulating ends of a bone defect, various instruments are used, often not meeting the tasks, but adapted to a given situation, depending on the anatomical features of the bone. The lack of special equipment significantly complicates the technology of surgical intervention, increases the time of the operation and does not guarantee the fusion of the false joint. Therefore, the surgeon is forced to additionally use bone autografts, intraosseous and extraosseous metal implants, and complex structures in the form of external fixation devices [Ahmed M. Thabet, Dror Paley, Mehmet Kocaoglu, Levent Eralp, John E. Herzenberg, Omer Naci Ergin, 2008].

For resection of pseudarthrosis, the following instruments are most often used [see. GOST 25725-89, Medical instruments. Terms and Definitions]:

Medical nippers - a double-edged articulated tool for biting bone tissue by closing the blades. Serves for cutting the bone, refreshing its edges and biting off small bone protrusions after cutting (with amputation of a limb). This tool is not suitable for processing large bones and cannot provide absolute congruence of surfaces.

Medical saws are a multi-bladed medical instrument with teeth set apart, designed to work with bone tissue and cut plaster casts. Designed for sawing hard tissues (bones and cartilage) during resection or amputation of limbs and bone grafting - osteosynthesis. Depending on the design, saws are divided into: frame, sheet, knife (with translational working movement), circular (with rotational working movement). The tool provides the simplest cross-sections of the bone, but does not provide absolute congruence and parallelism of the planes (Product catalog NPO DEOST, AO, DePuy, Smith and Nephew, ESI - www.deost.ru).

A medical chisel is a single-edged medical instrument with a blade with a double-sided sharpening, perpendicular to the axis of the instrument, designed to cut bone tissue with a hammer. They are used for chiselling and dissecting bones during various surgical operations (Product catalog of NPO DEOST, www.deost.ru).

Medical chisel - a single-edged medical instrument with a blade with one-sided sharpening, perpendicular to the axis of the instrument, designed to cut bone tissue with a hammer. Medical chisels and chisels do not provide absolutely congruent articulating surfaces, especially complex conical or spherical shapes.

A medical rasp is a multi-blade tool with notches located on the plane of the working part for treating the surface of bone tissue, but does not provide absolute congruence to the opposite surface of a complex shape.

In dental practice, it is known to use a set of tools for treating dental cavities, which includes the following tools: a medical drill, a medical drill, a drill, a medical drill.

Instruments for dentistry are not suitable for processing large surfaces, for creating congruent surfaces of tubular bones, thigh, lower leg, shoulder. Dental instruments are not dimensionally correct as the working parts are less than 10 mm in cross section.

In recent years, there has been a trend in the replacement of bone defects with implants, including bioactive ones, which are made using additive technology, provide rapid fusion and restore the anatomical length of the bone, but require standardization of the processing of bone fragments in order to completely adapt the free ends of bone fragments to the end surface of the implant. [www.deost.ru; Mironov S.P. et al., 2015; patent RU 162540; patent RU No. 171823; patent RU 173381; patent RU 173377; Bioactive implants in the treatment of pseudarthrosis and defects of long bones / Tomsk: Publishing house of the Tomsk Polytechnic University, 2021. - 312 p.; Popkov A.V., Kononovich N.A., Gorbach E.N., Popkov D.A., 2021].

A huge variety of forms of the ends of fragments of the defect and pseudarthrosis encountered in clinical practice requires the adaptation of bone articulating surfaces. Known tools do not allow for effective adaptation of the closed ends of the tubular bones.

The technical objective of the invention is to provide mechanical processing of the ends of bone fragments to give a congruent shape to the closed ends, to match the ends with defects and false joints of tubular bones, thigh, lower leg, shoulder, forearm.

The essence of the technical solution

The technical result consists in enabling (mechanical) surgical treatment of the tubular bone. Moreover, processing with minimal tissue trauma in the damaged segment is provided, giving the joined ends a congruent shape, adapting the surfaces of the joined ends of the fragments according to the geometric shape of the treated surface.

The technical result is achieved by the fact that a set of tools for adapting articulating surfaces in a defect of long tubular bones includes three pairs of commensurate cutters equipped with working ends: a conical shape for processing bone fragments with a hypoplastic form of a defect, a cylindrical shape for processing bone fragments with a normoplastic defect, a spherical shape for processing bone fragments with a hyperplastic defect, each pair of cutters contains one cutter with an external working surface and one cutter with an internal working surface equipped with cutting edges, the transverse size of the working end of the cutters corresponds to the size of the transverse size of the bone diaphysis, the working ends of the cutters are cylindrical and spherical with the end surface is made with a piercing point and with cutting edges for opening the medullary canal as the instrument is immersed in the bone, the piercing point is 10 mm long.

The specified essence allows to achieve the claimed technical result. Treatment of a formed false joint and defect of a long tubular bone using a set of instruments allows processing the articulating surfaces of the bone (thigh, lower leg, shoulder, forearm), resection of non-congruent bones, opening of the medullary canal, removal of fibrous and cartilaginous tissues to ensure direct contact of the bone tissue.

The technical solution is illustrated by graphic materials.

Fig.1 - three pairs of proportional cutters, equipped with working ends of a cylindrical, spherical and conical shape (the drill is shown conditionally, it is used as a drive for cutters);

Fig.2 - a pair of commensurate cutters, equipped with working ends of a conical shape;

Fig.3 - a pair of commensurate cutters, equipped with working ends of a cylindrical shape;

Fig.4 - a pair of commensurate cutters, equipped with working ends of a spherical shape;

Fig.5 - processing of the tibia with a cutter with a working end of a spherical shape (a hemisphere with an outer working surface);

Fig.6 - working ends of cutters with an outer working surface (cylindrical, conical, spherical);

Fig.7 - three pairs of commensurate cutters equipped with working ends of a cylindrical, spherical and conical shape (top view).

Specification:

1 - conical cutter with an outer working surface;

2 - conical cutter with an internal working surface;

3 - cylindrical cutter with an outer working surface;

4 - cylindrical cutter with an internal working surface;

5 - spherical cutter with an outer working surface;

6 - spherical cutter with an internal working surface;

7 - working end of a conical shape;

8 - working end of a cylindrical shape;

9 - working end of a spherical shape;

10 - cutting edges;

11 - piercing point;

12 - outlet channels;

13 - drill;

14 - shank.

Implementation of the invention

A huge variety of forms of the ends of fragments of the defect and pseudarthrosis encountered in clinical practice requires the adaptation of bone articulating surfaces. A set of tools for adapting articulating surfaces in a defect of long tubular bones makes it possible to process the ends of the bone and ensure effective adaptation of the occluded ends.

A set of tools (figure 1) for adapting the articulating surfaces in the defect of long tubular bones includes three pairs 1 and 2, 3 and 4, 5 and 6, commensurate cutters equipped with working ends: conical shape 7 (figure 2) for processing bone fragments when hypoplastic form of the defect, cylindrical shape 8 (figure 3) for processing bone fragments with normoplastic form of the defect, spherical shape 9 (figure 4) for processing bone fragments with hyperplastic form of the defect.

Each pair 1 and 2, 3 and 4, 5 and 6 contains one cutter with an outer working surface and one cutter with an inner working surface equipped with cutting edges 10. 3 The transverse size of the working end of the cutters corresponds to the average statistical value of the transverse size (width) of the bone diaphysis.

A pair of cutters 1 and 2 with working ends of a conical shape 7 (figure 2) for processing bone fragments with a hypoplastic form of the defect contains one cutter 1 with an outer working surface and one cutter 2 with an inner working surface equipped with cutting edges 10.

A pair of cutters 3 and 4 with working ends of a cylindrical shape 8 (figure 3) for processing bone fragments with a normoplastic form of the defect contains one cutter 3 with an outer working surface and one cutter 4 with an inner working surface provided with cutting edges 10.

A pair of cutters 5 and 6 with working ends of a spherical shape 9 (figure 4) for processing bone fragments with a hyperplastic defect form, contains one cutter 5 with an outer working surface and one cutter 6 with an inner working surface equipped with cutting edges 10.

Moreover, the working ends of the cutters of cylindrical 8 and spherical 9 shapes from the end surface are made with a stabbing point 11 and with cutting edges for opening the medullary canal as the tool is immersed in the bone. The stabbing point 11 is 10 mm long with cutting edges for opening the medullary cavity. Hemispherical cutter 5 with external cutting blades (cutting edges) contains outlet channels 12 for cut tissue.

In the hypoplastic form of a bone defect, the ends of the fragments are atrophic, pointed, there are no periosteal stratifications, pronounced eburnation of the medullary canal, and dangling pathological mobility is clinically noted. Surgical processing of the distal fragment of the bone defect is carried out with a conical cutter 2 with internal cutting blades (cutting edges) (figure 2), and the processing of the proximal fragment with a proportional conical cutter 1 with external cutting blades (cutting edges) (figure 2).

In the normoplastic form of the defect, the ends of the fragments are usually without extensive periosteal stratifications, moderately osteoporotic, the endplates are traced in the form of narrow sclerotic stripes, pathological mobility is pronounced (10-200). Surgical processing of the distal fragment of the bone defect is carried out with a cylindrical cutter 4 with internal cutting blades (cutting edges) (Fig. 3), and the proximal fragment is processed with a commensurate cylindrical cutter 3 with external cutting blades (cutting edges) (Fig. 3).

In the hyperplastic form of the defect, the ends of the fragments are "bamboo-like" thickened, the endplates are pronounced, their boundaries are indistinct. Clinically, tight pathological mobility is determined (but patients complain of soreness). Surgical processing of the distal fragment of the bone defect is carried out with a spherical cutter 6 with internal cutting blades (cutting edges) (figure 4), and the processing of the proximal fragment is proportional to the cutter 5 in the form of a hemisphere with external cutting blades (cutting edges) (figure 4).

The tool can be used for machining the ends of bone fragments to give a congruent shape to the closed ends, to match the ends with defects and false joints of tubular bones.

A set of instruments is made for each segment of the upper and lower extremities separately (thigh, lower leg, shoulder and forearm) based on the average diameter of the diaphysis of the femur, tibia, humerus and ulna in the population, with a deviation of no more than 1-3 mm.

The height of the processing of the ends of the bone defect does not exceed 10 mm and the cutters have a piercing tip at the top (Fig.6) with cutting edges for simultaneous opening of the medullary canal as the tool is immersed in the bone, with minimal tissue trauma in the damaged segment.

The transverse size of the working end 7, 8, 9 cutters for processing the femur corresponds to the average value of the transverse size of the diaphysis of the femur in the population.

The transverse size of the working end 7, 8, 9 cutters for processing the femur corresponds to the average value of the transverse size of the diaphysis of the femur in the population.

The transverse size of the working end 7, 8, 9 cutters for processing the tibia corresponds to the average value of the transverse size of the diaphysis of the tibia in the population.

The transverse size of the working end 7, 8, 9 cutters for processing the humerus corresponds to the average value of the transverse size of the diaphysis of the humerus in the population.

The transverse size of the working end 7, 8, 9 cutters for processing the ulna corresponds to the average value of the transverse size of the diaphysis of the ulna in the population.

Surgical intervention using a set of tools is performed as follows.

With skeletal traction, the main elements of the displacement of bone fragments are eliminated (along the length, width and periphery). Then, a longitudinal incision is made at the level of the defect. The muscles are pulled apart, the ends of the bone fragments are exposed. Above the free ends of the bone fragments, the periosteum is dissected by 1.5-2 cm. Then, one by one, the ends of the bone fragments are brought into the wound and treated with a cutter of the appropriate diameter to a depth of no more than 10 mm to ensure complete adaptation of the surface of the bone fragments or the surface of the bone and the cylindrical implant. The cutter is selected from a pair of 1 and 2, 3 and 4, 5 and 6, commensurate cutters equipped with working ends: conical shape 7 (figure 2) for processing bone fragments with a hypoplastic form of the defect, cylindrical shape 8 (figure 3) for processing fragments bones with a normoplastic form of the defect, spherical shape 9 (figure 4) for processing bone fragments with a hyperplastic form of the defect. To drive the cutter 1, 2, 3, 4, 5, 6, a drill 13 is used, the shank 14 of the cutter is installed in the drill chuck 13.

The cutters are equipped with working ends ranging in size from 20 to 40 mm in cross section, depending on which particular bone they are intended for processing and, in terms of the size of the working end, correspond to the width of the shaft of the bone being processed; during manufacture, the size is selected depending (equal) on the average statistical width of the shaft bones in the population.

A cylindrical implant of the length required to compensate for the shortening is placed in a bone defect, after which osteosynthesis is completed using available means, for example, an external fixation device or a bone plate. If there is no shortening of the limb segment, then after processing the bone ends, the latter are fixed with each other in an adapted position with an external fixation device. After that, the wound is sutured in layers and treatment is continued.

The technical result consists in increasing the efficiency of surgical treatment of the bone with minimal tissue trauma in the damaged segment, giving the occluded ends a congruent shape, adapting the surfaces of the occluded ends of the fragments in terms of geometric shape, length, thickness and radius of the treated surface.

Claims (1)

A set of tools for adapting articulating surfaces in a defect of long tubular bones, characterized by the fact that it includes three pairs of proportional cutters equipped with working ends: a conical shape for processing bone fragments with a hypoplastic defect, a cylindrical shape for processing bone fragments with a normoplastic defect, a spherical shape for processing bone fragments with a hyperplastic defect, each pair of cutters contains one cutter with an external working surface and one cutter with an internal working surface, equipped with cutting edges, the transverse size of the working end of the cutters corresponds to the size of the transverse size of the bone diaphysis, the working ends of the cutters are cylindrical and spherical in shape from the end surface are made with a piercing point and with cutting edges for opening the medullary canal as the instrument is immersed in the bone, the piercing point is 10 mm long.

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