RU2796873C1 - Set for installation of a plate for osteosynthesis in the treatment of valgus deformity of the first toe and a method of its use - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: set for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe includes a support stand for the operating table, two bone screws for the first metatarsal bone, a guide body for two bone screws for the first metatarsal bone and for the support stand, a needle for drilling a through hole in the bone, a pin guide with a bearing plane and a pin, a flat blade for forming a flat sawdust on the head of the first metatarsal bone under the bearing plane of the pin guide, a drill with a stop for the pin hole of the pin guide, a drill guide, a flat blade guide, a cannulated V-chisel for osteotomy of the head of the first metatarsal bone, having a guide sleeve for the wire, a rasp for the bone bed under the immersion part of the plate for osteosynthesis, a rasp guide, a vertical guide to the guide for a flat blade, a transverse guide for the vertical guide and for the rasp guide, a longitudinal guide to the guide body and to the cross rail and auxiliary clamps. A method of installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe using the above kit, during which a stand and a guide body are installed, with the help of which holes are drilled in the first metatarsal bone, into which bone screws are then wrapped and fixed with clamps in guide body. Then the rack is removed. The longitudinal guide is connected to the guide body and fixed with a lock, after which the longitudinal guide is connected to the transverse guide. Then the vertical and transverse guides are connected and fixed with a latch. After that, the flat blade guide is connected and fixed with a retainer with a vertical guide. After that, using a flat blade for dissection of bone tissues, sawdust of the head of the first metatarsal bone is performed. The vertical guide connected to the flat blade guide is then removed. Then, with the help of a drill guide and a drill with a stop, a hole is drilled in the bone. The needle guide is installed on the sawdust in such a way that the pin is placed in the drilled hole, and the support plane of the needle guide is aligned with the plane of the sawdust. Then the pin is placed in the through guide hole of the pin guide and the hole is drilled into the bone using the pin. The spoke guide is then removed, leaving the spoke in the hole formed by it. Then, a cannulated V-shaped chisel is placed on the free end of the spoke. Then osteotomy of the head of the first metatarsal bone is performed. Next, a rasp guide is installed on the transverse guide, after which, with the help of a rasp, a nest is formed under the submersible part of the osteosynthesis plate, in which the osteosynthesis plate is installed.

EFFECT: inventions provide an increase in the effectiveness of Hallux Valgus treatment and expansion of the possibilities of controlled manipulations and visual control while maintaining accessibility.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics, namely to a set for installing a plate for osteosynthesis in the treatment of hallux valgus deformity of the first toe (hereinafter referred to as "Hallux Valgus") and a method for using it.

Today, Hallux Valgus is one of the most common orthopedic diseases, accounting for about 75% of all orthopedic foot pathologies. This deformity of the first toe can be accompanied by significant pain and limitation of movement. In this case, Hallux Valgus is eliminated only with the help of surgery. Currently, there are many different methods for treating this pathology and their improvement, as well as the evaluation of their effectiveness, especially for severe Hallux Valgus, are extremely relevant tasks for developers in the field of traumatology and orthopedics (Pavlova N.V., Sotnikova K.I., Surgical treatment of hallux valgus MECCHNIKOV READINGS-2021, proceedings of the 94th All-Russian Scientific and Practical Student Conference with International Participation, 2021. I. I. Mechnikov North-Western State Medical University, 165-166, eLIBRARY ID: 46407793) .

Thus, a device and a method for personalized treatment of Hallux Valgus are known (Device for personalized treatment of hallux valgus deformity of the toe and method of its use: patent RU2741198, Russian Federation, application RU2020115314, application 04/30/2020, publ. 01/22/2021). This device contains the first and second templates and a fastener for installation on a flat surface of sawdust of osteochondral exostosis of the head of the first metatarsal bone. The second template is designed to be installed on the first template with a tenon-groove connection. The fastening element is made of a rounded shape and is equipped on the extraosseous surface with a pin for fixing on the flat surface of the sawdust of the osteochondral exostosis of the head of the first metatarsal bone and has risks corresponding to the risks on the first template for orienting the position of the fastener. A hole for a repositioning tool is made in the center of the fastener. The first template contains a through hole for adaptation with the metatarsal head. The mentioned through hole and the extraosseous surface of the template are made according to the individual parameters of each patient, taking into account the anatomical features of his foot. The first template has channels for passing self-tapping screws for fixation to the bone and channels for screws for osteosynthesis. The first template contains grooves designed to receive the spikes of the second template. The second template contains a guide for the movement of the repositioning tool, in which the stop for the lowest position of the repositioning tool corresponds to the hole for installing the repositioning tool in the fastener. The second template on the inner surface contains spikes for installation in the grooves of the first template. The first and second templates each have a sawdust guide for the metatarsal head, and these guides coincide. A method for personalized treatment of valgus deformity of the first toe using the above device, during which the patient's foot is examined using radiation diagnostic methods with and without load, the results of which are used to produce the above personalized device. Further, at the stage of surgical treatment, after access from the medial side of the foot to the first metatarsal bone, the first template is adapted to the head of the first metatarsal bone using the hole intended for this and fixed with self-tapping screws. Then, sawdust of exostosis is made along the surface of the first template, after which a fastener is installed on the formed surface with the help of a pin so that the risks on the first template and the fastener coincide. Then, a second template is installed on the first template using a tenon-groove connection, after which a repositioning tool is installed into the bone through the guide and the hole in the fastening element and the metatarsal head is repositioned. Further, osteosynthesis screws are installed in the channels for osteosynthesis screws on the first template, which fix the head of the metatarsal bone relative to the diaphysis. Further, the instrument, self-tapping screws, fastener and templates are removed, the wound is sutured, plaster is applied.

The disadvantages of these devices and method include relatively high complexity in implementation. This is due to the need for special software for processing data from computed tomography of the patient's feet into a virtual operation performed on expensive equipment. At the same time, qualified bioengineers who have undergone appropriate training are also needed for implementation. Also, special equipment is required for the implementation of additive technologies in the manufacture of personalized templates, namely a printer for 3D printing of individualized products (templates) made of medical titanium, a special furnace for annealing and relieving residual stresses, devices for surface grinding, shot blasting, creating threads in holes , cleaning (removal of powder and lubricant residues), sterilization, as well as marking and packaging of individual templates.

Also known is a device for the treatment of Hallux Valgus (Orthopedic bone clamp: international application WO2021001835, United States of America, application US201962870056, 07/03/2019, publ. 01/07/2021), containing the first lever attached to the support bar (rack) and the second lever made with the ability to move along the support bar. The support bar includes teeth that engage with a protrusion on the second arm. This engagement forms a ratchet which can be unlocked with a push button. The second arm may include a bracket (extending in the direction of the first arm) for stabilization on the support bar. The device also contains a second bar (stand) attached to the first lever with the possibility of movement. Both levers are designed to be in contact with bone during use. The portions of the levers intended for contact with the bone are rough or serrated to facilitate engagement. Also, the levers have holes for knitting needles and other tools, including those used for sawdust, i.e. levers serve as guides for surgical manipulations. Also, one of the levers can be made of two parts, each of which can move independently of each other. In this case, the device may contain a rotary handle and a threaded rod for ease of manipulation. Also, the device can additionally include a force sensor. This technical solution is taken as a prototype of the proposed device.

The disadvantage of this device is the relatively low efficiency of the treatment of Hallux Valgus and the limited possibilities of manipulation and visual control. This is due to a number of features of this design and the way it is used. So, after performing a strictly transverse osteotomy of the distal part of the first metatarsal bone, when installing this device, the displacement of the distal fragment downwards is not excluded, which greatly complicates the subsequent reposition of the crossed bones. In addition, the introduction of a metal structure for fixing the osteotomy zone intramedullary without a guide is associated with the possibility of its rotational displacement in the frontal plane. At the same time, rigid fixation of the metal structure to the cortical bone of the diaphysis using a screw completely eliminates the possibility of dynamization of the osteotomy site and, therefore, eliminates early static loading after surgery and prolongs the time of bone tissue consolidation at the intersection. Also, when the pronation rotation of the distal part of the osteotomized first metatarsal bone is eliminated, it is not possible to determine the required degree of rotation to restore the disturbed “sesamoid hammock” ratios. Relatively minimally invasive access provided in the prototype, despite the apparent "low-traumatic" and cosmetic operation, significantly limits the surgeon's visual control, especially when flashing "blindly" the medial part of the capsule of the first metatarsophalangeal joint.

The technical problem is the need to develop an effective kit for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe and a method for using it, devoid of the above disadvantages.

The technical result consists in increasing the effectiveness of the treatment of Hallux Valgus and expanding the possibilities of controlled manipulations and visual control while maintaining accessibility.

The technical result is achieved by the fact that the set for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe, including a support post and guides for surgical manipulations, according to the invention, additionally contains a guide body, a longitudinal guide, a transverse guide, a vertical guide, a flat blade for dissecting bone tissues, blade guide, rasp guide, pin guide with pin, drill with stop, pin, cannulated V-chisel, rasp and accessory retainers.

This kit allows for effective treatment of Hallux Valgus and expands the possibilities of manipulation and visual control compared to analogues. At the same time, the proposed set remains quite affordable in terms of the possibility of its implementation. The main set can be implemented in various versions.

In a preferred embodiment of the invention, the kit contains two rod retainers, longitudinal, transverse and vertical guide retainers, a blade guide retainer and a rasp guide retainer as auxiliary retainers.

The technical result is also achieved due to the method of installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe using the kit described above, during which a stand and a guide body are installed, with the help of which a hole is drilled in the first metatarsal bone, into which a bone screw is then wrapped, which is fixed with a latch, after which the rack is removed and the longitudinal guide is connected to the guide body and fixed with a latch, after which the transverse guide is connected to the longitudinal guide, then the longitudinal and vertical guides are connected and fixed with the latch, after which the blade guide is connected and fixed with a retainer with a vertical guide, after using a flat blade for dissection of bone tissue, sawdust of the head of the first metatarsal bone is made, then the vertical guide connected to the blade guide is removed, after which, using the guide of the central hole and the drill, a hole is drilled in the bone, on sawdust the needle guide is installed in such a way that the pin is placed in the drilled hole, and the support plane of the needle guide is aligned with the sawdust plane, then the needle is placed in the through guide hole of the needle guide and the hole is drilled in the bone using the needle, then the needle guide is removed while the needle remains in the hole formed with its help, then a cannulated V-shaped chisel is installed on the free end of the spoke, after which osteotomy of the head of the first metatarsal bone is performed, then the rasp guide is installed, after which, using the rasp, a nest is formed under the submersible part of the plate for osteosynthesis, into which plate for osteosynthesis.

Within the framework of the claimed invention, a cannulated V-shaped chisel is preferably used according to patent RU59393 (A chisel for angular osteotomies of the metatarsal bones: patent RU59393, Russian Federation, application RU2006112959, application 17.04.2006, publ. 27.12.2006). Also in a preferred embodiment of the invention, a plate for osteosynthesis according to patent RU2694470 is used (Device for fixing bone fragments when performing distal osteotomy of the first metatarsal bone: patent RU2694470, Russian Federation, application RU2019108623, application 03/25/2019, publ. 07/15/2019).

The claimed invention is illustrated by drawings, where in Fig. 1 shows the rack, Fig. 2 - guide body, in Fig. 3 - the first and second rod retainers, in Fig. 4 shows the fixation of the guide body on the first metatarsal bone, in Fig. 5 - longitudinal guide, in Fig. 6 - fixation of the longitudinal guide on the guide body, in Fig. 7 shows the latch of the longitudinal guide, in Fig. 8 - transverse guide, Fig. 9 shows the fixation of the transverse guide on the longitudinal guide, Fig. 10 shows a vertical guide, FIG. 11 shows the vertical guide lock, FIG. 12 illustrates the fixation of the vertical rail on the transverse rail, FIG. 13 shows the blade guide, FIG. 14 blade guide retainer, in FIG. 15 shows sawdust of the head of the metatarsal bone, in Fig. 16 drill guide, and in FIG. 17 - drill, in Fig. 18 shows the process of drilling a hole in the bone, FIG. 19 - spoke guide, in Fig. 20 shows the process of drilling a hole in the bone with a pin, FIG. 21 shows a cannulated V-chisel, FIG. 22 shows the osteotomy of the head of the first metatarsal, FIG. 23 shows the rasp guide, FIG. Fig. 24 fixation of the rasp guide, Fig. 25 shows the fixation of the rasp guide on the transverse guide, Fig. 26 - rasp, in Fig. 27 - handle, in Fig. 28 - union nut, in Fig. 29 - replaceable working part, in Fig. 30 - plate for osteosynthesis, and in Fig. 31 shows the formation of a socket under the immersion part of the plate for osteosynthesis.

When describing the invention in the figures, the following designations are used:

1 - rack;

2 - guide body;

3 - longitudinal guide;

4 - transverse guide;

5 - vertical guide;

6 - blade guide;

7 - rasp guide;

8 - spoke guide;

9 - drill with stop;

10 - knitting needle;

11 - cannulated V-shaped chisel;

12 - rasp;

13 - bone screw;

14 - rack base;

15 - long support bar;

16 - short support bar;

17 - screw for connecting the support bars;

18 - corner samples;

19 - screw;

20 - finger;

21 - inner guide housing;

22 - connecting sleeve;

23 - outer guide housing;

24 - semicircular grooves;

25 - central through holes;

26 - screw fixing the guide body;

27 - central holes;

28 - thread;

29 - handle;

30 - corner samples;

31 - threaded hole;

32 - plane of the operating table;

33 - the first lock rods;

34 - through hole for bone screw;

35 - first metatarsal bone;

36 - the second lock rods;

37 - transverse through threaded hole;

38 - threaded rod;

39 - handle;

40 - flats;

41 - T-shaped longitudinal guides;

42 - longitudinal guide groove;

43 - lock longitudinal guide;

44 - through threaded hole;

45 - threaded rod;

46 - handle;

47 - persistent cylindrical tip;

48 - flat;

49 - t-shaped transverse guides;

50 - transverse guide groove;

51 - transverse guide lock;

52 - through threaded hole;

53 - threaded rod;

54 - handle;

55 - persistent cylindrical tip;

56 - flat;

57 - T-shaped vertical guide;

58 - vertical guide groove;

59 - vertical guide retainer;

60 - through threaded hole;

61 - threaded rod;

62 - handle;

63 - persistent cylindrical tip;

64 - flat;

65 - grips for the blade guide;

66 - through groove;

67 - cylindrical groove;

68 - p-shaped guide;

69 - cylindrical part;

70 - threaded shank;

71 - blade guide lock;

72 - through threaded hole;

73 - turnkey flats;

74 - cylindrical part;

75 - flat area;

76 - drill guide;

77 - handle;

78 - fitting disk;

79 - through axial hole;

80 - drill;

81 - working part;

82 - threaded part;

83 - emphasis;

84 - cylindrical shank;

85 - replaceable emphasis;

86 - cylindrical part;

87 - internal threaded hole;

88 - through hole;

89 - hole in the bone;

90 - front surface;

91 - rear surface;

92 - handle;

93 - middle part;

94 - installation disk;

95 - pin;

96 - through guide hole;

97 - reference plane;

98 - handle;

99- guide sleeve for the spoke;

100 - working part;

101 - emphasis;

102 - stop lock;

103 - internal through hole;

104 - transitional part;

105 - V-shaped part;

106 - sharpening;

107 - scale;

108 - through threaded hole for the stop lock;

109 - cylindrical head;

110 - inner hole for a screwdriver;

111 - threaded section;

112 - back;

113 - front V-shaped part;

114 - stepped groove;

115 - threaded connection;

116 - rear end of the stop;

117 - front end of the stop;

118 - head;

119 - rectangular ledge;

120 - threaded hole;

121 - U-shaped guide;

122 - shank;

123 - rectangular selection;

124 - through hole;

125 - rasp guide lock;

126 - threaded rod;

127 - handle;

128 - flat;

129 - handle;

130 - union nut;

131 - replaceable working part;

132 - drummer;

133 - middle part;

134 - threaded part;

135 - external thread;

136 - p-shaped through groove;

137 - internal axial hole;

138 - shank;

139 - conical tip;

140 - through axial hole;

141 - threaded hole;

142 - round support platform;

143 - angular sample;

144 - shank;

145 - rod;

146 - tip;

147 - cylindrical rod;

148 - emphasis;

149 - angular sample;

150 - cylindrical part;

151 - rectangular guide section;

152 - shaping part;

153 - pyramidal sharpening;

154 - plate for osteosynthesis;

155 - section of the submersible part;

156 - flat blade for dissection of bone tissue.

Kit consists of stand 1, guide body 2, longitudinal guide 3, transverse guide 4, vertical guide 5, blade guide 6, rasp guide 7, wire guide 8, drill with stop 9, wire 10, cannulated V-chisel 11, rasp 12, bone screws 13 and auxiliary fixators.

The base of the rack 14 is assembled from a long support bar 15 and two short support bars 16. The bars are fixedly connected using screws for connecting the support bars 17. To ensure a fixed connection, corner samples 18 are located at both ends of the support bars. To the long support bar 15 using screws 19 two pins 20 are fixedly fixed. The inner guide body 21 is fixedly connected with the connecting sleeve 22 by means of a press fit. The inner guide body 21 and the outer guide body 23 on one side have semicircular grooves 24 and central through holes 25. of the connecting sleeve 22 and passes through the central holes 27 in the outer guide housing 23 and the inner guide housing 21, while the semicircular grooves 24 on the inner guide housing 21 and the outer guide housing 23 must face each other. After placing the fixing screw of the guide body 26 along the axis of the connecting sleeve 22, the fingers 20 are placed inside the guides formed by semicircular grooves 24 on the inner guide body 21 and the outer guide body 23. At one end, the fixing screw of the guide body 26 has a thread 28 for connection with the guide body 2 , and on the other hand, the handle 29 is equipped with two angular recesses 30 to enable the connection of the rack 1 and the guide body 2 manually. Through the threaded hole 31 in the body of the guide 2 and the thread 28, a threaded connection is created for the screw fixing the body of the guide 26 and the body of the guide 2. Beforehand, the screw for fixing the body of the guide 26 is tightened with a force that allows free movement of the inner guide body 21 and the outer guide body 23 along the axis of the fingers 20 and free rotation of the guide body 2 relative to the axis of the connecting sleeve 22.

The first rod lock 33 and the second rod lock 36 consist of a threaded rod 38 and a handle 39. The handle is made in the form of a cylinder with two flats 40 to ensure the grip of the handle 39 when manually tightening the first rod lock 33 and the second rod lock 36.

The body of the guide 2 has symmetrically located T-shaped longitudinal guides 41 on both sides, and the longitudinal guide 3 has a corresponding longitudinal guide groove 42.

The latch of the longitudinal guide 43 consists of a threaded rod 45, a handle 46 and a thrust cylindrical tip 47. The handle 46 is made in the form of a cylinder with two flats 48 to ensure the convenience of gripping the handle 46 when manually tightening the latch of the longitudinal guide 43.

The longitudinal guide 3 has symmetrically located T-shaped transverse guides 49 on both sides, and the transverse guide 4 has a corresponding transverse guide groove 50.

The transverse guide latch 51 consists of a threaded rod 53, a handle 54 and a thrust cylindrical tip 55. The handle 54 is made in the form of a cylinder with two flats 56 to ensure the grip of the handle 54 when manually tightening the transverse rail latch 49.

The vertical guide 5 has a T-shaped vertical guide 57, and the transverse guide 4 at both ends has symmetrically arranged vertical guide grooves 58 corresponding to the T-shaped vertical guide 57.

The vertical guide latch 59 consists of a threaded rod 61, a handle 62 and a thrust cylindrical tip 63. The handle 62 is made in the form of a cylinder with two flats 66 to ensure the grip of the handle 62 when manually tightening the vertical guide latch 59.

The vertical guide 5 at both ends has symmetrically located grips for the blade guide 65, while each grip for the blade guide 65 has a through groove 66 and two cylindrical grooves 67. The vertical guide 5 has five sizes differing in angle α between the axis of the through groove 66 and the plane of symmetry t-shaped vertical guide 57. As options, the following can be used as values of α: 88, 85, 83, 81, 79 degrees. The specific version of the vertical guide 5 is selected in accordance with the operation plan.

The blade guide 6 has a U-shaped guide 68, a cylindrical part 69 and a threaded shank 70.

Blade guide latch 71 has a threaded through hole 72, wrench flats 73, cylindrical part 74.

The drill guide 76 consists of a handle 77, a fitting disk 78 and has a through axial hole 79.

The drill 80 consists of a working part 81, a threaded part 82 with a stop 83, a cylindrical shank 84 and a replaceable stop 85. In this case, the replaceable stop 85 consists of a cylindrical part 86, a part with an internal threaded hole 87 and has a through hole 88. The replaceable stop 85 has at least two versions, differing in the long cylindrical part 86. The replaceable stop 85 is connected to the threaded part 82 of the drill 80 by means of a threaded connection, implemented using an internal threaded hole 87 and an external thread on the threaded part 82. The choice of the size of the replaceable stop 85 is made in accordance with the plan operations.

The spoke guide 8 consists of a handle 92, the middle part 93, the installation disk 94, the pin 95. In this case, the middle part 93 has a through guide hole 98 for the spoke 10. The spoke guide 8 has at least three sizes differing in angle β between the support plane 97 of the installation disk 94 and the axis of the through guide hole 96. Alternatively, the following can be used as β values: 78, 88, 91 degrees. The specific version of the needle guide 9 is selected in accordance with the operation plan.

The cannulated V-shaped chisel 11 consists of a handle 98 of the guide sleeve for the spoke 99, the working part 100, the stop 101, the stop lock 102. The guide sleeve for the spoke 99 has an internal through hole 103. The working part 100 consists of the transition part 104 and the V part 105. The front edge of the V-shaped part 105 has a sharpening 106. On the transition part 104 there is a scale 107 and a through threaded hole for the latch stop 108. The latch stop 102 consists of a cylindrical head 109 with an internal hole for a screwdriver 110 and a threaded section 111. Stop 101 consists of a rear part 112 and a front V-shaped part 113. A stepped groove 114 is located in the rear part 112 of the stop 101. The stop 101 is fixedly fixed on the working part 100 by means of the stopper 102 in such a way that the V-shaped part 113 of the stop 101, respectively is placed on the V-shaped part 105 of the working part 100, while the cylindrical head 109 is placed in the stepped groove 114, and the threaded section 111 and the through threaded hole for the latch stop 108 form a threaded connection 115. Before tightening the threaded connection 115, aligning the rear end of the stop 116 with one of the strokes of the scale 107 provides the required distance K from the front end of the stop 117 to the front edge of the V-shaped part 105.

The transverse guide 4 in the middle part has a rectangular protrusion 119 in which a through threaded hole 120 is located. The rasp guide 7 consists of a U-shaped guide 121 and a shank 122. The shank 122 has a rectangular sample 123 and a through hole 124.

The rasp guide latch 125 consists of a threaded rod 126, a handle 127. The handle 127 is made in the form of a cylinder with two flats 128 to ensure the grip of the handle 127 when manually tightening the rasp guide latch 125.

The rasp 12 consists of a handle 129, a union nut 130 and a replaceable working part 131. The handle consists of a drummer 132, a middle part 133 and a threaded part 134. The threaded part 134 has an external thread 135, a U-shaped through groove 136, an internal axial hole 137. The union nut 130 consists of a shank 138 and a conical tip 139 and has a through axial hole 140. The shank 138 has an internal threaded hole 141 and a round support pad 142. The conical tip 139 has two turnkey corners 143. The replaceable working part 131 consists of a shank 144 of the rod 145 and a tip 146. The shank 138 consists of a cylindrical rod 147 and a stop 148. The stop has two angular samples 149. The rod 145 consists of a cylindrical part 150 and a rectangular guide section 151. The tip 146 has a shaping part 152 and pyramidal sharpening 153 at the end. The shape of the shaping part 152 corresponds to the shape of the section of the immersion part 155 used by the plate for osteosynthesis 154. The replaceable working part 131 can have more than one size, which is determined by the shape of the shaping part in accordance with the size of the used plate for osteosynthesis 154. The size of the replaceable working part 131 is selected in accordance with operation plan.

The claimed method of using the kit for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe is carried out as follows.

In the assembled state, the stand 1 and the guide body 2 are installed horizontally on the plane of the operating table 32. By moving the stand 1 along the plane of the operating table 32 and rotating the guide body 2 relative to the connecting sleeve 22, the position and orientation of the guide body 2 required for the insertion of two bone screws 13 ( threaded rods) into the first metatarsal bone 35 of the patient according to the operation plan. After reaching the required position and orientation of the guide body 2, the fixing screw of the guide body 26 is tightened with a force that ensures the fixed fixation of the inner guide body 21 and the outer guide body 23 relative to the pins 20, as well as the fixed fixation of the guide body 2 relative to the connecting sleeve 22. Through one from the through holes for the bone screw 34 available in the body of the guide 2, a hole is drilled in the first metatarsal bone 35. The bone screw 13 is screwed into the bone through the through hole for the bone screw 36 through the through hole for the bone screw 36 and is fixedly fixed in the body of the guide 2 using the first latch rods 33, which is wrapped in the corresponding transverse through threaded hole 37 in the body of the guide 2 and abuts against the bone screw 13. Through the free through hole for the bone screw 34, a second hole is drilled in the first metatarsal bone 35. In the drilled hole through the through hole used for drilling under the bone screw 34, the second bone screw 13 is screwed into the bone and fixed in the body of the guide 2 with the help of the second fixator of the rods 36, which is screwed into the corresponding transverse through threaded hole 37 in the body of the guide 2 and abuts against the second bone screw 13. After that, the fixation screw the body of the guide 26 is unscrewed from the threaded hole 31; in this case, the stand 1 and the body of the guide 2 are separated. The stand 1 is removed.

The longitudinal guide 3 is connected to the body of the guide 2 in such a way that the T-shaped longitudinal guides 41 are inside the longitudinal guide groove 42. Then the longitudinal guide 3 moves along the T-shaped longitudinal guides 41 to the position required according to the operation plan. After that, the latch of the longitudinal guide 43 is wrapped in a through threaded hole 44 in the body of the guide 2 and abuts against the longitudinal guide 3, while ensuring a fixed connection of the body of the guide 2 and the longitudinal guide 3.

The longitudinal guide 3 is connected to the transverse guide 4 in such a way that one of the symmetrically arranged T-shaped transverse guides 49 is inside the transverse guide groove 50. Then the transverse guide 4 by moving along the T-shaped transverse guides 49 is set to the position required according to the operation plan . After that, the latch of the transverse guide 51 is wrapped in a through threaded hole 52 in the longitudinal guide 3 and abuts against the transverse guide 4, while ensuring a fixed connection between the longitudinal guide 3 and the transverse guide 4.

The transverse guide 4 is connected to the vertical guide 5 in such a way that the T-shaped vertical guide 57 was inside one of the vertical guide slots 58. Then the vertical guide 5 moves along the T-shaped vertical guide 57 and is installed in the position required according to the operation plan. After that, the lock of the vertical guide 59 is wrapped in a through threaded hole 60 in the transverse guide 4 and abuts against the vertical guide 5, while ensuring a fixed connection between the transverse guide 4 and the vertical guide 5.

The cylindrical part 69 of the blade guide 6 is placed in one of the cylindrical grooves 69, while the threaded shank 70 passes through the through groove 66. part 69 is placed in a free cylindrical groove 69. The blade guide 71 is set to the position required according to the operation plan and fixed relative to the vertical guide 5 by tightening the blade guide retainer 71 with a wrench.

A flat blade for dissecting bone tissue 156 is installed inside the U-shaped guide 68, then the serrated end of the flat blade is brought to the head of the first metatarsal bone and sawdust is made to form a flat platform 75 on its surface. After that, the lock of the vertical guide 59 is unscrewed and the vertical guide 5 with the elements attached to it is removed.

The flat surface of the fitting disk 78 is aligned with the flat platform 75. Then, by moving along the flat platform 75, the drill guide 76 is set to the position required according to the operation plan and pressed against the flat platform 75. After that, the working part 81 of the drill is placed in the through axial hole 79. Then a hole is drilled in the bone 89 until the stop of the front surface 90 on the replaceable stop 85 into the back surface 91 on the drill guide 76.

The pin 95 is placed in the drilled hole in the bone 89, and the support plane 97 of the setting disk 94 is pressed against the flat area 75. Then the needle 10 is placed in the through hole 96 and the through hole is drilled in the bone using the needle 10. After that, the needle guide 8 is removed when this spoke 10 remains in the hole formed with its help.

The anvil 101 is fixedly fixed on the working part 100 by means of the stop latch 102 in such a way that the V-shaped part 113 of the stop 101 is respectively placed on the V-shaped part 105 of the working part 100, while the cylindrical head 109 is placed in the stepped groove 114, and the threaded section 111 and a through threaded hole for the retainer stop 108 form a threaded connection 115. Before tightening the threaded connection 115, aligning the rear end of the stop 116 with one of the strokes of the scale 107 provides the required distance K from the front end of the stop 117 to the front edge of the V-shaped part 105.

The free end of the pin 10 is placed in the inner through hole 103 of the guide sleeve under the pin 99. Then, the head 118 of the first metatarsal bone 35 is osteotomized, with the pin 10 acting as a guide element.

The rectangular protrusion 119 is placed in the rectangular recess 123. The threaded rod 126 is placed in the through hole 124 and is screwed into the threaded through hole 120. The rasp guide 7 is fixed relative to the transverse guide 4 by tightening the rasp guide lock 125.

The replaceable working part 131 is fixedly connected to the handle 129 using a union nut 130. In this case, the cylindrical rod 147 is placed in the internal axial hole 137, the corner samples 149 are placed in the U-shaped through groove 136, and the threaded part 134 and the internal threaded hole 141 form a threaded compound.

The rectangular guide section 151 is placed inside the U-shaped through-slot 136, while the forming part 152 acquires the orientation required according to the operation plan. If necessary, one bone screw 13 is removed, after which the pyramidal sharpening 153 is brought to the edge of the bone and, by means of impact action on the impactor 132, the shaping part 152 is immersed in the bone, forming a bone bed under the immersion part 155 of the plate for osteosynthesis 154. Then, the plate is installed in the formed socket for osteosynthesis 154.

The claimed invention is illustrated by clinical examples.

Example 1

A 75-year-old patient was admitted with a diagnosis of transverse flatfoot with hallux valgus deformity of the first toe of the left foot. After the examination, it was decided to perform surgical treatment using the proposed device and method. During the operation, all the necessary manipulations were performed according to the method. First, the post and guide body were installed, with the help of which a hole was drilled in the first metatarsal bone. A bone screw was screwed into this hole, which was fixed with a fixator. Next, the post was removed, the longitudinal guide was connected to the guide body and secured with a retainer. The longitudinal guide was connected to the transverse guide, and then the transverse and vertical guides were connected and fixed with a retainer. The blade guide was then connected to the vertical guide. Next, using a flat blade for dissection of bone tissues, sawdust was made of the heads of the first metatarsal bone, after which the vertical guide connected to the blade guide was removed. Then, using the central hole guide and the drill, a hole was drilled into the bone. The needle guide was installed on the sawdust in such a way that the pin was placed in the drilled hole, and the reference plane of the needle guide was aligned with the plane of the sawdust. Then the pin was placed in the through guide hole of the pin guide and a hole was drilled in the bone using a pin, then the pin guide was removed, while the pin remained in the hole formed with it, then a cannulated V-shaped chisel was installed on the free end of the pin and docked with the free the end of the needle. Next, an osteotomy of the head of the first metatarsal bone was performed, after which a rasp guide was installed and with its help a bed was formed under the submersible part of the plate for osteosynthesis. At the final stage of the operation, a plate for osteosynthesis with a screw was installed in the patient's formed bone bed. The remaining elements of the kit were dismantled and removed, the postoperative wound was sutured, and an aseptic bandage was applied to the leg.

The patient was examined 6 weeks after the operation: the correction of the metatarsal bone and hallux valgus deformity of the first toe took place, X-ray control was performed: the site of the osteotomy of the first metatarsal bone was fused. The hardware (plate for osteosynthesis) with the screw removed. Recommended physical therapy and walking without crutches. Examined after 6 months: satisfied with the result of the operation, uses standard shoes, walks and stands without restrictions.

Example 2

A 49-year-old patient was admitted with a diagnosis of right-sided transverse flatfoot with hallux valgus deformity of the first toe of the right foot. After the examination, it was decided to carry out treatment using the proposed device and method. During the operation, all the necessary manipulations were performed according to the method, including alternately installing the appropriate nozzles and templates as shown in example 1. At the final stage of the operation, a metal structure (plate for osteosynthesis) was selected and installed for the patient, gypsum was not required. The remaining elements of the kit were dismantled and removed, the wound was sutured.

The patient was examined 6 weeks after the operation: the correction of the metatarsal bone was successful, X-ray control was performed: the site of osteotomy of the first metatarsal bone was consolidated, the plate for osteosynthesis was removed. After 6 months, the patient was additionally examined, no undesirable effects were found. The patient is satisfied with the result of the operation, uses standard shoes.

Claims (3)

1. A set for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe, including a support stand for the operating table, characterized in that it has two bone screws for the first metatarsal bone, a guide housing for two bone screws for the first metatarsal bone and for the supporting rack, a pin for drilling a through hole in the bone, a pin guide with a reference plane and a pin, a flat blade for forming a flat sawdust on the head of the first metatarsal bone under the reference plane of the pin guide, a drill with an emphasis for a hole for the pin of the guide for the pin, a drill guide, a guide for a flat blade, a cannulated V-shaped chisel for osteotomy of the head of the first metatarsal bone, having a guide sleeve for the wire, a rasp for the bone bed under the immersion part of the plate for osteosynthesis, a rasp guide, a vertical guide to the flat blade guide, a transverse guide for the vertical guide and for the rasp guide, the longitudinal guide to the guide body and to the transverse guide and auxiliary locks. 2. The kit according to claim 1, characterized in that as auxiliary clamps it contains two rod clamps, longitudinal, transverse and vertical guide clamps, a blade guide clamp and a rasp guide clamp. 3. A method for installing a plate for osteosynthesis in the treatment of valgus deformity of the first toe using the kit according to claim 1, during which the rack and guide body are installed, with the help of which holes are drilled in the first metatarsal bone, into which bone screws are then wrapped, which are fixed with clamps in the guide body, after which the post is removed, the longitudinal guide is connected to the guide body and fixed with a lock, after which the longitudinal guide is connected to the transverse guide, then the vertical and transverse guides are connected and fixed with the lock, after which the flat guide the blades are connected and fixed with a retainer with a vertical guide, after that, using a flat blade for dissecting bone tissue, sawdust of the head of the first metatarsal bone is made, then the vertical guide connected to the flat blade guide is removed, then the hole is drilled using the drill guide and the drill with an emphasis in the bone, a needle guide is installed on the sawdust in such a way that the pin is placed in the drilled hole, and the support plane of the needle guide is aligned with the plane of the sawdust, then the needle is placed in the through guide hole of the needle guide and the hole is drilled in the bone using the needle, then the guide is removed pins, while the pin remains in the hole formed with its help, then a cannulated V-shaped chisel is installed on the free end of the pin, after which the head of the first metatarsal bone is osteotomized, then a rasp guide is installed on the transverse guide, after which, using a rasp, a nest is formed under the submersible part of the plate for osteosynthesis, in which the plate for osteosynthesis is installed.

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