RU49708U1 - DEVICE FOR ROTARY OSTEOTREPANATION OF THE LIMBS OF THE EXTREMITIES - Google Patents

Abstract

The utility model relates to medical equipment, namely to devices for osteotrepanation of phalanxes of limbs and can be used for surgical treatment of ischemic syndrome of upper and lower extremities, namely Raynaud's syndrome and atherosclerosis obliterans of lower limb arteries in an outpatient setting. The problem solved by the proposed utility model is to reduce the number of complications by reducing soft tissue trauma. The problem is solved by a device for rotational osteotrepanation of phalanges of limb bones, containing a milling cutter and a conductor hollow along the entire length, equipped with a holding pavilion with a restraining platform, and the cutting edge of the distal end working part is beveled at an angle of 45 degrees to its longitudinal axis moreover, the site-limiter is located on the side of the connection of the working part with the pavilion-retainer. Figure 1.2.

Description

The utility model relates to medical equipment, namely, devices for trepanation of phalanx of limbs and can be used for surgical treatment of ischemic syndrome of upper and lower extremities, namely Raynaud's syndrome and atherosclerosis obliterans of lower limb arteries in an outpatient setting. The closest in technical essence to the prototype is a device for trepanation of the bones of the leg and thigh, proposed by F. Zusmanovich in 1991. This device, which represents the cutter, allows you to trepan only the bones of the lower leg and thigh. However, the inconvenience is that in order to perform osteotrepanation using a known device, tissue dissection in the area of the proposed osteotrepanation is required. Intravenous or epidural anesthesia is required. Duration surgery usually takes about 30 minutes. Moreover, the known device cannot be used for trepanation of the bones of the phalanges of the fingers of the upper and lower extremities, since it does not provide the rigid directional fixation necessary for trepanation of small bones, which is accompanied by a high risk of trauma to the latter, due to the possible sliding of its cutting edge from the bone (1 , 2).

A new technical challenge is to reduce the number of complications by reducing soft tissue injuries.

The task is achieved by a new device for rotational osteotrepanation of the phalanges of the extremities, containing a cutter, moreover, it further comprises a conductor hollow along the entire length from the proximal end, equipped with a holding pavilion with a restraining platform, and the cutting edge of the working part of its distal end is beveled at an angle of 45 degrees to its longitudinal axis, moreover, the limiter platform is located on the side of the connection of the working part with the holding pavilion. The length of the working part is 6 mm., The inner diameter of the conductor is 7 mm.

The device for rotational osteotrepanation of the phalanges of the extremities depicted in Fig. 1,2 consists of a milling cutter - 1 (Fig. 1) and a conductor - 2 (Fig. 2) at the proximal end of the working part of which there is a 20 mm long hollow conductor along the entire length., equipped with a holding pavilion - 5 with a restraining platform - 6, and the restraining platform is located on the side of the connection of the working part with the holding pavilion, and at the distal end of its working part is 6 mm long. there is a cutting edge - 4, made beveled at an angle of 45 degrees to its longitudinal axis, the inner diameter of the conductor is 7 mm.

The device operates as follows:

In aseptic conditions, after processing the surgical field according to Grossikh-Filonchikov, local anesthesia of the sites of the alleged operation. The cutting edge - 4 working parts - 3 conductors - 2 produce individual punctures of soft tissues without dissecting them over the alleged areas of trepanation until they stop in the bone. The conductor - 2 is fixed perpendicular to the longitudinal axis of the bone behind the pavilion-retainer - 5 by the hand of the surgeon. Then, in the cavity of the conductor, through the cavity of the holding pavilion - 7, place a mill - 1 with a diameter of 2 to 6 mm, connected to the drive. The drive is represented by a commercially available Rhythm electric drill with an adjustable speed. The drive is turned on at low speeds not exceeding 1900 rpm, and osteotrepanation is performed, in which the cutter penetrates only to the bone marrow. After this, the drill is removed from the conductor, the latter is removed from the soft tissues. A postoperative puncture does not require suturing, and the latter, after treatment with an antiseptic, is covered with an aseptic dressing. The duration of the operation does not exceed 15 minutes.

The proposed device has been tested in thirty patients with atherosclerosis obliterans of lower limb arteries IIa-IIIb degree (aged 47 to 87 years) and, in 15 patients with Raynaud's syndrome (aged 32 to 75 years) in the outpatient surgery department of the Tomsk clinic Military Medical Institute. Moreover, with critical ischemia of the lower extremities, treatment was performed in 14 patients, in eight cases of which amputation of the limb was previously proposed. When observing patients for six months, purulent-septic complications from the soft tissues and bones were not observed in any patient. Due to the minimum diameter of the working part of the conductor, postoperative cosmetic defects in patients were absent.

Thus, the proposed device is simple to use, consisting in the absence of the need for epidural or intravenous anesthesia, reduction of trauma and related complications of various origins and therefore, it can be used in a significant number of patients, without significant restrictions on an outpatient basis.

It is also important that the use of the proposed device allows osteotrepanation in a more gentle mode for soft tissues, while maintaining the microstructural relationship of the bones with the cambial layer of the periosteum.

LITERATURE

1. 3usmanovich F.N. A new method of activation of collateral circulation - revascularizing osteotrepanation // Herald of Surgery 1991; 146; 5-6: S.114-115.

2. Zusmanovich F.N. Revascularizing osteotrepanation in the treatment of patients with obliterating diseases of the lower extremities / Kurgan: Publishing House of KSPI, 1996.-92 p.

3. Zusmanovich F.N. Osteotrepanation - an alternative to amputation of an extremity during its ischemia // Surgery 1992; 1: S.94-94.

4. Larionov A.A., Rechkin M.Yu., Schurova E.N. and others // Bulletin of Traumatology and Orthopedics. N.N. Pirogova.-2004; 1, C.

Claims (2)

1. Device for rotational osteotrepanation of the phalanges of the extremities, containing a cutter, characterized in that it further comprises a conductor hollow along the entire length, provided with a retaining pavilion with a restraint pad from the proximal end, and the cutting edge of the working part of its distal end is beveled at an angle of 45 ° to its longitudinal axis, and the platform-limiter is located on the side of the connection of the working part with the pavilion-retainer. 2. The device according to claim 1, characterized in that the length of the working part is 6 mm, the inner diameter of the conductor is 7 mm.