RU88937U1 - DEVICE FOR INTRAOPERATIVE X-RAY CONTROL - Google Patents

Abstract

A device for intraoperative x-ray monitoring, which is a stand for a cassette with x-ray film, characterized in that it consists of parts of a standard set of Ilizarov apparatus, namely, plates of three sizes, threaded rods, bolts, nuts and brackets of two sizes.

Description

In the treatment of fractures of the femoral neck there are two types of osteosynthesis - open and closed. With open osteosynthesis, an arthrotomy of the hip joint is made, bone fragments are exposed and repaired under the control of vision, which are fastened with a pin driven from the underwent region along the axis of the femoral neck. This method is traumatic and often leads to severe coxarthrosis and even aseptic necrosis of the femoral head. Therefore, the closed, or extra-articular, method of osteosynthesis of the femoral neck has become widespread, which consists in the following. The patient is placed on an orthopedic table and reposition of bone fragments by removal of the lower limb by 15-25 degrees, traction along the axis and internal rotation of the thigh by 30-40 degrees. The achieved reposition is confirmed by x-ray and proceed to surgery. After dissection of the soft tissues and skeletonization of the area of the subrovert region, a pin is inserted that fastens the bone fragments without deviating from the axis of the femoral neck. Since bone fragments are not visible during closed osteosynthesis, many surgeons resort to the help of various directors (Kaplan A.V., Petrova B.A., Abdueva B.D., Yasnova E.F. and others). A common drawback of the use of these guides is the need to purchase and the availability of multicomponent non-standard devices and the complexity of their use with a forced significant increase in the volume of operation. So, when using the guide A.V. Kaplan (Fig. 1, a, b), it is necessary to significantly increase the length of the surgical wound and the length of the skeletonization of the proximal femur, which lengthens the healing time and increases the risk of early and late postoperative complications.

In order not to use guides, many surgeons do as described in the “National Guide to Traumatology” edited by G.P. Kotelnikov and S.P. Mironov (2008). Parallel to the pupartic ligament, a metal plate with holes is hemmed to the skin of the patient’s abdomen. Several Kirschner spokes are drawn from the subrochanteric region, guided by the alleged neck of the thigh. If after x-ray control from these spokes the position of at least one suits the surgeon, then on this - optimal - a three-bladed nail is carried out. After fastening the bone fragments, they are knocked together with an impactor.

Thus, the need for repeated x-ray control in the process of closed osteosynthesis of femoral neck fractures is beyond doubt. The X-ray apparatus “Arman-1” is most widely used for these purposes due to its design features: small size, relative lightness of construction and maneuverability. X-ray control is performed to confirm the adequacy of the closed reposition of bone fragments, the correctness of the spokes and the optimal direction of administration of the metal structure. If the fashed (anteroposterior) radiography is not difficult, —the cassette wrapped in a sterile sheet is simply placed under the patient’s buttock, then performing a side or axial image is fraught with some technical difficulties. So, to hold the cartridge in an upright position, you have to use various pillows or rollers, for which there should be sufficient space on the orthopedic or operating table (figure 2). The position of the cassette is difficult to control and very unstable. If the cassette is not held upright, then someone from the medical staff has to hold it, which is associated with extremely undesirable (and repeated repetition - dangerous!) Radiation exposure.

To prevent the above disadvantages, the proposed device (figure 3), which is a stand under the cassette with x-ray film. The device consists of parts of a standard set of Ilizarov apparatus: plates of three sizes - 346- (1), 236- (2) and 49-mm plate (3); 70 mm threaded rod (4); bolts (5); nuts (6); one- (7) and two-hole (8) brackets. Apply the device as follows. A cassette with an x-ray film, 24 by 34 cm in size, is vertically placed on top of both two-hole device brackets (8) and secured by tightening the nuts (6) on both bolts (5). In this case, the bolts abut their end surface against the plane of the lower part of the cartridge, which ensures the stability of its predetermined position. The device together with the cassette is mounted on a standard portable tripod for intravenous transfusions at the required height, distance and perpendicular to the beam of the x-ray machine. The device is attached to a tripod (Fig. 4) by tightening the nuts (6) on a threaded rod (4) with a tight clip on the tripod tube (9) between the 49-mm (3) and 346-mm (1) plates.

This device significantly expands the capabilities of x-ray control in the operating room with the receipt of informative x-ray due to the installation of the cartridge in any plane and at any angle. So, you can adjust the height level, the plane of installation of the cartridge and the distance from the cartridge to the x-ray. The cassette can be stably fixed in the desired position without the support of its medical staff. In addition, there is no need to cover the cassette with sterile linen, since it is not necessary to lean it against the patient within the surgical field.

As an example of the application of the proposed device, the following observation.

Patient G., 67 years old, was admitted to the Republican Orthopedic and Traumatology Center in Makhachkala on October 23, 2007 with a diagnosis of Closed abduction transcervical fracture of the neck of the left femur with displacement.

From the anamnesis: 3 hours before admission to the hospital when falling on his side, the patient received a personal injury. An emergency blockade of the fracture site was performed with a 2% novocaine solution and under local anesthesia they imposed skeletal traction on the femoral condyles with a load of 5 kg.

10/29/07, the operation was performed as planned: Closed osteosynthesis of the neck of the left femur with Smith-Petterson three-blade nail. The patient was placed on an orthopedic table and repositioned of bone fragments by abduction of the lower limb by 25 degrees, traction along its axis and internal rotation of the thigh by 40 degrees. The success of the reposition was verified by x-ray of the hip joint in two projections - anteroposterior (direct) and axial. To take a picture in direct projection, a cassette wrapped in a sterile sheet was placed under the patient’s buttock. When performing axial radiography, the cartridge was vertically mounted outside the surgical field near a large trochanter from the outside of the allotted thigh (the x-ray was directed from the inside of the thigh). For this, a device was used that consists of parts of a standard set of Ilizarov apparatus: 346-, 236- and 49-mm plates of a 70-mm threaded rod, bolts, nuts, one- and two-hole brackets. A cassette with an x-ray film measuring 24 by 34 cm was vertically mounted on top of both two-hole device brackets and secured by tightening the nuts on both bolts. The device together with the cassette was mounted on a tripod for intravenous transfusions at the desired height perpendicular to the x-ray beam. Mounting to a tripod was performed by tightening the nuts on the threaded rod of the device with a tight clamp of the tripod tube between the 49-mm and 346-mm plates. Then, parallel to the pupartic ligament, a metal plate with holes was sutured to the skin of the patient’s abdomen, and several Kirschner spokes were drawn from the underrospective region, oriented along the neck of the thigh, and then the x-ray was performed again with a similar application of the proposed cassette holder device. After X-ray control, a spoke was left that was optimally passing through the center of the neck of the femur, along which a three-blade nail, 9 cm long, was drawn. After fastening the bone fragments, they were knocked together with an impactor. The operation is completed by x-ray control.

The advantages of the proposed device are as follows:

1) The ability to obtain informative radiographs due to the installation of the cartridge in any necessary plane and at any angle. So, you can adjust: a) the height of the cartridge - the ability to mount the device throughout the entire tripod; b) the distance from the cassette to the x-ray - by installing a tripod at any distance from the x-ray apparatus; c) the mounting plane - by turning the tripod around its axis;

2) Maneuverability, handling properties and stability of the cartridge;

3) Exclusion of radiation exposure to medical staff, as no need to support the cassette;

4) Reducing the risk of impaired sterility of the surgical field, as the cassette is mounted on a tripod outside the surgical field - without having to lean it against the patient;

5) Reducing the consumption of sterile material, because no need to cover the cassette with a sterile sheet;

6) Reducing the time spent on x-ray control, and therefore the total time for surgery and the patient is under anesthesia;

7) No need to find parts, because all of them are from a set of Ilizarov’s apparatus, as a rule, available in any orthopedic and traumatology department.

Thus, the proposed device is effective and economical, and its use allows to achieve improved treatment results for patients with fractures of the femoral neck.

Claims (1)

A device for intraoperative x-ray monitoring, which is a stand for a cassette with x-ray film, characterized in that it consists of parts of a standard set of Ilizarov apparatus, namely, plates of three sizes, threaded rods, bolts, nuts and brackets of two sizes.