RU99952U1 - DEVICE FOR IMPLEMENTING OSTEOSYNTHESIS - Google Patents

Abstract

 A device for performing osteosynthesis, comprising a guide with an opening for the conducted knitting needle, characterized in that it is provided with two functional plates forming the handle, one of the plates has an opening for the guide of the needle, arcuate at an angle of 125 ° and having a longitudinal channel for holding the knitting needle, and also equipped with a directional axis indicator with the ability to adjust its position and fixation on the L-shaped curved rod, mounted on the second plate.

Description

The utility model relates to medical equipment, namely to surgical instruments used in traumatology and orthopedics, and can be used for cortical osteosynthesis of fractures of the surgical neck of the humerus or fractures of the femur in the proximal section.

A device known as a “needle guide” comprising a housing with bone fixing elements and a guide assembly having a spoke holder located in the housing with the ability to move in the same plane and rotate, characterized in that, in order to ensure the movement of the spokes in all planes, the spoke holder is made in the form of a ball with a tube having a longitudinal channel under the spoke and installed in the housing using plates with an opening for a ball of a spoke holder located in the housing with the possibility of movement in the plane of the plates and fixing via clamps the plates (RF patent №2012276, 15.05.1994).

It is known "Device for osteosynthesis of fractures of the proximal end of the humerus" containing a osseous plate with holes and teeth for insertion into the head of the humerus, characterized in that the length of the teeth is 150-180% of the diameter of the head of the humerus, and the immersed half of the teeth are made parallel to each other and at an angle of 95-140 ° to the axis of the plate, and the osseous halves of the teeth diverge at an angle of 30-40 ° and arcuate in shape along the longitudinal relief of the metaphysis (RF patent No. 2143862, 01/10/2000).

A device is known "Self-locking needle for the treatment of fractures of the femoral neck" containing a sharpened proximal end, characterized in that the proximal end of the spoke is an elastic locking element made, for example, in the form of an elastic lobe, in the treatment of unstable fractures at the distal ends of the spokes emerging from bones, springs are located (RF patent No. 25159, 09/20/2002).

Known devices allow knitting needles to be carried out only rectilinearly without changing the direction of the knitting needles.

A device for transosseous osteosynthesis of fractures of the surgical neck of the humerus. The device contains two arcs connected by threaded rods, brackets and transosseous clamps. The device is characterized in that the proximal portion of the spoke fixing the head of the humerus is corkscrewed with a length of 1.5-2.5 cm and a diameter of turns from 0.8 to 1.2 cm (RF patent for utility model No. 72842, 10.05. 2008).

The closest in technical essence is a "device for conducting knitting needles", containing a guide with a hole for the conducted knitting needles, pivotally mounted in a fork. The device is also equipped with a threaded rod and a removable additional guide knitting needle and a bracket for securing the conducted and additional guide knitting needles at a distance sufficient to accommodate the limb. The plug is made at the end of a threaded rod (RF patent No. 2197916.10.02.2003).

The disadvantages of the prototype device include the inability to change the angle of the spokes inside the bone marrow canal, as well as the complexity of the design, its manufacture and use.

The objective of the claimed device is the development of a simpler and more effective design, which provides the ability to change the angle of the knitting needle intraossally, accurate and less traumatic holding the needles during transosseous osteosynthesis of fractures of the surgical neck of the humerus or femur.

The problem is solved in that the device for osteosynthesis is equipped with two functional plates forming the handle, one of the plates has an opening for the guide of the needle, curved arcuate at an angle of 125 ° and having a longitudinal channel for holding the knitting needle, and the device is equipped with a pointer to the direction axis with the possibility of adjustment its position and fixation on the L-shaped curved rod, mounted on the second plate.

The technical result is the provision of stable fixation of fractures of the surgical neck of the humerus without injuring the shoulder joint and paraarticular anatomical formations, due to the precise conduct of the knitting needle through the soft tissues and bones of the limb at the required angle and in any desired direction. The ability to control in several planes, provided by the proposed device, allows you to set the spoke in the right direction from the first time. This is achieved by the fact that the guide of the spokes is arcuately bent at an angle of 125 ° and ensures the arrangement of the device parts at a distance sufficient to accommodate the limb, as well as the ability of the spokes to elastically bend inside the longitudinal channel of the needle guide inserted through the opening of the cortical bone wall into the cavity of the bone marrow canal , thus, the spoke along the arc of the needle guide changes direction inside the bone, thereby changing the alignment of the input and output.

The utility model is illustrated by drawings (FIGS. 1-16.), In which the proposed device is shown in axonometric projection.

The osteosynthesis device comprises: rectangular plates 1 and 2, forming when connecting the two clamps 3 the handle of the device, a L-shaped curved rod 4 with a diameter of about 3.4 mm, rigidly connected to the plate 2 and the sleeve 5 with an inner diameter of 2.1 mm, having threaded hole for fixing screw 6; a directional axis indicator 7 mounted in the sleeve 5 and fixed in position by a fixing screw 6. The plate 2 has an opening for the outlet of the spoke guide 8 having a longitudinal channel through which the spoke is passed 9. The guide pin 8 has an outer diameter of 3.6 mm and an inner diameter 2.0 mm and curved arcuately in the lower section by 125 °, along the circumference r = 50.0 mm. The length of the flat part of the needle guide 8, before attaching to the plate 1 is 90.0 mm, on the other side of the plate 1, the needle guide goes beyond the hole in the plate 2 by 2.0 - 3.0 mm. All parts of the device are made of stainless steel. The device is disinfected after each use. In addition to the listed parts of the device for osteosynthesis, the following notation is shown and entered in the figures (Figs. 2-16): 10 - large tubercle of the humerus, 11 - fracture line, 12 - drill, 13 - lavsan thread, 14 - wire, 15 - stopper, 16 - a metal washer, 17, 18 - two rods of Bogdanov, 19 - twisting of the ends of the wire 14, 20 - loop. These designations explain the use of the device in clinical practice.

A device for osteosynthesis is used as follows.

The patient is placed on an operating table with a hanging in / limb (weight), which facilitates reposition, perform manual reposition of the fragments according to one of the known methods under the control of radiography (x-ray, image intensifier control). After processing the surgical field, from the external surface of the shoulder with a trocar, transcutaneously, through soft tissues at an angle of 45 °, a channel is directed towards the diaphysis of the shoulder 10 4.0 cm below the surgical neck (fracture line 11). Through the trocar guide with a drill 12 (diameter 4.0 mm) at an angle of 45 °, a channel is made in the cortical layer of the shoulder, directed towards the geometric center of the circle of the diaphysis (Figure 2). The trocar is removed and replaced by a needle guide 8, which, holding the plate 1 in hand, is inserted into the prepared diaphysis channel (Figure 3). To the plate 2, rigidly fastened to the spokes guide 8, using the clamps 3, a plate 1 with a rigidly fixed to it, L-shaped rod 4 is connected, which, in turn, is rigidly connected to the sleeve 5 (Figure 4). The needle guide 8 is installed in the bushing 5 channel so that the direction axis indicator 7 is directed from above, pointing to the apex of the large tubercle of the humerus 10, where a 2.0 cm skin incision is performed parallel to the fibers of the rotational cuff of the shoulder. The deltoid muscle fibers are bluntly separated over the area the rotational cuff and the proximal part of the shoulder tubercle 10. The direction axis indicator 7 is carried out in the bushing channel 5 all the way to the apex of the shoulder tubercle 10 and is fixed with a fixing screw 6 (Figure 5). Through the guide of the needles 8, a spoke 9 with a diameter of 1.5 cm is carried out, it is brought out in the upper part of the large tubercle of the shoulder 10, through the upper skin incision (Fig.6). The plate 2 with a pointer to the axis of direction 7 is disconnected (Fig.7). The end of the spoke 9 is bent in the form of a loop to which the lavsan thread 13 is tied (Fig. 8). The knitting needle 9 is pulled back all the way to the stitch of the knitting needle 9 to the edge of the knitting needle guide 8, the knitting needle guide 8 and the knitting needle 9 are removed, while the remaining dacron thread 13 connects both fragments through the holes and leaves through both surgical wounds (Fig. 9).

A wire 14 with a diameter of 0.1 cm, a length of 40-50 cm is bent in half, and in the bending region the knot is fixed to the upper end of the Dacron thread 13 (Figure 10), the Dacron thread 13 is pulled through the lower channel - now the double wire 14 connects both through the holes fragments and exits through both surgical wounds. Lavsan thread 13 is removed (11). In the bending region of the wire 14, a stopper 15 is fixed (previously made in the form of a wire spiral with a diameter of up to 5.0 mm and consisting of three turns (Figs. 12-13). The wire 14 is pulled through the upper hole so that the stopper 15 rests on the cortical edges of the lower holes (Fig. 14.) According to the known method, through the upper wound at a distance of 1.5 cm from each other in the front-rear direction along the anatomical neck line, two Bogdanov rods 17, 18 are inserted antegrade to the level of holes located at the proximal ends of the rods 17, 18. Upper shoulder opening reinforced with a metal washer 16, previously worn on both ends of the wire 14 (Fig. 15.) One of the wire ends 14 is drawn through the holes of the rods 17, 18, starting from the rear pin of the rod 18. The pins of the rods 17, 18 are immersed in the head of the large tubercle of the shoulder 10 to the level of passage in the holes of the wire 14. The wire ends are fixed to each other at the level of the washer 16 by twisting 19 the ends of the wire 14. By twisting 19, compression is performed between the fragments of the large tubercle of the shoulder 10, and, if necessary, controlled compaction. The ends of the wire 14 bite, leaving a twist 19 of a length of 1.0 cm (Fig. 16), twist 19 of the wire 14 is immersed in the hole of the washer 16. If necessary, increase the compression between the fragments of the large tubercle of the shoulder 10, perform additional twisting of the wire 14 by forming a loop 20. wounds are sutured tightly.

With the surgical treatment of fractures of the proximal femur, the use of the device is similar to that described above.

The performance of the claimed device is confirmed by a clinical example.

Patient Yu-va, 71 years old, medical history No. 102824, was treated in the trauma department of GB-1, from 09.15.09 to 02.10.09 with a diagnosis of Closed fracture of the surgical neck of the right humerus with displacement of fragments, s / injury to the right wrist joint. 09/22/09, surgical treatment was performed - closed reposition, metal osteosynthesis with pins and wire loop, performed intraossally using the proposed device. The limb was fixed with a scarf dressing for up to 6 months. On the third day after the operation, the patient began to exercise therapy for the shoulder joint. Already after 8 months after the operation, the patient fully served herself, the metalwork was removed after 4 months.

Thus, the claimed device allows for a transossal method of conducting a wire loop, which significantly reduces the invasiveness of the operation, due to the lack of the need to access the fracture area and the head of the humerus, while retaining all the advantages of the method of fixing the fracture with pins with tension in the area of the fracture created by the wire loop .

The use of the proposed device allows you to perform minimally invasive operations on the proximal shoulder, can also be used for spokes for combined stress osteosynthesis of the shoulder and thigh (Solomin L.N. Fundamentals of transosseous osteosynthesis by G.A. Ilizarov apparatus:

Monograph. - SPb. LLC MORSAR AV, 2005. p2.11 346-379 s). Also, the device can be used to hold spokes through the bone in hard-to-reach anatomical areas. We performed 9 operations using this device / 6 on the neck of the humerus and 3 on the proximal femur /. In all cases, satisfactory results were obtained, confirmed by observation of patients over the next 12 months after surgery.

The utility model has the following advantages:

The device is technologically simple to manufacture, does not complicate the work of a trauma surgeon when used, provides high quality surgical treatment without injuring the shoulder joint and paraarticular anatomical structures and, due to the reduction of intra- and postoperative complications.

Claims (1)

A device for performing osteosynthesis, comprising a guide with an opening for the conducted knitting needle, characterized in that it is provided with two functional plates forming the handle, one of the plates has an opening for the guide of the needle, arcuate at an angle of 125 ° and having a longitudinal channel for holding the knitting needle, and also equipped with a directional axis indicator with the ability to adjust its position and fixation on the L-shaped curved rod, mounted on the second plate.