RU2152764C1 - Device for adjusting endoprosthesis cup position in setting hip joint endoprosthesis - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has three units (A, B and C) fixed one relative to another. Unit A has base having limb, bushings having slots and upright, adjusting screw for fixing the upright having arrow attached to it, fastening screw for fixing the base having U-shaped groove on the lower surface for being fixable to special rest member of operation desk. Unit B has axial rod, removable bushing having fixed rod and mark corresponding to the limb. Unit C has unit B modified in a way that the fixed rod is substituted with a short fixed rod having guiding members (three of them in particular case) being in perpendicular relation to one another. EFFECT: enhanced accuracy in setting endoprosthesis cup in cases of coxarthrosis of compensatory fixed scoliosis of lumbar vertebral column region, hip joint misalignment in frontal plane, pelvis rotation about longitudinal body axis. 12 cl

Description

 The invention relates to medicine, namely to operative orthopedics.

 There is a method of installing the hip component (cup) of the hip joint endoprosthesis in the patient’s side position (Kornilov N.V., Voitovich A.V., Mashkov V.M., Epshtein G.G. Surgical treatment of degenerative-dystrophic lesions of the hip joint. .-Petersburg, 1997.- S. 165-169). Similar tactics are followed by Bonnomet F., Kempf J.F. Technique de mise en place des protheses totales de hanche sans ciment. Editions Techniques - Ency-clopedie Medico-Chirurgicale (Paris - France), Technique chirurgicales - Ortho-pedie-Traumatologie, 44-667, 1993, 12 P; Mathys R. Isoelastische Huftprothesen. Manual fur chirurgische und operative Tchnikennnn. Verlag Hans Huber Bern-Gottingen-Toronto. - 1992.- P 21.

The method of cup implantation described by the authors for hip replacement is a classic and consists in the following. Hip arthroplasty is performed in the patient’s position on the “healthy” side. During the operation, after appropriate treatment of the acetabulum with milling cutters, an implant cup is implanted with the necessary angle of inclination of 45 ^o down and 10 ^o anteriorly.

 For the exact installation of the cup, the authors use a special device orienting the cup in the acetabulum.

 However, the special device used by the authors to orient the endoprosthesis cup in the acetabulum, containing two guides, cannot orient the endoprosthesis cup in the acetabulum in cases of patients with coxarthrosis with compensatory fixed scoliosis of the lumbar spine, pelvic distortion in the frontal plane and pelvic rotation around the longitudinal axis body.

 A close solution to this problem can be achieved using the methodology of Mathys R. Isoelastische Huftprothesen. Manual fur chirurgische und operative Tchnikennnn. Verlag Hans Huber Bern-Gottingen-Toronto. - 1992.- P 21.

 The objective of the invention is to ensure the accuracy of the position of the cup of the hip joint prosthesis in the acetabulum in cases of patients with coxarthrosis with compensatory fixed scoliosis of the lumbar spine, distortion of the pelvis in the frontal plane and rotation of the pelvis around the longitudinal axis of the body.

 This object is achieved in that to ensure the accuracy of the position of the cup of the hip joint prosthesis in the acetabulum during hip joint replacement, the proposed device for orienting the position of the endoprosthetic cup for hip joint replacement in patients with coxarthrosis and the presence of compensatory scoliosis of the lumbar spine and transversal spine planes and rotation around the longitudinal axis of the body consists of three nodes, interlocking dr d with a friend, moreover, node A has a base with a U-shaped groove and a limb, bushings with a stand and an arrow fixed in it, as well as adjusting and fixing screws, and node B has an axial shaft and a limb, removable and non-removable bushings, while the latter is fixed fixed rod, on which is mounted a node C consisting of a node B, where instead of the fixed rod there is a short fixed rod with mutually perpendicular guides, while the technical solution of the device and the method of attachment to the operating table provide hydrochloric perpendicular position of the device nodes in 3 planes, able to set the guide device and all the nodes in twelve positions.

In FIG. 1 shows a device for orienting an endoprosthesis cup. (Mathys R. Isoelastische Huftprothesen. Manual fur chirurgische und operative Tchnikennnn. Verlag Hans Huber Bern-Gottmgen-Toronto. - 1992.- P 21);
in FIG. 2 shows a device for orienting the position of the endoprosthesis cup when the hip joint is assembled, side view;
in FIG. 3 - a device for orienting the position of the cup of the endoprosthesis during hip replacement, front view;
in FIG. 4 shows separately the nodes of the device: A, B, and C;
in FIG. 5 - node A of the device, side view;
in FIG. 6 shows the combined position of the device node A;
in FIG. 7 shows a device assembly B;
in FIG. 8 shows the combined position of the device node C;
in FIG. 9 depicts options for the positions of the guides and components of the device, demonstrating its technical capabilities;
in FIG. 10 shows a device (a) for orienting the location of an endoprosthesis cup during hip replacement and a device (b) inserted in an acetabulum for orienting an endoprosthesis cup;
in FIG. 11 - the moment of adaptation of the device (b) for orienting the endoprosthesis cup to the device (a) for orienting the position of the endoprosthesis cup during hip joint replacement;
in FIG. 12 is the final stage of adaptation of the device (b) for orienting the endoprosthesis cup to the device (a) for orienting the position of the endoprosthesis cup during hip joint replacement.

 The device consists of three nodes A, B, and C.

 Node A consists of a base (1), on the upper surface of which there is a limb (2), bushings (3) with a slot (4) with a stand (5), an adjusting screw (6) for fixing the stand (5), which is fixed in it arrow (7), a fixing screw (8), used to fix the base (1), on the lower surface of which there is a U-shaped groove (9) for fixing to a special support of the operating table.

 The assembly B consists of an axial shaft (10), a removable sleeve (11) with a through hole (12) for fastening the strut (5) of the assembly A, a limb (13), and a fixed sleeve (14) having a fixed shaft (15) and a mark (16) for limb (13).

 Node C consists of node B, where instead of the fixed rod (15), a short fixed rod (17) is fixed, having mutually perpendicular guides (18), for example, three pieces.

 The device operates as follows.

 The patient is on the operating table in a position on his side. During hip replacement surgery after preparation of the acetabulum for implantation of the endoprosthesis cup, the device for orienting the position of the endoprosthesis cup is fixed on a special support of the operating table (Fig. 10a) so that the base (1) of node A is at the level of the iliac crest, and the leg (5) Node A is on the line that mentally divides the acetabulum into the front and back parts in half. Based on the data on the degree of pelvic distortion obtained in the preoperative period during clinical and radiometric studies of the patient, the guides (18) of node C should be installed at the required design angle in three planes: horizontal, frontal and sagittal.

 To do this, first install node A on a special support of the operating table, as described above, and fix it with a fixing screw (8). The stand (5) is turned anteriorly so that the arrow (7) fixed in it, moving in the slot (4) of the sleeve (3) of the base (1), indicates the required calculated angle (degree) of the limb (2) of the cup anterior inclination, after which the stand (5) is fixed with the adjusting screw (6) of the sleeve (3).

 The node B is fixed to the stand (5) of the node A. The mark (16) of the node B is set to the required design angle (degree) of the limb (13) of the cup tilt down.

 The node C is fixed to the fixed rod (15) of the node B. The mark (16) of the node C is set to 0 of the limb (13) of the node C.

 After completing these manipulations, the guides (18) of the assembly C are automatically set at predetermined angles of inclination anteriorly and downward (Fig. 12a).

 After the guides (18) of the node C are installed at the required design angles, a device is inserted into the acetabulum (Fig. 1, 10b, 11b) to orient the cup so that the axes of its guides (19) (Fig. 11b, 12b) coincide in all planes with axes of guides (18) of node C.

 Then, focusing already on the position of the guides (19) of the device (b) (Fig. 1, 12b) for orienting the cups, they proceed directly to the installation of the prosthesis cup at predetermined design angles.

 If desired or necessary, the guides of the device can be installed at the desired design angles before the operation and not spend minutes performing all the manipulations during the operation.

Clinical example:
Patient P., born in 1931, I / B N 715-579, was admitted to the medical institution TMO-2 on September 21, 1999 for planned surgical treatment.

 Diagnosis: False joint of the neck of the left thigh. Insolvency of osteosynthesis of the left femoral neck. Pronounced brush-like reconstruction of the head of the left thigh. Bending-contracting contracture. Pain syndrome. NF joint 4th degree.

 Concomitant diagnosis: IHD. Angina is unstable, stabilization in the second FC. H1. Hypertensive b-n, 2 tbsp., Mild labile hypertension. Chronic bronchitis with asthmatic component. PTB of the left lower leg. Common osteochondrosis.

In the preoperative period, the patient was examined, the angles of the deviation of the pelvis in the frontal projection and anteriorly were determined. The angle of inclination of the left half of the pelvis downward was 15 ^o , the angle of deviation of the left half of the pelvis anteriorly was 14 ^o . Intraoperative correction of the incline of the prosthesis cup is provided (Fig. 7).

 09/28/99, Operation N 213-214 - prosthetics of the left hip joint with a Muller Cup N50 on bone cement "Palakos R", M. Müller leg N 11 on bone cement "Palakos R". P / O diagnosis: the same.

 Chir .: Kolesnik A.I., Ac. Brezhneva N.L., Ivanova G.P.

Duration: 3 hours 35 minutes, blood loss: 1200 ml
Anesthesiologist: Chursin Yu.M.

Anesthesia: endotracheal anesthesia
Op. sister: Yakovleva T.M.

Exodus: Discharged 10/12/99
Protocol
1. A section of up to 21 cm long on the outer surface of the joint layer-by-layer exposed the trochanteric region of the femur. Hemostasis and toilet wounds with antiseptics during the operation.

 2. The capsule of the joint is exposed. Hemostasis and toilet wounds with antiseptics during the operation. The capsule is dissected. The head is free from the neck. The head is dislocated from the cavity; it is deformed, flattened. Hemostasis and toilet wounds with antiseptics during the operation.

3. The device (a) for orienting the position of the endoprosthesis cup during hip replacement is fixed on a special support of the operating table (Fig. 10a). The guides (18) are set to tilt angles: down 15 ^o , anteriorly - 14 ^o (Fig. 12a).

 4. The acetabulum is machined with cutters NN 48 - 52.

 5. A device (b) for orienting the endoprosthesis cup (Fig. 10b, 11b) is inserted into the acetabulum. The device (b) is given a position, the axes of its guides (19) coincide with the axes of the guides (18) of the device (a) (Fig. 12).

 6. An M50 Muller cup was implanted on Palakos R bone cement at predetermined angles.

 7. The proximal femur is treated with the Rasp N7.5, -11.25.

 8. The femoral canal is blocked by a silicone plug, the clinical use of which is approved by the Ministry of Health of the Russian Federation.

 9. An Müller leg N 11.25 was implanted on the Palakos R bone cement.

 10. The head Мх32 is selected. The head is set into the cavity. The range of motion in the joint is sufficient.

 11. Toilet wounds with an antiseptic. Layer wound closure with 2 drains left for active aspiration. Rubber graduates in subcutaneous fat.

 12. Elastic bandaging of the legs.

 Thus, the proposed device compares favorably with the prototype, its technical solution allows to achieve the objective of the invention due to the fact that its design solution allows you to properly orient the cup of the hip joint prosthesis in the acetabulum in cases of compensatory fixed scoliosis of the lumbar spine in patients with coxarthrosis skew of the pelvis in the frontal plane and rotation of the pelvis around the longitudinal axis of the body.

Claims (1)

 A device for orienting the position of the endoprosthesis cup during hip replacement, having two guides, characterized in that to ensure the accuracy of the position of the hip joint cup in the acetabulum during hip replacement in cases of compensatory fixed scoliosis of the lumbar spine in patients with coxarthrosis in the frontal plane and rotation of the pelvis around the longitudinal axis of the body, the device consists of nodes, interlocking captured with each other, and node A has a base with a U-shaped groove and a limb, bushings with a stand and an arrow fixed in it, as well as adjusting and fixing screws, and node B has an axial shaft and a limb, removable and non-removable bushings, while in the latter, a fixed rod is fixed, on which a node C is mounted, consisting of a node B, where instead of a fixed rod there is a short fixed rod with mutually perpendicular guides.

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