RU2262320C2 - Device for carrying out intramedullary tibia osteosynthesis using blocking screws - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device has rod, guide strip having holes, distal and proximal contact members. The rod has rectangular cross-section and smooth holes for receiving screws and threaded connection holes. The proximal contact member has axle with threaded ends and nuts. The axle is screwed into the threaded hole and fixed with a nut to the guide strip. The distal contact member has axle with threaded tip members and search end, fixing bushing and nut, and guiding bushings for drilling. The axle is mounted and fixed in the rod by means of search end and threaded connection and in the strip by screwing-in the fixing bushing and nut. The guide bushing for drilling has threaded connection with the guide strip.

EFFECT: high accuracy and simplified blocking method without image tube being required.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

Known devices for intramedullary osteosynthesis of the tibia with blocking, the use of which requires x-ray control of the blocking process.

To exclude X-ray methods for controlling distal blocking, the following were developed:

1. special rods having devices at the ends for jamming in the medullary canal (Tkachenko S.S. et al. Osteosynthesis. - L .: Medicine, 1987, pp. 26-27);

2. guiding devices fixed at the proximal end of the rod (Herzog K. Verlängerungsosteotomie unter Verwendung des percutan gezielt verriegelten Marknagels. Hefte Unfallheilkd. 1951. - No. 42. - P. 226; Berentey G. Neues Zielgerät für die distalefelgtegel. - 1983. - No. 165. - P. 260; Soyka P, Bussard C. Zur Verriegelungsnagelung - Ein stabiles Zielgerät für die distale Verbolzung. Helv Chir Acta. 1990. - No. 57. - P. 117; FR 2385378 Al (ATLANTIS FINANCE SA ) 10.27.1978), including a system in which, in order to increase the accuracy of screw penetration into the rod openings, the latter are performed immediately before the rod is inserted into the marrow canal (Device for intramedullary osteosy nteza.Description of the invention to the copyright certificate SU 992045 A. Baskevich M.Ya., BI, 1983. - No. 4);

3. a system, which is a device that combines intramedullary osteosynthesis with a rod interstitial device, in which the rod is blocked in the bone marrow canal with threaded rods fixed in a plate, which is also a guiding device (Device for osteosynthesis of tubular bones. Description to the copyright certificate SU 1616639 A1. Vygovsky N.V., BI. - 1990. - No. 48);

4. systems based on a change in magnetic fields from arising moving twisting waves from rods (Börner M., Brudermann U., Klemm K., Ziegelmüller R. Distale Zielgerät für die Verriegelungsnagelung. Hefte Unfallheilkd. 1984. - No. 182. - P. 387; Klemm K., Börner M. Interlocking nailing. Med Focus. 1985. - No. 6. -P.1; Holistien S., Ruth JT Elektromagnetik distal targeting for the placement of transverse interlocking screws. Osteoporos Int. 1996. - No. 3.- P.196);

5. systems that analyze rod deformation (Krettek C., Mannβ J., Könemann B., Miclau T. et al. The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. J. Biomech. 1997.-No. 30.- P.391).

The most common was the development of guiding devices. However, simply fixing them at the proximal end of the rod cannot take into account its deformation during insertion. For this reason, the “free-hand” method is the most common method for distal blocking (Müller M.E., Allgover M., Schneider R., Willinegger X. Guidelines for internal osteosynthesis. Method recommended by the AO group (Switzerland) ./ Per. from German .-- M .: Ad Marginen, 1996. - 750 p .; Hudson I. Locking nailing: an aid to distal targeting. Injury. 1989. - No. 20. - P.129; Rao JP, Allerga MP, Benevenia J ., Dauhajre TA Distal screw targeting of interlocking nails. Clin. Orthop. 1989. - No. 238 - P.245; Conlan DP Grosse and Kempf locked intramedullary nailing: an improved distal locking screw drill guide. JR Coil. Surg. Edinb. 1990 , - No. 35. - P.61; Höntzsch D, Weller S Die distale Verriegelung von Marknägelin mit transversalen Schr auben oder Bolzen. Oper. Orthop.Traumatol. 1991. - No. 3. - P.25; Hashemi-Nejad A., Garlich N., Goddard NJ A simple jig to ease the insertion of distal screws in intramedullary locking nails. Injury. -1994.-No. 25.-P.407).

Recently, a system has been developed without using X-ray control of blocking using nozzles fixed proximally and oriented relative to the distal end of the rod (Krettek C., Könemann B., Farouk O., Kromm A., Schandelmaier P., Tscherne H. Vergleich eines durchleucchtungsfreien mecchanischen Zeilsystems und einer Freihandtechnik für die Plazierung von distalen Verriegelungsschrauben von Tibianägeln. Chirurg. 1997. - No. 68.-P.1194-1201).

The latter was used by us as a prototype. It consists (Fig. 1) of a tibial rod without drilling the medullary canal (1), an insertion handle (2), a node for connecting the guide bar and an insertion handle with different lengths of the selected rod (3), guide bar (4) , a distal contactor, consisting of a rod connected to the guide bar, and an L-shaped transmitter (5).

The disadvantages of this system are:

1. the device has a sliding console, which reduces the rigidity of the structure;

2. the distal contactor consists of 2 nodes, which increases the complexity of the distal blocking and reduces the stiffness of the connection of the guide bar relative to the rod;

3. Anchor mounting of the distal contactor, requiring three technological operations using 2 parts;

4. the need to use 2 separate guide bars for distal and proximal blocking;

5. the need for interchangeable anchoring of the distal contactor for rods of different diameters;

6. the possibility of wear of the mounting sleeve for drilling relative to the guide plate during repeated use due to smooth surfaces, which reduces the accuracy of drilling.

The technical result of the proposed device is to increase the accuracy and simplify the technique of distal locking with screws during intraosseous osteosynthesis with a rod without using an electron-optical transducer.

The specified result is achieved by the fact that:

1. There is one guide bar;

2. the distal contactor consists of 1 node;

3. there is a threaded connection of the distal contactor, consisting of 1 part;

4. the ability to perform distal and proximal blocking with one guide bar;

5. The guide system is universal for the use of rods of various sizes;

6. There is a threaded connection between the drill sleeve and the guide bar.

The invention is illustrated in figure 2 (General view of the device), Figure 3 (sketch of the device), Figure 4 (radiographs of the patient, performed before (A), on the day (B) of the operation and after 4 months (C).

The device (Fig. 3) consists of a rod (12) of rectangular cross section 7 × 8 mm with a fixed proximal curvature, having smooth screw holes and threaded (connecting) holes, a guide bar with holes for the fixing and guide nodes (8), the proximal a contactor consisting of an axis with threaded ends (6) and a nut (7), a distal contactor including an axis with threaded ends and a search end (11), a retaining sleeve (9) and a nut (10), guide bushing for drilling (13) .

The device is used as follows: the rod (12) is inserted into the medullary canal using a bar fixed at the proximal end, which is then removed. An axis (6) is screwed into the proximal threaded hole and fixed with a nut (7) to the guide bar (8), which is oriented along the axis of the tibia. After insertion of the sleeve into the hole for the distal contactor in the guide bar, the anterior cortical layer is drilled with a diameter of 7 mm. The sleeve is removed, and in its place, through the existing hole in the bone, the axis (11) is installed and fixed in the rod using the search end and the threaded connection, and in the bar - by screwing the fixing sleeve (9) and nut (10). Thus, a rigid cantilever is formed, which allows the introduction of a drilling sleeve (13) to drill through both cortical layers and the hole in the shaft. A self-tapping screw is inserted through the formed channel, after which the guide device is dismantled.

Example. Patient B-va N.V., 29 years old, medical history No. 1775, was treated at the trauma unit from July 17 to August 12, 2002 due to a combined injury: CCI. Brain concussion. Closed comminuted triple fracture of the bones of the right tibia with displacement of fragments (figa). Closed comminuted fracture of the proximal metaepiphysis and inner ankle of the left tibia with displacement. Closed screw-shaped fracture of the middle third of the left humerus with displacement of fragments. July 31, 2002, under intubation anesthesia, osteosynthesis of the right tibia was performed with a rod with locking screws (three screws in the proximal and distal segments) according to the method described above (Fig. 4B), osteosynthesis of the left tibia and left humerus with plates. The postoperative period was uneventful. The patient was discharged on day 13 after surgery for outpatient treatment. 4 months after the operation (Fig. 4C) on the control radiographs the formation of bone callus is determined on all damaged segments. The patient walks with a metered load on both lower limbs.

Using the proposed device provides the following positive effects:

1. the possibility of using the device without an electron-optical converter;

2. reduction in the number of necessary actions due to the use of a single guide system for proximal and distal blocking;

3. achieving a hard screw connection of all nodes of the device.

Claims (1)

A device for intramedullary bone osteosynthesis with screw locking, comprising a rod, a guide bar with holes, a distal and proximal contactors, characterized in that the rod is made of rectangular cross-section with smooth holes for screws and threaded connecting holes, the proximal contactor consists of an axis with threaded tips and nuts , while the axis is screwed into the threaded hole and fixed with a nut to the guide bar, the distal contactor includes an axis with a threaded tip and a search end, a fixing sleeve and a nut, guide sleeves for drilling, the axis being mounted and fixed in the shaft using the search end and a threaded connection, and in the bar - by screwing the fixing sleeve and nut, the guide sleeve for drilling has the possibility of a threaded connection with guide bar.

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