RU2290119C1 - Method for carrying out osteotomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves cutting bone with Gigli saw. The saw is preliminarily introduced into perfusion therapy tube having a window 2/5 times as wide as diameter and as long as sawing movement amplitude, cut at the level of saw operation part. Saw handles are brought outside by piercing the tube wall. The saw is arranged on the bone at osteotomy place with the window turned to the bone. Osteotomy is carried out. Pins of 2 mm are used as the handles. The tube for introducing the saw, is manufactured from polyvinyl chloride or silicon.

EFFECT: reduced risk of soft tissue injuries; high quality of osteotomy.

3 cl, 3 dwg

Description

The invention relates to medicine, in particular to traumatology in the treatment of abnormal metacarpal fractures, as well as in the collection of bone grafts, for example, fibula on a vascular pedicle, toes; when it is necessary to produce an osteotomy, while maximally preserving the soft tissues surrounding the osteotomy area.

Numerous osteotomy methods are known. In particular, an osteotomy can be performed with an oscillatory or circular saw, osteotome using the classical method of osteotomy with a Jigli saw (Lubotsky 1963). All of them are convenient to use and widely used, but they have a significant drawback: the risk of damage to soft tissues, which is unacceptable when working near blood vessels or nerves. There are recommendations for protecting soft tissues from damage. In this case, they usually use some kind of flat metal tool, pushing the soft tissue away from the area of impact of the saw or osteotome. Most often, a Buyalsky spoon or a Farabef hook is used for this.

The prototype of the invention was the method of osteotomy during osteoplastic trepanation using a wire saw. At the same time, it was proposed to use the Podreza spatula (clock spring) to protect brain tissue (Shevkunenko V.N. 1947). In later manuals for these purposes, it is proposed to use the Polenov probe (Fig. 2) (Ostroverkhov et al. 1963). The Polenov probe, unlike a spatula, has a thickening at one end and a hook for holding a wire saw. These techniques are usually effective, but difficult to work with in areas such as the hand or foot (osteotomy of the metacarpal or metatarsal bones) due to their anatomical features. The proximity of easily damaged structures - vessels, nerves, tendons in combination with a group arrangement of 2-5 metacarpal and metatarsal bones makes it difficult and sometimes impossible to use the usual tools. Thus, the use of known methods of osteotomy is dangerous either by damage to soft tissue structures, or by a decrease in the quality of the osteotomy itself.

The technical solution of the invention is to reduce the risk of soft tissue damage while maintaining the quality of the osteotomy. The result of the invention is achieved by performing an osteomy with a Gigli saw and simultaneous patching of soft tissues with a soft protector that does not interfere with the course of the saw and the accuracy of the specified direction of the osteotomy, which is made from a PVC tube from the perfusion therapy system.

The compliance of the technical solution with the criterion of "novelty" is determined by the absence in the prior art of an identical technical solution to achieve the claimed result.

Compliance with the criterion of "industrial applicability" is determined by the effectiveness of osteotomy itself, the low likelihood of damage to soft tissues, the simplicity of this manipulation, and the willingness to proceed with the widespread adoption of the claimed method, for which it is advisable to obtain patent protection of a new development.

In the proposed method for the production of osteotomy, a saw is used Gigli (Fig.1-A). The saw is pre-embedded in a silicone tube from a sterile perfusion therapy system (FIG. 1-B). In the tube there is a window ~ 2/5 of the diameter (Fig. 1-B) at the level of the working part of the saw for the length of the amplitude of the sawing movements. To prevent the tube from slipping relative to the saw, the handle of the saw (it may be 2.0 mm needles) are held in the holes piercing the tube profile (Fig. 1-D). The saw is mounted on the bone at the site of osteotomy, the tube is oriented by the window towards the bone. Further actions do not differ from those for osteotomy using the Gigli saw according to the accepted methodology.

Clinical example

Patient I., 19 years old, was admitted to the 16th department of RNIITO in a planned manner with a diagnosis of a malformed fracture of the 3 metacarpal bone of the left hand. The patient complained of a significant rotational displacement of the 3rd metacarpal bone, which manifests itself when the fingers are bent by “crawling” the 3rd finger onto the 4th. The patient was shown surgery: corrective osteotomy osteosynthesis of the 3rd metacarpal bone. When performing the operation, osteotomy was performed according to the proposed technique. Revision of the wound, as well as examination data confirmed the complete integrity of the soft tissues in the area surrounding the osteotomy site.

Bibliography

1. Shevkunenko V.N. A short course of operative surgery and topographic anatomy, "Medgiz", - 1947, - Moscow, - P.216.

2. Ostroverkhov G.E., Lubotsky D.N., Bomosh Yu.M. The course of operative surgery and topographic anatomy, "Medgiz", - 1963, - Moscow. S.361-363.

3. Usoltseva EV, Mashkara K.I. "Surgery of diseases and injuries of the hand", "Medicine", - 1986, - Leningrad. S.276.

4. Belousov A.E. Plastic reconstructive and aesthetic surgery. "Hippocrates", - 1998, - St. Petersburg. S.271.

Claims (3)

1. A method of osteotomy, including bone sawing using a Gigli saw, characterized in that the saw is preliminarily inserted into the tube from the perfusion therapy system, in which a window is cut at the level of the working part of the saw with a value of ~ 2/5 of the diameter per amplitude of sawing movements, hold the handle of the saw, piercing the tube, the saw is installed on the bone at the osteotomy, orienting the tube with the window towards the bone, then carry out the osteotomy. 2. The method according to claim 1, characterized in that as the handles of the saw use spokes of 2.0 mm 3. The method according to claim 1, characterized in that the tube into which the saw is inserted is made of PVC or silicone.

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