RU2220673C2 - Method for forming osseous channels - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: the present innovation deals with treating patients, with luxations of acromial clavicular end, in particular. The method for forming osseous channel deals with drilling two osseous through channels with separate input openings on superior osseous surface. The second channel is drilled at an angle to the first one and its output opening is formed in output opening of the first channel. In this method one should apply a device that contains a rod with an arresting device for plunging depth, a plank with measuring sections being cross-sectional to the rod, a coupling with a fixing bolt and a tube. Tube's position is determined by the following formula: X = a + b, where X - the distance from plank's external surface up to crossing site of tube's superior surface and plank's inferior surface; a - fixed distance between inferior surfaces of an arresting device and a plank, b - the depth of the first channel. At first, one should measure the depth of the first drilled channel to add the known distance from inferior surface of an arresting device up to plank's inferior surface to the value obtained. The sum obtained is counted from rod's external surface by the scale of measuring sections on a plank, and at the level of this label one should fix the crossing of tube's superior edge with plank's inferior edge. Then the rod is introduced into input opening of the first channel up to arresting device's support into osseous surface, a drilling element is introduced into tube's cavity to drill the second channel according tube's direction. As a result, improved operative treatment, decreased osseous trauma and decreased number of complications are achieved due to providing the possibility for improved operation. EFFECT: higher efficiency of operation. 1 cl, 2 dwg _

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the formation of channels in the bone during surgical treatment of patients, in particular, with dislocations of the acromial end of the clavicle.

 A known method of surgical treatment for dislocation of the acromial end of the clavicle, including drilling four bones in the bones: two in the clavicle and two in the acromial process at a distance of 10 mm between them in a downward direction. Through the formed channels in the clavicle, an elastic element (vascular catheter) is passed with the removal of its ends above the clavicle. The withdrawn ends of the elastic element cross, pass through the channels in the acromial process from the bottom up and are connected together above the acromion (Ishchenko V.P., Ishchenko I.V. , traumatology and prosthetics. 1989. 1. C 53).

 The disadvantage of this method of surgical treatment is that when two through channels are formed in the cortical layer of the lower surface of the acromial process, two separate exit openings are formed, which leads to excessive bone injury and does not contribute to the reduction of complications and the improvement of surgical treatment. In this method, there are no signs when drilling into the bones of channels converging at an angle to a more reliable and accurate formation of the outlet of the second channel in the outlet of the first on the lower surface of the acromial process.

 There is also known a method of forming a channel in the bone using a special device for guiding the drilling element through the guide tube into the bone (Kaplan A.V. Closed injuries of bones and joints. Second supplemented and revised edition. M., Medicine, 1967, p. 54).

 The disadvantage of this method is the absence of signs in it, which enable the formation of channels converging at an angle with one common outlet on the lower surface of the acromial process hidden from the eyes.

 Closest to the proposed technical essence and the achieved result is the method given by the latter, which we take as a prototype, and its disadvantages are described above.

 The technical result consists in improving surgical treatment, reducing bone trauma and reducing complications by providing the possibility, when drilling into the bones of channels converging at an angle, to more accurately form the outlet of the second channel in the outlet of the first on the lower surface of the acromial process.

The technical result is achieved by the fact that the method of forming channels in the bone involves drilling two through channels in it with separate entrance holes on the upper surface of the bone. Moreover, the second channel is drilled at an angle to the first and its outlet is formed in the outlet of the first channel. In this case, a device is used that contains a rod with a limiter for immersion depth, a bar with dimensional divisions transverse to the rod, a sleeve with a fixing bolt and a tube, the position of which is determined by the formula X = a + b,
where X is the distance from the outer surface of the bar to the intersection of the upper surface of the tube with the lower surface of the bar,
a - a fixed distance between the lower surfaces of the limiter and strap,
in - the depth of the first channel.

 At the same time, the depth of the channel drilled by the first channel is measured first, the known distance from the lower surface of the limiter to the lower surface of the bar is added to the obtained value, the resulting amount is counted from the external surface of the rod on the scale of graduated marks on the bar and at the level of this mark, the intersection of the upper edge of the tube with the lower edge is established slats. Then the rod is inserted into the inlet of the first channel until the stopper rests on the bone surface, and a drilling element is inserted into the cavity of the tube and a second channel is drilled in the direction of the tube.

 In a preferred embodiment of the method, the inlet in the cortical layer of the bone of the first channel is drilled with a drill with a diameter equal to the diameter of the rod.

 The essence of the proposal and a specific example of the method is illustrated by drawings. Figure 1 shows a device, a view in side projection with a vertically drilled first channel in a thin bone. Figure 2 - the same, with an inclined drilled first channel in a thicker bone. In figure 1 and 2 are indicated: 1 - the core of the device; 2 - the lower end of the rod; 3 - limiter of the depth of immersion of the rod into the bone canal; 4 - transverse to the rod strap; 5 - coupling; 6 - tube; 7 - slice of the lower end of the tube; 8 - a fixing bolt; 9 - dimensional divisions on the bar 4; 10 - acromial process of small thickness; 11 - a common outlet on the lower surface of the thin bone; 12 - acromial process of considerable thickness; 13 is a common outlet on the lower surface of a thicker bone. Letter designations: "a" - a fixed distance between the lower surfaces of the limiter and the device bar; "in" - the depth of the first channel. In figure 2 with a thicker bone 12 and with an inclined formation of the first channel with the rod inserted into it, similar letter designations, but with the number "1" behind them below.

 A specific example of the method in the vertical formation of the first channel in the bone. When drilling in the bone 10 of the first channel, the inlet in the cortical layer is formed with a drill with a diameter equal to the diameter of the rod. Determine the depth "in" the channel - the distance between the cortical upper and lower surfaces of the bone. The proper position of the tube 6 with the sleeve 5 on the bar 4 is determined by the formula X = a + b, where X is the proper distance from the outer surface of the rod 1 to the intersection of the upper surface of the tube 6 with the lower surface of the bar 4. The distance X is the sum of the depth of the first channel and the distance between the lower surfaces of the stop 3 and strap 4. Since the distance “a” is a constant and equal to 10 mm in a particular device, and the channel depth “b”, different in different bones, turned out to be 10 mm in a specific example, the desired value of X is 20 mm . The resulting amount of 20 mm is counted from the outer surface of the rod 1 according to the scale of 9 graduations on the bar 4. At the level of this mark (20 mm), the intersection of the upper edge of the tube 6 with the lower edge of the bar 4. Set the bolt 8 to fix the coupling 5 with the tube 6 to the bar 4. Through the upper inlet into the first channel drilled along the axis, the lower end 2 of the rod 1 of the device is inserted until the stop 3 stops into the upper cortical layer of bone 10. The end of the drilling element (drill from the drill) is inserted into the tube 6 and along the tube 6 and continue her projection drilled they create a second channel in the bone in a predetermined direction, which ensures the formation of the outlet of the second channel in the outlet of the first.

The significance of the differences of the invented method is as follows. The method is carried out using a new device that we have developed, which contains a rod with a limiter for immersion depth, a bar with dimensional divisions transverse to the rod, a sleeve with a fixing bolt, and a tube, the position of which is determined by the formula. This provides the possibility of forming at an angle to the first of the second channel, with one outlet. Measuring the depth of the first channel drilled and adding to this value the known distance from the lower surface of the limiter to the lower surface of the bar allows you to get the side length of the future triangle. When measuring on the scale of measured divisions on the bar from the outer surface of the rod the length of the measured side of the triangle, we get the second side of the triangle that is equal in length. Since the bar is placed at right angles to the rod and the sides of the triangle are equal, it turns out to be rectangular and isosceles. The introduction of a portion of the rod of the device into the inlet of the first channel until the lower surface of the limiter abuts against the bone surface ensures that it is dosed into the channel. Placing the tube at an angle of 45 ^o relative to the rod and the bar and the intersection of the upper edge of the tube with the lower edge of the bar on the measured length of the leg of the isosceles triangle provides a projection of the upper edge of the tube into the outer edge of the outlet, and its lower edge into the inner edge of the outlet. As a result, after the drilling element is inserted into the tube and the bone is drilled in the direction of the tube, the outlet of the second channel is aligned with the outlet of the first channel.

 In a preferred embodiment of the method, drilling the inlet in the cortical layer of the bone of the first channel with a drill with a diameter equal to the diameter of the rod, ensures the accuracy of the direction of insertion and location of the rod along the first channel in the bone. In addition, a sufficiently tight entry of the working part of the rod into the inlet and part of the first channel ensures reliable retention of the rod in the bone, which improves the quality of formation of the second channel.

 Thus, the claimed method in the aggregate of its characteristics leads to the achievement of a technical result: the possibility, when drilling into bones of channels converging at an angle, to more accurately form the outlet of the second channel in the outlet of the first on the lower surface of the acromial process, which reduces bone injury, improves the quality of the surgical treatment, reduces the likelihood of complications, reduces the time of inpatient treatment and creates an economic effect.

 The application of the invention is possible in pediatric and field surgery.

Claims (2)

1. A method of forming channels in the bone, including drilling two through channels with separate inlet holes on the upper surface of the bone, the second channel being drilled at an angle to the first and its outlet being formed in the outlet of the first channel, characterized in that the device is used, comprising a rod with a limiter for immersion depth transverse to the rod with a graduated bar, a sleeve with a fixing bolt and a tube, the position of which is determined by the formula X = a + b, where X is the distance from the outer surface of the bar to the intersection of the upper surface of the tube with the lower surface of the bar; a - a fixed distance between the lower surfaces of the limiter and strap; in - the depth of the first channel, first, the depth of the channel drilled by the first is measured, the known distance from the lower surface of the limiter to the lower surface of the bar is added to the obtained value, the resulting amount is counted from the external surface of the rod on the scale of graduated marks on the bar and at the level of this mark the intersection of the upper edge of the tube with the lower edge is established straps, then the rod is inserted into the inlet of the first channel until the stop stops in the bone surface, and a drilling element is introduced into the cavity of the tube and drilled into the second channel in the direction of the tube. 2. The method according to claim 1, characterized in that the inlet in the cortical layer of the bone of the first channel is drilled with a drill with a diameter equal to the diameter of the rod.

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