RU235030U1 - Device for standardizing the use of an electronic optical converter in foot surgeries - Google Patents

Abstract

The utility model relates to medicine, namely to surgery, traumatology and orthopedics, radiation diagnostics, and is a device for correct placement of the foot with the possibility of preoperative planning, intraoperative control of its position using an electronic optical converter (EOC). A device for standardizing the relative position of the foot and the electronic optical converter, including horizontal and vertical parts with the possibility of their movement relative to each other and fixation, characterized in that the parts of the device are made of X-ray negative sterilizable material; horizontal part - a base 25 cm wide, 50 cm long and 3 cm thick has two blind grooves with threads in the distal end for fixing to it with wing nuts at an angle of 90° a vertical part 25 cm wide, 50 cm long and 3 cm thick, having two through longitudinal grooves and in the upper part a through channel with a diameter of 3 cm, located at an angle of 20° to the perpendicular to the end of the vertical part, while the inner part of the through channel is made of a tube of radiopaque material. 2 fig.

Description

The utility model relates to medicine, namely surgery, traumatology and orthopedics, radiation diagnostics, and is a device for correct placement of the foot with the possibility of preoperative planning, intraoperative control of its position using an electronic optical converter (EOC).

A method of using a special platform for radiological determination of the position of the metatarsal heads during preoperative planning in the treatment of patients with forefoot deformities is known [1]. The disadvantage of this method is the impossibility of using the platform during foot surgery due to the technical complexity of its sterilization. The study can only be performed with the patient standing on the platform.

A device for multi-projection X-ray negative placement of the hand during X-ray imaging is known - a base equipped with a working surface, support surfaces, shaped recesses for the fingers, the base is made of X-ray negative material. [2]. The disadvantage of the device is the impossibility of its use in foot surgeries, the device does not solve the problem of standardization of X-ray angulometric studies at the stages of surgical treatment using EOP.

A device for positioning distal extremities during radiography is known. The device comprises a base with a slot, on which a graduated scale is fixed, having a lock and through holes made with a step of 10°. A vertical plate with screws on the ends is located in the slot, made with the possibility of moving up to 50° to the right and left along the graduated scale. The vertical plate is equipped with a removable radiolucent cuff for fixing the extremity being examined [3].

The disadvantages of the device are the difficulty of monitoring the same position of the foot and the location of the EOP relative to each other at different stages of planning, conducting and evaluating the results of surgical intervention. Using the device requires additional skills and efforts from the surgeon to calibrate the position of the X-ray angulometric equipment at the stages of the operation. It is impossible to use the device when performing operations on the forefoot in full, due to the lack of access of the surgeon to the lateral surfaces of the foot when fixing it. We took this device as a prototype.

The purpose of creating a utility model is to develop a device for standardizing the relative position of the foot and the electronic optical converter.

This goal is achieved by the fact that the parts of the device are made of radiopaque sterilizable material; the horizontal part-base 25 cm wide, 50 cm long and 3 cm thick has two blind grooves with threads in the distal end for fixing to it with wing nuts at an angle of 90° of the vertical part 25 cm wide, 50 cm long and 3 cm thick, which allows using the device in all patients regardless of anthropometric features. The vertical platform has two through longitudinal grooves and in the upper part a through channel with a diameter of 3 cm, located at an angle of 20° to the perpendicular to the end of the vertical part. A necessary condition is that the inner part of the through channel is made of a tube of radiopaque material.

The parts of the device are made of X-ray negative sterilizable material, such as textolite or plastic. This allows free use during surgical interventions. The dimensions of the horizontal part-base are optimal for use in patients with any length of the shin. The dimensions of the vertical part of the device are optimal for patients with different foot sizes.

The longitudinal grooves of the vertical part allow free selection of the height of fixation of the horizontal part to it, optimal for the position of the patient's foot. Fixation of the parts of the device to each other with two wing screws is simple, reliable and convenient.

The location of the through channel with a diameter of 3 cm at an angle of 20° to the perpendicular to the end of the vertical part is necessary to comply with the standard deviation of the X-ray beam during preoperative radiography.

The inner part of the through channel is made of a tube made of radiopaque material, such as stainless steel, due to the ease of its sanitary treatment and sterilization.

The device for standardizing the mutual arrangement of the foot and the electronic optical converter includes horizontal and vertical parts made of X-ray negative sterilizable material. The horizontal part-base 25 cm wide, 50 cm long and 3 cm thick has two blind grooves with threads in the distal end for fixing the vertical part to it with wing nuts at an angle of 90°. The vertical part 25 cm wide, 50 cm long and 3 cm thick has two through longitudinal grooves and in the upper part a through channel 3 cm in diameter, located at an angle of 20° to the perpendicular to the end of the vertical part. The inner part of the through channel is made of a tube made of X-ray contrast material.

The utility model is illustrated with graphic material.

Fig. 1 shows a diagram of the device in isometric projection,

Fig. 2 – side view,

where 1 is the horizontal base part; 2 is the vertical part; 3 is the longitudinal grooves of the vertical part; 4 is a through channel with a tube made of radiopaque material; 5 is a blind groove with a thread in the distal end of the horizontal part; 6 is a wing nut.

The device is used as follows.

The patient is placed on the operating table in such a way that his lower leg presses the horizontal part 1 of the device to the operating table. The optimal height of the vertical part 2 is selected taking into account the size of the patient's foot. The vertical part 2 is fixed using two wing nuts 6 through the longitudinal grooves 3 of the vertical part 2 in the blind grooves 5 of the horizontal part 1 at an angle of 90°. The device is shifted proximally until the plantar part of the foot is completely adjacent to the vertical part 2. The EOP is installed above the operating table and adjusted in such a way that the radiopaque tube of the through channel 4 of the vertical part 2 of the device has the appearance of a regular ring on the EOP monitor. Preoperative control images are taken. The device is shifted distally and the necessary surgical manipulations are performed on the foot tissues. If necessary, intraoperatively, the device is again moved until the plantar part of the foot rests against the vertical part 2 of the device and the correctness and completeness of the manipulations are monitored.

The application of the utility model is illustrated by clinical examples.

Example 1. Patient R., 53 years old, came to the traumatology and orthopedic department complaining of pain, deformation of the forefoot of the right foot, and inability to select correct footwear. Clinical examination revealed valgus deviation of the first toe of the right foot, medial exostosis of the head of the first metatarsal bone of the right foot. According to the radiography of the right foot in two projections, deformation of the forefoot of the right foot is determined due to varus deviation of the first metatarsal bone and valgus deviation of the proximal and distal phalanges of the first toe of the right foot.

Before the operation, the horizontal part—the base of the device, on which the patient's lower leg is placed—is installed on the operating table. The parts of the device are fixed to each other at an optimal height, taking into account the size of the patient's foot. The device is shifted proximally until the plantar part of the foot rests against the vertical part. The correct position of the EOC relative to the operating table and the patient's foot is determined by monitoring the image of the radiopaque tube of the through channel of the vertical part of the device in the form of a regular ring on the monitor. The study is performed. Preoperative marking is made. The device is shifted distally.

Using special drills for minimally invasive surgery, the medial exostosis was removed and a distal subcapital osteotomy S.E.R.I., Akin osteotomy of the proximal phalanx of the 1st toe of the right foot was performed. The position of the EOP relative to the patient's foot was adjusted using the device intraoperatively at each stage of the surgical intervention: medial exostosectomy, subcapital osteotomy, Akin osteotomy, use of a repositioning instrument to displace fragments of the first metatarsal bone, application of a fixing bandage and final control of the results of the surgical intervention.

There were no intraoperative complications, injuries to anatomical structures, or difficulties with EOP control. The device made it easy to restore the correct mutual position of the foot and EOP at all stages of surgical manipulations. The patient was examined dynamically. Eight weeks after the operation, according to foot X-ray data in two projections, signs of correct position and consolidation of bone fragments of the first metatarsal bone and the main phalanx of the first toe were noted.

Example 2. Patient A., 36 years old, came to the traumatology and orthopedic department complaining of pain in the plantar surface of the left forefoot when walking. Clinically, signs of metatarsalgia are determined in the projection of the heads of the second and third metatarsal bones. According to the X-ray data of the left foot in two projections, deformation of the forefoot of the left foot is determined due to the excess length of the second and third metatarsal bones when constructing the Lelievre parabola in accordance with the Maestro criteria.

Before the operation, the horizontal part is installed on the operating table – the base of the device, on which the patient's lower leg is placed. The parts of the device are fixed to each other at an optimal height, taking into account the size of the patient's foot. The device is shifted proximally until the plantar part of the foot rests against the vertical part. The correct position of the EOC relative to the operating table and the patient's foot is determined by monitoring the image of the radiopaque tube of the through channel of the vertical part of the device in the form of a regular ring on the monitor. The study is performed. Preoperative marking is made. The device is shifted distally.

Using special drills for minimally invasive surgery, distal metaphyseal extra-articular non-fixed osteotomies of the second and third metatarsal bones (DMMO) were performed. The position of the EOP relative to the patient's foot was corrected using the device intraoperatively at each stage of the surgical intervention: transverse subcapital osteotomies of the metatarsal bones, manual correction of the position of the distal fragments of the second and third metatarsal bones, application of a fixing bandage and final control of the results of the surgical intervention.

There were no intraoperative complications, injuries to anatomical structures, or difficulties with EOP control. The device made it easy to restore the correct mutual position of the foot and EOP at all stages of surgical manipulations with the foot. The patient was examined dynamically. Eight weeks after the operation, according to foot X-ray data in two projections, signs of correct position and consolidation of bone fragments of the second and third metatarsal bones were noted.

The device for standardizing the relative position of the foot and the electronic optical converter can be used in trauma and orthopedic hospitals when planning and performing operations on the foot.

SOURCES OF INFORMATION

1. Leonova, S. N. New radiological method for examining patients with forefoot deformities / S. N. Leonova, I. V. Usoltsev, M. A. Kosareva // Acta Biomedica Scientifica (East Siberian Biomedical Journal). - 2022. - Vol. 7, No. 6. - P. 239-249.

2 Russian Federation Patent for Utility Model No. 199319 dated 08/26/2020 “Device for multi-projection X-ray negative hand placement during radiography.

3 Russian Federation Patent for Utility Model No. 42413 dated 10.12.2004 “Device for positioning distal parts of limbs during radiography.”

Claims (1)

A device for standardizing the relative position of a foot and an electronic optical converter, including horizontal and vertical parts with the ability to move them relative to each other and fix them, characterized in that the parts of the device are made of a radiopaque sterilizable material; the horizontal part-base, 25 cm wide, 50 cm long and 3 cm thick, has two blind grooves with a thread in the distal end for fixing to it with wing nuts at an angle of 90° a vertical part 25 cm wide, 50 cm long and 3 cm thick, having two through longitudinal grooves and in the upper part a through channel with a diameter of 3 cm, located at an angle of 20° to the perpendicular to the end of the vertical part, wherein the inner part of the through channel is made of a tube made of radiopaque material.