RU2373888C2 - Rod apparatus for transosteal osteosynthesis of tibia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology. Rod apparatus contains rings with holes, threaded bars, connecting rings to each other, resetting elements, made in form of brackets with treaded hole at the base, equipped with transosteal rods and fixed on rings. Apparatus is equipped with units, made each in form of threaded rod with versatile hinge, which forms fastening block and block of transosteal rod fixation, and locking bolt for said blocks stabilisation. Transosteal rods have possibility of rotational and axial movement and fixation with nuts. Fastening block is placed with possibility of movement and fixation with nuts. Threaded ends of resetting units are installed in holes of brackets placed on internal surfaces of apparatus rings.

EFFECT: invention ensures reduction and simplification of operation traumaticity, improvement of apparatus reposition properties, ensuring increase of operative treatment efficiency.

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Description

The invention relates to medicine, is used in traumatology orthopedics for transosseous osteosynthesis of long tubular bones.

There are various devices used for this purpose, in particular the device most widely used abroad [1] for transosseous osteosynthesis. However, it has the following disadvantages: when the support pins are inserted into the bone fragments, the pins must be installed strictly parallel to each other with certain distances in terms of clamp size. In this case, technical difficulties arise associated with the installation of the apparatus, and the duration of the operation is extended.

The rod analogue of transosseous osteosynthesis of VVFurdyuk can serve as another analogue [2]. The disadvantages of this apparatus are the design complexity, as a result of which there are difficulties in combining the threaded bushings of the fixation and reposition units located on the same axis on opposite sides of the apparatus.

The apparatus of V.V. Furdyuk [3] is known for transosseous osteosynthesis of long tubular bones, which includes an elongated frame with slots, on the parallel walls of which there are reposition and fixation nodes. In this case, the reposition units are made in the form of sliders with spacer threaded bushings and displacement nuts on the bodies of the sliders. Another disadvantage of this apparatus is the technical complexity of the design that occurs when installing the apparatus.

The closest in technical solution to the claimed one is the prototype compression and distraction apparatus of G. A. Ilizarov [4] that we adopted for the reposition and osteosynthesis of long tubular bones. The apparatus includes rings interconnected by threaded rods, and with bones and their fragments or fragments, by knitting needles. Thanks to the universal set of details of the design of external osteosynthesis, consisting of rings, arcs, threaded rods, from the apparatus of G.A. Ilizarov, you can create many options depending on the purpose. However, despite the advantage of this device compared to the above counterparts, it, in turn, also has a number of disadvantages. The device is bulky, which causes significant inconvenience to the patient with osteosynthesis of the upper third of the femur. The rigidity of fixation of a fragment in an annular support with spokes depends on the magnitude of the deflection of each of the spokes under the influence of a certain force. To prevent slipping of bone fragments along the spoke under the action of a force in the direction of its axis, the installation of a second spoke is necessary, in which case a deflection also occurs, but only of one spoke, while the second, due to its low sliding resistance, practically does not participate in fixation. A similar bone displacement also occurs when forces are applied to both spokes. In this case, the deflection of the spokes and sliding of the fragment along them occur simultaneously. Thus, the use of paired knitting needles in each support 2 times increases the morbidity and complicates the operation compared with the results when only one knitting needle is used. In this case, however, a twofold increase in stiffness does not occur. When applying the Ilizarov apparatus, the angle of intersection of the spokes within 30-60 degrees leads to a sharp drop in the stiffness of fixation of bone fragments in the direction of an acute angle, especially if an arc is used as a support. Holding knitting needles for bone fixation is a key point in the application of the apparatus. The spokes should be carried out with absolute accuracy, because it determines the position and stability of the apparatus. Moreover, during the holding of the needle, its sharp end penetrates into tissues of various densities, hidden from the eyes of the surgeon. The features of these tissues can change the trajectory of the spoke, leading to damage to vital structures (vessels and nerves). When carrying out knitting needles to prevent limitation of mobility and contracture of the joint, the muscles should be in a functional extension position. The closer the needle goes to the joint, the more you must follow this rule. When holding knitting needles in the distal part of the tibia of the foot, the position of flexion (plantar flexion) should be given, when the knitting needle is passed through the front fascial-muscular cases, and when holding it through the rear fascial-muscular cases, the foot should be in the extension position (back flexion). It is also advisable to give the position of flexion in the knee joint. It is no coincidence that many researchers [5, 6] use rods instead of spokes. In the ring supports of the Ilizarov apparatus, the deflection of the spokes increases due to the mobility of the butt joints of the half rings or the movement of the spokes in the spoke holders. This contributes to the functional load on the limb, in which there is an effect of additional tension of the spokes. In this case, acceptable, relatively small levels of deformation of the spokes when they are carried through the bone and the installation of the apparatus are obvious. The stress concentration zones formed in this case at the points of bending of the spokes upon their exit from the bone cause its directed resorption. The tensioned needle gradually straightens and lengthens, its tension decreases. To maintain the required level of fixation stiffness, it is necessary to pull the knitting needles once every 7-10 days. The small surface area of the spokes increases the pressure in the area of their contact with the tissues (skin and bone), leads to resorption in the overpressure zone and a decrease in fixing ability. Against the background of soft tissue gliding over the knitting needles, quite a few infectious and other complications arise - from 12 to 60% up to the development of spoke osteomyelitis - up to 2% of cases. All this reduces the benefits of spoke devices - low invasiveness and versatility of use.

The core external fixation, taking into account the literature, provides constant rigid compression (distraction) of bone fragments, increases the stability of fixation in case of multiple fractures of the femur, tibia, humerus and other long tubular bones, reduces the mass and dimensions of the external fixation apparatus, allows you to begin to develop movements 2-3 days after surgery, because during osteosynthesis with a rod apparatus, transosseous rods are passed through the skin of the tibia, and fascial-muscular cases Melt intact, so the knee and ankle joints are retained full range of motion, you can start early in the injured limb loads, to reduce time of stay of patients on bed rest in the hospital, to perform additional surgical procedures without having to remove the device. The main biomechanical conditions for fracture consolidation are accurate reduction and strong fixation of bone fragments, as well as preservation of limb function during treatment. The advantages of this pivotal apparatus are: ease of installation on a segment of a limb, reduction of operation time, reduction of the number of skin wounds, unilateral installation of transosseous rods, no need for transsegmental transosseous rod, which reduces the risk of damage to the neurovascular formations and increases the number of venues . The unilateral arrangement of transosseous rods allows the use of complex rehabilitation therapy for a damaged limb. Some authors refer to the disadvantages of the method of rod external fixation: non-uniformity of fixation in various planes, the use of the method mainly in traumatology and less often in orthopedics, low repositioning capabilities of apparatuses (O.V. Beidik). The rod apparatus offered by us simply and efficiently solves any repositional fixation problems optimally from the point of view of biomechanics, allows achieving complete and accurate reposition of bone fragments due to the presence of repositional nodes in the apparatus. When using annular supports in the rod apparatus during compression along the axis of the bone between fragments, a uniform distribution of pressure occurs along the bone perimeter, and when using arc supports in the rod apparatus during compression between fragments, more pressure is concentrated on the side of the arc supports, and on the opposite side, the pressure decreases.

The essence of the invention lies in the combination of essential features sufficient to achieve the desired technical result, namely, to reduce the invasiveness of the operation, its simplification, improve the repositional qualities of the apparatus, which increase the efficiency of surgical treatment.

This essence lies in the fact that the core apparatus for transosseous osteosynthesis of the tibia, containing rings with holes, threaded rods connecting rings, and reponing elements made in the form of brackets with a threaded hole at the base, equipped with transosseous rods and fixed on the rings, characterized in that it is equipped with reponentive nodes, each made in the form of a threaded rod with a universal hinge, which form a mounting unit and a fixation unit transosseous rod, and a locking bolt for stabilization of the said blocks, transosseous rods have the possibility of rotational and axial movements and fixing with nuts, the fastening block is placed with the possibility of movement and fixing with nuts, and the threaded ends of the repair units are installed in the holes of the brackets with a threaded hole at the base located on the inner surfaces of the rings apparatus and fixed with bolts. The adjustable location on the threaded rods of the attachment unit and the fixation unit in the form of a universal joint passing through their holes of transosseous rods provide, after preliminary elimination of rotational displacements, a complete and accurate adjustable closed reposition of bone fragments in these planes. The drawing shows an apparatus for transosseous osteosynthesis with reposition nodes.

The rod apparatus for transosseous osteosynthesis contains rings 1 with holes, interconnected by threaded rods 2. On brackets 3 with a threaded hole at the base, mounted on the inner surfaces of rings 1 and fixed to the ring with bolts 12, transosseous rods 4. Brackets 3 and 5 with a threaded hole at the base to the rings are fixed with bolts 12. On the inner surfaces of the middle rings 1 on the brackets 5 with a threaded hole at the base are installed reponentive nodes 6. Reponent elements You are made in the form of brackets 5 with a threaded hole at the base, fixed on the rings 1 with bolts 12 and equipped with threaded rods 8, on which the mounting blocks 11 and fixing blocks 10 are installed in the form of a universal joint, and a locking bolt 13 to stabilize the said blocks . In the hole of the fixation unit, a transosseous rod 9 is installed, which has the possibility of rotational and axial movements and fixation by nuts 7, and the threaded ends of the reponentive nodes 6 are placed with the possibility of movement and fixation by nuts 7 in the holes of the brackets 5 located on the inner surfaces of the middle rings of the apparatus. The working parts of transosseous rods in the drawing are immersed in bone models.

The apparatus is used as follows: after the rotational displacement of bone fragments in the upper third of the tibia is eliminated, the trocar is inserted through the microinvasion to the bone, the stylet is removed, a channel is inserted through the tube for insertion of the transosseous rod 4 through both cortical layers perpendicular to the axis of the tibia, and transosseous rod is inserted is fixed to the ring 1 using the bracket 3 with a threaded hole at the base and bolt 12. Four rings 1 are mounted from the Ilizarov apparatus, the rings are connected between threaded rods 2. Similarly, the transosseous rod 4 is installed on the distal fragment of the tibia, closer to the joint strictly in the same plane as the previously inserted transosseous rod and is fixed to the lower ring using the bracket and bolt. The second pair of transosseous rods 9 is introduced closer to the fracture line. They are mounted on the repair nodes 6, putting them on with holes located in the fixing blocks 10, and fixed with nuts 7. The repair nodes 6 by means of brackets 5 and bolts 12 are fixed to the inner surface of the middle rings 1. The rings 1 are connected to each other by threaded rods 2. Under the x-ray control reposition by moving the elements of the reponent nodes 6 with nuts 7 in perpendicular directions, i.e. by directly manipulating the universal joint with threaded rods 8 and transosseous rods 9.

With the correct location of the bone fragments of the tibia, they are brought closer to the compression by means of threaded rods 2 connecting the rings 1. To stabilize the achieved reduction, an additional transosseous rod is introduced into each fragment at an angle of 60 degrees. to its axis, and transosseous rods 4 are fixed to the rings using brackets 3, and the mounting unit and the fixing unit is stabilized by a locking bolt 13.

Information sources

1. Swiss patent No. 0684928, cl. A1B 17/60, 1994.

2. Furdyuk V.V. A.S. No. 1766390, A61B, 17/60, 1993.

3. Furdyuk VV RU 2152190 C1, A61B 17/66, 09/23/1998.

4. Tkachenko S.S. Ostensynthesis. L., Medicine, 1987.- p. 122-123.

5. Golyakhovsky V., Frenkel V. Manual on transosseous osteosynthesis using the Ilizarov method. St. Petersburg, 1999 - p. 84-98.

6. Beidik O. V., Kotelnikov G. P., Ostrovsky N. V. Osteosynthesis with rod and spoke rods of external fixation. Samara, 2005 .-- p.17-27.

Claims (1)

The rod apparatus for transosseous osteosynthesis of the tibia, containing rings with holes, threaded rods connecting rings, reponent elements made in the form of brackets with a threaded hole at the base, equipped with transosseous rods and fixed on the rings, characterized in that it is equipped with reponent nodes each made in the form of a threaded rod with a universal joint that forms a fastening block and a block for fixing the transosseous rod, and a locking bolt for stabilization of the said blocks, transosseous rods have the possibility of rotational and axial movements and fixing with nuts, the fastening block is placed with the possibility of movement and fixing with nuts, and the threaded ends of the reparation nodes are installed in the holes of the brackets located on the inner surfaces of the rings of the apparatus.

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