RU2640015C2 - Device for jaw fractures treatment - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: device for lower jaw fractures treatment includes a rod-shaped body with a thread on the outer surface from the end and a nut screwed thereon, the body is expanded from the end opposite to the end face and penetrating the jaw body, a plate, with a through transverse hole on one side containing the rod-shaped body, and a transverse protrusion on the other side with an extra hole containing an additional rod-shaped body including a rectilinear part, end part bent in the direction opposite from the transverse protrusion towards forming an acute or right angle of not more than 90° with the rectilinear part, as well as another end part that has a thread with an extra nut screwed on the outer surface in contact with the plate transverse protrusion. On the bent end part of the additional rod-shaped body, grooves are provided for metal ligature anchoring. On the plate, sharpened protrusions are made facing away from the transverse protrusion and located near the through hole of the plate symmetrically from its axis. The nut screwed on the rod-shaped body from the side facing the plate, has a spherical shape, and the part of the plate through hole facing the nut also has a spherical shape. The plate through hole on the opposite side has an extension to its outer surface. The extra nut from the side facing the plate transverse protrusion and the facing part of the plate transverse protrusion extra hole lateral also have a spherical shape, while the through a hole of the plate transverse protrusion from the opposite side has an extension to the outer surface.EFFECT: invention provides prevention of bedsores in the jaw mucosal surface under contacting detail parts, simplified installation, improved ease of installation and comfort.2 cl, 19 dwg

Description

The invention relates to medicine, namely to dentistry, traumatology and, in addition, to veterinary medicine. It is intended for the treatment of jaw fractures.

Known device Yu.M. Taraeva for the treatment of fractures of the lower jaw, containing an intraosseous transverse spoke with thread and nuts on both ends, two longitudinal knitting needles with a L-shaped end with a thread and a nut on the other end, as well as an intermediate L-shaped plate with holes (see USSR copyright certificate No. 860757, priority 10/19/1979, A61B 17/18). The transosseal needle is installed with threaded ends at the base, two L-shaped spokes with threaded (threaded ends) are mounted on the base in a plane perpendicular to the main spoke, and the base is made in the form of two corners. In FIG. 1 shows a general view of a device for treating jaw fractures, and FIG. 2 - an example of the installation of the device on the lower jaw. Reposition and compression of bone fragments is carried out by tightening the nuts on the threaded ends of the spokes.

This device is the closest analogue.

Its disadvantages are:

- design complexity due to a significant number of parts;

- the possibility of bedsores in the mucous surface of the jaw under the corners of a large area, directly laid on the mucous membrane of the jaw and pressed to it without the possibility of antiseptic treatment (irrigation) of the mucous membrane and wound surface under the corner;

- the difficulty of installation, especially from the lingual surface of the jaw;

- the presence of sharp protruding surfaces that can injure the mucous membrane of the tongue, lips, cheeks;

- increased rigidity (increased rigidity and lack of compliance);

- limited possibilities for readjustment, reconfiguration, change of position in space of individual elements of the device, for example, depending on the individual structural features of the jaw of the patient (the corners after fixing on the jaw dictate a strictly defined position of the L-shaped knitting needles, which after fixing cannot be adjusted, that is, adjusted , orient in space, under the individual structural features of the jaw of the patient, for example, if the jaw is narrow or, conversely, wide, or, for example, the angle of the jaw Okiyo, or low, or medium, i.e. in the known device there is insufficient flexibility in the device, which is necessary to compensate for the individual surface structures, angles and body of the mandible).

The technical task of the claimed invention is:

- simplification of the design due to the reduction in the number of parts and assemblies;

- prevention of the formation of pressure sores in the mucous surface of the jaw under contacting parts that do not lead to compression of the mucosa, since they are laid with a gap from the jaw mucosa and do not press directly against it, providing the possibility of antiseptic treatment (irrigation) of the mucosa and wound surface under the corner and ensuring trophic mucosa tissue, that is, blood circulation and metabolism in these areas are not disturbed, the mucosa "breathes";

- simplification of installation;

- improving installation convenience and comfort (in which neither the doctor nor the patient receives significant stresses and stresses when installing and fixing the claimed device in the oral cavity);

- the use of smooth streamlined surfaces in the design, as well as the absence of a significant number of parts from the lingual surface of the jaw;

- a decrease in rigidity (a decrease in rigidity and an increase in the compliance of the components of the claimed device during installation);

- providing additional opportunities for readjustment, reconfiguration, changing the position in space of individual elements of the claimed device, for example, depending on the individual structural features of the jaw of the patient.

The technical result is achieved by the fact that in the device for treating jaw fractures, including a rod-shaped body with a thread on the outer surface from the end, designed to penetrate through the jaw body, a plate on one side having a through transverse hole, and on the other side, a transverse protrusion on one side from the surface of the plate, a rod-shaped body is placed in the through hole of the plate, a nut in contact with the plate is screwed onto the rod-shaped body, the transverse protrusion of the plate has an additional squaw a significant hole, in an additional through hole of the transverse protrusion of the plate there is an additional rod-shaped body containing a rectilinear part and an end portion bent to the opposite side of the transverse protrusion to form an angle with a rectilinear part of not more than 90 °, the other end part of which has a thread on the outer surface onto which an additional nut is screwed in contact with the transverse protrusion of the plate, according to the invention, the rod-shaped body is made with broadening from the end, opposite of the end, which is threaded on the outer surface.

This set of common essential features is the essence of the claimed invention. It is necessary and sufficient in all cases of its implementation.

Such a technical solution has the following advantages compared to the prototype:

- simplification of the design due to the reduction in the number of parts and assemblies;

- prevention of the formation of pressure sores in the mucous surface of the jaw under contacting parts that do not lead to compression of the mucosa, since they are laid with a gap from the jaw mucosa and do not press directly against it, providing the possibility of antiseptic treatment (irrigation) of the mucosa and wound surface under the corner and ensuring trophic mucosa tissue, that is, blood circulation and metabolism in these areas are not disturbed, the mucosa "breathes";

- simplification of installation,

- improving installation convenience and comfort (in which neither the doctor nor the patient receives significant stresses and stresses when installing and fixing the claimed device in the oral cavity);

- the use of smooth streamlined surfaces in the design, as well as the absence of a significant number of parts from the lingual surface of the jaw;

- a decrease in rigidity (a decrease in rigidity and an increase in the compliance of the components of the claimed device during installation);

- providing additional opportunities for readjustment, reconfiguration, changing the position in space of individual elements of the claimed device, for example, depending on the individual structural features of the jaw of the patient.

In addition, the advantage of the claimed technical solution is the use of one transosseous needle of small diameter (approximately 1.6 mm), which significantly reduces the risk of the development of the inflammatory process in comparison with the use of screw means for fixation, and also reduces the risk of rejection of its components due to the fact that the specified screw means (screws, screw implants) are not used to fix the claimed device to the jaw, which can be torn away by the body. At the same time, trauma is significantly reduced, because a small-diameter transosseous needle (approximately 1.6 mm) is used, and the number of holes is reduced to one compared to fixing the claimed device on the jaw with external screws, the number of which reaches 6, and the jaw bone is literally riddled with them.

The claimed device is especially relevant in the complete absence of teeth, when it is not possible to fix the teeth.

Another advantage is the restoration of chewing function in the very first days after surgery. The patient begins to chew non-coarse food without a large amplitude of opening his mouth, thereby healing is accelerated, good health and overall health are maintained.

Thanks to the claimed device, the patient is discharged after a week or 7-10 days. In practice, it can be discharged 2-3 days after the operation. Once a day, he comes for antiseptic washing in the places where the rod-shaped body exits the bone.

Another advantage: the claimed device has a cosmetic advantage, expressed in that it is practically invisible.

In addition, in relation to the claimed device, the applicant considers it necessary to highlight the following development and / or refinement of its essential features related to particular cases of implementation or use.

The nut screwed onto the rod-shaped body from the side facing the plate may have a different shape. However, it is preferable that it has a spherical shape, and the portion of the through hole of the plate facing it has a spherical shape, and on the opposite side of the through hole of the plate, it is desirable that it would expand to its outer surface. Thanks to these features, the device is individually configured for the structural features of the jaw of the patient (the possibility of a significant magnitude of the amplitude of displacement and / or rotation in the space of individual elements of the claimed device in the process of setting up and installing the device in the oral cavity).

The additional nut from the side facing the transverse protrusion of the plate may also have a different shape. However, according to the applicant, it is advisable that it would have a spherical shape, and the portion of the additional through hole of the transverse protrusion of the plate facing it would also have a spherical shape, and on the opposite side, the through hole of the transverse protrusion of the plate, it would be desirable to have an extension to its outer surface.

Owing to these features, as in the previous case, the device is individually configured for the particular structure of the patient's jaw (the possibility of a significant magnitude of the displacement amplitude of individual elements of the claimed device in the process of setting up and installing the device in the oral cavity is provided).

To increase the reliability of fixation of the apparatus with the function of chewing and speech, it is desirable that the angle between the rectilinear part of the additional rod-shaped body and the end part bent to the side opposite to the transverse protrusion be sharp.

It is preferable that the pointed protrusions would be made on the plate, facing the side opposite to the transverse protrusion, preferably near the through hole of the plate symmetrically from its axis. This increases the reliability of fixation of the apparatus in the place of attachment to the rod-shaped body on the bone. On the other hand, this allows not to violate the trophic tissue under the plate 8, accelerates the healing of bone tissue of the lower jaw during fractures. Due to the pointed protrusions between the plate and the bone tissue, a space is formed for additional antiseptic treatment at the places where the rod-shaped body 2 exits the bone.

To increase the reliability of fixation, so that the end portion 16 does not fall out of the recess 46, it is desirable that the broadening of the rod-like body has a pair of parts, and the part immediately adjacent to the rod-like body has a flat surface on the side of the rod-like body and the sides are parallel to the axis of the rod-like body, and the other part of the broadening would have a wider flat part from the side of the rod-shaped body, with an additional rod-shaped body, at least in the place bent in the opposite direction In the case of a protrusion, the side of the end part would be made of a material allowing manual depressions to be performed to anchor the metal ligature.

The invention is illustrated by drawings:

in FIG. 1 shows the claimed device assembly, a longitudinal section;

in FIG. 2 is the same, section along AA in FIG. one;

in FIG. 3 is the same side view along arrow B in FIG. one;

in FIG. 4 depicts a separate plate 8 with a transverse protrusion 10 and pointed protrusions, side view with a tear;

in FIG. 5 is the same, section along BB in FIG. four;

in FIG. 6 - same, top view;

in FIG. 7 shows an additional rod-shaped body 14, side view;

in FIG. 8 shows a rod-shaped body 2, side view;

in FIG. 9 shows a part of the rod-shaped body 2 in the region of broadening 21, enlarged;

in FIG. 10 is the same, view along arrow G in FIG. 8;

in FIG. 11 shows a pointed protrusion 37, side view;

in FIG. 12 shows a plate 8, a cross section;

in FIG. 13 - same, top view;

in FIG. 14 is the same side view;

in FIG. 15 shows a transverse protrusion 10, a cross section;

in FIG. 16 is the same, view along arrow D in FIG. fifteen;

in FIG. 17 shows a nut 12, side view;

in FIG. 18 is the same, view along arrow E in FIG. 17;

in FIG. 19 shows the claimed device assembly, a perspective view.

The device 1 for the treatment of fractures of the jaw includes a rod-shaped body 2 with a thread 3 on the outer surface 4 from the end face 5, designed to penetrate through the body 6 of the jaw 7 (Fig. 1-3). In addition, the device includes a plate 8, on the one hand having a through transverse hole 9, and on the other, a transverse protrusion 10 on one side of the surface 11 of the plate 8. A rod-shaped body 2 is placed in the through hole 9 of the plate 8. A nut is screwed onto the rod-shaped body 2 12 in contact with the plate 8. The transverse protrusion 10 of the plate 8 has an additional through hole 13. In the additional through hole 13 of the transverse protrusion 10 of the plate 8, an additional rod-shaped body 14 is provided containing the rectilinear part 15 bent in the opposite lateral protrusion side end portion 16 to form an angle α with a straight portion is not more than 90 ° (i.e. acute or right angle without turning into a straight angle) (FIG. 1, FIG. 7). The other end part 17 of the additional rod-shaped body 14 has a thread 18 on the outer surface 19, on which an additional nut 20 is screwed in contact with the transverse protrusion 10 of the plate 8. The rod-shaped body 2 is made with a broadening 21 from the end 22, opposite the end 5, from which the thread is made 3 on the outer surface 4.

The nut 12 screwed onto the rod-like body 2 from the side 23 facing the plate 8 has a spherical shape 24, and the portion 25 of the through hole 9 of the plate 8 facing it also has a spherical shape 26, and from the opposite side 27, the through hole 9 of the plate 8 has an extension 28 to its outer surface 29.

The additional nut 20 from the side 30 facing the transverse protrusion 10 of the plate 8 has a spherical shape 31, and the portion 32 of the additional through hole 13 of the transverse protrusion 10 of the plate 8 facing it also has a spherical shape 33, and from the opposite side 34, the through hole 13 of the transverse the protrusion 10 of the plate 8 has an extension 35 to its outer surface 36.

The angle α between the rectilinear part 15 of the additional rod-shaped body 14 and the end part 16 bent to the opposite lateral protrusion is sharp (Fig. 1, Fig. 7) or a straight line. It can not be more than 90 °.

On the plate 8, pointed protrusions 37 are made, facing the side opposite to the transverse protrusion 10 (Fig. 4, Fig. 5, Fig. 11).

The pointed protrusions 37 are located near the through hole 9 of the plate 8 symmetrically from its axis 38.

The broadening 21 of the rod-shaped body 2 has a pair of parts, the part 39 immediately adjacent to the rod-shaped body has a flat surface 40 from the side of the rod-shaped body 2 and the sides 42 parallel to the axis 41 of the rod-shaped body 2, and the other part of the broadening 21 has a wider flat part 44 with side of the rod-shaped body 2, and the additional rod-shaped body 14, at least in place 45 bent to the opposite side of the transverse protrusion of the side of the end portion 16 is made of material that allows you to ubleniya 46 manually for anchoring the metal ligatures 54 (FIG. 1, FIGS. 7-10). These design features can improve the reliability of fixation of the apparatus and its elements in the oral cavity in the treatment of fractures of the lower jaw so that the end portion 16 does not fall out of the recess 46.

The invention is implemented as follows.

Before the operation, a recess 46 is made in place 45 of the end portion 16 bent to the opposite transverse protrusion, which is made of material that allows these recesses 46 to be made manually using a special durable disk. After the apparatus has been assembled and installed in the oral cavity, a metal ligature 54 is taken, it is tied to the place of the recess 46, then one end of the metal ligature 54 is held under the lower jaw, and the other end of the attached ligature is held over the lower jaw. After that, both ends of the ligature are pulled up and tied around the side 42. The protruding ends of the metal ligature are cut off with wire cutters.

When assembling the device, the protrusion 48 of the transverse protrusion 10 is inserted into the hole 47 of the plate 8 and rigidly connected to each other, for example by laser welding. After that, in each hole 49 of the plate 8, an end portion 50 of each pointed protrusion is inserted and also rigidly connected to each other, for example by laser welding.

The proposed technical solution to the problem is illustrated by the example of its use for surgery: "Treatment of a fracture in the region of the angle of the lower jaw." This is the most demanded and important problem, since there are few options and treatment methods proposed in this area due to the complex anatomical structure of the jaw in this place and the nearest anatomical structures.

1. In preparation for surgery, the patient is performed orthopantomography, as well as computed tomography (hereinafter referred to as CT).

2. According to the data obtained during orthopantomography and CT, a three-dimensional model of the lower jaw is performed.

3. Based on this model, the installation of the claimed device on the lower jaw is designed and modeled, taking into account the location of the teeth, the location of the fracture line of the lower jaw, as well as the location of the neurovascular bundle of the lower jaw.

4. During the operation, the patient is given an infiltration or conduction anesthesia.

5. Next, a through hole, for example, with a diameter of 1-1.6 mm, is drilled strictly between the roots of the teeth in the transverse direction.

6. A rod-shaped body 2 is inserted into the drilled hole from the lingual side.

7. From the cheek side, the plate 8 is threaded onto the peering end of the rod-shaped body 2 through the through hole 9.

8. Screw the nut 12 onto the thread 3, slightly pressing the plate 8 against the mucosa.

9. Under infiltration anesthesia from the vestibular (buccal) side of the branch 51 of the lower jaw, an incision is made of soft tissue to the bone, approximately 20 mm long.

10. In the transverse direction, a hole 55 is drilled with a special dental tip, with a diameter of, for example, 1-1.7 mm, possibly perpendicular to the plane of the bone or at an angle α (Fig. 1). The distance from the hole 55 to the fracture line 52 should be at least 10 mm.

11. The bent end portion 16 of the additional rod-shaped body is inserted into the hole 55 of the lower jaw branch.

12. The rectilinear part 15 of the additional rod-shaped body 14 is inserted through the extension 35 into the through hole 13 of the transverse protrusion 10.

13. At the end of the rectilinear part 15 of the additional rod-shaped body 14, an additional nut 20 is screwed, slightly pressing against the transverse protrusion 10.

14. Reposition (slightly orientate) and fix fragments of the position of the central occlusion.

15. Start screwing the nut 12 and the additional nut 20 until tight tightening (tight force) using a special wrench.

16. The patient is offered to open and close his mouth several times. The fact that the position of the central occlusion has not changed confirms that the nuts are tightened sufficiently.

17. Restoring the correct bite (normal bite) and the correct comparison of bone fragments shows the control orthopantomogram.

As noted above, the pointed protrusions 37 are made on the plate 8, facing the side opposite to the transverse protrusion, preferably near the through hole of the plate symmetrically from its axis (Fig. 3). This increases the reliability of fixation of the apparatus in the place of attachment to the rod-shaped body on the bone. On the other hand, this feature improves trophic tissue under the plate 8, accelerates the healing of bone tissue of the lower jaw during fractures. Due to the pointed protrusions 37 between the plate 8 and the bone tissue, a space 53 is formed for additional antiseptic treatment at the points of exit of the bone of the rod-shaped body 2.

The invention is illustrated by a clinical example.

Example 1

Patient A., 30 years old, was admitted with a diagnosis of bilateral fracture of the lower jaw in the region of angles with a downward displacement of the bone fragment from 38 to 48 teeth.

Under anesthesia, 4 ml of ultracaine was strictly between the roots of 35 and 37 teeth and 45 and 47 of the lower jaw (36 and 46 teeth were absent in the patient) to the left and right, at a distance of 5 mm from the upper edge, a through hole with a diameter of 1.6 mm was drilled in the transverse direction.

Then installed the apparatus according to the claimed invention according to the above scheme.

Within 4-6 days, due to medical intervention in the area of the corners of the lower jaw, soft tissue edema was determined.

A week after the operation, the patient was discharged from a medical institution, because he did not need further treatment and special nutrition.

One month after the operation, the control x-ray determined the narrowing of the fracture line without violating the normal bite.

After that, the device was disassembled and removed from the oral cavity.

For one and a half to two years of observation, no pathological reactions of bone and soft tissues were noted. In the center of the fracture, a dense bone callus was formed.

As a result of the operations, as noted above, restoration of the jaw function immediately after the operation, which meets the requirements of compression osteosynthesis and creates controlled compression between the fragments, was achieved.

The device is universal, as it is suitable for any fractures of the lower jaw along its entire length (except for the venous processes and articular heads, fractures of which make up a small percentage).

This treatment illustrates an example of the use of the claimed invention.

Using the claimed device allowed:

- simplify the design by reducing the number of parts and assemblies;

- to increase the convenience, simplicity and comfort of installation and use of the device for the doctor and patient (when using the device, neither the doctor nor the patient receive significant stresses and stresses when installing and fixing the claimed device in the oral cavity);

- to prevent the formation of pressure sores in the mucous surface of the jaw under the contacting parts, since the apparatus when used does not compress the mucosa and fits with a gap from the jaw mucosa, does not press directly against it, providing the possibility of antiseptic treatment (irrigation) of the mucous and wound surfaces under the corner and providing trophism of the mucous tissue, that is, blood circulation and metabolism in these areas are not disturbed, the mucosa “breathes”;

- the use of smooth streamlined surfaces in the design, as well as the absence of a significant number of parts from the side of the lingual surface of the jaw, significantly prevents trauma to the tongue, significantly reduces interference with chewing and speech;

- the device is characterized by a decrease in rigidity (a decrease in rigidity and an increase in the flexibility of the parts of the claimed device during installation);

- the device provides additional opportunities for readjustment, reconfiguration, change of position in space of individual elements of the claimed device, for example, depending on the individual structural features of the jaw of the patient.

In addition, the advantage of the claimed technical solution is the use of one transosseous needle of small diameter (approximately 1.6 mm), which significantly reduces the risk of the development of the inflammatory process in comparison with the use of screw means for fixation, and also reduces the risk of rejection of its components due to the fact that the specified screw means (screws, screw implants) are not used to fix the claimed device to the jaw, which can be torn away by the body. At the same time, trauma is significantly reduced, because a small-diameter transosseous needle (approximately 1.6 mm) is used, and the number of holes is reduced to one compared to fixing the claimed device on the jaw with external screws, the number of which reaches 6, and the jaw bone is literally riddled with them.

Especially relevant is the claimed device in the complete absence of teeth, when it is impossible to fix the teeth.

Another advantage is the restoration of chewing function in the first days after surgery. The patient begins to chew non-coarse food without a large amplitude of opening his mouth, thereby healing is accelerated, good health and overall health are maintained.

Thanks to the claimed device, the patient is discharged after a week or 7-10 days. In practice, it can be discharged 2-3 days after the operation. Once a day, he comes for antiseptic washing in the places where the rod-shaped body exits the bone.

Another advantage: the claimed device has a cosmetic advantage, expressed in that it is practically not visible to the interlocutors surrounding the patient.

These and numerous other variations of the invention are covered by the following claims.

Claims (2)

1. Device for treating fractures of the lower jaw, including a rod-shaped body (2) with thread (3) on the outer surface (4) from the end face (5) and a nut screwed on it (12), made with a broadening (21) from the end face (22) ), opposite the end face (5), and penetrating through the body of the jaw, a plate (8) having on one side a through transverse hole (9) in which a rod-shaped body (2) is placed, and on the other hand a transverse protrusion (10) having an additional through hole (13), in which an additional rod-shaped body (14) containing the rectilinear part (15), the end part (16), bent to the opposite side from the transverse protrusion (10) with the formation with the rectilinear part (15) of an acute or right angle of not more than 90 °, as well as another end part (17) having a thread (18) with an additional nut (20) screwed onto the outer surface (19) and in contact with the transverse protrusion (10) of the plate (8), while in place (45) on the bent end part (16) of the additional rod-shaped body (14), recesses (46) for anchoring the metal ligature (54), and on the plate (8) are made pointed (37) protrusions facing the opposite side of the transverse protrusion (10) and located near the through hole (9) of the plate (8) symmetrically from its axis (38), and the nut (12) screwed onto the rod-shaped body (2) with the side (29) facing the plate (8) has a spherical shape (24), and the portion (25) of the through hole (9) of the plate (8) facing it also has a spherical shape (26), the through hole (9) of the plate (8) on the opposite side (27) has an extension (28) to its outer surface (29), an additional nut (20) on the side (30), tapered to the transverse protrusion (10) of the plate (8), and the portion (31) facing it of the additional through hole (13) of the transverse protrusion (10) of the plate also have a spherical shape, and the through hole (13) of the transverse protrusion (10) of the plate with the opposite side has an extension (35) to its outer surface. 2. The device according to claim 1, characterized in that the broadening (21) of the rod-shaped body (2) has a pair of parts, of which the part (39) directly adjacent to the rod-shaped body has a flat surface (40) on the side of this body and side sides parallel to the axis of this body, and the other part of the broadening from the side of the rod-shaped body has a wider part (44).

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