RU2692526C1 - Universal reposition-fixation ring with dynamic compression for surgical treatment of displaced fractures of acetabulum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Universal reposition-fixation ring with dynamic compression for surgical treatment of displaced acetabulum fractures has a concave shape and holes for insertion of screws. Ring has the shape of an open hemisphere, internal and external surfaces, an upper inlet hole and a lower hole, a row of holes and recesses along the edge of the ring wall along the entire perimeter for inserting fixing screws through them into the wall of the acetabulum. Contour of open hemisphere corresponds to contour of cartilaginous surface of acetabulum, has two ends, on which there is one hole and one cavity for introduction through them into acetabulum of fixing screws. Along the entire edge of the wall of the ring of the upper inlet hole there are recesses located at a distance from each other and provided for holding fastening screws through them at different angles, which provides the introduction of screws directly into the bone massif of the wall of all depressions and fixation of fragments or columns of acetabulum to the ring by fastening screws. After inserting the fixing screws into the wall of the acetabulum at an angle, the screw cap extends into the inner part of the ring. Along the entire length of the ring wall there is a row of holes for insertion of fixing screws into the wall of the acetabulum. Holes are located relative to cavities of the wall edge of the ring of the large upper inlet in staggered order, deviating from the lower edge of the recesses in the direction to the lower opening of the ring. Screws are fitted so that after their introduction, the screws are located above the level of the inner wall of the ring and are located in the inner part of the ring.

EFFECT: invention provides dynamic compression in surgical management of displaced fractures of acetabulum.

1 cl, 17 dwg

Description

Universal repositioning-fixation ring with dynamic compression, for surgical treatment of displaced acetabular fractures, relates to medicine, to operative orthopedics and traumatology, hip joint endoprosthesis, experimental medicine, and biomechanics.

Several devices have been proposed that are implanted into the acetabulum in order to restore its support and biomechanics for defects of the acetabulum of various origins, namely, for defects caused by the development of osteolysis after hip arthroplasty, and for traumatic defects (Fig. 1, 2, 3).

The closest solution to the problem of treatment of displaced acetabular fractures can be achieved by using the Muller ring (Fig. 1), which (which - if we are talking about all three rings - Figs 1, 2, 3) allows you to insert screws into the acetabulum fragments. However, these devices do not allow insertion of screws into the bone mass of the acetabulum walls at an acute angle, and the arrangement of the screw insertion holes does not allow concentrating the efforts of fixing various fragments of the acetabulum, taking into account the classification of acetabular fractures (Fig. 13) (Muller ME , Allgower M., Schneider R., Willinger X. Guide to internal osteosynthesis. - M., 1996. - 756 p.).

The technical result is the development of a universal reposition-fixation ring with dynamic compression, for the surgical treatment of displaced acetabular fractures.

The technical result is ensured by the fact that it has the form of an open hemisphere, the inner and outer surfaces, the upper inlet opening, and the lower opening, a series of openings and recesses along the edge of the ring wall around the perimeter for inserting fixing screws into the wall of the acetabulum through them,

at the same time, the contour of the open hemisphere and corresponds to the contour of the cartilaginous surface of the acetabulum has two ends, at which there are

one hole and one well for inserting fixing screws through them into the acetabulum,

and along the entire edge of the wall of the upper inlet ring there are depressions spaced apart from each other, and are provided for holding fixing screws through them at different angles, which ensures the introduction of screws directly into the bone mass of the walls of all sections of the depression, and fixation of fragments or columns the acetabulum to the ring with mounting screws

at the same time, after inserting the fixing screws into the wall of the acetabulum at an angle, the screw head will stand in the inner part of the ring, and along the entire length of the ring wall there are a number of holes for inserting the fixing screws into the wall of the acetabulum, while the holes are located with respect to the recesses of the wall edge the rings of the large upper inlet in staggered order, some distance from the lower edge of the recesses in the direction towards the lower opening of the ring,

at the same time, the seating of the screws is provided in such a way that after their insertion the heads of the screws are above the level of the inner wall of the ring and will stand in the inner part of the ring.

The invention is illustrated by the following figures.

FIG. 1. A photo of the acetabular strengthening ring ME is presented. Muller (ME Muller).

FIG. 2. A photo of an acetabular strengthening ring with a hook from Protek, Switzerland (PROTEK) is presented.

FIG. 3. A photo of the Burkh-Schneider acetabular strengthening ring (N.V. Burch-R. Schneider) is presented.

FIG. 4. A photo of a universal repositioning-fixation ring with dynamic compression is presented, for the surgical treatment of displaced acetabular fractures. View from the side of the large top opening. 1 - the inner surface of the ring; 3 - a large upper inlet ring; 5 - ring openings; 6 - the ends of the ring; 7 - deepening the edge of the ring wall of the large upper inlet of the ring.

FIG. 5. A photo of a universal repositioning-fixation ring with dynamic compression is presented for the surgical treatment of displaced acetabular fractures. View from the side of the large upper inlet. 2 - the outer surface of the ring; 4 - large lower opening of the ring; 5 - ring openings; 6 - the ends of the ring; 7 - recesses of the ring.

FIG. 6. A photo of the ileum bone with an established universal reposition - fixation ring is presented. 7 - deepening the edge of the ring wall of the large upper inlet of the ring; 8 - screws, fixing fragments of the acetabulum to the ring; 21 - cutting of the acetabulum; 22 - the rear edge of the acetabulum; 23 - the leading edge of the acetabulum notch.

FIG. 7. A photo of the acetabulum fracture scheme B2.2 according to the international classification AO / ASIF is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 9 - right iliac bone; 10 - ischium; 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 14 - line of transverse acetabular fracture; 15 - the line of fracture of the pelvic posterior column; 16 - the line of fracture of the anterior column of the pelvis; 17 - posterior column of the acetabulum; 18 - front column of the acetabulum.

FIG. 8. A photo of the acetabulum fracture scheme B2.2 according to the international classification AO / ASIF is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 9 - right iliac bone; 10 - ischium; 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 14 - line of transverse acetabular fracture; 15 - the line of fracture of the pelvic posterior column; 16 - the line of fracture of the anterior column of the pelvis; 17 - posterior column of the acetabulum; 18 - front column of the acetabulum; 19 - diastasis between the acetabular fragments.

FIG. 9. A photo of the acetabular fracture scheme B2.2 according to the AO / ASIF international classification is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 9 - right iliac bone; 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 14 - line of transverse acetabular fracture; 15 - the line of fracture of the pelvic posterior column; 16 - the line of fracture of the anterior column of the pelvis; 17 - posterior column of the acetabulum; 18 - front column of the acetabulum; 19 - eliminated diastasis between fragments of the acetabulum; 21 - cutting of the acetabulum through which the fracture line passes; 22 - the rear edge of the acetabulum; 23 - the rear edge of the acetabulum notch.

FIG. 10. A photo of the acetabulum fracture scheme B2.2 according to the international classification AO / ASIF with the established universal reposition-fixation ring is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 6 - the ends of the ring; 9 - right iliac bone; 10 - ischium; 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 14 - line of transverse acetabular fracture; 15 - the line of fracture of the pelvic posterior column; 16 - the line of fracture of the anterior column of the pelvis; 17 - posterior column of the acetabulum; 18 - front column of the acetabulum; 19 - eliminated diastasis between fragments of the acetabulum.

FIG. 11. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with a diastasis between fragments is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 14 - line of transverse acetabular fracture; 15 - the line of fracture of the pelvic posterior column; 16 - the line of fracture of the anterior column of the pelvis; 17 - posterior column of the acetabulum; 18 - front column of the acetabulum; 19 - diastasis between fragments of the acetabulum; 20 - the outer surface of the greater trochanter of the femur.

FIG. 12. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with eliminated diastasis between fragments is presented. Transverse fracture of the acetabulum. Fracture of the posterior colony pelvis. Fracture of the anterior colony pelvis. 11 - the upper edge of the acetabulum; 12 - acetabulum; 13 - the upper part of the articular surface of the acetabulum, associated with the iliac bone (the main fragment of the acetabulum); 17 - posterior column of the acetabulum; 18 - front column of the acetabulum; 19 - eliminated diastasis between fragments of the acetabulum; 20 - the outer surface of the greater trochanter of the femur; 21 - cutting of the acetabulum through which the fracture line passes; 22 - the rear edge of the acetabulum; 23 - the leading edge of the acetabulum notch.

FIG. 13. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with a fixed diastasis between fragments and an established universal reposition-fixation ring is presented.

FIG. 14. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with a fixed diastasis between fragments and an established universal reposition-fixation ring is presented. 5 - holes in the wall of the ring for the insertion of mounting screws; 8 - mounting screws inserted into the wall of the acetabulum through the holes (5) of the ring.

FIG. 15. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with a fixed diastasis between fragments and an established universal reposition-fixation ring is presented. 7 - deepening the edge of the ring wall of the large upper inlet of the ring; 8 - mounting screws inserted into the wall of the acetabulum through the holes of the ring; 20 - the outer surface of the greater trochanter of the femur.

FIG. 16. A photo of the acetabular fracture of the corpse B2.2 according to the AO / ASIF international classification with a fixed diastasis between fragments, a universal reposition-fixation ring and fragments of the acetabulum fixed to the ring with fixing screws is presented. 6 - the ends of the ring, interconnected after the final reposition of the acetabular fragments; 8 - mounting screws inserted into the wall of the acetabulum through the holes of the ring; 20 - the outer surface of the greater trochanter of the femur.

FIG. 17. A photo of the right ilium and the acetabulum is presented (photo taken from the atlas of the anatomy of RD Sinelnikov). 21 - cutting of the acetabulum; 22 - the rear edge of the acetabulum; 23 - the leading edge of the acetabulum notch.

The device contains the following elements

It has the form of an open hemisphere (Fig. 4), an inner (Fig. 4-1) and an outer (Fig. 4-2) surface, a large upper inlet (Fig. 4-3), and a large lower opening (Fig. 4- 4), a series of holes (Fig. 4-5),

at the same time, the contour of the open hemisphere corresponds to the contour of the cartilaginous surface of the acetabulum, and the right and left (Fig. 17),

has two ends (fig. 4-6), on which there is one hole and one hole for inserting fixing screws through them into the acetabulum,

and along the entire edge of the ring wall of the large upper inlet there are recesses (Figures 4-7), spaced from each other at a certain distance, and provided for holding fixing screws through them at different angles, which ensures the introduction of screws directly into the bone mass of the entire wall divisions of the depression, and fixation of fragments, or columns of the acetabulum to the ring with fixing screws,

at the same time, after inserting the fixing screws into the wall of the acetabulum, at an angle of the head of the screws stand above the edge of the wall of the ring of the large upper inlet and into the inner part of the ring a few mm (Fig. 6-8),

and along the entire length of the ring wall there are a number of holes for inserting the fastening screws into the wall of the acetabulum, while the holes are located with respect to the grooves of the edge of the wall of the ring of the large upper inlet hole in a staggered manner, some mm from the lower edge of the grooves the lower hole of the ring

at the same time, the landing of the screws is provided in such a way that after their insertion the heads of the screws are above the level of the inner wall of the ring and stand in the inner part of the ring by a few mm (Fig. 6 - 8),

and this position of the caps of all the fastening screws introduced creates the necessary height of the space between the outer surface of the polyethylene cup and the inner surface of the ring, which, in, is filled with bone cement when the polyethylene cup is installed.

The device works as follows

The operation of the device is described by the example of acetabular fracture B2.2 according to the AO / ASIF international classification (Fig. 7). We model a fracture of the right acetabulum B2.2 according to the international classification AO / ASIF by osteotomy of the acetabulum with the creation of a diastasis between the fragments (Fig. 8). At the next stage, using the toolkit, we perform a maximum approximation of the displaced fragments to each other, achieving the most accurate reposition (Fig. 9).

Next, a universal (for the left and right acetabulum) repositional-fixation support ring, with a size corresponding to the size of the acetabulum, is installed in the acetabulum so (Fig. 10) so that the ends of the ring are directly at the acetabulum notch (Fig. 10 - 6) .

Then the ring is fixed to the upper part of the articular surface of the main fragment (Fig. 10 - 13) of the acetabulum (13) associated with the iliac bone (9) by inserting screws (8) through the corresponding holes (5) located within the upper part of the articular surface the acetabulum associated with the ileum (the main fragment of the acetabulum) - (13). Then we consistently insert the screws through the articular surface of the fragment of the posterior column of the pelvis (Fig. 10 - 17) and the anterior column of the acetabulum (Fig. 10 - 48) through the corresponding holes of the first and second row of the ring. Screwing the screws alternately, we tighten the fragments of the back and front columns to the ring and thus fix them.

Experimental example

The operation of the device is described by the example of acetabular fracture B2.2 according to the AO / ASIF international classification on a cadaveric material with reposition and fixation of fragments by a universal reposition-fixation support ring (Fig. 7, 8, 9, 10). The corpse is laid on its side.

A classic outward-anterior approach is used, which is used for endoprosthetic replacement of the hip joint. We simulate a fracture of the acetabulum B2.2 according to the international classification AO / ASIF by osteotomy of the acetabulum (Fig. 11) with a diastasis between fragments. We perform using the toolkit to bring the displaced fragments closer to each other, achieving the most accurate reposition (Fig. 12).

Next, a universal (for the left and right acetabulum) repositional - fixation support ring, with a size corresponding to the size of the acetabulum, is installed in the acetabulum so (Fig. 10) so that the ends of the ring are located directly at the edges of the acetabulum notch (Fig. 6, 9 , 12, 17).

Then the ring is fixed to the upper part of the articular surface of the main fragment (Fig. 14, 15) of the acetabulum associated with the iliac bone by introducing mounting screws (8) through the corresponding holes (5) located within the upper part of the articular surface of the acetabulum associated with Ilium (the main fragment of the acetabulum). Then we sequentially insert the screws (figs. 15–8) through the recesses of the edge of the wall of the ring of the large upper inlet (figures 15–7) into the back and front columns. Screwing the screws alternately, we tighten the fragments of the posterior and anterior columns to the ring and thus further replenish them and perform the final reposition of the acetabular fragments, as indicated by the convergence of the ring ends, and fix it (Fig. 16).

Thus, a universal repositioning - fixation ring with dynamic compression for the surgical treatment of displaced acetabular fractures allows:

• taking into account access to the hip joint, it provides for the reposition and fixation of the acetabular fragments directly from the cavity itself, which does not entail one of the most unpleasant moments in reposition - the detachment of soft tissues from the central and intermediate fragments and thereby prevents the breakdown of their blood supply;

• versatility allows reposition and fixation of both the right and left acetabulum.

• the holes in the ring wall for holding fastening screws through them are located with respect to the grooves of the upper edge of the ring wall so that they are under the gaps between the grooves, that is, in a staggered lock, provides the screw with a stronger fixation in the bone;

• perform a reposition of acetabular fragments;

• perform the final reposition of acetabular fragments due to the dynamic properties of the ring;

• reliable fixation of the acetabular fragments to the support ring due to the introduction of fixing screws into the bone mass of the acetabular walls at different angles;

• perform bone grafting of the defects of the wall and bottom of the acetabulum;

• the created spatial crossing of screws inserted into the bone mass of the acetabulum increases the strength of fixation of fragments to the ring, which generally improves the stability of the osteosynthesis;

• perform subsequent hip arthroplasty.

• in the early stages to begin active restoration of movements in the operated joint objectively there is a positive therapeutic effect, which consists of:

- to reduce the time of surgery, because only one external access to the hip joint is used, consequently, in reducing blood loss; - reducing tissue trauma by optimizing the implementation of surgical intervention;

• the presence of an early economic effect, which consists in reducing the cost of treatment due to the use of only one external - anterior access to the hip joint, therefore, and reducing the expendable surgical material.

• the presence of a long-term economic effect, consisting in the early rehabilitation of the patient, reducing the time of disability, and hence the cost of treatment.

• there is a social effect by restoring the patient’s quality of life.

Claims (6)

Universal repositional fixation ring with dynamic compression for surgical treatment of displaced acetabular fractures, having a concave shape and holes for inserting screws, characterized in that it has the shape of an open hemisphere, the inner and outer surfaces, the upper inlet and the lower hole, a number of holes and grooves along the edge of the ring wall around the perimeter for inserting fixing screws through them into the wall of the acetabulum, the contour of the unclosed hemisphere corresponds to the contour of the cartilaginous surface of the acetabulum, has two ends, which have one hole and one hole each for inserting fixing screws through them into the acetabulum, and along the entire edge of the wall of the upper inlet ring there are depressions spaced apart from each other and provided for holding fixing screws through them at different angles, which ensures the introduction of screws directly into the bone mass of the walls of all sections of the depression and fixation of fragments or columns of the acetabulum to ring fixing screws at the same time, after inserting the fixing screws into the wall of the acetabulum at an angle, the screw head will stand in the inner part of the ring, and along the entire length of the ring wall there are a number of holes for inserting fixing screws into the wall of the acetabulum, while the holes are located with respect to the recesses of the edge of the wall of the ring of the large upper inlet in staggered order, some distance from the lower edge of the recesses in the direction of the lower opening of the ring, while the screws are provided in such a way that after they are inserted rings and stand in the inner part of the ring.

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