RU2758130C1 - Method for percutaneous insertion of pins into femoral neck - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, in particular to orthopedics and traumatology, and can be used to treat fractures of the femoral neck. Through the skin, pins are inserted into the femoral neck between the large and small trochanters at an angle of 110-160 degrees under X-ray control, without bringing the apical end of the pin to the edge of the femoral head by 2-3 cm. Next, the pins are nearly cut off over the skin and brought to another 2-3 cm. Then the spins are broken off at the bone by rocking the distal part of the pin and the free end is removed.EFFECT: method provides a minimal risk of soft tissue traumatization by the distal ends of the pins, ensures the treatment of a fracture in weakened patients who have contraindications to surgical treatment associated with open reposition, soft tissue traumatization and the use of more massive metal structures, and also simplifies osteosynthesis and removal of metal structures and minimizes blood loss due to the combination of methods for the claimed invention.1 cl, 2 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology, and can be used to treat fractures of the femoral neck.

The progressive increase in the number of elderly and senile people suffering from osteoporosis is steadily leading to an increase in fractures of the proximal femur in the structure of general injuries. Among this type of injury, a fracture of the femoral neck is of particular medical and social importance, leading to a permanent loss of not only disability, but also self-care skills for a long period. In addition, a high percentage of mortality in victims in the first year after injury (from 7.6 to 9% and from 27.3% to 45% according to various authors), mainly elderly and senile patients with existing background pathologies, pose an urgent task further search for effective ways to restore the integrity of the proximal femur [Belinov NV. et al. Fractures of the femoral neck against the background of osteoporosis // Transbaikal Medical Bulletin. 2007. No. 1. S. 57-59; Ershova O.B. et al. Results of a prospective study of the outcomes of fractures of the proximal femur in the elderly // Osteoporosis and Osteopathy. 2000. No. 1. S. 9-10.].

At the present stage of development of medicine, the priority method of treating hip fractures is the surgical one. Currently, there are various techniques and designs for the treatment of fractures of the femoral neck: osteosynthesis with nails (Knowles, Deyerle, Smith-Petersen, Thornton, Hansson, DHS, cannulated AO screws, etc.), designs based on the Ilizarov apparatus, Tronzo screws (1988 ). The variety of metal fixators and surgical techniques poses a difficult choice task for the traumatologist-orthopedist, which, most often, is limited by the material and technical base of the hospital hospital and the skills of the specialist himself. In addition, the applied method of treatment should have low trauma in relation to not only soft tissues, but also to bone substance. Most of the metal structures are quite massive, and, passing through the proximal and distal fragment of the fracture, significantly violate the integrity of the bone trabeculae and blood vessels, increasing the risk of postoperative complications and ineffective consolidation [Slobodskoy A.B. et al. Treatment of trochanteric fractures at the present stage (literature review), 2018; Stadnikov V.V., Rusanov A.G. Application of screw devices for osteosynthesis of fractures of the proximal femur. 2009].

There are less invasive ways to treat a hip fracture using pins. Osteosynthesis with a beam of thin wires is widely covered in Russian literature: V.A. Goncharenko and M.G. Leikin (1981), E. Ya. Zheidurs and V.V. Zirdzinyn (1983), E.V. Zverev and V.G. Evstratov (1989), A.F. Lazarev (1999). A different number of knitting needles with different diameters and methods of their location have been proposed.

The method of inserting the pins into the femoral neck can be percutaneous or open. With the open method, an incision is made in the skin and soft tissues in the projection of the introduction of the needles into the bone. In this case, after insertion into the bone, the ends of the needles can be cut and bent directly at the bone and they will not injure the surrounding soft tissues (for example, Patent RU 2181266, A61B 17/56, A61B 17/74, publ. 20.04.2002). However, this method injures soft tissue, requiring open access.

This disadvantage can be eliminated by percutaneous introduction of the needles. A.F. Lazarev (1999) suggested performing osteosynthesis with a bundle of V-shaped bent pins. He recommended leaving the outer ends of the needles under the skin, above the skin, or under the fascia. However, this method also has drawbacks: the ends of the spokes serve as "entry gates" for infection and, during the period of activation, leads to increased pain syndrome due to trauma by the end of the spokes of soft tissues.

For the first time, we have proposed a percutaneous method of introducing the wires into the femoral neck, in which the outer end of the wire is located directly at the cortical layer of the bone, does not perforate the skin and does not injure soft tissues.

The introduction of the needles according to our proposed method is carried out as follows (Figures 1 and 2). In the operating room, the patient is laid on an orthopedic operating table. Then, in compliance with the rules of asepsis-antiseptics, the surgical field is processed and delimited with sterile linen. The needles (1) are inserted into the femoral neck (2) between the greater (3) and the lesser trochanter (4) at an angle of 110-160 degrees under X-ray control through the fracture line (5), while the apical end of the wire should not reach the edge of the head hips by 2-3 cm. Then the needles are bitten over the skin, inserted another 2-3 cm. (6) and break off at the bone by rocking movements of the distal part of the needles. The broken off distal end of the wire is removed. The insertion of the wires can be carried out without incisions under local anesthesia through the skin of the subtrochanteric region of the thigh; suturing is not required. Aseptic dressings are applied to postoperative wounds.

The technical result of the method is:

1. Minimal risk of trauma to soft tissues by the distal ends of the spokes;

2. It is possible to use the method in debilitated patients with contraindications to surgical treatment associated with open reduction, soft tissue trauma and the use of more massive metal structures;

3. Ease of implementation of osteosynthesis and removal of metal structures, minimal blood loss.

The novelty of the proposed method lies in the percutaneous method of introducing the pins into the femoral neck, in which the pins are passed percutaneously and break off at the border of the cortical layer, which leads to minimal trauma to soft tissues and bone matter, with the possibility of performing osteosynthesis only against the background of local anesthesia.

Claims (1)

The method of percutaneous insertion of the needles into the femoral neck, which consists in the fact that through the skin into the femoral neck between the greater and lesser trochanters, the needles are inserted at an angle of 110-160 degrees under radiological control through the fracture line, without bringing the apical end of the needles to the edge of the femoral head by 2 -3 cm, then bite the needle over the skin and insert it another 2-3 cm, break off the needle near the bone by swinging the distal spoke and remove the broken distal end of the spoke.

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