RU2827762C1 - Bone drilling device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to a device for bone drilling. Bone drilling device includes a drill guide made in the form of a trocar consisting of a stylet and a tube. Tube has an end bevelled at angle of 45 degrees, the edge of the bevelled surface of which is ground from the outside to the inside at angle of 45 degrees. Formed pointed tenon of the end of the tube has a longitudinal undercut to depth of 2-3 mm at angle of 45 degrees from the outside to the inside, which forms two equal denticles at the end, which are made to rest against the bone.

EFFECT: use of the invention allows providing higher clinical effectiveness in the patients with injuries or diseases of the locomotor organs in need of precision closed or open drilling of the bone.

1 cl, 1 dwg

Description

The invention relates to medical technology, namely to devices used in traumatology and orthopedics.

In surgical traumatology and orthopedics, drilling of the bone with the formation of channels in it is widely used for various purposes: insertion of screws and rods during internal or external osteosynthesis, bone decompression and leveling of hypertension to improve microcirculation and accelerate bone tissue remodeling in aseptic osteonecrosis, osteochondropathy of the epiphyses and apophyses of bones, osteoarthritis, pseudoarthrosis of long tubular bones. In addition, drilling of the bone is necessary for the formation of transosseous channels during lavsanoplasty of damaged ligaments, for transosseous conduction and fixation of tendons, etc. In this case, the selected method of osteoperforation and the instrumentation for its implementation largely determine the accuracy and quality of important stages of the operation and affect the effectiveness of the surgical intervention as a whole. The quality of osteoperforation is largely determined by the choice of the point of emphasis of the drill tip on the outer surface of the bone with drilling it without deviating the drill from the given direction. Otherwise, the edges of the external opening become loosened, the diameter increases, and the intraosseous canal deviates from the intended direction. The drill tip, installed perpendicularly with a tight stop against the external surface of the bone, often shifts away from the intended point when the drill chuck rotates, especially if it is the cortical plate or diaphysis of a tubular bone, where it is harder and smoother. If drilling is not performed strictly perpendicular to the bone surface, but at an angle, the instability of the stop and the probability of the drill tip slipping off the bone surface increases many times as the angle of deviation of the drill from it increases and, accordingly, the angle between the drill axis and the bone surface decreases.

Analogues

The following analogues are known to prevent the drill tip from slipping off the bone during osteoperforation (Sources of information: Traumatology and Orthopedics: A Manual for Doctors / Ed. N.V. Kornilov: in 4 volumes. - V. 1: General Issues of Traumatology and Orthopedics. - St. Petersburg: Gipppokrat, 2006. - 624 p. - Pp. 303-388; Traumatology: National Guidelines / Ed. G.P. Kotelnikov, S.P. Mironov - 4th ed., revised and enlarged. - Moscow: GEOTAR-Media, 2022. - 784 p. (Series "National Guidelines") DOI: 10.33029/9704-6636-0-INJ-2022-1-784): perpendicular drill stop in the bone, and then, when the drill tip is immersed in the bone, the drilling is deflected from the perpendicular plane; manual formation of a recess with an awl or a center punch at a given point on the bone surface - and the deeper the greater the expected instability of the stop - into which the drill is then rested and drilling begins. In addition, drills of increasing diameters are used separately or in combination (since preliminary drilling with a smaller drill facilitates drilling with a larger diameter drill), trocars and special guides. Drilling of the bone is performed with drills both openly - through a surgical wound with economical skeletonization of the bone area for drilling, and closed, through an incision-puncture with a pointed scalpel and with the help of a trocar and guides. When forming an intraosseous canal openly, in order to overcome the tendency of the tip of the rotating drill to slip off the smooth surface of the bone at the beginning of drilling, some instrument is often used as a limiter for this displacement. This could be, for example, a raspatory in the form of a stop in the bone on the path of the drill sliding.

The design features of the analogues are as follows: perpendicular stop of the drill tip into the bone and rotation of the drill until it is minimally immersed in the bone, after which the drill is given the desired direction; manual formation of a recess at a given point on the bone surface with an awl or a punch; use of preliminary drilling with a drill (or drills) of a smaller diameter.

Criticism of analogues

The use of preliminary drilling with a drill of a smaller diameter, along with facilitating the subsequent formation of an intraosseous canal of the required diameter, is associated with an increase in surgical time and not only does not completely eliminate the same difficulties for a drill of a smaller diameter, but also adds new ones in the case of closed osteoperforation, when blindly through soft tissues, “by touch”, it is necessary to find the hole formed in the bone with the tip of the drill with a smaller drill and drill along the course of this canal.

The use of an improvised limiter, such as a raspatory, resting against the bone in the path of the drill's sliding during open osteoperforation, that is, through the surgical wound, does not exclude the deviation of the drill in both directions along the line of the raspatory blade, which is accompanied by a loss of drilling accuracy and destruction of the outer edges of the bone canal.

Forming a recess at the site of the upcoming drilling with an awl or a core, in addition to additional time costs and labor intensity of forming a recess at the level of the cortical plate of the diaphysis, is ineffective due to the usually insufficient depth of the recess. Therefore, this technique for gaining stability of the rotating drill also requires its vertical installation on the bone with subsequent deviation from the perpendicular plane to the desired angle as the intraosseous canal deepens during drilling. However, this is inevitably accompanied by widening of the entrance hole and the intraosseous canal and, accordingly, a significant weakening of the bone being drilled itself.

In addition, the disadvantages of analogues are the following:

- the risk of the awl slipping off the bone surface with damage to the paraosseous soft tissues, and often important anatomical structures, the likelihood of which increases, firstly, when the direction of the upcoming drilling deviates from the perpendicular plane of the bone and, secondly, when the point of emphasis on the bone is eccentric, on the edge or crest of the bone;

- the possibility of bone wedging due to the “cleaver effect” cannot be ruled out, especially if it is sclerotic and fragile.

Therefore, as a prototype, we have chosen the optimal one among the listed analogs for closed and open osteoperforation, a guide in the form of a trocar tube. Prototype

A guide in the form of a trocar tube, described in the manual “General principles of surgical operations technology” (Burykh M.P. General principles of surgical operations technology // Manual for surgeons. - Rostov n / D.: Phoenix publishing house, 1999. - 544 p.) was selected as a prototype device.

A trocar is a surgical instrument designed to penetrate cavities of the human body through integumentary tissues while maintaining their tightness during manipulations. In traumatology and orthopedics, it is also used as a drill guide. In closed osteoperforation, it is used assembled, when the trocar is advanced through a cut-notch through soft tissues until the tip of the stylet rests on the bone. Holding the trocar tube resting against the bone, the stylet is removed from it and, without losing contact between the tube and the bone, a drill is inserted into it, the end of which rests against the bone. Then the drill is given the desired direction and osteoperforation is performed. In open osteoperforation, only the trocar tube without the stylet is usually used.

Criticism of the prototype

Although the prototype device, as a guide, prevents drill deviation and improves the quality of osteoperforation, it also has disadvantages, which include the following:

- non-replaceability of the instrument tube with one standard size, which limits the choice of drills of different diameters for osteoperforation;

- the surgeon is forced to adhere to a perpendicular direction of the instrument tube stop in the bone due to the possibility of it slipping during the process of giving the drill chuck a rotary motion, especially if the bone surface is round and smooth. If drilling is performed at an angle, then there remains a significant probability of the cylindrical surface of the end of the tube slipping off the bone, increasing as the angle of deviation of the drill from the plane of the bone increases;

- rotational instability of the trocar tube retention on the bone surface at an acute drilling angle.

The purpose of the invention is to optimize the design of the device and, as a consequence, increase the effectiveness of treating patients with injuries or diseases of the musculoskeletal system, requiring precision closed or open drilling of the bone.

The essence of the invention

A device for drilling a bone is proposed (Fig. 1, a), which is a guide for drills in the form of a trocar consisting of a stylet (pos. 1) and a tube (pos. 2), characterized in that the tube (pos. 2) of two standard sizes has (Fig. 1, b) an end (pos. 3) beveled at an angle of 45 degrees, the edge of the beveled surface of which is ground along its entire length from the outside inward at an angle of 45 degrees (pos. 3), and the resulting pointed spike is longitudinally filed with a needle file or a triangular file with fine notches to a depth of 2-3 mm at an angle of 45 degrees from the outside inward with the formation of two equal teeth (pos. 4) at the end.

The trocar (Fig. 1, a) consists of a stylet (pos. 1), which is 105 mm long and 4 mm in diameter, and a tube, which has two sizes: a smaller one, with a length of 90 mm, an external diameter of 5.5 mm and an internal diameter of 4.5 mm, and a larger one, with a length of 90 mm, an external diameter of 6 mm and an internal diameter of 5 mm.

The device is used as follows. In case of closed osteoperforation, it is used assembled together with the stylet (pos. 1), when the trocar is advanced through a cut-notch through soft tissues until the stylet tip rests on the bone. Holding the tube (pos. 2) of the trocar resting against the bone, the stylet (pos. 1) is removed from it and, without losing contact of the tube (pos. 2) with the bone, the drill is inserted into it, the end of which rests on the bone. Then the drill is given the required direction and osteoperforation is performed. In this case, the edge of the beveled surface (pos. 3) of the tube (pos. 2) does not tend to slip off the smooth surface of the bone and to rotational instability due to the rest of the two teeth of its tip (pos. 4) on the bone.

In case of open osteoperforation, i.e. through the surgical wound and the skeletonized section of the bone intended for drilling, only the trocar tube (pos. 2) is used without the stylet (pos. 1). The tube (pos. 2) is pressed against the bone with two teeth (pos. 4), given the required direction and the drill is inserted into it. In this case, the end of the tube (pos. 3), beveled at an angle of 45 degrees, does not tend to slip and easily maintains the exact direction of the drill during osteoperforation.

Example of device application

As an example of the application of the proposed device, we present the following observation.

Patient B., 58 years old, was admitted to the Republican Center for Traumatology and Orthopedics (RCTO) in Makhachkala on 12/12/2023 with the diagnosis: Chronic rupture of the tendon of the long head of the biceps muscle of the right shoulder. From the anamnesis: an industrial injury, a month ago, while unloading building materials, when the patient was unable to hold a heavy box in the air, he felt a sharp pain and crunch in the upper third of the right shoulder. During examination, a typical soft tissue depression was noted along the anterior surface of the right shoulder, and in the middle and lower thirds - a mobile neoplasm of soft elastic consistency (a muscle roller gathered into a lump).

On December 13, 2023, a planned operation was performed under conduction anesthesia according to Kulenkampf: Tenodesis of the tendon of the long head of the biceps muscle of the right shoulder. The operation was performed as follows. A longitudinal skin incision, 5 cm long, was made along the anterior-outer surface of the lower third of the right shoulder in the projection of the muscle roller of the biceps muscle. The proper fascia of the shoulder was dissected and the muscle roller of the long head of the biceps muscle, gathered into a lump, was exposed. The muscle was straightened, its torn and somewhat frayed tendon at the end was identified, which was stitched along 3-4 cm according to Cuneo with a strong lavsan thread. Then, through a 4-cm incision in the projection of the long head of the biceps muscle of the intertubercular groove of the proximal humerus, deserted without the tendon, a bone canal was formed transversely with a drill of 4.5 mm in diameter. In this case, a pre-fabricated device for drilling the bone was used - a trocar tube, 90 mm long, with an outer diameter of 6 mm and an inner diameter of 5 mm. The end of the tube had an end beveled at an angle of 45 degrees, the edge of the beveled surface of which was ground down along its entire length from the outside to the inside at an angle of 45 degrees, and the resulting pointed spike was longitudinally filed with a file to a depth of 2 mm at an angle of 45 degrees from the outside to the inside with the formation of two equal teeth at the end. The end of the tendon, reinforced with a lavsan suture according to Cuneo, was brought out of the first wound into the second with a Mikulicz clamp and passed through the formed transverse intraosseous canal. The tendon was sutured under tension in the form of a loop below the formed intraosseous canal. The soft tissue depression at the site of the long head of the biceps muscle was eliminated, the anatomical integrity and continuity of the biceps were restored. The wounds were washed with antiseptic solutions and sutured. The postoperative period was uneventful, the wounds healed primarily. We assessed the result of the operation as good.

Features of an invention that distinguish it from a prototype

The design features (distinctive features from the prototype) of the bone drilling device are as follows:

- the device is a trocar and consists of a stylet (Fig. 1 pos. 1) and a tube (Fig. 1 pos. 2), which has two standard sizes: a smaller one, with a length of 90 mm, an external diameter of 5.5 mm and an internal diameter of 4.5 mm, and a larger one, with a length of 90 mm, an external diameter of 6 mm and an internal diameter of 5 mm;

- the tube (Fig. 1 pos. 2) has an end beveled at an angle of 45 degrees (Fig. 1 pos. 3),

- the edge of the beveled surface of the end (pos. 3) of the tube (pos. 2) is ground along its entire length from the outside inward at an angle of 45 degrees (Fig. 1 pos. 3);

- the pointed end spike (Fig. 1 pos. 3) of the tube is longitudinally filed with a needle file or a triangular file with fine notches to a depth of 2-3 mm at an angle of 45 degrees from the outside to the inside, forming two equal teeth (Fig. 1 pos. 4).

The technical result (advantages over the prototype) of the device for drilling bone are as follows:

- two sizes of the tube (pos. 2) of the device allow for the optimal use of a wider range of drill sizes: the smaller tube, with an internal diameter of 4.5 mm, is optimal for drills with a diameter of 2 to 4.3 mm, and the larger tube with an internal diameter of 5 mm is optimal for drills with a diameter of 3.2 to 4.8 mm;

- the beveling of the end (pos. 3) of the tube (pos. 2) of the trocar at an angle of 45 degrees ensures its more stable retention by the apex of the acute angle on the surface of the bone in both closed and open osteoperforation;

- grinding from the outside inward along the entire length of the edge of the end of the tube at an angle of 45 degrees (pos. 3) ensures smoother and more atraumatic advancement of the trocar through soft tissues in case of closed osteoperforation and more stable retention of the end of the tube on the bone surface in case of both closed and open osteoperforation;

- two identical 2-3 mm teeth (pos. 4) on the end (pos. 3) of the beveled surface of the trocar tube (pos. 2), evenly distributing the load between themselves, are resistant to deformation and provide the device with: a) rotational stability; b) elimination of the “cleaver effect” with wedging of fragile and sclerotic bone; c) prevention of excessive immersion in loose porous bone;

- the bevel of the end (pos. 3) of the trocar tube (pos. 2) and the presence of two identical 2-3 mm teeth (pos. 4) on it are necessary and sufficient to prevent slipping from the bone even with a significant deviation from the perpendicular plane and a further decrease in the acute angle between the trocar tube and the bone surface;

- the ability to do without a stylet (pos. 1) on the skeletonized area of the bone when forming a precision intraosseous canal - without its uncontrolled expansion and destruction of the edges of the entrance hole;

- cost-effectiveness and ease of manufacture of the device, which can be made by converting a conventional trocar and a metal catheter using a minimum of metalworking tools;

- the device is reusable and does not lose its operational properties after long-term use.

Thus, the proposed device allows to increase the efficiency of treatment of orthopedic and traumatological patients requiring precision closed and open osteoperforation.

Information taken into account:

1) Traumatology and orthopedics: A guide for doctors / Ed. N.V.Kornilov: in 4 volumes. - V.1: General issues of traumatology and orthopedics. - St. Petersburg: Gipppokrat, 2006. - 624 p. - P.303-388;

2) Traumatology: National Guidelines / Edited by G.P. Kotelnikov, S.P. Mironov - 4th ed., revised and enlarged. - Moscow: GEOTAR-Media, 2022. - 784 p. (Series "National Guidelines") DOI: 10.33029/9704-6636-0-INJ-2022-1-784;

3) Device for precision osteoperforation (Guseynov A.G.). Patent for invention No. 2410058 dated 27.01.2011;

4) Device for osteoperforation (Guseynov A.G.). Patent for invention No. 2465847 dated 11/10/2012;

5) Burykh M.P. General principles of surgical operations technology // Manual for surgeons. - Rostov n / D.: Phoenix Publishing House, 1999. - 544 p. - prototype device.

Claims (1)

A device for drilling bone, including a drill guide made in the form of a trocar consisting of a stylet and a tube, characterized in that the tube has an end beveled at an angle of 45 degrees, the edge of the beveled surface of which is ground down along its entire length from the outside inward at an angle of 45 degrees, and the resulting pointed spike at the end of the tube has a longitudinal cut to a depth of 2-3 mm at an angle of 45 degrees from the outside inward, which forms two equal teeth at the end, made for abutment against the bone.

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