RU2340296C2 - Device for osteotomy of shin bone - Google Patents

Abstract

FIELD: medicine; orthopedy and traumatology.

SUBSTANCE: device contains the case and carving bars with the hinge, thus the last have bracing possibility in Ilizarov apparatus support. The case has excision possibility. The device also has an oseotome, fixing perosseous elements, sliding bars with a through cut for placing of carving bars and lock screws for an oseotome, fixing perosseous elements, sliding bars and carving bars with the hinge. The case is executed in the form of a guide-arch with a through cut for an oseotome and with the through apertures placed in parallel to the cut for introduction of fixing elements. The grooves for sliding bars are created on the guide-arch extremities.

EFFECT: possibility of the referred carrying out of perosseous elements for bracing of the articulate extremity of the bone, performance of an osteotomy with an adjustable angle of an inclination of its plane and use of parts of the device for distraction with formation of sphenoidal regenerate.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of knee joint deformity, namely, periarticular tibial osteotomy.

The invention is known - a guide device for osteotomy (1), used for transverse rotational osteotomy of the proximal femur in a given plane for the treatment of aseptic necrosis of the head and coxarthrosis. The device contains a locking element in the form of a lining with holes for screws and a housing with a scale. The axis of the slit guide is located in the housing perpendicular to the axis of the lining and is connected to the guide through a pair of brackets and two pairs of rods, fixed in mutually perpendicular planes through a pair of adapters. The screw is used to fix the brackets and rods, and also fixes the slotted guide. The guiding device is fixed in the undervert region of the thigh with the help of a retaining pad and brackets so that the neck-diaphyseal angle is set on the goniometer scale, and the adapters are fixed with screws so that the slot saw guide is located above the line of the proposed bone section. With this installation of the guide device, the slotted guide of the saw is set strictly perpendicular to the axis of the femoral neck. After that, an oscillating saw produces an alternate osteotomy in a given plane, turn the head around the longitudinal axis by the required angle, then perform osteosynthesis and the wound is sutured in layers.

However, the known device has significant disadvantages.

1. To install the guide requires exposure of the proximal femur by soft tissue incision (at least 10 cm), necessarily accompanied by blood loss, and in combination with the terms of wound healing, it increases the duration of postoperative rehabilitation.

2. The guide is fixed using two screws, which not only lengthens the operation time, but also by leaving holes after removing the screws, weakens the bone.

3. Direct osteotomy is supposed to be performed only by an oscillatory saw, which is a complex and expensive device.

4. The use of a guide does not imply the use of fasteners for subsequent osteosynthesis of osteotomized fragments.

Closest to the proposed one is a compression-distraction apparatus for performing osteotomy in an experiment and clinic, which allows to obtain a transverse bone fracture without displacement of fragments while maintaining the intraosseous microvasculature (2).

Known compression and distraction apparatus contains rings interconnected by couplers, knitting needles, spoke holders and spoke tensioners. The apparatus is equipped with an additional ring connected to the main one using threaded rods and plates, and the threaded rod at the junction with the main ring has a hinge. Spacers are mounted on an additional ring.

Violation of the integrity of the bone is carried out as follows: through the metaphyses of the bone in the plane of its cross section, one pair of intersecting spokes is carried out and the transosseous apparatus is installed.

Soft tissue is dissected to the periosteum. A wire is drawn around the bone, which is fixed in the spacers mounted on the ring. By pulling at the ends of the wire, circular compression of the bone is performed before the onset of the fracture.

However, the known device has significant disadvantages.

1. Performing an osteotomy at an angle to the longitudinal axis of the bone using a known device is impossible, because the design does not provide for the installation of the main annular support at an angle to the base apparatus and the longitudinal axis of the bone.

2. Pulling a wire using a groove probe in the zone of high osteotomy (1.5-1.0 cm 6 backward from the joint gap) is impossible due to the extremely high risk of damage to the vascular-nervous structures of the popliteal region / or the risk of penetration into the cavity of the knee joint.

3. The annular support used for osteotomy does not allow it to be used to simultaneously perform both osteotomy and the safe conduct of transosseous elements.

Based on the existing level of structures for performing osteotomy of long bones, the task was set: to provide the possibility of directional transosseous elements to fix the articular end of the bone, to perform an osteotomy with an adjustable angle of inclination of its plane, as well as the use of parts of the distraction device with the formation of a wedge-shaped regenerate.

The problem is solved as follows.

A device for osteotomy of the tibia to the Ilizarov apparatus contains a body and threaded rods with a hinge, the latter being able to be fixed in the support of the Ilizarov apparatus. The housing has the ability to be removed. What is new in solving this problem is that it has an osteotome, fixing transosseous elements, sliders with a through slot for accommodating threaded rods and locking screws for the osteotome, fixing transosseous elements, sliders and threaded rods with a hinge. The casing is made in the form of a guide arc with a through slot for the osteotome and with through holes placed parallel to the slot for introducing fixing elements, grooves for the sliders are selected at the ends of the guide arc.

We explain the essential distinguishing features of the proposed device for osteotomy of the tibia.

The execution of the body in the form of a guiding arc with a through slot along the radius of the guiding arc with an opening angle of 50 degrees to accommodate an osteotome allows periarticular osteotomy from a minimal skin incision, without risk of damage to the popliteal neurovascular structures.

Placing through holes for introducing fixing transosseous elements (spokes) parallel to the slot allows you to accurately enter transosseous elements (spokes) at a certain angle to each other and is safe with respect to the posterior structures of the knee joint, as well as perform an osteotomy strictly in a certain plane.

The execution of grooves at the ends of the guide arc, in which sliders with a through slot are installed to accommodate threaded rods equipped with hinges, and fixing threaded rods in the support of the Ilizarov apparatus can reduce the time of surgery, its invasiveness, and in combination with a minimal skin incision, reduce the time of general rehabilitation .

The equipment of the osteotome, fixing transosseous elements, sliders and threaded rods with hinges with locking screws is necessary to stabilize the position of the device elements at the stages of the periarticular osteotomy of the femur.

The use of transosseous elements in the form of spokes conducted through the through holes in the guide arc and fixed with clamping screws allows the use of these spokes to stabilize the device before performing the osteotomy directly.

The design of the device provides its versatility, as it is used for subsequent osteosynthesis.

Patent studies on subclasses А61В 17/56, А61В 17/68, А61В 17/72 and analysis of scientific and medical information reflecting the current level of technologies and designs for the treatment of varus deformity of the knee joint did not reveal devices identical to the proposed one. Thus, the proposed device is new.

The interconnection and interaction of the essential distinguishing features of the proposed device ensures the achievement of a new technological medical result in solving the problem, namely: the possibility of first conducting directed transosseous fixing elements for fixing the articular end of the bone, then directed osteotomy with the regulation of the angle of inclination of its plane, and in the postoperative period - the use of parts of the device for distraction with the formation of a wedge-shaped regenerate. Thus, the proposed technical solution has an inventive step.

The proposed device for periarticular tibial osteotomy is industrially applicable in the field of practical health care, since the device is available for manufacture at the present stage of development of the medical industry and osteotomy with subsequent osteosynthesis using the proposed device can be reproduced repeatedly, without requiring the use of exceptional means for implementation.

The essence of the design of the proposed "Device for osteotomy of the tibia" is illustrated by drawings, where:

figure 1. - general view of the device,

figure 2. - use of the device for osteotomy.

A device for osteotomy of the tibia contains a body made in the form of an arc-guide (1) with a through slot (2) along the radius of the arc-guide (1) to accommodate an osteotomy (3). The working part of the osteotome (3) is made in the form of a cutting frame (4). Through holes (5) are made on the body of the arc-guide (1) for introducing fixing transosseous elements (6), for example, in the form of spokes that are parallel to the slot (2). At the same time, grooves (7) are selected at the ends of the guide arc (1), in which sliders (8) with a through slot (9) are installed to accommodate threaded rods (10) equipped with hinges (11). The threaded rods (10) are fixed in the support (12) of the Ilizarov apparatus. Osteotome (3), fixing transosseous elements (6), sliders (8) and threaded rods (10) with hinges (11) are equipped with locking screws (13).

Apply the proposed device as follows.

After processing the surgical field, the distal base support (12) of the Ilizarov apparatus is mounted on the tibia using two standard rings and (4) spokes of the Ilizarov apparatus set so that both ring supports (12) are centered and interconnected by threaded rods (10). Next, a guide arc (1) with sliders (8) and threaded rods (10) with hinges (11) is assembled so that the guide arc (1) is located on the medial surface of the knee joint, and the distal ends of the threaded rods (10) are fixed in the support (12) of the Ilizarov apparatus. Through the middle hole (5) in the guide arch (1), a standard “control” needle (6) with a diameter of 1.8 mm is pierced, piercing the skin at a level corresponding to 1.0 cm distal to the subchondral bone, until it stops in the cortical bone of the medial condyle tibia and fix the transosseous element (6) in the form of a spoke with a stabilizing locking screw (13). The threaded rods (10) with hinges (11) are also stabilized by the locking screws (13). It is important that the “control” and subsequent transosseous elements (6) in the form of spokes are carried out strictly parallel to the joint space of the knee joint. This stage of the operation is controlled by an x-ray. After performing x-ray control, the “control” transosseous element (6) in the form of a spoke, with the correct orientation, is carried out with a drill transsegmental and again fixed with a locking screw (13). Then, with a drill, the second and third spokes (6) with a diameter of 1.8 mm are trans-segmented and are also fixed to the guide arc (1) with locking screws (13). Thus, before the main stage - an osteotomy - the module "guide - Ilizarov apparatus" is mounted.

On the inner surface of the knee joint, at a level 1 cm distal to the joint space of the knee joint, in the projection of the medial condyle of the tibia, a skin incision is made 2 cm long in the transverse direction to the long axis of the limb. Through the slot (2) of the guide arc (1), an osteotome (3) is inserted, the working part of which is made in the form of a cutting frame (4), 2 mm thick and 15 mm wide. Penetrating through a skin incision, an osteotome (3) is placed on the cortical plate of the medial condyle of the tibia, and then, with the help of a hammer, the osteotomy of the tibia is directly performed. After crossing the cortical plate with the osteotome (3), the locking screws (13) of the transosseous elements (6) are removed, the spokes and threaded rods (10) with hinges (11) are loosened. The transosseous elements (6) in the form of spokes are pulled in such a way as to free the holes (5) of the guide arc (1), the guide arc (1) is removed. Additional transosseous elements (6) in the form of spokes are fixed in an additional annular support (12) of the Ilizarov apparatus, which is connected to a previously mounted distal base support by threaded rods (10). The wound is sutured tightly. In the postoperative period, a wedge-shaped distraction regenerate is formed according to the generally accepted technique. Toward the end of the distraction period, a wedge-shaped gap is formed in the supra-tibial zone of the tibia, restoring the long axis of the limb, creating the prerequisites for reducing the progression of the development of degenerative changes.

Thus, the proposed “Device for osteotomy of the tibia to the Ilizarov apparatus” provides for surgical treatment of knee joint deformity, the possibility of initially conducting transosseous fixing elements to fix the articular end of the knee joint, and then performing directed osteotomy at the required angle. In further treatment, the device is used for subsequent osteosynthesis. The technology for using the device is simple and affordable for most specialized departments; The design of the lock does not have fragile or difficult to manufacture parts.

Information sources

1. A.S. SU 1505528 A1. Divakov M.G. Publ. 09/07/89, bull. No. 33.

2. A.S. SU 906550 A1. Ilizarov G.A., Pereslitskikh P.F., Nikitenko I.K., Shevtsov V.I. Publ. 02/23/82, bull. Number 7.

Claims (1)

A device for osteotomy of the tibia to the Ilizarov apparatus, comprising a body and threaded rods with a hinge, the latter being able to be fixed in the support of the Ilizarov apparatus, and the body has the ability to be removed, characterized in that it has an osteotome, fixing transosseous elements, sliders with a through slot for placement of threaded rods and locking screws for an osteotome, fixing transosseous elements, sliders and threaded rods with a hinge, the housing is made in the form of an arc-guide with a through slot for Otomo and arranged parallel to the slot through-holes for the introduction of fixing elements, with the ends of the arc-guide grooves sliders selected.

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