RU2614208C2 - Anchor for legiment and muscles reinsetion in case of their separation from bones and key for installation and removal - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: anchor for legiments and muscles reinsertion in case of separation from the bone comprises a threaded cylindrical portion and a head for the anchor installation and removal key, with hole and slots in the thread on both sides. Grooves are made along the entire length of the thread, a suture hole extends perpendicularly to the side surface and connects slots in the middle part, the key head has a cylindrical shape with flats at the grooves in the thread. The key for installation and removal of the above anchor is T-shaped and includes a handle and a rod. The working end of the rod is a stepwise cup, two opposing recesses are arranged on the lower step, coming from the edges of the rod to the handle. The recess height exceeds the anchor head height by 1 mm, while the walls of the lower cup step are flat from the inside at anchor head flats. The side wall of the rod contains an inclined channel extending to the upper step of the cup for suture withdrawal from the rod cavity, the channel outlet opening is located in a plane perpendicular to the side recesses plane.

EFFECT: structural strength to secure the suture, suturing without any contact with the cutting edge of the anchor.

2 cl, 6 dwg

Description

The invention relates to medicine, namely to orthopedics and traumatology, and can be used to fix tendons during plastic reconstruction of the ligamentous apparatus.

In order to stabilize the reconstructed ligaments, their primary fixation is carried out in the formed intraosseous tunnel and, in addition, the plastic material of the ligaments (or ligaments) is fixed at the place of anatomical attachment to the bone. Screw anchor structures are used, which can have external and lateral grooves and a central channel, or the screw part of the retainer with a deep thread has a transverse channel for placing plastic material in the form of bundles, tapes. A cannulated screw carrying plastic ligamentous material is inserted and twisted in the intraosseous tunnel, while the ligamentous material in the form of a tourniquet (tape) is adjusted and fixed between the anchor screw and the bone walls of the intraosseous tunnel (US 8632568 B2, M. cl A61B 17/04, A61B 17/86, 2014).

The disadvantages of the design are:

1) The depth of the grooves and the diameter of the internal channel, limited by the dimensions of the structure, for placement of plastic material in them in the form of bundles, tapes.

2) The need for accurate adaptation of the intraosseous tunnel to the size of the helical anchor structure.

3) For accurate tension of the reconstructed ligament by screwing into the intraosseous tunnel a screw anchor structure that carries plastic material in the form of bundles, tapes, additional measuring instruments are required, the number of surgical procedures is increased, the operation time is lengthened.

4) The mobility of the helical anchor structure is possible up to migration in the case of resorption surrounding the bone screw, and in patients with osteoporosis.

A known method of reconstructive restoration of the cruciate ligament of the knee joint (US patent 7,530990 B2, M. Cl. A61B 17/04, A61F 2/08, 2009), including methods of forming a ligament of plastic material in the form of bundles, conducting a reconstructed ligament the intraosseous tunnel and bone fixation using 1-2 external locking plates with holes for holding and tensioning the ligamentous material and fixing the plate to the bone with screws, as well as fixing the reconstructed ligament inside the tunnel with a bone locking element transplant.

The disadvantages of the proposed method for reconstruction of the cruciate ligament of the knee joint are:

1) The need for skeletal bone in the positioning area of the osseous locking plate.

2) It is possible premature resorption or slipping into the joint cavity of the internal locking element from the bone graft.

3) The limited dimensions of the through longitudinal channel in the inner locking element for carrying out a reconstructed ligament of sufficient thickness.

4) Injury of the tendon-ligamentous apparatus of the joint with a massive locking plate, deficiency of integumentary soft tissues to cover the plate.

Closest to the anchor is the anchor from the kit for endoscopic insertion, containing the anchor, an elongated cylindrical element for connection to the drive (patent US 5443482 B2, M. CL. A61B 17/00, A61F 1/00, 1995). An anchor consists of a cylindrical part with a thread and a pointed end on one side and an eye for thread on the other side. Grooves are made on the anchor thread for mounting the elongated fingers of the elongated cylindrical element, which is an intermediate link for connecting to the drive.

The design has the following disadvantages:

1. Sophisticated, expensive construction.

2. Small contact area and, as a result, high eye pressure for the thread on the ligature.

The closest to the key is the design of a screwdriver with a T-shaped handle, consisting of a handle and a shaft with a cross-shaped or hexagonal pen on the end (Catalog. Implants and tools for internal osteosynthesis. JSC SIBELCOM, Belovo, Kemerovo Region)

The disadvantage of this device is the inability to reliably capture the anchor during its installation and removal of suture material from the anchor to the outside.

Objective: to create a tool kit for reinsertion of muscles and tendons with the possibility of ease of manufacture, structural strength for fixing the ligature, holding the ligature without contact with the cutting edge of the anchor, creating a key that allows the installation of the anchor with the ligature and its output to the outside.

The task is achieved by an anchor for reinsertion of tendons and muscles when they are separated from the bone. The anchor contains a cylindrical part with a thread and a turnkey head for installing and removing the anchor. The anchor has a hole and grooves on both sides of the thread. The grooves are made over the entire length of the thread. The ligature hole extends perpendicular to the side surface and connects the grooves in the middle part. The turnkey head has the shape of a cylinder with flats on the side of the grooves in the thread.

The task is also achieved by the fact that they use the key to install and remove the anchor, a T-shape, consisting of a handle and a rod. The working end of the rod is made in the form of a stepped glass. On the lower stage of the glass there are two opposed recesses extending from the edge of the rod to the handle, the height of the recess exceeds the height of the head of the anchor by 1 mm. Moreover, the walls of the lower stage of the glass from the inside from the side of the flats of the head of the anchor are made flat. In the lateral wall of the rod, an inclined channel passes to the upper stage of the glass to withdraw the ligature from the cavity of the rod to the outside. The outlet of the channel is located in the plane perpendicular to the plane of the side recesses.

The proposed design of the anchor and key allows, when used, to provide a deep introduction of the ligature and firmly fix it in the bone mass. The system of holes in the anchor and grooves allows the ligature to be drawn inside the key without contacting it with the cutting edges of the anchor. Then the ligature is brought out through the outlet and wound on the handle of the key, which ensures the tension of the ligature and keeps in stable condition the connection of the key worn on the head of the anchor. The ligature that fixes the tendon to the bone remains intact to ensure stable, firm fixation with proper load distribution.

The proposed device is presented in FIG. 1-6.

In FIG. 1 is a front view of the anchor.

In FIG. 2 is a side view of the anchor.

In FIG. 3 is a top view of the anchor.

In FIG. 4 - key side view.

In FIG. 5 - key front view.

In FIG. 6 is a bottom view of a key rod.

An anchor for reinserting tendons and muscles when they are torn off the bone contains a cylindrical part with thread 1 and a turnkey head 2 for installing and removing the anchor. The anchor has a hole 3 in the thread 1 and grooves 4 on both sides. The grooves 4 are made over the entire length of thread 1. The hole for the ligature 3 extends perpendicular to the side surface and connects the grooves 4 in the middle part. The turnkey head 2 has the shape of a cylinder with flats 5 from the side of the grooves 4 in the thread 1. The anchor is made of titanium.

The key for installing and removing the anchor, the T-shape consists of a handle 6 and a rod 7. The working end of the rod is made in the form of a stepped glass. On the lower stage of the glass 8, two opposed recesses 9 are made, extending from the edge of the shaft 7 to the handle 6. The height of the recess 9 exceeds the height of the head of the anchor 2 by 1 mm. The walls of the lower stage of the glass 8 from the inside from the side of the flats of the head of the anchor are made flat. In the side wall of the rod 7 passes an inclined channel 10 to the upper stage of the glass 11 to output the ligature from the cavity of the rod 7 to the outside. The outlet 12 of the channel 10 is located in the plane perpendicular to the plane of the side recesses. The key is made of titanium.

The key can be used to remove the anchor as follows. If it is necessary to remove the anchor, they access its head, insert the head of the anchor into the end of the key glass, as during installation, and remove the anchor by rotating counterclockwise. The anchor bed is covered with local tissues.

Designs are used for reinsertion of tendons and muscles when they are torn from the bone. The method consists in exposing the bone bed, forming a 5.5 mm hole with a drill, introducing an anchor with a ligature with the key, and then sewing the tendon to the separation point. To introduce the anchor, the ligature is carried out through the hole 3, its ends are placed in the channels 4, held along the flats 5 of the head 2 of the anchor and through the inner cavity of the rod in the form of the lower stage of the glass 8 and and the upper stage of the glass 11 of the rod 7 of the key, through the channel 10 and hole 12 brought out. The key is put on with the working end on the head of the anchor 2. In this case, the side slots of the key 9 are installed opposite the channels 4. The ends of the ligature are pulled and wound on the handle of the T-shaped key. An anchor with a ligature is inserted into the hole and, turning the key, screw it into the bone. In this case, the walls of the lower stage of the glass 8 with their planes act from the inside on the flats of the head of the anchor, causing it to be screwed in. After installing the anchor, unwind the ligature, remove the key, freeing the ends of the ligature.

Tendons and muscles are reinserted when they are torn from the bone in patients with separation of the distal and proximal shoulder biceps tendons, shoulder rotator tendons, extensor tendons of the knee joint (own ligament of the patella and tendon of the rectus femoris muscle), Achilles tendon.

Example 1. Patient L., 54 years old.

Diagnosis: tendon rupture of the long head of the biceps of the shoulder. The operation of tenodesis in the inter-tubercle groove was performed using the proposed designs. An anchor with a ligature using a key was inserted into the proximal part of the inter-tubercle groove in the bone bed, the tendon was highlighted, stitched, and fixed. With the introduction of the anchor, there is no violation of the integrity of the ligature. Seams, aseptic dressing, kerchief dressing. Dosed active movements the day after surgery. After 12 months, the volume of active movements and limb function during dynamometry does not differ from those in the contralateral.

Example 2. Patient B., 43 years old.

Diagnosis: separation of the patellar ligament. The operation of reinsertion of the tendon to the tibial tuberosity was performed using the proposed anchor and key. Two anchors with a ligature are introduced into the bone bed of the tibial tuberosity. There is no violation of the integrity of the ligature. The tendon is highlighted, stitched, held fixation. Seams, aseptic dressing, gypsum splint. Dosed active flexion movements, passive extension movements on the seventh day after surgery. After 4 weeks, active dosed extension movements began. After 12 months, the volume of active movements and limb function during dynamometry does not differ from those in the contralateral.

Example 3. Patient Yu., 36 years old.

Diagnosis: separation of the Achilles tendon from the calcaneal tuber. The operation of reinsertion of the tendon to the calcaneal tuber was performed using the proposed anchor and key. An anchor with a ligature is introduced into the bone bed of the tuber, the end of the tendon is highlighted, stitched as close as possible to the calcaneal tuber and fixed on it. Seams, aseptic dressing, gypsum splint. Dosed active plantoflexion movements, passive dorsoflexion movements of the foot on the seventh day after surgery. After 2 weeks, active dosed movements of dorsoflexion of the foot began. After 12 months, the volume of active movements and limb function during dynamometry do not differ from those in the contralateral.

Claims (2)

1. Anchor for reinsertion of tendons and muscles when they are torn off the bone contains a cylindrical part with a thread and a turnkey head for installing and removing the anchor, has a hole and grooves on both sides of the thread, characterized in that the grooves are made over the entire length of the thread, hole under the ligature runs perpendicular to the side surface and connects the grooves in the middle part, the turnkey head has the shape of a cylinder with flats on the side of the grooves in the thread. 2. The key for installing and removing the anchor according to claim 1, made of a T-shape and consisting of a handle and a rod, characterized in that the working end of the rod is made in the form of a stepped glass, two oppositely located recesses made from the edges of the rod to the handle, the height of the recess exceeds the height of the anchor head by 1 mm, while the walls of the lower stage of the glass from the inside from the side of the flats of the head of the anchor are made flat, an inclined channel passes in the side wall of the rod to the upper stage of the glass for output ligatures from the cavity of the rod to the outside, the outlet of the channel is located in the plane perpendicular to the plane of the side recesses.

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