Surgical instruments or methods for treatment of bones or joints and devices specially adapted therefor (A61B17/56)

A   Human necessities(312083)
A61B17        Surgery(21508)
A61B17/56                     Surgical instruments or methods for treatment of bones or joints; devices specially adapted therefor(4383)
ethod for planning and implementation of long bones deformations correction // 2641840
FIELD: medicine.SUBSTANCE: when planning the correction of a deformation containing a torsion component, the proximal and distal articular ends of the deformed model are sequentially positioned strictly in the frontal and sagittal planes, determining the deformation peak; the deformed bone model is fixed in the transcutaneous apparatus used to eliminate all components of the deformation until it completely coincides with the "standard", then all actions are exactly repeated to eliminate the deformation in the clinic.EFFECT: method allows to increase the accuracy of planning and correction.19 dwg
ethod for treatment of c2 vertebra injury // 2641160
FIELD: medicine.SUBSTANCE: access is performed in the C4 vertebra projection along the outer edge of the nodal muscle in the direction between the sternocleidomastoid muscle and the anterior scalene muscle. Then a channel is formed laterally from the internal jugular vein, common carotid artery and vagus nerve to the C3 vertebra, starting from the bottom edge of the transverse process of the C3 vertebra base, through its body into the C2 vertebra body at an angle of 50-70° of the axial line of the C3 vertebra and 5-10° in the frontal plane of the median line of the spine. The fixing screw is inserted into the created channel. Similarly, the vertebrae are fixed from the opposite side of the neck.EFFECT: method allows to reduce trauma, labour, avoid prolonged immobilization.8 dwg
ethod for correction of multi-level deformations of long-bones // 2640999
FIELD: medicine.SUBSTANCE: transosseous elements are directed and the proximal, distal and intermediate supports of the external fixation apparatus are mounted. Osteotomy is performed at the level of each of the deformation vertices. An orthopedic hexapod is mounted. Hexapod strata are fixed only to the proximal and distal supports, and the intermediate supports are connected with ones located above and below by means of elastic rods. Hexapod parameters and pre-operative planning data are input into a computer program and the computer program is used to calculate the deformation correction by combining the distal fragment axis with the proximal fragment axis. Then the lengths of the hexapod strata are changed manually based on the calculations performed, thus making simultaneous correction of deformations at all levels. The elastic rods and hexapod strata are replaced with fixed articulations or straight threaded rods.EFFECT: method allows to increase stability of fixation, provide conditions for regenerates rebuilding.41 dwg
ethod for tibial intercondyloid eminence fracture treatment // 2640945
FIELD: medicine.SUBSTANCE: diagnostic arthroscopy of the injured knee joint is performed in standard antero-lateral and antero-medial arthroscopic portals. The fragment is placed on its bed and fixed with a tibial guide, through which the K-wire is directed via proximal epimetaphysis of the tibia. An additional "central" arthroscopic portal is performed, through which a tibial guide is placed on each fragment of the split intercondylar eminence. A cylindrical drill guide is inserted into the joint and positioned at an angle of 45° on the front intercondylar eminence. A K-wire is inserted along the guide at an angle of 45° from front to back, from top to bottom diagonally to the posterior cortical layer of the tibia. Cannulated drill bit is used to drill through the channel along the entire length of the meta-epiphysis. The wire is removed together with the drill. A biodegradable fixative is introduced into the formed channel. Changing the arthroscopic portals, medially and laterally at an angle of 70°, crosswise, front to back, from the outside to the inside, wires are inserted into the cortical layers of the medial and lateral condyles, along which channels are drilled and biodegradable fixatives are introduced.EFFECT: method allows to reduce traumatism, increase the reliability of fixation.5 dwg
ethod for blocked intramedullary osteosynthesis // 2640790
FIELD: medicine.SUBSTANCE: rodis implanted. The rod is blocked distally with two screws, proximally - with one screw. Decompression fasciostomy of the posterior surface and posterior deep osteo-fascial cases is made from access for proximal blocking screw implantation. Decompression fasciotomy of the posterior surface case is performed by cutting the fascia posteriorly from the edge of the tibia and parallel to it. Decompression fasciotomy of the posterior deep case is performed retreating posteriorly from the fascicotomy line of the posterior surface case and parallel to it.EFFECT: method allows to prevent local hypertensive ischemic syndrome.2 cl
ethod for surgical treatment of nonunion fractures and false joints of hand navicular bone // 2640088
FIELD: medicine.SUBSTANCE: bone marrow is used as a transplant, which is obtained by puncture from the patient's ilium wing. Several fenestration holes are formed in the false joint area, the obtained punctate is injected into each of the latter. An external fixation device is applied. Two-time replaceable uniform distraction and compression in the radiocarpal joint is carried out alternately discretely in time in the 0.25 mm mode 2 times a day for at least 8 to 10 weeks. Further, after the final gradual dropping of distraction, the external fixation device is transferred to the fixation mode until the scaphoid fragments fully consolidate.EFFECT: method allows to maintain the mechanical strength of the fragments ends, create a tight contact between the fragments.3 cl, 3 dwg, 1 ex

ethod for manufacturing implant for prosthetics of orbit walls // 2639429
FIELD: medicine.SUBSTANCE: at the first stage, the length of the implant side corresponding to the level of the outer edge of the orbit is determined. At the second stage, measurements are carried out to determine the dimensions of the prosthesis side which will be located on the inner edge of the orbit. Observing all the obtained dimensions, an implant is made of titanium or its alloy based on a metal mesh, repeating the contours of the prosthetic orbit part.EFFECT: method allows to increase the availability of the method while maintaining the quality of the implant and surgical intervention in general, shorten the duration of the preoperative period.6 dwg

ethod for surgical treatment of palmar fibromatosis of ii-iii degree of expression // 2639021
FIELD: medicine.SUBSTANCE: two longitudinal incisions are made at the level of proximal and distal edges of the strands, while preserving the natural folds of the palm. A tunnel is formed on the palmar surface, in the course of which the skin is dissected and initial subcutaneous excision is performed. Then local point removal - subaponeurotic - excision of fibrotic tissues is performed. The strands with a part of palmar aponeurosis on the fingers are removed through separate additional C-shaped incisions along the palmar-lateral surface of the fingers. After contracture removal, aluminium modelled langettes are superimposed on each finger individually.EFFECT: method avoids formation of extensive scars.1 ex, 6 dwg

Device for external fixation of abdominal wall for compartment syndrome treatment in case of tertiary peritonitis // 2638764
FIELD: medicine.SUBSTANCE: device consists of Kirschner spokes, two supports arranged in parallel planes connected by three threaded rods, a compression device in the form of a threaded rod, at one end of which a bar is installed by means of nuts with broad side plane perpendicular to the threaded rod. Each support is made in the form of three beams with longitudinally located holes, connected in the form of a staple with bolts and nuts. The ends of Kirschner's spokes are attached to the free ends of the staple through brackets with a threaded shank spoke-fixing bolt. The threaded rods are installed in parallel in the middle part of the corresponding beams. The second end of the threaded rod is attached to the middle threaded rod by means of brackets and nuts.EFFECT: effective relief of abdominal compartment syndrome, is universal and can be used in a single unit with external fixation devices for pelvic bones fractures and hip proximal fractures in combination with abdominal trauma.1 dwg
ethod for humerus false joint treatment // 2638427
FIELD: medicine.SUBSTANCE: deep artery of the shoulder and the collateral radial artery with the comitant veins are mobilized from the radial nerve and surrounding tissues, from the exit from the spiral canal to the level of the distal metadiaphysis of the humerus. In a single complex with the isolated vessels, their branches and branches of the recurrent radial artery to the periosteum of the external epicondyle of the humerus, a periosteal cortical autograft is raised, the periosteum is raised as flaps on front and back the outer surfaces of the external epicondyle at the level of attachment of the long beam hand extensor including a fragment thereof. The periosteum flaps are turned laterally. The cortical plate is perforated along the perimeter of the taken autograft and lifted. The complex of tissues is rotated into the false joint area. The cortical part of the autograft is placed in the bed formed in the false joint area to the depth of the autograft cortical plate thickness. Subcutaneous flaps are brought apart to the sides along the surface of humerus fragments and fixed.EFFECT: method allows to ensure transplant survival, shorten the duration of treatment.6 dwg
ethod for surgical access to hip joint in endoprosthesis // 2638426
FIELD: medicine.SUBSTANCE: central line is drawn from the top to the bottom above the greater trochanter. On this central line, points of the proximal and distal border of the larger trochanter are marked. The distance between these points is measured and divided into 3 equal parts, highlighting the proximal, middle and distal part. The first incision is made from the proximal point along the muscle fibres of the middle gluteus muscle in the anterior-upper direction 3 cm in length. The second incision is made from the point on the border between the middle and distal third of the larger trochanter in the anterior direction, departing 1 cm from the central line, 3 cm in length. The third incision is made by connecting the initial points of the first and second incisions with each other, in the form of an arc with convex side directed anteriorly. The middle gluteus muscle is cut off from the anterior surface of the larger trochanter within the incisions made. The resulting flap of the medial gluteus muscle is shifted anteriorly and fixed with instruments.EFFECT: invention allows to reduce traumatism, shorten the period of rehabilitation due to faster recovery of the muscular environment and hip joint function.5 dwg
ethod for operational access to medial part of ankle bone joint surface // 2638280
FIELD: medicine.SUBSTANCE: after surgical medial linear access to the distal tibia, the medial ankle is isolated, leaving the attachment site of the deltoid ligament intact. Through the tip of the medial ankle, under X-ray control, two spokes are inserted at an angle of 45° to the axis of the tibia and parallel to each other, two cannulated malleolar screws are inserted along the guide spokes, forming channels therethrough for the subsequent fixation of the medial malleolus. Under X-ray control, an axial spoke is directed in the distal metaepiphysis of the tibia in the projection of the inner ankle tip, 2 centimetres above the articular cleft of the ankle joint, in the frontal plane, orienting it on the line of transition of the articular surface of the tibia to the articular surface of the medial malleolus. Further, using the axial spoke as a zero point, the medial malleolus of the ankle with an oscillatory saw is osteotomized distally in the form of a chevron with an angle between the osteotomy shoulders of 60°, as a result of which the anterior and posterior parts of the tibia remain intact, as well as the attachment site of the deltoid ligament. The osteotomized fragment of the medial malleolus is displaced medially and downward and its provisional fixation with Kirchner needles or inducing sutures is performed. After the main stage of the operation, the osteotomized fragment of the medial malleolus is laid on the mother bed and fixed with two malleolar cannulated screws, introducing them into the previously prepared channels.EFFECT: method allows to achieve a good visualization of the articular surface of the ankle bone to perform mosaic osteochondroplasty of bone and cartilaginous defects, stability of the osteosynthesis of the osteotomized fragment of the medial malleolus is ensured, and frontal instability of the ankle joint is prevented.7 dwg, ex 1

ethod for femoral head defect treatment // 2637290
FIELD: medicine.SUBSTANCE: osteotomy of the large trochanter apex is performed. Surgical dislocation of the femoral head is performed from the acetabulum. The cartilaginous cover of the head is dissected along the anterior surface. The periosteum is dissected along the neck axis. The periosteal-chondral flap is peeled off. Longitudinal osteotomy of the lateral part of the head and neck and transverse osteotomy of the lateral part of the neck base are performed. The resulting bone fragment is removed. Spherical shape is provided for the lateral edge of the head. The wound surface of the head and neck is covered with a periosteal-chondral flap. The periosteal-chondral flap is fixed by sutures and screws to the head. The head is inserted into the acetabulum. The large trochanter is transposed. The obtained position of the large trochanter is fixed by screws. An external fixation device is mounted on the pelvic and femoral bones. The obtained position is stabilized and the hip joint is unloaded. Postoperatively, development of passive movements in the hip joint is performed.EFFECT: method allows to improve spatial relationships in the hip joint, provide the possibility of joint unloading and development in the postoperative period.9 dwg
ethod for pelvis reconstruction in case of complex posttraumatic deformations // 2637283
FIELD: medicine.SUBSTANCE: external fixation device is imposed on the wings of the ilium and the femur of the functionally shortened limb. The hip joint and iliac bone in the nadacetabular region are fixed on the superior pelvic bone. The iliac bone is accessed. Transverse osteotomy of the iliac bone is performed proximally to the nadacetabular region. Access to the public and ischial bones of the inferior pelvic bone is provided. Osteotomy of the pubic and the ischial bones is performed through the zone of improperly fused fragments. Using the external fixation device, one-stage elimination of pelvis deformation is performed, forming a diastase in the body of the ilium. The mesh implant made in the form of a hollow cylinder with mesh walls and jagged edges is filled with osteoplastic material. The mesh implant is inserted into the diastase of the ilium. Bone screws made with a tuning fork head are inserted. The first bone screw is placed under the anterosuperior osteotomy of the ilium, the second bone screw is placed in the anteroinferior osteotomy of the ilium, the first and second bone screws are joined together by a smooth stem. The third and fourth bone screws are inserted into the pubic bones on either side of the symphysis, the fifth bone screw is inserted under the anterior-superior tip of the iliac bone of the inferior pelvic bone, the third, fourth and fifth bone screws are connected by a smooth stem modelled congruently to the bone surface. Structure stability is checked. The external fixation device is removed.EFFECT: method allows to simultaneously eliminate deformity, reduce the risk of inflammatory complications, improve the patient's quality of life in the postoperative period.3 dwg
ethod for plasty of defects of acetabulum antero- and posterosuperior edge with structural autobone in hip joint endoprosthesis // 2637105
FIELD: medicine.SUBSTANCE: bone bed is formed in the true acetabulum by milling cutters. The area of "undersupplication" of the endoprosthesis pelvic component in the area of acetabulum defect is estimated. Osteoperforation with spokes is performed on the acetabulum defect surface with its treatment with bone spoons. An autotransplant is made, for this, the femur head is separated, cutting across the femur neck with an electric saw, the femur head is cut across from the neck saw line into two parts, the most proper part is selected, processed with a bone clipper, bringing geometry of this part up to congruence with the acetabulum surface defect, while maintaining the cortical layer. The autotransplant is oriented with its cortical layer outwards, so that a part of the autotransplant hangs into the acetabulum area, and is preliminarily fixed with spokes in the area of the defect. The position of the autotransplant is checked and, if necessary, corrected. The autotransplant is fixed with compression screws. The overhanging part of the autotransplant is treated with spherical mills. The shape of the bone bed is controlled by placing a test cup into it. A cement-free pelvic component is installed. The pelvic component is jammed due to a tight fit with respect to the angles of inclination and antetorsion. Spokes are removed. The femoral component of the endoprosthesis is installed. The head of the femoral component is inserted into the pelvic component.EFFECT: stability of the endoprosthesis pelvic component.2 dwg
ethod for substitution of cartilaginous tissue defects // 2637103
FIELD: medicine.SUBSTANCE: crushed autologous cartilage taken from the cartilage part of the rib mixed with fibrin glue is implanted into the defect area, the proportion of the mixture for defect replacement is 20-40% of the volume of fibrin glue and 60-80% of the volume of cartilage.EFFECT: method allows to provide a high regenerative potential of the implant, to ensure replacement of defects of various sizes.2 dwg, 1 ex
ethod for two-stage hip replacement in congenital hip dislocation // 2636903
FIELD: medicine.SUBSTANCE: during the first surgical intervention, neck osteotomy is performed with removal of the head. The body of the modular stem of the hip endoprosthesis is mounted, hip traction towards the cotyloid cavity to tense the muscles is carried out, and a femoral bone is fixed in the achieved position. Above the iliac wing, an incision of soft tissues is made, a support plate is placed on the iliac crest. A tunnel towards the femoral bonesaw-line is formed in the muscles. A distraction device is installed through the formed tunnel, consisting of a pivotally connected fastening unit having through holes for locking screws and a rectangular protrusion, and a cylindrical body including a rod element with a threaded portion at the free end extending beyond its end surface on the proximal end side under the action of liquid injected into the internal cavity of the cylindrical body through a hydraulic pump connected to it. The threaded portion of the rod element is connected to the support plate mounted on the ilium crest, and the protrusion of the fastening unit is inserted into the groove in the body of the monolithic stem of the endoprosthesis, further fixing the position of the device by means of locking screws installed through the through holes in the femoral bonesaw-line. A flexible tube connecting the cylindrical body with the hydraulic pump is led out through an additional puncture outside the surgical wound. In the postoperative period, the hip reduction is performed discretely in time using the installed device, increasing its length by 1-2 mm per day. When the reduction of the proximal part of the hip reaches the level of the true acetabulum, the second surgical intervention is carried out, during which the distraction device is removed and the acetabular component of the hip endoprosthesis with the head and the neck is installed, assembling the structure.EFFECT: full reduction of the hip dislocation with minimal loss of bone mass and an improvement in the patient's life quality during the period of treatment.1 ex, 1 dwg
ethod of treating acromioclavicular joint dislocation // 2636856
FIELD: medicine.SUBSTANCE: using a drill with a diameter 4.3 mm a channel at the base of the coracoid process is formed between the attachment points of conical and trapezoidal ligaments. Two "block systems" are modelled, each of which includes a non-absorbable, woven, polyester thread with diameter of 1 mm and two support platforms in the form of titanium buttons with four holes in sizes of 4×12 mm each, for that holdout platforms of "block-systems " are bound, carrying out the thread through their central holes in two plies and leaving the thread ends from one side. The holdout platform of each "block-system" is introduced into the previously formed channel. Two through channels are formed with drill with a diameter 4.3 mm in the collarbone at the places of attachment to it of conical and trapezoidal ligaments. Remaining holdout platforms of each "block-system" are passed through the channels formed in collarbone from the bottom up, for that the loop is conducted through the channels in collarbone with the help of Deschamps needle, leaving its ends out of the wound, the loop is tied with thread, previously conducted through the unengaged hole of holdout platform, remaining holdout platforms are egested through the collarbone channels by pulling the ends of the loop thread, conducting one holdout platform in each channel. Holdout platforms pull together among themselves by uneven tension of ends of "block-system" threads, ensuring the removal of dislocation and reduced acromioclavicular joint fixation. The ends of threads are connected by 3 nodes.EFFECT: method helps to achieve both vertical and horizontal stability in acromioclavicular joint, to reduce the risk of relapse.2 dwg
ethod for optical medical navigation system application for visualization and quantitative evaluation of quality of fragments reposition in case of pelvic bone fracture // 2635451
FIELD: medicine.SUBSTANCE: third positioner with passive markers is installed on the movable part of the pelvic bone. On the X-ray computer tomograph, images of the fixed part of the pelvic bone with a reference positioner with passive markers installed thereon and a movable part of the pelvic bone with the third positioner with passive markers installed thereon are recorded. At the workstation of the X-ray computer tomograph, image processing is performed and a 3D segmented image of the fixed part of the pelvic bone with a reference positioner with passive markers installed thereon and of the movable part of the pelvic bone with the third positioner with passive markers installed thereon, as well as of the fracture region is plotted. The processing results are transferred to the optical medical navigation system computer via the computer network and displayed on the screen to the surgeon for planning and subsequent management of surgical instruments during operation. On the display screen, the surgeon indicates the points of compliance in the fracture region on the 3D segmented image of the fixed part of the pelvic bone and the moving part of the pelvic bone, which, when combining the movable part of the pelvic bone and the fixed part of the pelvic bone during surgery, should be maximally approximated. During the operation using the optical medical navigation system, the reference positioner with passive markers and the third positioner with passive markers installed on the patient and visible by the stereo video cameras of the optical medical navigation system are geometrically linked to the segmented 3D images of the reference positioner with passive markers and the third positioner with passive markers and corresponding segmented fixed portion of the pelvic bone and the movable part of the pelvic bone. During surgery, the moving part of the pelvic bone and the fixed part of the pelvic bone are brought together by "manual" actions and set in the position for subsequent fixation with a screw. On the display, a 3D segmented image of the fixed part of the pelvic bone and the movable part of the pelvic bone is displayed in real time with the information on the distances between the correspondence points in the fracture region that must be maximally approximated to ensure the alignment of the fixed part of the pelvic bone and the movable part of the pelvic bone. The second positioner with passive markers is installed on the drill. To direct the needle through the desired areas in the fixed part of the pelvic bone and the movable part of the pelvic bone, the direction of needle drilling is determined by a schematic image of the passive markers of the first positioner with the passive markers located on the guiding needle and the depth of needle drilling according to the schematic drawing of the passive markers of the second positioner with the passive markers with respect to the 3D image of the fixed part of the pelvic bone and the movable part of the pelvic bone displayed of the optical medical navigation system screen. Further the needle is drilled into the fixed part of the pelvic bone and the movable part of the pelvic bone. The guiding needle is removed. A screw fixing the movable part of the pelvic bone to the fixed part of the pelvic bone is installed along the needle. The needle is removed and the wound is sutured.EFFECT: reduced radiation load on the patient, increased functionality of the method.2 cl, 3 dwg
ethod for treatment of severe congenital varus deformity of the femoral bone neck // 2635441
FIELD: medicine.SUBSTANCE: femur is demoted using transosseous distraction device with external fixation. Hip joint arthrodesis is performed. After consolidation is achieved, pelvic osteotomy is performed in the arthrodesis region, and the limb lengthened by means of thetransosseous distraction device with external fixation.EFFECT: method allows to restore the support function, prevent pain, provide cosmetic result.7 dwg
ethod for stabilising spinal column, preventing and treating spinal cord swelling and device for its implementation // 2634641
FIELD: medicine.SUBSTANCE: in the intervertebral space, a microradiator device is installed, made in the form of a spiral, rigidly connected to the ventral plate, which is fixed to adjacent vertebrae so that the spiral contacts the dura mater. The ends of the spiral are connected to cold mains, which are taken out through separate mini-incisions outwards and connected to a pump with a refrigerant tank. The circulation process of refrigerant cooled to 3-5 degrees is carried out in a closed loop. The temperature in the microradiator is monitored by means of a temperature sensor located in the outflow main, after termination of hypothermia, the cold mains are disconnected from the microradiator.EFFECT: provides prevention and treatment of the spinal cord swelling, as well as reliable stabilisation.2 cl, 2 dwg

ethod of approach to hip joint // 2634072
FIELD: medicine.SUBSTANCE: fascia lata is dissected longitudinally, the fascia lata is also dissected by an additional incision at an angle of 45° to the first longitudinal incision so that the intersection point of the longitudinal dissection and dissection at an angle of 45° is by 2 cm more distal than the projection of the greater trochanter apex.EFFECT: method allows to increase the angle of the surgical view, reduce the risk of fracture of the femur proximal end.1 dwg

ethod for calculating correction in rearfoot deformations // 2634043
FIELD: medicine.SUBSTANCE: on the foot X-ray executed in the lateral projection, a point "a" is put corresponding to the posterior edge of the articular surface of the trochlea of talus, and a point "b" corresponding to the anterior edge. A line 1 is drawn through the points "a" and "b" and a point "c" is put on this line anterior to the point "b" at a distance equal to ab×2.6. A line 2 is drawn from point "c" downwards at an angle of 16° to the inteval bc. A distance equal to ab×4.8 is marked on the line 2 from the intersection point of the lines 1 and 2, and a point "d" is put. A line 3 is drawn through the most remote points of the calcaneus crest and a line 4 is drawn from its center, perpendicular to the line 3. The intersection point of the lines 2 and 4 is the vertex of the calcaneus deformation. After the virtual osteotomy is performed, the distal fragment of the calcaneus is moved so that the lines 2 and 4 are coaxial, and the rear boundary of the moved fragment coincides with the "d" point. On the basis of the obtained data, the angle and distance to which the distal fragment of the calcaneus bone must be moved in order to achieve the correct position of the rearfoot are determined.EFFECT: allows to accurately plan the reconstruction of the rearfoot.24 dwg, 1 ex
ethod for surgical treatment of cranial vertebra rupture // 2634028
FIELD: medicine.SUBSTANCE: mini-access to the transverse processes of the cranial vertebra is performed transmmuscularly through the sternocleidomastoid muscle under the mastoid processes on both sides, 2.5-3.5 cm long. Transarticular fixation is performed through the anterior arch of the cranial vertebra into the body of the second cervical vertebra with fixation direction from top to bottom, left and right, at an angle of 24-35° to the horizontal plane and from front to back at an angle of 8-12° to the frontal plane.EFFECT: method provides low invasiveness, reduces blood loss.1 cl
ethod for operational treatment of greater pectoral muscle tendon rupture // 2633942
FIELD: medicine.SUBSTANCE: tendon is stitched with crossed lavsan threads, which are pulled through two transverse canals formed in the humerus head, in the frontal plane and connected on its posterior surface. The greater pectoral muscle tendon is directed through the two channels formed in the humerus head 1 cm below the channels formed earlier, the free ends of the tendon are held in the thickness of the greater pectoral muscle tendon and in the greatest pectoral muscle in the form of a "snake" and fixed as per Pulvertaft.EFFECT: method allows to ncreas the fixation strength.1 cl
ethod for surgical treatment of foot in case of purulent-necrotic damage // 2633628
FIELD: medicine.SUBSTANCE: methodincludes autopsy of the purulent focus and its active drainage, for which the skin, subcutaneous tissue, superficial and intrinsic fascia are dissected and excision of the affected, purulent-fused tissues is performed. Skin incision is made proximal to the medial malleolus 5-7 cm parallel to posterior margin of tibia. The tendon of the posterior tibial muscle, the tendon of the long finger flexor, the neurovascular bundle representing the posterior tibial artery and the tibial nerve, and the tendon of the long flexor of the first toe are found. Then, the tendon involved in the pathological process is cut at the site of its passage into the muscular part. The proximal end of this tendon is released, the drainage is fixed to the distal end. The remaining part of the tendon is pulled out by the distal end in the foot wound, with drainage placed instead. When the tendon of the long finger flexor is removed, the short finger flexor is cut off from it.EFFECT: method prevents the spread of purulent-inflammatory process in the proximal direction along the tendons.2 cl, 1 ex, 5 dwg
ethod for anatomic single-beam plasty of anterior cross-shaped ligament by patellar ligament transplant // 2633277
FIELD: medicine.SUBSTANCE: "bone-tendon-bone" autotransplant is taken from the patient: a bone block from the middle part of the lower pole of the patella and from the tibia at the site of the patella ligament attachment to the tuberosity of the tibia and the patellar ligament between these bones from the middle third of the patellar ligament. Through transverse apertures are made through each bone block of the autotransplant for filaments for autotransplantation. Channels are made in the tibia and femur. The femoral canal is formed from a point defined as follows: the point of intersection of the lateral intercondylar and lateral bifurcation edges is determined, a retreat is made from this point along the bifurcation margin at a half distance to the articular surface of the condyle and 2 mm posterior and further in a plane parallel to the lateral bifurcation margin by the thickness of the patellar ligament between the bone blocks of the bone-tendon-bone autotransplant. Bone blocks of the autotransplant are sequentially placed in the channels in the tibial and femur bones and fixed to the walls of the channels after connecting ligament tension.EFFECT: method increases transplant fixation stability.1 cl
ethod for wound closure following hip joint surgery // 2632536
FIELD: medicine.SUBSTANCE: wide fascia of the femur is dissected first longitudinally, and then transversely downward. The first layer of the allograft of the preserved dura is sutured to the muscles along the external surface of the hip, then the allograft is folded and withdrawn through the incision of the wide fascia of the hip, the wide fascia of the hip is sutured through the allograft, then the allograft is folded and stacked so as to completely cover the hip fascia suture and is hemmed thereto.EFFECT: reliable strengthening of the myofascial layer.4 dwg, 1 ex
ethod of exploring hip replacement // 2632525
FIELD: medicine.SUBSTANCE: according to the volume parameters of the acetabulum defect, a computer model of the spacer is created, one side of which coincides with the relief of the acetabulum bottom and the second is made in the form of a hemisphere. The 3D printer produces a spacer form with a hole in the housing, which consists of two parts. The form is erected intraoperatively. Bone cement with an antibiotic is poured through the hole in the housing. After the cement hardens, the form is divided, obtaining a spacer anatomically identical with the acetabulum defect, it is placted in the acetabulum defect on the bone cement, and an endoprosthesis cup is placted in the hemisphere.EFFECT: method allows to restore the function of the joint, reduce the risk of the inflammatory process recurrence.1 cl

Device and method of blocked external osteosynthesis of condylar fractures of long bones // 2632508
FIELD: medicine.SUBSTANCE: device for blocked external osteosynthesis of condylar fractures of long bones includes a plate, cancellous and cortical screws. The plate is made longitudinally curved in shape of the synthesized condyle and narrowed to the end along the length with the upper edge twice as wide as the lower one, with pointed lateral edges and tooth cutting along the edges for contact with the bone, with holes made top-down first in two transverse rows: in the top row with three, and in the bottom row with two. Between the two holes of the second row there is a hole for Kirschner's wire. The end holes of the first row of the plate are cut at an angle of 10° to the sides, and the average one is perpendicular to the plate, without thread. The two holes of the second row of the plate are cut at an angle of 10° to the sides. One longitudinal row of holes running along the top of the plate, which are cut alternately left-and-right at an angle of 10°, is located along the center of the plate curvature downward with an indent to a certain distance from the transverse ones. On the upper half of the plate thickness, the holes are made cone-shaped with a conical screw thread, and the other half of the plate thickness is smooth with diametre providing a passage, creating a tight contact in the threadless part of the screw. The cortical screw is made with a tapered thread under the cap on the half of the head, coincides with a similar thread of the upper half of the plate thickness. When screwing the screw bears against the edges of the plate hole and protrudes beyond its lower edge, and the length of the screw consists of the following: the screw cap, the thickness of the plate at an angle and 2 mm of deviation from the plate, and the diametre of the bone revealed on the X-ray diffraction pattern. The upper screws are cancellous, and the lower ones are cortical - without threads on their body, which is cut only at the end of the rod by 1/3 of the length. The method of blocking osteosynthesis of metaphysial fractures of long bones consists in repositioning and fixing bone fragments and in using a plate which is placed on the fracture site. The fragments are reduced and the Kirschner's wire is inserted through the hole for the wire. Then, a hole is drilled in a bone through the middle hole of the plate of the upper row and the plate is fixed, and then the screws are inserted into the side holes of the upper row in the plate, then the screws of the second row are inserted, and when confirming the correct position of the fragments, the screws are inserted into the diaphyseal part of the damaged bone, the Kirchner's wire is removed.EFFECT: inventions provide the reliable fixation, minimum contact of the plate and bone surface, eliminating a risk of bed sores and disturbed repair process, simplifying the fixation procedure.2 cl, 7 dwg
ethod of treating patients with lumbar spinal stenos // 2631637
FIELD: medicine.SUBSTANCE: after performing decompression on the ipsilateral side, the area of the housing of the spinous process is identified, through which with the help of a high-speed drill, access to the spongy bone in the contralateral arch of the vertebra is performed. In the course of the arch, a full-length drill is performed without damaging the yellow ligament and the posterior cortical plate of the arch at this stage. After passing the arch, a borer is removed into the cavity of the zygapophysial joint on the contralateral side. Further, the mobilization of the removable arch part and the lower zygapophysial joint is carried out by perforating the upper and lower cortical plates of the arch. Then the mobilized fragment of the cortical plate of the arch and yellow ligament is pressed into the drilled channel, its removal is carried out in parts or in one block. A medial resection of the upper zygapophysial joint is performed using a borer or osteotribe.EFFECT: method reduces the risk of damage of the dural sac.6 dwg

ethod for implant osteointegration with compression load to prosthetic bone, and system for its implementation // 2631631
FIELD: medicine.SUBSTANCE: method for implant osseointegration with a compression load on the prosthetic bone consists in implant installation on which a device is installed to regulate compression, fixed in the orthosis and compressive load is performed on the bone. The system for implant osteointegration with compression load on the prosthetic bone allows to regulate the level of compression and contains a tubular bone implant, a device for compression regulation, orthosis. The tubular bone implant contains a threaded rod with a head made in the form of a hexagon with an internal thread and a groove from the outside. The threaded rod contains a ring lead-in part. The device for compression adjustment is fixed in the orthosis with screws and contains a lower cup fixed to the implant head by a screw, into which a spring is mounted, closed with the upper cup, into which an adjusting screw fixed with a lock nut is installed.EFFECT: improved quality and shortened implant survival time, reliable implant fixation in bone.2 cl, 2 dwg
ethod for surgical treatment of large joint periprosthetic infection using polyvalent fagoderm bacteriophage // 2631109
FIELD: medicine.SUBSTANCE: access is performed to the site of inflammatory complications. Modified necrotic tissue are cut removing abnormal soft tissues, including those from the metal endoprosthesis cavity, exposing the metal endoprosthesis surface. The metal endoprosthesis is separated, and its head and a plastic liner are removed. The wound cavity surface and the exposed surfaces of the disconnected metal endoprosthesis are washed, first, with 3% povidone-iodine solution using a pulse lavage system, then the wound cavity surface the exposed surfaces of the disconnected metal endoprosthesis are washed with 1% lavasept solution using ultrasonic lavage. The new endoprosthesis head and the new plastic liner of suitable size are placed in the metal endoprosthesis and the endoprosthesis integrity is restored. The wound cavity surface and the assembled metal endoprosthesis surface is washed with 1% lavasept solution using ultrasonic lavage. Gel with polyvalent Fagoderm bacteriophages is applied to the wound cavity surface and the assembled metal endoprosthesis surface, uniformly distributing it across the entire wound cavity surface and the assembled metal endoprosthesis surface, provding gel layer thickness of 1 to 3 mm. The wound is closed. Within 3-5 days of postoperative period, wound drainage is performed with 1% solution of Fagoderm bacteriophage upwards through the perforated drains.EFFECT: method allows to save the prosthesis, reduce the risk of re-intervention in the affected joint, restore the functionality of the patient's limb.13 cl
ethod for surgical treatment of large joints periprosthetic infection using polyvalent bacteriophage fagoderm and vacuum drainage of inflammation products // 2631052
FIELD: medicine.SUBSTANCE: modified necrotic tissues are cut removing abnormal soft tissues, including those from the metal endoprosthesis cavity, exposing the metal endoprosthesis surface. The metal endoprosthesis is separated, and its head and a plastic liner are removed. The wound cavity surface and exposed separated metal endoprosthesis surfaces are washed. The new endoprosthesis head and the new plastic liner of suitable size are placed in the metal endoprosthesis and the endoprosthesis integrity is restored. The wound cavity surface and the assembled metal endoprosthesis surfaces are washed. Gel with polyvalent Fagoderm bacteriophages is applied to the wound cavity surface and the assembled metal endoprosthesis surface, uniformly distributing it across the entire wound cavity surface and the assembled metal endoprosthesis surface. A porous sponge made of hydrophilic polyurethane substrate and impregnated with a 1% solution of Fagoderm bacteriophage is placed on the wound cavity surface and the metal endoprothesis surface as a wound filler . The open wound surface of the operated patient is covered with an insulator with self-adhesive edges, the insulator with self-adhesive edges is equipped with a vacuum system. Postoperative vacuum drainage of the bone and soft tissue inflammation products is performed on the wound surface through the pre-laid porous sponge.EFFECT: method allows to save the endoprosthesis, reduce the amount of surgical damage to anatomical structures, reduce the risk of re-surgery.3 cl, 3 ex
ethod for hand finger extensor tendons reconstruction // 2631045
FIELD: medicine.SUBSTANCE: finger is directed to the zero position. A month later, an autologous fat transplant is taken from the subcutaneous fat tissue. The inspiratory fluid is removed. Fan-shaped 2-3 microppassages of adipose tissue are performed with a volume of at least 20.0 ml in the recipient bed of the finger with an interval of 2-3 months between procedures. A diamond shaped transplant is taken from the wide fascia of the femur. Tenolysis, mobilization of lateral bundles and the central bundle of the tendon are performed. The transplant is sutured to the tendon stumps, to the legs of the lateral bundles and to the base of the middle phalanx.EFFECT: method restores the lost volume of soft tissues and the tendon function.1 ex

ethod for intra-articular calcaneus fractures treatment // 2630870
FIELD: medicine.SUBSTANCE: upper group of two longitudinal screws is passed through the upper part of the calcaneal tubercle into the anterior fragments of the calcaneus parallel to the sagittal plane so that the screws pass subchondrally through the articular surface fragments or immediately below the fragments. The lower group of two longitudinal screws is passed through the lower part of the calcaneal tubercle into the anterior fragments of the calcaneus parallel to the sagittal plane, combining the body of the calcaneus and calcaneal tubercle into one fragment. The upper and lower groups of longitudinal screws are located in the body of the calcaneus at an acute angle open to its posterior surface. The transverse screw is directed frontally through the fragments of the articular surface subchondrally with a support to the longitudinal screws of the upper group.EFFECT: method cllows to increase fixation stiffness by creating a secure frame under the articular surface, which secures the fragments.2 cl, 3 dwg
ethod for experimental anatomical and surgical justification of operative access to hip joint in case of acetabular pelvic fracture // 2629628
FIELD: medicine.SUBSTANCE: three main landmarks of the incision are marked with a marker, the first is the point at the level of the anterior superior iliac spine and 2 cm inside it, the second landmark is at the point of intersection of the vertical line extending posteriorly from the top of the large trochanter in the projection of the interstitial crest and the horizontal line extending three to five cm above the large trochanter top and the third landmark is three cm below the base of the large trochanter and in the projection of the anterior margin of the femur. The marker reconstructs the line of the future section at the indicated points. The skin and subcutaneous fat are cut along the planned line. The wound is expanded, accessed.EFFECT: method allows to experimentally justify access, reducing the risk of sciatic nerve neuropathy, peroneal muscles paresis, heterotopic ossification.37 dwg
ethod for surgical correction of spine sagittal disbalance // 2629328
FIELD: medicine.SUBSTANCE: in interbody spaces up to and below the vertebra, determined on the basis of preoperative planning, autoregally filled cages are introduced transforaminally from the rear access. Then, vertebra osteotomy is performed: its arch, processes and legs are removed, angular osteotomy is performed to the anterior quarter of its body and the ends of the formed wedge-shaped defect are brought together. After that, a modeled rod is laid in the previously installed transpedicular screws in the vertebral bodies above and below the osteotomous, final fixation of the achieved imbalance correction is performed.EFFECT: method allows to form a bone block between adjacent vertebrae, to provide reliable fixation, to prevent development of pathology of adjacent vertebral-motor segments.6 dwg
ethod for bone resection // 2629324
FIELD: medicine.SUBSTANCE: guiding spokes are directed through the bone strictly along the border of the pathological focus in the preoperative period. A series of computer tomograms is performed, an individual stereolithographic template with a through slot with jumpers corresponding to the line of bone resection is designed and printed on a 3D printer. The guide spokes are intraoperatively combined with their template slots. A tool is screwed into the template, having a sharp spike at one end for fixation in the bone, and a T-shaped handle at the other to hold the template. The template is pressed against the bone and an oscillating saw or cutter is used to resect the bone segment along the through slot of the template, gradually destroying its jumpers. The resected bone segment is removed, pulling the T-shaped tool handle. Without removing the template, the necessary treatment of the bone cavity is performed. The template and guide spokes are dismounted.EFFECT: method allows to increase the accuracy of resection, taking into account individual topographic and anatomical features.1 dwg

Skin grafting method // 2629063
FIELD: medicine.SUBSTANCE: skin-fat radial septal flap is formed and the donor's wound is closed with a primary suture. At that, the second skin-fat septal flap is formed in the radial artery projection, located at a distance of at least 1 cm from the previously cut one. At that, the area of the formed flaps shall be equal to the area of the defect to be replaced. The peripheral vascular pedicle is folded twice in the frontal plane, so that the skin surfaces are located on one side, and the area of pedicle inflection is between the flaps. A single flap of the necessary configuration is formed. The resulting single flap is moved on the peripheral vascular pedicle into the tissue defect and the donor wound is sutured after mobilization of its edges.EFFECT: reduced donor defect, increased useful part of the flap and shortened treatment period.2 dwg, 1 ex
ethod for surgical treatment of valgus deformation of first metatarsophalangeal joint // 2629038
FIELD: medicine.SUBSTANCE: tenolysis of the tendon muscle of the first toe muscle is carried out through projection access, only from the distal end of the metatarsal bone, in the region of the first metatarsal-phalanx with excision of the altered part of the bursa, to the proximal end of the main phalanx. After tenolysis, tendon tenoraphy is performed from the distal end of the metatarsal bone to the proximal end of the main phalanx, fixing it to the main phalanx, to capsule 1 of the metatarsophalangeal joint, to the diaphysis of the metacarpal bone. At each stage of fixation, the needle and thread are injected from the inside of the tendon, directed through its thickness, removed to its outer side, then brought from the outside of the tendon through its thickness to the inside, after which it is directed through the periosteum. The knots are tied between the bone and the tendon.EFFECT: method prevents disease relapse within three years.1 ex, 1 dwg
ethod for heterotopic ossification surgical treatment with local neural simulation of spastic syndrome // 2628370
FIELD: medicine.SUBSTANCE: for surgical treatment of heterotopic ossification with local neural simulation of the patient spastic syndrome, preliminary multilayer spiral computerized tomography (CT) is used to ptovide spatial imaging of bone structures and ossificates. The method of magnetic resonance imaging reveals the ossificate soft tissue component which is not visualized by MSCT. Then the heterotopic ossificate maturity stage is determine by calcium-phosphorus metabolism indices - alkaline phosphatase, osteocalcin, and bone matrix formation marker PINP - N-terminal pro-peptide of type 1 procollagen in patient's venous blood. If the measured parameters of N-terminal propeptide of type 1 procollagen - PINP are less than 76 ng/ml, even in case of an isolated lesion of one elbow or knee joint, alkaline phosphatase level is in the range 40-150 U/l and osteocalcin level is within 11-46 ng/mL, completion of osteoid formation and mineralization with formation and maturation of newly formed cancellous bone is concluded. In this case, surgical ossificates removal from the affected joint is prescribed. At that, local neural simulation of spastic syndrom is performed prior to surgical removal of ossificates, until it a stable decrease to the level of 0 to 1 on Ashworth scale is reached. Next, surgical treatment is performed involving ossificate resection or removal of an adequate volume of heterogeneous bone to restore the functionally adequate range of motion in the affected joint.EFFECT: possibility of surgical treatment of heterotopic ossification in patients with spastic syndrome, minimizing the risk of complications during surgical treatment, and pathological process recurrence.3 cl, 5 ex
ethod for low invasive surgical stimulation of reparative osteogenesis of slowly consolidated distraction regenerates in combination with false connection of limbs long bones of limbs in case of soft scar tissues // 2628368
FIELD: medicine.SUBSTANCE: under the control of electron-optical transducer, a guiding drill rod is introduced through the slow-consolidating distraction regenerate area and the false joint area, through which a cutting tool in the form of a cannulated flexible shaft with a drill is then introduced, and a hole of a specified diameter is formed in the medullary canal of the long tubular bone using a replaceable cutting tools set with drills of increasing diameter. A nanostructured composite implant is inserted into the formed internal cavities through a hole of a predetermined diameter formed in the medullary canal of the long tubular bone in slowly consolidating distraction regenerate and the false joint area.EFFECT: method allows to reduce the time of distraction regenerate reconstruction into a full bone.2 cl
ethod for hyaline cartilage production // 2627817
FIELD: medicine.SUBSTANCE: hyaline cartilage from the articular surfaces of the phalanx of additional fingers or toes of healthy children, removed intraoperatively in case of polydactyly. Some fragments of hyaline cartilage are used to carry out control studies, and the other part is used to obtain cell cultures.EFFECT: method provides high regenerative potential of the hyaline cartilage.1 cl
ethod for achilles tendon plasty // 2627293
FIELD: medicine.SUBSTANCE: in the thickness of the proximal and distal ends of a ruptured Achilles tendon, sagittal incisions are made into which a fine-celled lavsan band is laid, which is sutured to the sides of the convergent ends of the ruptured tendon side to side, and the preserved parathyon and ruptured tendon filaments are stitched with thin lavsan threads.EFFECT: method allows to create favorable conditions for tendon regeneration, reduce the risk of relapse.1 cl
ethod for correction of combined flexion contracture of three-phalangeal fingers and adduction contracture of first finger in case of spastic paralysis // 2627291
FIELD: medicine.SUBSTANCE: tendons of the superficial finger flexor is cut off at the level of the main phalanges, and the tendons of the deep finger flexor - 1 cm proximally to the wrist canal origin, followed by movement of the distal ends of the deep flexor tendons to the proximal ends of the superficial flexor tendons with elongation. The proximal ends of the tendons of this deep finger flexor are transposed, suturig them to the structures of the first ray of the hand, and the distal ends of the tendon of the superficial finger flexor are used to form the tenodes of proximal interphalangeal joints of II-V fingers.EFFECT: method allows to provide active removal and opposition of the first finger, prevent hyperextension in the proximal interphalangeal joints.4 cl, 7 dwg
ethod for correction of combined flexion contracture of three-phalangeal fingers and forearm pronation contracture // 2627290
FIELD: medicine.SUBSTANCE: tendons of the superficial and deep finger flexors are intersected, followed by the movement of distal ends of the tendons of the deep finger flexor to the proximal ends of the tendons of the superficial flexor with elongation. Tendons of the superficial finger flexor are cut off at the level of main phalanges, and the tendons of the deep finger flexor - 1 cm proximally to the wrist canal origin. The proximal ends of the tendons of the deep finger flexor are transposed in the subcutaneous tunnel through the ulnar side to the rear forearm and fixed to the distal metaepiphysis of the radius at the place where the brachial muscle tendon is attached, to obtain active supination, and the distal endsof the superficial flexor tendon are used to form the tenodes of proximal interphalangeal joints of II-V fingers.EFFECT: method allows to strengthen active supination, prevent hyperextension in proximal interphalangeal joints.10 dwg

Adjustable devices for knee arthritis treatment // 2626961
FIELD: medicine.SUBSTANCE: system for tibia angle changing for patient having knee osteoarthritis comprises an adjustable non-invasive implant and a drive member. The adjustable non-invasive implant comprises an adjustable actuator configured to fit inside the tibia longitudinal cavity and having an outer housing and an inner rod telescopically arranged in the outer housing. The outer housing is connectable to the first part of the tibia, and the inner rod is configured to be connected to the second part of the tibia. The second part of the tibia is at least partially separated from the first part of the tibia by means of osteotomy. The drive element comprises a permanent magnet and is adapted to remote actuation, in order to telescopically displace the inner rod relative to the outer housing. The system for bone angle changing includes an adjustable non-invasive implant and a drive member. The adjustable non-invasive implant comprises an adjustable actuator having an outer housing and an inner rod telescopically arranged in the outer housing. The outer housing is connected to the first anchor hole, and the inner rod is connected to the second anchor hole. The first anchor hole is configured to pass the first anchor to connect the adjustable actuator to the first part of the bone. The second anchor hole is configured to pass the second anchor to connect the adjustable actuator with the second part of the bone. The second part of the bone is at least partially separated from the first part of the bone by means of osteotomy. The drive element is adapted to remote actuation, in order to telescopically displace the inner rod relative to the outer housing. The adjustable non-invasive implant is adapted to be indefinite in angle relatively to at least one of the first or the second part of the bone when connected to both the first part and the second part of the bone.EFFECT: prevention of adjustment angle loss.20 cl, 69 dwg
ethod for acceleration of tubular bones distraction regenerate formation // 2626250
FIELD: medicine.SUBSTANCE: immediately after receipt of the required segment length, the bone is extended by another 4 mm. A carbon nanostructure cylindrical implant with ends having the form of truncated cone is placed into the bone regenerate, diameter of the implant is 30% of the bone diameter, and its length exceeds the required value of elongation by 4 mm. After implant insertion the bone fragments are brought together to the required value of elongation so that the ends of the implant were introduced into the medullary channels of proximal and distal bone fragments (2 mm for each piece). Fixing is performed using the device to form a strong supporting ability of the bone-carbon unit.EFFECT: method can shorten the life of hardware fixation, duration of treatment.2 cl, 10 dwg

ethod of treatment of front shoulder dislocation in patients with erbe's paresis // 2626197
FIELD: medicine.SUBSTANCE: moving the tendon of the long head of the biceps arm muscle to the inside and sew it into the fold of the capsule of the shoulder joint. Z-shaped lengthen the tendon of the subscapular muscle. Move a large round muscle on the vascular-neural bundle through the subcutaneous canal, formed in the armpit, onto the anterior surface of the shoulder joint and fix it to the beak-like process of the scapula and anterior portion of the deltoid muscle.EFFECT: method reduces the risk of relapse of the dislocation.11 dwg
 
2551274.
Up!