A method of surgical correction of growth of the lower jaw, the device for the surgical correction of growth of the lower jaw
The invention relates to medicine, namely to dental surgery, and may be applicable for surgical correction of growth of the lower jaw. Create a bone defect in the form of niches in the section between the cutting branches and the angle of the mandible. Carry out mechanical adjustable impact on the direction and magnitude of compression through the device from a super-elastic Nickel-titanium that is placed and fixed in the newly created bone defect. The device comprises fixing elements and the active drive. The locking elements are in the form of two parallel and opposed spaced pads of porous titanium nickelide, United active drive. Active actuator is made in the form of at least one spiral spring tension or camshaft steps of necesitaremos wire with the effect of sverkhelastichnosti. The invention allows to reduce the trauma and the risk of complications, to reduce the complexity of treatment. 2 S. and 2 C.p. f-crystals, 1 tab., 5 Il. The invention relates to medical technology, and specifically to means reparative dental surgery.The development and growth of tissue, updating, reparative regeneration after the surface is angosta). The balance of these processes, resulting in a specific shape and transverse dimensions of the bone, genetically regulated through hormonal information, as well as the external factor impact (functional load). Growth in length is due to the proliferation of chondrocytes cells cartilage epiphyseal bone ends.Violation of these factors is the cause of the abnormalities of bone formation and, as a consequence, various pathologies in the body. Disproportion of growth of the bones of the upper and lower jaws leads to abnormal dentition dentition: distal (abnormal forward position of the upper jaw) and anterior (forward extended lower jaw). This, in turn, causes a partial dysfunction of the masticatory apparatus and the lameness of the whole digestive process, as well as articulation and cosmetic defects, what is the cause of emotional suffering.Thus, the specified bone pathology plays a prominent role in the physical and mental health of the organism, and its treatment is a separate, long-standing and complex task of medicine. The most simple, from the standpoint of prior art known, is a method of correction of the jaws by direct kirurgiateenused an autograft, or a local displacement of the bone fragment. Such operations of vysokoaromatichnyj and involve greater risk of insolvency. In the case of correction of the asymmetric distortions during operations is not always possible to correctly choose the distance that must be displaced bone fragment. There is a necessity of subsequent corrective operations, i.e., additional trauma patient.Known more gentle way of correction of jaws at the distal occlusion  , using the functionally active orthodontic appliances. With their help lower jaw forward forward, stimulating growth of the articular head. Acceleration of osteogenesis stimulate the overlay lip peloton and buccal shields for stretching the muscles of the lower lip and chin and enhance blood flow to apollinea basis of the dentition.The method has several drawbacks: it is preferable only at a young age, uses bulky and complicated apparatus that creates for the patient long-term discomfort, require additional corrective actions with the upper jaw using extraoral facial arc.The possibility of effective correction of the size of the bones appeared in the 50-ies of the last century in connection with otkryli dosed by mechanical impact (compression-distraction) on correctable bone in the area of artificially created bone defect. For the first time this method was used in orthopedic surgery  (method, I. Ilizarov). Subsequently, the method has been applied in oral and maxillofacial surgery . As a technical tool was developed compression-distraction apparatus  - similar to the proposed device. It contains the locking elements in the form of pins fixed in fragments of bone after osteotomy, and the active element - hard spring or screw drive. The method comprises 4 main phases of operation: 1. Osteotomy - mechanical injury, such as cutting the bone. Trauma is the trigger for bone tissue regeneration: allocated collagenase proteins that regulate the repair processes.2. The compression ratio. Convergence and compression of the bone fragments. Formed well vascularization granulation tissue. Under the influence of regulator proteins produced primary bone spur.3. Traction (distraction). Permanent injury bone spur causes release of Nikolayevich proteins and the formation of callus. Dosing traction and rigid fixing of a given reposition of bone fragments is compression-distraction (destructive) apparatus.Osili standards.The method allows to avoid bone grafting, less traumatic and dangerous for the patient, has limits elongation of the lower jaw to 2.5, see the disadvantages of the method include increased risk of complications, the difficulty of choosing speed traction when a mismatch physiological process osteopathy may be premature consolidation of the bone fragments (too slow stretching), or the formation of a false joint (excessively rapid stretching). The need for long-term daily and multiple activation compression-distraction device makes the method time-consuming and inconvenient for the physician and for the patient.This method, as the closest to the technical essence similar, selected as a prototype proposals - way.The device for implementing this method - compression-distraction apparatus comprises a fixing elements spokes with a screw threaded for strengthening bone fragments, mounting straps, couplings and nuts and active actuator screw or spring type. Intraoral variant of this device  is selected as a prototype proposals device. Structural complexity, bulkiness, the discomfort of Debreceni - reduction of trauma, the risk of complications. This technical result is achieved in that in the method of surgical correction of growth of the mandible, including the creation of bone defect and mechanical effects on bone in the area created bone defect, bone defect created in the form of niches in the section between the cutting branches and the angle of the mandible, the mechanical effect of exercise adjustable in the direction and magnitude of compression through the device from a super-elastic Nickel-titanium that is placed and fixed in the newly created bone defect.This technical result is also achieved by the fact that the device for the surgical correction of growth of the mandible that contains the locking elements and the active actuator, the locking elements are in the form of two parallel and opposed spaced pads of porous titanium nickelide, United active drive, made in the form of at least one spiral spring tension or camshaft steps of necesitaremos wire with the effect of sverkhelastichnosti.The preferred choice of the convex shape of the contact surface of the clamping elements. The preferred choice of material anticapitalista reachability technical result are the findings of the authors of the proposal research biomechanical regulation of osteogenesis in relation to the bones of the jaw apparatus, in particular to the lower jaw.The objective of the pilot study were searching areas on the lower jaw, the most sensitive to mechanical impact, the determination of methods of exposure for variable adjustment of the size and shape of the growing bone. The object of the study were dogs at the age of two months. As the technical means used in devices of necesitaremos wire effects sverkhelastichnosti and, for ease of installation, the shape memory effect. Registration of results was performed on the basis of comparison used and unused half of the jaw. For the study of medico-biological properties and role of the device material is Nickel-titanium, used a control group of animals (five animals, which ceteris paribus implanted the specified device with the variation of the shape of the contact surface of the clamping elements.Experimental technique: under General anaesthesia expose the bone in the area of the branches of the lower jaw and with the help of fissure boron circular cut in the anteroposterior direction of the cortical layer in the form of niche - form bed to install the device. In the experiment used two groups of the abdomen are connected by a segment of a spiral spring 2 camshaft actions and tensioning steps (Fig.2), where the active drive are two cylindrical helical spring 2, located outside of the device. In the second embodiment, the bone bed is made in the form of two adjacently located niches with preservation of the site of bone between them. Each niche is proportional to the contact area of the device. The bone bed (niches) play the role of artificially created bone defect.Cooled to 0oWith the active state drives (spring) devices shrink in the first embodiment and stretch in the second and installing the device in a prepared bed, where they carried out after heating, respectively compression adjacent to the bone defect sites or bone located between them. The wound is sutured. After three months the animals are removed from the experiment and the usual procedure performed morphological analysis taken out of the jaws by light microscopy.The experimental results presented in the table in the form of changes in the size of individual plots jaw, testify to the active influence of the implanted device on the growth of bone tissue and the formation of bone geometry, as well as the possibility of targeted regulation of these processes postraumatic, corresponding to the compact size of the device, as well as the possibility of endoscopic technology operations determine the technical result in reducing trauma.The biocompatibility of the material used devices, gentle and adequate impact on bone tissue reduces the risk of postoperative complications.The shape of the bone defect in the form of niche is defined by the outline of the implantable device. The location of the bone defect in the section between the cutting branches and the angle of the mandible due to the greater influence of the device on osteogenesis. Mechanical action through the device of titanium nickelide more other technical means corresponds to the physiology of bone tissue as biomechanical factor, and dynamic stability.The significance of the distinctive features of the invention device due to the following reasons: - the structure of the device, (having two opposed spaced locking elements) - implementation of compression in a given direction of the impact, - the material of the clamping elements (porous, nickelide titanium) - biocompatibility, best known osteointegration properties; - the active form is, small is for this reason that traumatic intervention; - the effect of sverkhelastichnosti active material actuator - dynamic stability compression, reducing the risk of postoperative complications.Additional technical result - the ease of installation of the device is created preliminary forming of the active element using the shape memory effect material.The convex shape of the outer surfaces of the clamping elements (pads in the proposal) allows to vary the magnitude and spatial distribution of compression.Novelty and inventive technical solutions proved their reveal of research, the results of which the specified set of features not previously been published, and in the world prior art is not found.Industrial applicability is determined by the willingness currently both objects to use in clinical practice.The illustrations presented in Fig. 1. Device for the surgical correction of the mandible in compression for external defect sites. 1 - fixing elements, 2 - active actuator.Fig. 2. Device for the surgical correction of the mandible in compression nutrident the second jaw experimental animals after correction of the compression mechanism external sites.Fig. 4. Pictures experienced 1) control and 2) the lower jaw of experimental animals after correction of the compression mechanism of the inner section.Fig. 5. Photograph of the bite of the animal after conducting asymmetric correction.Table. The morphological results of the experiment. The relative sizing of the area of the lower jaw after the correction of its growth offered by the device. The sign " - "containment," + " - increase growth.Achievable technical result was confirmed by experimental validation of the proposed method and device for animals (not purebred dogs) conducted research Institute in Novosibirsk).In the experiment used the device for the correction of growth of the lower jaw in variant I (Fig.1) and option II (Fig.2).Option I. the Device comprises two clamping element 1 flat, elliptical in plan form with a size 10x7 mm along the axes of the ellipse and a thickness of 0.5 mm of porous permeable Nickel-titanium brand TN-1P. Active drive - compression spring 2, systems in accordance with locking elements, forms, has a total of 3 wire coils, of which the two extreme seamed in the peripheral areas of the clamping elements. the real springs of nickelide titanium T-10 effects of shape memory and sverkhelastichnosti. The wire diameter of 0.2 mmThe device in accordance with the proposed method works as follows.The experimental dogs - two-month puppy under General anesthesia an incision on the edge of the lower left jaw area close to the middle between the cutting branches and angle, push the chewing muscles and expose the bone. The cortical layer of bone cut from all sides in the anteroposterior direction and deepen the incision in the spongy layer in the form of niches with rectangular geometry and dimensions corresponding to the device (Fig.1) to the compressed spring active drive. The device in chilled chloroethyl state is compressed prior to the closing of the coils of the spring, immediately and freely immersed in the newly created niche oriented relative axis device contravene the length of the bone. The wound cover and sutured in layers. Next, the operation of the device is targeted. Spring active drive when utorevenue to the body temperature of the animal seeks to restore the original "stretched" size and through the contact surfaces of the clamping elements 2 produces pressure (compression) on the areas of spongy bone tissue adjacent to the bone defect.The adjustable period of growth the lower the enta evaluated relative to the right half of the lower jaw, not exposed to, and made the following values: Acceleration of growth of branches for 75% of the height of the alveolar ridge is 19.7%, the height of the coronal ridge of 13.2%. The slowdown in the growth of body length - 17.3%, length of the articular head is 9.6%, the thickness of the alveolar ridge to 3.7%.Option II. Device unlike I contains as the active drive cylindrical spiral springs 2 strain (Fig.2). Spring diameter 4 mmThe device in action exposes the compression section of the trabecular bone of the lower jaw located between the locking elements. For this bone defect that serves as a bed for implantable devices are in the form docfragment niches, each with dimensions corresponding individual element. Spring 2 active actuator operable stretched. After implantation and warming efforts elastic deformation effect on the convergence of the locking elements, i.e., subjected to compression area of bone within the device. Orientation last the same as option I, i.e., the conditional axis of the device contravene bones.The results of the experiment.Acceleration of growth of branches to 50%, of the height of the coronal ridge at 7.1%, the thickness of the alveolar ridge of 2.6%. The slower growth in length is the beautiful animals 5 animals each. The results indicate the functioning of the claimed objects, i.e., the possibility of correction of the growth of the lower jaw and correction of malocclusion (Fig. 3, 4, 5) and the reachability of the technical result of the proposed invention. According to the criteria of clinical practice the method and the device are sufficiently developed for wide application in medicine.Sources of information 1. Vernadsky Y. I. Traumatology and reconstructive surgery of the maxillofacial region. Kiev, 1985, S. 331-370.2. Khoroshilkina F. J. , Frankel, R. , Denner L. M. and other Diagnostics and functional treatment subcluster-facial anomalies. M.: Medicine, 1987, S. 181-257.3. Ilizarov, A., Helimski, M., Barabash, A. P. Morphological picture of reparative regeneration of bone tissue. Proceedings of the Kurgan NICOT. Chelyabinsk, 1976, vol.2, S. 36-42.4. The koganovich S. I. Compression osteosynthesis in the treatment of injuries of the lower jaw. Reporting scientific conference Stavropol medical Institute. Stavropol, 1967, S. 284-285.5. Bezrukov C. M., Robustula So, the Manual of surgical dentistry and maxillofacial surgery, so 2. M.: Medicine, 2000, S. 307-315.
Claims1. The way surgical correot was established in the region of the bone defect, characterized in that the bone defect created in the form of niches in the section between the cutting branches and the angle of the mandible, the mechanical effect of exercise adjustable in the direction and magnitude of compression through the device from a super-elastic Nickel-titanium that is placed and fixed in the newly created bone defect.2. Device for the surgical correction of growth of the mandible that contains the locking elements and the active actuator, characterized in that the securing elements are in the form of two parallel and opposed spaced pads of porous titanium nickelide, United active drive, made in the form of at least one spiral spring tension or camshaft steps of necesitaremos wire with the effect of sverkhelastichnosti.3. The device according to p. 2, characterized in that the contact surface of the clamping elements are made convex.4. The device according to PP.2 and 3, characterized in that the active material actuator is selected from a shape memory effect.
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.
EFFECT: higher efficiency of therapy.
5 dwg, 1 ex