The method of osteosynthesis of bones tibia in domestic animals
The invention relates to medicine, namely to veterinary medicine, and can be used for osteosynthesis of bones tibia in cats and small dogs. Through each of the fragments are at least one pair of spokes, the intersection of which is placed in the bone. Have one pair of spokes at the level of the tibial tuberosity. Hold one of the spokes of the pair meditrinalia point vcol through the head of the fibula, approaching the cranial edge. Spend a second needle in medicardium direction at an angle to the first pin 80 to 90°. Holding a second pair of spokes on the minimum distance of 0.5 cm from the ankles. Hold one of the spokes of the pair in meditrinalia direction. Spend a second needle in medicardium. The angle of intersection of the spokes of the second pair is 70 to 90°. Fix the ends of the spokes in the supports external device. The method allows to eliminate the damaged joint capsules, nerves and blood vessels, to ensure stable fixation to preserve the function of the adjacent joints. 1 C.p. f-crystals, 6 ill.
The invention relates to the field of veterinary medicine, in particular intended for the treatment of injuries of Pets, in particular for the treatment of bone injuries holocaustic fragments.
Known splinting with external fixation device, transmitting acting on bone strength at the proximal to distal main fragment, and splinting using shims mnogopredmetnaja fracture, the fragments which are too small for osteosynthesis screws. The plate acting on bone forces are transmitted from the distal to the proximal fragment, bypassing the fracture (, Hans Nymand, Peter F. Suter. Disease of dogs. A practical guide for veterinarians. 8 ed. / Lane. with it. - M.: “Aquarium”, 1998 - 816 S.).
However, splinting rarely possible to achieve accurate reposition of bone fragments.
Known design support apparatus for transosseous osteosynthesis performed arcuate shape and a variable width, the size of the support is within 240-270° circle (Certificate 3539, Russia. Publ. 16.02.1997. Bull. No. 2).
However, the diameter of the known support is fairly large size and weight, which limits its use in the treatment of injuries of the bones tibia in small animals (cats and dogs of small breeds).
Known apparatus for the treatment of injuries and diseases of the femur of animals containing the proximal arcuate, middle and distal zamknutyi in the form of crossed spokes and rods, as well as fasteners. Spokes, mounted on the secondary support, have a smaller angle of intersection than at the distal and rod clamps are installed on opposite sides of the plane of the arcuate support from the intersection of two mutually perpendicular planes. The contour of the middle and distal supports homotheticity similar to the contour of the cross section of the hips of the animal at the level of the intertrochanteric region, and the proximal arcuate bearing congruent middle and distal minus a cut, homothetic inner part of the loop (Certificate 14122, Russia. Publ. 10.07.2000. Bull. No. 19).
However, the known apparatus is intended for the treatment of injuries and diseases of the hip bone.
The known method of osteosynthesis of diaphyseal fractures of the tibia, in which the spokes spend eccentric anteriorly with respect to the center of the transverse size of the bone in the frontal plane, and the threaded rods hold parietal and parallel to the outer cortical plate of the tibia at an angle, open to joint (Patent 2062611, Russia. Publ. 27.06.1996).
However, the known method is used in clinical medicine and does not take into account the anatomical shank small animals.
Known sosabravo bone three spokes in the transverse direction after the introduction 2-3 spokes through the upper part of the fibula to the tibia with fracture of fibula in the upper third, or after inside bone osteosynthesis fibula fractures of both bones at the same level or enter through the top of the fibula fragments at the bottom of the fragments of the tibia in the transverse direction 3 spokes at fracture of the fibula below the level of the tibia, using needles with a diameter up to 2 mm (Patent 2028107, Russia. Publ. 02.09.1995).
However, the known method does not take into account the anatomical shank small animals and is intended for use in clinical medicine.
Known apparatus for the treatment of fractures using ring external fixation, which consists of four rings and imposed by the closed method (Vet. Clin. North Am. Small Anim. Pract. - 1999. - Vol.29, No. 5, p. 1153-1169).
However, the known apparatus does not allow to achieve stable fixation of comminuted fractures of the small breeds of domestic animals due to the location of the intersection of the spokes out of the bone tissue and the lack of a second support made in the form of 3/4 ring, in addition, restricts the function of the hock due to the lack of the lower support in the form of an arc.
The present invention is to develop a method of transosseous osteosynthesis and mediapart for its implementation, providing a closed rap to the anatomical features of the segment.
The problem is solved in that in the method of osteosynthesis of bones tibia in cats and small dogs, including the fixation of tibia spokes and fastening their ends in bearings external device, through each of the fragments are at least one pair of spokes, the intersection with dice, with one pair of spokes feature at the level of the tibial tuberosity, and one of the spokes of the pair spend meditrinalia point vcol through the head of the fibula, approaching her cranial edge, a second pin carried out in medicardium direction at an angle to the first pin 80 to 90°, the second pair of spokes spend at least 0.5 cm from the ankles, with one of the spokes of this pair is carried out in meditrinalia direction, and the second in medicardium, the angle of intersection of the spokes of the second pair is 70 to 90° to perform the method uses mediapart containing ring and arc supports are interconnected for movement and provided with uniformly spaced holes, in which the supports are connected in pairs with each other, in blocks, where one block is made from arc supports, and the second from the ring and arc supports, in addition, the blocks are connected with the possibility of prodelin the Oka - on the opposite side of divorce arcs of the first block, in addition, the arc of the second unit is located outside.
It is advisable to increase the rigidity to pass through each of the fragments on an extra pair of spokes, with each additional pair to hold at a distance of not more than 1 cm from the line of fracture, in addition, point vcol one of the spokes of an additional pair of proximal fragment should choose an area above the caudal edge of the lateral surface of the tibia, and the second needle of the pair perform at an angle 55-65° with respect to the second pin of the pair and the extra spokes on the distal fragment should be conducted with crossed bones inside 60-85°.
In the embodiment of mediapart to reduce weight expediently supports made of aluminum, with a minimum inner diameter of the supports must be not less than 49,7 mm, a hole diameter not less than 5 mm, the axis of the holes should be placed in relation to each other at an angle of 15°, and divorce each arc is equal to 120°.
Patenting an invention to explain a detailed description of the exemplary embodiment of the method of surgical treatment, by using mediapart for its implementation, radiographs and diagrams shall be placed spokes at different levels: A) the first pair; C) an extra pair on the proximal fragment; (C) an additional pair at the distal fragment; (D) a second pair;
Fig.3 - copy radiographs before treatment of the animal according to the invention;
Fig.4 - copy radiographs during treatment;
Fig.5 - copy radiographs after treatment;
Fig.6 - the nature of the beast in the treatment process.
Mediapart for the treatment of diaphyseal fractures of the tibia in animals comprises a support 1 (Fig.1) made in the form of 3/4 ring, which made the holes. Bearing 2 is made in the form of a ring, has openings and is connected to the support 1 by the rods 3, 3A and 4. On the supports 1 and 2 indirectly fixed to the ends of the fixation elements, made in the form of spokes, respectively 5, 6 and 7, 8. Support 9 made in the form of 3/4 ring, associated with the possibility of longitudinal displacement of the support 2 by items 10, 11, 12, made in the form of threaded rods. Items 10, 11, 12, made in the form of threaded rods are connected with the supports 2 and 9 by means of pairs of nuts respectively 13 and 14, 15 and 16, 17 and 18, 19 and 20, 21 and 22, 23 and 24.
Bearing 25 is made in the form of 3/4 ring and secured to the support 9 by means of rods 26, 26 and 27. Supports 9 and 25 have openings. A pair of fixation elements 28, 29 and 30, 31, made in the form of spokes, which zakreplyaya and link before surgery. The size of the supports depends on the amount of the tibia in the upper third of the small pet breeds considering the fact that the inner edge of the supports 1, 2, 9, 25 should retreat from the skin surface is not less than 1.5-2 cm
Supports 1, 2 and 9, 25, connect the short threaded rods, respectively, 3, 3A, 4 and 26, 26a, 27, forming two blocks. The latter are connected with threaded rods 10, 11, 12. The length of the rods in each case the individual that depends on the length of fragments and directly the tibia.
Supports 9, 25 completed the arc and form a bearing block by means of threaded rods 26, 26a and 27, which is designed for installation on the proximal fragment. Divorce arc supports 9 and 25 must be oriented Caudalie. Bearing 1 is made arc. It is connected with the annular support 2 threaded rods 3, 3A, 4, forming a second support unit. It is designed to overlay the distal fragments. When this divorce support 1 must be oriented cranially.
In terms of operating the animal under General barbituric narcosis after processing operating margins of 5% alcoholic solution of iodine through the proximal and distal fragments conduct intersecting spokes perpendicular to their axes, respectively 30 and 31, 28, and 29, 7 and 8, 5 and 6 (the medial. The needle 30 is carried out in meditrinalia direction across the head of the fibula or slightly distal to it that prevents damage to the common peroneal nerve, which runs along the lateral surface of the tibia adjacent to the caudal edge of the head of fibula. Vicol spokes 30 exercise in the middle of the medial surface of the proximal segment of the tibia. The pin 31 is carried out in medicardium direction with an angle of intersection inside the bones 80-90° (Fig. 2A) with respect to the needle 30. Point vcol spokes 31 is the middle of the lateral surface of the proximal segment of the tibia. Vicol spokes 31 passes in the region of the caudal edge of the medial surface of the tibia. The ends of the spokes 30 and 31 are fixed on the arc of the support 25.
Through distal fragments conduct vzaimoperekrehivayutsya in the bones of the spokes 5 and 6 at a distance of at least 0.5 cm from the ankles. They are fixed on the arc of the support 1. The needle 5 is carried out in meditrinalia direction, and the needle 6 in medicardium. The angle of intersection inside the bones of 70 to 90° (Fig. 2d).
When there is a displacement of the fragments along the length of the implement to the desired magnitude of the distraction, for the promotion of nuts 13, 15, 17, 20, 22, 24 and zakroczym AMCOW determined by x-ray.
After eliminating bias through the proximal fragments conduct spokes 28 and 29 mainly at the level of the crest of the tibia or distal to it, which depends on the size of the proximal fragment. The pin 28 is carried out in meditrinalia direction, the pin 29 is in medicardium. When conducting spokes 28 take into account the topography of the anterior tibial artery. Last after the release of the interosseous space passes through the caudal edge of the lateral surface of the tibia, and just distal to its crest (up to 2 cm, depending on the length of the segment) moves to the cranial surface. Such conduct can prevent damage to the anterior tibial artery. The angle of intersection of the spokes 28 and 29 inside the bone - 55-65° (Fig. 2B). The spokes 28 and 29 are fixed on the arc of the support 9.
The spokes 30, 31, 28, 29 on its way inevitably go with the lateral surface partially through the front of the tibia, the long peroneal muscles and the long extensor of the toes, with the medial - in the area of the insertion polyoxazolines muscles.
Through distal fragments conduct intersecting spokes 7 and 8 with an angle of intersection inside the bones 60-85° (Fig. 2C). The ends of the spokes 7 and 8 are fixed on the support ring 2.
When Prov is it tibial artery and vein, deep peroneal nerve, tendon of the anterior tibial muscle and the long extensor of the toes; caudal - tibial nerve and the Achilles tendon; with lateral superficial peroneal nerve and saphenous vein of the lower leg small, reaching accompanied by the homonymous artery and nerve.
The apparatus is removed in the presence of clinical and radiological signs of Union. The main indicators for the removal of the device are the results of a clinical sample. The last is as follows: remove the threaded rods 10, 11, 12, connecting blocks mediapart. Bone make careful flexion and rotational loads. The criterion for removal of the device is the absence of pathological mobility and pain in the region of the fracture.
An example of performing the method and use of mediapart
Case history No. 454. Animal - cat "Mumps", age 1.5 years, weight 2,7 kg Brief history: 10.08.02 animal returned from a walk, then stopped to lean on the left pelvic limb. Visually on the lateral surface of the left tibia was observed laceration. Veterinary specialists of the place of residence on the soft tissue were imposed knotted the about was satisfactory, the position of the body in space is a natural standing from the major body systems (respiratory, digestive, cardiovascular, urinary, nervous) pathology was not detected. Palpation in the middle third of the diaphysis of the left tibia was determined tenderness, crepitus, abnormal mobility. The x-ray axis of the bones of the left tibia was wrong, in the region of the middle third of the diaphysis was determined by a large number of small fragments, displacement of bone fragments in width and length (Fig.3).
On the basis of history, clinical examination and radiography was diagnosed with an open comminuted fracture of the left tibia in the region of the middle third of the diaphysis.
The owners of the animal offered surgical treatment, which was obtained their consent.
In terms of operating the anesthetized animal spent processing operating margin of 5% alcoholic solution of iodine. Through the proximal and distal fragments held by two pairs vzaimoperekreshchivajushchihsja spokes 5 and 6, 7 and 8, 28 and 29, 30 and 31, which are secured in the supports 1, 2, 9, 25 mediapart (Fig. 4). With one of the spokes of the second pair, carried out through the proximal fragments, is the soldering on the medial surface. In the end the network control clinical and radiographic examination, on the basis of which the decision on termination of the fixing apparatus. The animal's overall condition was satisfactory, the cat completely relied on the limb, the function of adjacent joints remained in full (Fig.6). Atrophy of the soft tissues of the left pelvic limb was not determined.
Three weeks after the removal of the device remained good anatomofunctional status segment (Fig.5).
The proposed method and mediapart for its implementation allow you to use arc and ring support small mass and adapted to the anatomical features of the segment. Provide closed reposition, hard stable fixation of bone fragments preserve the function of the adjacent joints. This eliminates the possibility of damage to the articular capsules, common peroneal, superficial peroneal, deep peroneal, tibial nerve, the anterior tibial artery and vein, saphenous vein of calf small caudal muscle groups, tendons of the anterior tibial muscle and the long extensor of the toes.
1. The method of osteosynthesis of bones tibia in cats and small dogs, including the fixation of tibia spokes and over the her one of a pair of spokes, the intersection with dice, with one pair of spokes feature at the level of the tibial tuberosity, and one of the spokes of the pair spend Medio-cranial point vcol through the head of the fibula, approaching the cranial edge, a second pin carried out in the Medio-caudal direction at an angle to the first pin 80 to 90°, the second pair of spokes spend at least 0.5 cm from the ankles, with one of the spokes of this pair is carried out in Medio-cranial direction, and the second in the Medio-caudal, the angle of intersection of the spokes of the second pair is 70 to 90°.
2. The method according to p. 1, characterized in that is carried out through each of the fragments on an extra pair of spokes, with each additional pair is conducted at a distance of not more than 1 cm from the line of fracture, in addition, point vcol one of the spokes of an additional pair of proximal fragment is the area above the caudal edge of the lateral surface of the tibia, and the second pin of this pair is performed under an angle 55-65° with respect to the second pin of this pair.