Method of arthroscopic reconstruction of posterior cruciate ligament and set of instruments for protection of popliteal artery in course of its realisation
SUBSTANCE: group of inventions relates to traumatology and orthopaedics. A set of instruments for the protection of the popliteal artery in the operation of arthroscopic reconstruction of the posterior cruciate ligament includes a guide-pin, which is sharpened from both ends, with a sharpening from one end being trihedral; the device for the protection of the popliteal artery, consisting of a working part and a handle, rigidly fixed at the right angle to each other, with the working part representing a cylindrical rod, which at the free end has a flattened section with through holes, located at an equal distance from each other, at an angle to the longitudinal axis of the working part, the flattened section of the working part is smoothly curved at an obtuse angle; a limiter on a cannulated drill, representing hollow cylinders of the different height with an internal diameter, corresponding to the drill diameter. A step-by-step formation of the tibial bone tunnel is realised. The operated extremity is bent in the knee joint at the right angle. Beginning of the tibial tunnel is determined more laterally and lower than the tibial tuberosity and formed at an angle of not less than 55° to the articulate surface of the tibia. The guide-pin is passed with the sharp trihedral sharpening forward, then removed and introduced with the other end forward. After that, the device for the protection of the popliteal artery is introduced through the posterior-medial access, and the guide-pin is wedged in the closest to it hole of the flattened section of its working part. Limiters are successively put on the drill, with the number of limiters being selected in such a way that the part of the drill, free from the limiters, corresponds to the tibial tunnel length. The cannulated drill is passed along the guide-pin, fixed in the device for the protection of the popliteal artery, and the tibial tunnel is formed.
EFFECT: group of inventions makes it possible to reduce a risk of injuring the popliteal artery, reduce a risk of purulent-inflammatory complications.
2 cl, 1 ex, 10 dwg
Group of inventions relates to medicine, namely to traumatology and orthopedics, and can be used in arthroscopic reconstruction of the posterior cruciate ligament (PCL) as measures to prevent and reduce the risk of trauma of the popliteal artery (PA).
Arthroscopic one-beam auto - and alloplasty is the most commonly used option restore PGS. When performing arthroscopic PCL reconstruction one of the main problems is the proximity of the location and, as a consequence, the high risk of injury to the popliteal neurovascular bundle in the formation of tunnels for carrying out the transplant, especially in the tibia. In recent years the published results of various studies aimed at establishing the methods, allowing to reduce the possibility of damage to the popliteal artery (1-4). However, none of the proposed methods surgery cannot completely eliminate the possibility of injury of the vessel.
The closest analogue is spezialitaten (wire catcher) produced by Artrex (5). According to the standard technique of introducing him into the knee joint is performed through an anterior approach, which significantly reduces the manipulative capabilities of the surgeon. The tunnel formed in the tibia at an angle of 45° to the plateau and the beginning of his Nachod�tsya medial to the anterior edge of the tibia. When conducting spokes-guide wire and drill in this case there is a high probability of intersecting the direction of the tibial bone tunnel and running PA. In addition, a significant drawback of specealitatea is that it is inserted through the anterior-medial or anterior-lateral "working" accesses, which significantly limits the manipulative capabilities of the surgeon, and the working part is fixed on the end of the spokes-the Director, almost blindly. The latter, in turn, increases the risk of slipping off the needles with the working part of specealitatea and the migration outside the joint cavity, leading to a risk of injury to the PA.
The technical result is to optimize conditions for performing arthroscopic PCL reconstruction with minimal trauma intervention and to minimize the risk of complications.
- Reliable fixation of the spokes in the device to protect the PA and the possibility of visual control over her situation makes it impossible for her to shift into soft tissue and wound her PA.
- The optimal direction of the tibial bone tunnel and the angle of flexion of the knee joint, identified in the topographic-anatomical experiment (6) such that the probability of crossing conducted spokes-guide wire with the progress of the PA is extremely low.
- The inability to move the drill into the area of the PA is achieved �and through the use of limiters, reduces the working part of the drill to the length of the forming tunnel.
- Reduces the risk of purulent-inflammatory complications in the area of the tibial tunnel, since the beginning it is formed lateral to and below the tibial tuberosity, and this area is sufficiently pronounced an array of muscle tissue, wound closure creates preconditions for better healing.
- Improved visualization during the formation of the channel and increase the manipulative capabilities of the surgeon reduces the overall duration of the surgical intervention.
The result is achieved due to the application of the developed set of tools for the protection of the PA, namely, devices for protection of PA, spokes-guide wire with extra sharpening on the opposite end of the type of "knitting needles", the required number of stops on with cannulated drill bit, and use of, and also determining the direction of the tibial tunnel in the experiment, which gradually formed at a certain angle of flexion of the lower limb in the knee joint. Device for protecting the PA injected through an additional postero-medial access (the main front accesses remain free for manipulation of the surgeon), hole in the working end of the device to protect the PA under visual control lock the working end of the spokes-guide wire, having�th special sharpening (like "knitting needles").
In the figures shown:
Figure 1. The analogue and the prototype of the protective device. PCL elevator and wire catcher (Artrex), where 1 is the working part of the device.
Figure 2. Device for protecting PA, where 2 is the working part, 3 - knob, 4 - flattened portion of the device, 5 - openings in the working section.
Figure 3. The needle-guide, where 6 is a General view, 7 - sharpening the type of "knitting needles"; 8 - standard triangular sharpening.
Figure 4. End sharpening spokes-guide wire, where 7 - sharpening the type of "knitting needles".
Figure 5. End sharpening spokes-guide, where 8 is the standard triangular sharpening.
Figure 6. A set of constraints on the drill bit, with 9 - cylinder, 10 mm width, 10 - cylinder with a width of 5 mm, 11 is a cylinder with a width of 2.5 mm.
Figure 7. The position of the stops on the drill bit, where 12 is the length of the drill in a limited set of constraints.
Figure 8. The direction of the tunnel in the tibia, front view, where 13 is the inlet of the tunnel.
Figure 9. The direction of the tunnel in the tibia, a side view, where 14 is the angle of channel inclination relative to the horizontal plane.
Figure 10. Fixing spokes-guide wire in the working part of the device to protect PA (scheme method), where 15 is the last part of the spokes are fixed in the working part of the device to protect PA (zone of contact needles and devices), 16 - direction holding the spokes.
P�redlagaemyi a set of tools are made of medical steel and consists of defender of the popliteal artery (figure 2), spokes-guide wire (figure 3, 4, 5) and the required number of stops on the drill bit (figure 6, 7).
Device for protecting the PA has the working part 2 of flattened section 4 and the handle 3. The working part 2 and the handle 3 is rigidly fixed at an angle of 90° to each other through serial adhesions. The working part 2 is a cylindrical rod with a diameter of 6 mm, flattened-to-end and having a smooth curve at an obtuse angle. For example, in the present specimen, the bending angle of 170° and the vertex angle of the bend is located at a distance of 10 mm from the end of the working part. Flattened section 4 of the working portion is one third of its total length and has a through hole 5 with a diameter of 2 mm and held at an angle of 65° to its longitudinal axis. The openings 5 are located on the flattened portion at an equal distance from each other. For example, nine holes at a distance of 3 mm from each other in the present sample, the first of them is located at a distance of 5 mm from the end of the working part.
The angle the holes, the bending angle of the working part and all the parameters measured we developed the design identified by the authors as a result of a targeted search in the experiment, the anatomical preparations, which confirmed and justified according to the anatomical features of the knee joint and the arrangement operational to�Tupou.
The needle-guide wire (figure 3) has a diameter of 2.4 mm and different sharpening both ends (figures 4, 5). At one end is made of a standard triangular sharpening 8, on the opposite - sharpening type "knitting needle" 7.
Limiters on with cannulated drill bit (figure 6, 7) are uneven hollow cylinders with an inner diameter corresponding to the outside diameter with cannulated drill bit from the standard set for plastics MCS, such as 9 mm and, respectively, an outer diameter of 12 mm. the Set is, for example, five cylinders 9 height 10 mm, two cylinders 10 height 5 mm and two cylinders 11 with a height of 2.5 mm.
The group of inventions is as follows.
According to the standard technique, surgery is performed through four access - standard Antero-medial and Antero-lateral and more posterior-medial access for instrumentation and access below and medial to the tuberosity of the tibia, corresponding to the entrance formed in a tibial bone tunnel. In our proposed method the first three access form without distinction, but the last one not define medial and lateral to and below the tibial tuberosity. After preparing the bed for the formation of the tibial tunnel (figure 8) is injected into the joint Director from the standard set �La plastique PGS. With it, hold the needle-guide wire 6 three-sided grinding 8 forward bending of the operated limb at an angle of 90° in the knee joint. The needle-guide wire 6 is carried out until it stops in the target pointer on the working side of the guide wire. However, the beginning of the tibial tunnel 13 is formed lateral to and below the tibial tuberosity (figure 8). The angle of the tunnel 14 to the tibial plateau at least 55° (figure 9). When these conditions are met, the risk of crossing the direction of the spokes and stroke PA is minimized. The needle-guide wire 6 is carried out initially sharp three-sided grinding 8 forward, then remove and re-enter on the same channel, but forward the sharpening on the type of "knitting needles" 7. The guide wire is removed. As a result of these manipulations after removing the guide wire, the end of the spokes 7 is located in the posterior intercondylar area of the tibia (area intercondyllaris posterior). Device for protecting PA popliteal artery enter the working part 2 in the rear section of the knee joint through an additional postero-medial access. Then under arthroscopic control by the end of the spokes 7 "put" on the most close to it is located the hole 5 of the working parts of the device to protect the PA popliteal artery 4. Due to the difference in the diameter of the hole 5 and the original sharpening needles last 6 reliably jams in the backcourt. T�Kim, the contact zone 15 (jamming) needles and devices to protect PA area corresponds intercondyllaris posterior.
The optimal direction of the tibial bone tunnel and the angle of flexion of the knee joint revealed in the topographic-anatomical experiment. The angle of inclination of not less than 55° identified by the group of authors as the best when conducting experimental work on the anatomical material. Than vertical direction of the tunnel, the lower the risk of injury to the PA, however, it increases its length. Thus, the authors consider the optimal formation of a tunnel under an angle of 55° to the tibial plateau.
On with cannulated drill bit successively strung limiters, starting with 9 and maximum to a minimum height of 11 (figure 7), picking up their numbers so that the remaining free portion of the drill fit the length of the tibial tunnel. Next on the needle-wire is carried out with cannulated drill bit to form the tibial tunnel. Thereby eliminating the possibility of penetration of the needles and drills beyond the posterior capsule of the knee joint and iatrogenic damage to the PA.
Patient A., age 20, with damage to the posterior cruciate ligament of the right knee joint. Range of motion (flexion of 80 degrees, extension 130°), the symptom back of a drawer 6 mm, Lachmann t�St ++.
Made alloplasty posterior cruciate ligament using the proposed methodology, with application of the developed Toolkit. Operation time 1 h 10 min, Intraoperative blood loss of 50 ml In the early postoperative period vascular complications not revealed. Postoperative rehabilitation by the standard technique. As a result managed to achieve increased range of motion: flexion 45°, extension 180°, the symptom back of a drawer after 3 months. after surgery 2 mm, Lachmann test is negative.
1. Ahn J. H. Increasing the distance between the posterior cruciate ligament and the popliteal neurovascular bundle by a limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction: a cadaveric angiographic study / J. H. Ahn, J. H. Wang, S. H. Lee, J. C. Yoo, W. J. Jeon // Am J Sports Med. - 2007. - vol.35(5) - p.787-792.
2. Cosgarea, A. J. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal / A. J. Cosgarea, D. E. Kramer, M. S. Bahk, W. G. Totty, M. J. Mata // J Knee Surg. - 2006 - vol.19(3) - p.181-185.
3. Pace J. L., Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy / J. L. Pace, S. J. Wahl // Arthroscopy - 2010 - vol.26(5) - p.637-642.
4. Yoo J. H. The location of the popliteal artery in extension and 90 degree knee flexion measured on MRI / J. H. Yoo, C. B. Chang // Knee - 2009 - vol.16(2) - p.143-148.
5. Noyes F. R., PCL Reconstruction with the Acufex® Director™ Drill Guide using the Noyes All-Inside and Tibial Inlay Techniques with a Double-Bundle Quadriceps Tendon Graft / Frank R. Noyes, Jeffrey D. Harrison // Cincinnati Sportsmedicine and Orthopaedic Center, Cincinnati, Ohio. - http://metodebok-ortopedi.ihelse.net/Metodobok_legr/Pdf/V1-plc.pdf.
6. Kuznetsov I. A. Topographic-anatomical approaches to the development of the system of protection of the popliteal artery when performing arthroscopic grafting posterior cruciate ligament / I. A. Kuznetsov, N. F. Fomin, D. A. Shulepov // Traumatology and Orthopedics of Russia - 2012 - 4(66) - p. 26-32.
1. A set of tools to protect the popliteal artery in arthroscopic reconstruction of the posterior cruciate ligament, including a needle-guide wire having a shank with two ends, with one end sharpened triangular; a device to protect the popliteal artery, consisting of a working part and a handle rigidly fixed at right angles to each other, wherein the working part is a cylindrical rod, which at the free end has a flattened section with through holes, spaced at equal distance from each other, at an angle to the longitudinal axis of the working portion, the flattened portion is smoothly bent at an obtuse angle; limiters on with cannulated drill bit, which represents an uneven hollow cylinders with an inner diameter corresponding to the diameter of the drill.
2. Method of arthroscopic reconstruction of posterior cruciate ligament using the kit according to claim 1, including a gradual formation of a tibial bone tunnel, for which the operated limb bend in the knee at right corner�Ohm, the start of the tibial tunnel determines lateral to and below the tibial tuberosity and form an angle of at least 55° to the articular surface of the tibia, the needle-guide wire carried a sharp three-sided grinding forward, then extracted and injected it forward the other end, then through the posterior-medial access enter a device to protect the popliteal artery and wedge the needle-guide wire in most closely located to her hole flattened portion of its working parts, then a drill consistently strung constraints, the number of which is adjusted so that free from the constraints part of the drill fit the length of the tibial tunnel, then the needle-guide wire fixed in the device to protect the popliteal artery, performed with cannulated drill bit to form the tibial tunnel.
SUBSTANCE: osteotomy is performed with exposing the distal ulnar metaphysis by a long linear incision 3.0-4.5 cm along the ulnar surface. Distal ulnar osteotomy and intraoperative single-step redressment are performed through the approach created at 3.0 cm above the ulnar styloid at an angle of 45°. The radiocarpal joint is fixed with an orthosis for 2-2.5 weeks.
EFFECT: method enables reducing the number of intraoperative injuries, gaining in the radiocarpal motions as much as possible, avoiding metal structures to be applied, and reducing the immobilisation length.
2 ex, 1 dwg
SUBSTANCE: musculocutaneous vascularised and innervated island flap comprising the active greater teres muscle, a descending branch of the circumflex scapular artery, and the subscapular nerve is separated. The above flap is moved towards the elbow joint, with its muscular portion placed between the caput mediale and caput longum of the triceps muscle of the arm and anchored to a transition point of the tendon portion of the triceps muscle into the muscular one. The greater teres muscle is preserved attached to the humerus. As it may be required to bring the above flap down, it is possible to dissect away its attachment point of the greater teres muscle from the humerus. A tendon auto- or allograft is used to anchor the flap to the transition point of the tendon portion of the triceps muscle into the muscular one if the muscular portion does not appear to be long enough.
EFFECT: eliminating flexion contracture in the elbow joint and recovering the active flexion of the forearm in the motor unit deficiency.
4 cl, 7 dwg, 1 ex
SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for realisation of periacetabular triple osteotomy of pelvis in teenagers. Access to ischial and pubic bone is realised in projection of adductor muscles - longitudinal adductor access, in position of bending and abduction in hip joint. Tenomyotomy of adductor muscles is performed. In intermuscular space in blunt way performed is access to femur trochantin, where tendon part of iliolumbar muscle is exposed and its tenotomy is carried out. Branch of ischial bone, covered from outside with external obturator muscle, is identified under acetabulum. External obturator muscle is perforated. Ischial bone is bypassed with raspatories from inside and outside and oblique osteotomy is performed in front-to-back direction. Osteotomy of upper branch of pubic bone is performed. Osteotomy of ilium is performed from front access.
EFFECT: method makes it possible to reduce access trauma, provide realisation of surgery under conditions of hip head compression or its high position in case of dislocation.
SUBSTANCE: tendons of flexors and extensors of additional and basic rays are cut at the level of medium third of metatarsal bone and medium third of second instep bone respectively. Underdeveloped metatarsal bone of additional ray and underdeveloped first finger of base ray are removed. Anatomically correctly developed finger of additional ray is transferred on anatomically correctly developed metatarsal bone of basic ray. Flexor and extensor tendons of formed first ray are sutured at the level of medium third of formed ray. Fixation of transferred fragments is realised due to K-wires and gypsum bandage in medium position of foot to knee joint.
EFFECT: method ensures normal growth of first ray and support ability of foot.
SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the treatment of purulent arthritis. Arthrotomy is carried out. Necrotised tissues, injured elements of the joint are ablated. Primarily a spacer from bone cement with an antibiotic is installed. The wound is sutured layer-by-layer. Drainage is carried out in portions, with the periodical closure of draining tubes in such a way, that drainage is realised for 5-10 min each hour on the first 2-3 days after operation. The spacer is replaced for the joint endoprosthesis after cupping the infectious process.
EFFECT: method makes it possible to reduce a risk of endoprophesies septic instability.
SUBSTANCE: invention refers to medicine, namely orthopaedics, and aims at treating a long-term rotator cuff injury. An incision 5-8 cm long is made from an inferior edge of a clavicle along an anterior surface of a shoulder along sulcus deltoideus (Ollier type) to access a rotator cuff. In an inner rotation position, the rotator cuff is sutured two or three times successively with the stitches transversely directed under each other to form a duplex rotator cuff segment.
EFFECT: invention enables reducing tissue injuries potentially accompanying a surgical intervention and the lengths of treatment and rehabilitation.
1 dwg, 2 ex
SUBSTANCE: point skin incision is made in a projection of a base of the 5th metacarpal bone, and a pin is inserted into a canal of the 5th metacarpal bone to reach a fracture level. That is followed by closed reduction of the fracture, and the pin is inserted transarticularly up to the level of a lower one-third of a proximal phalanx of a little finger.
EFFECT: more effective treatment ensured by the stable fixation of comminuted, spiral fractures and eliminating purulent-septic complications.
1 ex, 3 dwg
SUBSTANCE: formed concave spherical cutters are used to process end faces of bone fragments of the forearm to enlarge a contact area to a graft. An open reduction of the fragments involves measuring an existing defect in between. The graft of the required dimensions is created; the end faces of the graft are processed with convex spherical cutters of the similar radius. After the open reduction is completed and the graft is embedded between the fragments, the optimum contact area of the bone and graft is aimed. External or internal fixation is carried out to create compression between the fragments and graft and to ensure an extra stability of the maximum contact by shaping the end faces of the graft and fragments spherical.
EFFECT: method enables increasing fixation stability, providing the early functional load, and recovering the adjoining joint function.
SUBSTANCE: group of inventions refers to traumatology and orthopaedics and is applicable for subchondral strained reinforcement. The first version: one end of at least two pins is inserted subchondrally through articular surface fragments above a bone defect up to its cortical layer. The mechanical strain is generated in the pin; an arched curve is formed at an outer end of each pin, whereas a free linear segment of the pin thereafter is inclined by 45-60 degrees to a long axis of the bone, and then pressed to the bone with a clamp element by means of screws. The second version: one end of each pin is brought until it comes out from the opposite side of the bone, and a support pad is formed thereon; each pin is pulled up to contact the support pad to the opposite cortical layer of the bone; the pin is pulled up by its outer end; that is ensured by forming the arched curve of the pin at the end of each pin opposite the support pad and fixing it by at least two loops around the axis of the pin rod; the arched curve is bent to the bone, whereas the free linear segment of the pin end is placed on the surface of the bone surface for fixation thereto.
EFFECT: group of inventions enables preventing the secondary fragment displacement.
3 cl, 8 dwg
SUBSTANCE: not longer than 3 cm skin cut is performed above place of rupture on posterior surface of shin. Crucifirm sutures are applied on proximal and distal ends of Achilles tendon transcutaneously in front plane in such a way that one cruciform suture is located in deep and another - in superficial layer of Achilles tendon ends. Ends of Achilles tendon are brought into wound by threads, which are used to additionally apply blocking knots on proximal and distal tendon ends in order to prevent eruption of cruciform sutures. Threads are tightened and tied to each other, approaching tendon ends. Tendon ends are additionally strengthened with U-shaped sutures.
EFFECT: method increases accuracy of matching fragments of Achilles tendon by width and by length, reduces risk of injuring sural nerve.
3 dwg, 1 ex
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
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.
EFFECT: higher efficiency of therapy.
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.
EFFECT: increased accuracy of reposition, improved conditions for fusion.
SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.
EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.
SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.
EFFECT: complete repair of mobility in articulation.
SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.
EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.
3 cl, 3 dwg
SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.
EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.
47 cl, 11 dwg
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.
EFFECT: higher efficiency of fixation, decreased traumaticity.
3 cl, 2 dwg, 1 ex
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.
EFFECT: higher efficiency of therapy.
1 cl, 2 dwg
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should form a transplant out of femoral biceps' tendon, form an oblique-cross-sectional transfemoral canal in isometric area upon external femoral condyle, right to the front against insertion fibular collateral ligament, apply proximal end of crossed femoral biceps' tendon through this canal, fix the end of crossed femoral biceps' tendon upon internal femoral condyle. The method enables to prevent tendinous rupture at the site of its new fixation and avoid the loss of articular bending function.
EFFECT: higher efficiency of therapy.
2 dwg, 1 ex