Compression-distraction apparatus

 

(57) Abstract:

The invention relates to traumatology and orthopedics and can be used for treatment of fractures and deformity correction of the limbs. Threaded rods 2 frames 1 supply 5 specifiers and connected in a closed triangular frame with corner clamps 3 and nuts 10. On one of the frames of each unit installed floaters, 11, or 12. Triangular frame try on the patient, collect similar and connect them to the screw rod in one unit. Collect the second block on the first sample and placed on the limb. 3 C.p. f-crystals, 5 Il.

The invention relates to medical equipment, namely to the compression-distraction apparatus.

There are many options for compression-distraction apparatus for treatment of fractures and the correction of deformities of the limbs, for example the devices on the bus. St. 912156, 935093, 1217392, 1491493, 1496787, 1651885 and others.

These devices according to their classification characteristics belong to the category of the framework of multifunctional external fixator bones and joints are alternative machines circular, semicircular, curved spiciness supports.

The known device is the distribution of deforming loads between the spokes and frames, results in conditions of cyclic loading to plastic deformation and fracture of spokes, the stability of fixation of bone fragments and inflammation around the spokes that prolongs the duration of treatment and worsens the results. Specificatory they come, contribute to premature failure of the spokes in the area of their mutual contact with the needle, where in cases of forced (in most cases) bending spokes arises plot of concentration of internal stresses in the subsequent source of microcracks and so on, the Intensity of these devices is confirmed by a large rentgenopozitivnye, which reduces the information content of x-rays. Repositionned properties listed KDA limited.

Known devices with a triangular frames. It was used, for example, E. Yu Bartusevicius, P. A. Bubinas, K. C. Holubowski, K. H., Skibicka, A. A. Vizgirda (1989), submersible elements used rods; j.Hellinger, 1982 "Modern foreign external fixation devices", (in Ukr. Orthop., injuries. and FR. , 1987, N 8, pp. 71-73). In 1991, the Institute of Simunac et al., - in the journal. Orthopaedics, trauma. and FR. N 11S. 22-23.

Closest to the proposed technical solution is KDA on author.St. 1806663 T. A. Jasonterry, located on the frames spiegelzaal with spokes, as well as connecting blocks mechanisms longitudinal and rotational movement.

However, the frame of this apparatus may not ensure the prevention of "crush syndrome" soft tissue occurred when their swelling after injury or surgery, to ensure the stability of fixation by means of dosed multiple additional tension spokes, contributes to the gap Estonica under the influence of cyclic loads of spokes that are subjected to plastic deformation due to the disproportionate spacer frame with minimal elastic deformation. A constant internal size of the frame of the apparatus, preventing the possibility of smooth atraumatic remounting in cases of development of pressure sores tissues from the frame, combined with minimal maneuverability of specification strengthened spokes though from different angles, but only in the plane of the frame, and when you commit spokes carried out in the other planes, the latter have to bend that in the future naturally leads through cracks and destruction to the loss of stability and the full range of complications compression-distraction osteosynthesis. The absence of reasonable sizes of frames is avishay the possibility of damage like limbs, promotes the need to use longer than is necessary and enough spokes. Projection shadows reduce the diagnostic value of radiographs. Removable mechanisms longitudinal and rotational movement difficult, not only in production but also in installation and operation, provide a minimum amplitude of the angular position due to the onset of the inevitable mutual misalignment of the frames in which these mechanisms are strengthened. The inability smooth movement of the spokes specification along the placket frame deprives the surgeon the ability to produce the reposition of bone fragments in the plane of this frame, and the technical characteristics of specification not allow to strengthen, if necessary, the spokes on the threaded rod between the frames of one block. Spring Podshipnik known in medicine, but in this case they do not add advantages: no spring torque, which deprives the surgeon the possibility to accurately assign a loading dose is needed with regard to more than two dozen conditions (porosity of bones, the plane of fracture of bones, time after injury, the weight of the patient, the age, the size of the apparatus, and so on), which is fraught with complications and prolonged recovery time. Added to this is unreasonable and inadequate to the optimum mechanical compliance voltages at all levels conduct spokes in the terms of reference of Podshipnik.

The objective of the invention is the reduction of treatment time by improving the reliability of fixation and reducing the risk of complications with compression-distraction osteosynthesis.

The task is implemented due to the fact that the frames are made of threaded rods programmed length with floaters and specification and United through the perforated cuboid corner clamps; specificator made of composite symmetrical halves, the inner part of which is in the form of washers have an outside truncated spherical surface with a funnel-shaped cavities in the center, the outer part in the form of tori are spherical cavities on the size of the spheres of the internal parts on one side and a clamping nut on the other side, and the mechanism of spatial movements made in the form of the l - shaped threaded rod, installed their ends in floaters with measured rotation on the rod frames. As the sliders can be used angular latch and variants corner clamps, perforated at least two mutually perpendicular planes, and as pogrujennyh of Podshipnik - anchor stirrups with Podshipnik - Device for treating the Def than one extra pair of specification for spokes.

In Fig. 1 shows a compression-distraction apparatus, lateral projection, and Fig.2, the mechanism for moving blocks compression-distraction device, side view; Fig.3 - the mechanism of blocks movements of the compression-distraction apparatus comprising frame KDA; Fig.4 - specificator compression-distraction device Assembly on the threaded rod KDA; Fig.5 - axonometric projection compressing-distraction device.

KDA frame 1 contains the triangular shape of the support elements in the form of threaded rods 2, the ends of which are fixed cuboid corner clamps 3 connecting frame between a threaded rod 4, specificatory 5 spokes, mounted at an acute angle to the planes of the frame 1 and the frame in turn arranged in mutually angular positions within each of the blocks 6 or 7; the blocks of the frames are connected by a mechanism (s) of the mutual offset 8 bone fragments in the form of the l-shaped threaded rod 9 and nuts 10, floaters, 11-12, which are angular clamps 3.

Specificator 5 made of composite mirror-symmetrical enantiomer halves, the Central part of which is in the form of washers 13 are from the outer parts of specificator uses the slits 17 and 18, forming in comparison with the opposite half of specificator spoke channels, and the outer parts of specificator in the form of tori 19 with spherical cavities 20 in the size of the spheres 14 Central parts 13 have a platform 21 by screws 22 to lock the pairs of spokes 16 coaxially vectors of the two pairs of stacked slots at an angle to the planes of the frame 1; the upper block 6 frames provided in case of use of the apparatus together with Podshipnik on the lower limbs extra pair of specification 23 for additional spokes.

Compression-distraction apparatus is used as follows. Before surgery is performed R-graphy in two projections of the damaged segment of the limb and on a lateral radiograph produce the Assembly apparatus. When selecting lengths of threaded rods frames take into account the presence of the x-ray shadows from soft at the level of the alleged placement of frames. The formula to determine how long must be the rods for assembling frames, separately at each level. Threaded rods 2 frames 1 supply specification 5 and connected in a closed triangular frame with corner clamps 3 and nuts 10. On one of the frames of each unit must be installed floaters, 11 or 12, rste and internal channels on the diameter of the threaded rods in three mutually perpendicular planes. Specificatory have near the corner clamps and slide between specification on the threaded rods, one of each of the unit frames. In advance you can prepare a table of correspondences of the lengths of the rods with different lengths of the circumferences of extremities and use it.

Triangular frame try on the sick, collecting similar, they connect the threaded rod in one unit. Structurally, threaded rods, frames and connecting frames threaded rods differ only in length. The levels of holding spokes mark on the skin dye, and the connecting frame threaded rod (Assembly) set specificatory as a backup or for additional spokes in a particularly difficult clinical cases.

Collect the second block frames modeled first. When fitting both blocks 6, 7 distance to skin from sliders placed on the centers of the threaded rods frames, set not less than 2 cm in calculating the possible development of soft tissue swelling after surgery. The effective length of the rods inside collected before surgery frames less than their true length on the magnitude of B = a + b + c, where a is the angular thickness of the retainer frame, b is the thickness of the nut from the corner of the retainer frames, c - backup your size of each terminal in advance before surgery reduces nuts not less than 1 cm by running them from the corner clamps 3 in the direction of the sliders 11 or 12. When planning the installation of Podshipnik blocks of frames should be fitted with sliders. Holes not occupied with l-shaped rods after surgery strengthen the stirrups or Podshipnik. When planning for additional spokes on the threaded rod between the frames set specificatory.

Sterilize the assembled device before the operation of any of the available methods.

Nuts 10 near the anchor clamps 3 should not be tightened, and l - shaped threaded rod 8 may be installed in channels sliders any of the blocks of the frames or the blocks can be combined into a single frame of the machine.

In the operating room under General anesthesia in a planned before operation areas spend spokes. They are placed between the slots of the Central parts of specification 5 coaxially with the emerging spacetime channels. Involved can be two channels for two parallel spokes, or only 1 channel. Spokes clamp in specificatory nuts 10 on both sides of specificator. Wrench enlarge the inner size of the frames, ensuring the optimization of the size of the device and the tension of all speech the l-shaped threaded rod 9 on each side of the frames simultaneously. Angular displacement repairbot by distraction on two l-shaped rods. When the slider 11 of the third D-shaped rod must not be fixed on the threaded rod of the frame and be able to rotate around him.

The reduction in width is produced by dosed move a couple of wrenches of the slide from the sides of the frame, a threaded rod which is parallel to the vector of the upcoming shift, with nuts sbencivu in the opposite direction, and l-shaped threaded rods of the other two sliders lengthened in proportion to the magnitude repositioning move horizontally from the calculation of n 1,4 where n is the offset (in cm or mm) horizontally. In this case, the nut slides, fixing their position on the frame, must be dissolved and floaters to take a position at an angle to the plane carrying their frames. More complex displacement eliminate under the screen of the electron-optical Converter by metered-dose combinations of displacements in height and horizontally between the blocks.

When applying the device to the lower leg of the upper frame of the upper unit must be equipped with a pair of additional specification. It strengthens at least 1 extra needle in order whom the treatment. The need to strengthen the upper block additional pin (alternatively use thicker spokes on the upper unit of the device) is proved experimentally and confirmed clinically.

After the operation, the apparatus may be supplemented by podsobnykamy and screenname devices previously developed structures R. L. of Shevts, patents NN 1380745; 1741795.

Thus an Ilizarov apparatus devoid of shortcomings of its prototype, provides the implementation of the objectives, namely increases the reliability of the bones and limb segments due to the fact that his framework is based threaded rods of circular cross section with the elastic deformation and preventing the plastic deformation of the spokes and, consequently, their mechanical destruction. This elastic deformation of the core elements of the framework helps to prevent inflammation of the skin near the spokes and osteomyelitis, which is confirmed by large clinical trials. Excluded the occurrence of bedsores, skin edema, because the size of the pam device is designed precisely in accordance with the sizes of the circles limbs, it also eliminated the extra weight of the metal as a stimulator of bedsores on Kostya the boards spokes and sufficient for reliability - the fixation of the spokes, whereby the contact area of the spokes with clamping grooves elements of specificator maximum efforts compression by nuts evenly distributed completely absent area of the bend spokes (in the technique of this area is the "stress concentrator") and provided that the trajectory of her conduct at any required angle to the axis of the limb, and to the plane of the frame.

This range of benefits of specificator is provided with a spherical surface of the Central part, which is a spherical embedding the outer part of specificator allows you to generate between two mirror-image halves of the channels under the spokes, and the direction of the channels can be set in accordance with the clinical situation and change without the use of bending spokes effort. It is known that cyclic loadings exactly shear stresses provoke the destruction of the metal structures in the nodes of the connection, and on theory of the formation and growth of cracks, the bending of the spokes of the most dangerous: the absence of this factor is beneficial and makes a new design from the prototype.

Threaded rod between frames not only connect - unlike the prototype frame, they are able to bear the additional is mi. The ability to change the internal size of the apparatus and increase provides not only the prevention of bedsores from swelling, but also smooth the tension of the spokes at any stage of treatment, even without the use of spiranthinae, though contraindications to its use there.

The lightweight construction and features Omni-directional hinge incorporated in the mechanisms of mutual displacement of bone fragments, their increased rentgenopozitivee, compares favorably to the design of the prototype is not only easy to assemble, but the sharpness control in accordance with the laws of mechanics: floaters rotate l-shaped pivot around the longitudinal axes of the rods, frames, round section of the l-shaped rod in the matter short or long shoulder fixed in the slides, provides or mutual longitudinal rotation blocks, frames, or install them in angular position; as floaters, reinforced on both sides with nuts, allows smooth dosed move them around the perimeter frames. Because as sliders used can be perforated corner clamps known framework of apparatuses (for example, U.S. Pat. 1616640, class A 61 B 17/58, 2015687, class A 61 B 17/58 and others) obespecivaet with support for mounting additional rods (if necessary). In this embodiment, it is proposed to use corner clamps frames, but for a new purpose - to connect the blocks together. The triangular configuration of the device can be incorporated into the design of the known reference elements are circular or semicircular form, and Vice versa, use the triangular frame part of the apparatus other structures. The same applies to the design of specification: in the proposed apparatus can be used of specification: in the proposed apparatus can be used specificatory the framework of the apparatus construction of the present invention.

Reliable fixation when using Podshipnik is provided in the apparatus due to the additional spokes (or pairs of spokes). It evens out the distribution of deforming primarily spokes of the upper block of mass energies of the patient's weight between blocks KDA: quantity (kg) weight of the patient or the distribution on the spokes of the upper block exceeds the load attributable to the spokes of the lower unit in the apparatus with a pair stamping blocks 27 (in the initial phase regeneratio - 18% (in the solid phase of callus). In the proposed design provides an extra pair of specification on the frames of the upper block that avserv on the rods between frames. (R. L. Sevc, S. B. Zhidkov. The supporting stirrup in the system unit external external fixation lower extremity. //Experimental traumatology and Orthopaedics. Cyto - M., 1990, 104 S.)

1. Compression-distraction apparatus containing United in pairs with formation of units of the triangular frame of the supporting elements mounted on them specificatory in the form of washers with parallel slots for spokes connecting the frame of the threaded rod and the mechanism of the spatial displacement of the blocks of the frame, characterized in that the supporting elements are in the form of threaded rods with floaters, and United by a perforated cube-corner retainers, each specificator made of composite symmetrical halves with clamping nuts, located opposite one another, the inner part which is executed in the form of washers, with one hand truncated spherical surface with a funnel-shaped cavities in the center, and the outer part in the form of tori having spherical cavities for installation at a given angle of the spherical surfaces of the inner parts, on the one hand and clamping nuts on the other side, and parallel to the slot under the spokes are made from the other side who run their ends in floaters, with the possibility of rotation on the threaded rods, frames and move around the perimeter of the frames in the implementation of the distraction and compression between the blocks.

2. The apparatus according to p. 1, wherein each threaded rod is made with a circular cross section with a length

< / BR>
where a is the length of the threaded rod inside the frame;

L is the length around the circumference of the limb segment;

- constant;

b is a parameter that defines the minimum number of centimeters between the skin of the limbs and the screw rod of the frame, the stock length for the case of tissue edema;

C is a parameter determining the number of inches of threaded rod, occupied the corner clamps with nuts from the corner clamps frames.

3. The apparatus according to p. 1, characterized in that the slide is made in the form of a perforated parallelepiped having at least two mutually perpendicular planes are interconnected by channels under the l-shaped threaded rod.

4. The apparatus according to p. 1, wherein one of the outer blocks of the frames is provided with an additional two specification with spokes to use Podshipnik.

 

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