The method of treatment of injuries of the pelvic ring and the compression - distraction apparatus for its implementation

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of patients with severe injuries of the pelvic ring, especially its posterior - Pereloma-sacrum sprains, breaks the sacroiliac joints, fractures of Malena. When the horizontal position of the patient after treatment of the surgical field enter two spokes with stops in preneuring ity of each of the Ilium. The second pair of spokes is injected near the exit point of the front spokes front to back on the border between the anterior and middle thirds of the crest. Enter spokes without lugs, after which they prodelyvat forward, make stylepanel bending, forming the focus again returned to its original position. Spokes enter almost perpendicular to the vertical axis of the patient's body at an angle 8 to 10oto the sagittal plane. They are on the border between middle and posterior thirds of the ridges. In Peradeniya spine of the iliac bone at a depth of 3 cm enter the threaded rods. Then on the spokes and threaded rods mounted support ring of the two arcs that circle on the front and rear surfaces of the pelvis of the adjusting threaded rod on the brackets. To the spine. It is fixed with needles and rods, using the bracket, screw legs, bolts-specificatory, nuts, which provides a reduction in all planes offset with achieving rigid fixation. 6 C. p. F.-ly, 3 ill.

The invention relates to medicine, namely to methods and devices used in traumatology and orthopedics, and is intended for the treatment of patients with severe injuries of the pelvic ring, especially its posterior - Pereloma-sacrum sprains, breaks christozov-iliac joints, fractures of Malena.

The mechanism of fractures of the pelvis is the strong compression and impact in the horizontal, frontal (vertically down) and sagittal (vertical front to back) direction.

The duration of treatment is 10 - 12 weeks.

The main issues of this nature of the fractures, is providing dynamic stabilization of the pelvis for a long period of time required for the biological recovery of bone tissue, as well as the implementation of the repositioning in three mutually perpendicular planes, prevention of fractures of the bone structure of the pelvis and internal injuries of the pelvis during reposition.

A well-known conservative is the situation on Volkovich ("frogs"), produce skeletal traction limbs for namesake hips, and, if necessary, for the wings of the Ilium. Bed lasts up to 3 months.

The disadvantage of this method is the impossibility of managed reposition of bone fragments in three mutually perpendicular planes and create a reliable fixing and long-term "chaining" of the patient to the bed. Long-term lack of exercise leads to complications of the respiratory system, cardiovascular system, gastrointestinal tract and osteoporosis affect the reparative processes of the bones.

Known methods of treatment of fractures of the pelvic ring by percutaneous holding the bones of the pelvis clamping elements with the use of external fixation devices.

Ways to facilitate early activation of patients due to fixation of bone fragments. For example, the known method based on the introduction in the crests of the iliac bones on three core bonded plates, on which the front and rear surfaces of the pelvis are interconnected telescopic screed.

However, if the fractures with displacement of bone fragments, this method does not provide a reduction in more than one plane and reliable fixez the hand, this can lead to spalling, as the crest of the Ilium does not have sufficient parameters to ensure reliable fixation rods. And chipped bones can cause damage to the internal blood vessels and bleeding.

The closest analogue to the claimed method according to the combination of features and technical result is a method of treatment of injuries of the pelvic ring by percutaneous holding the bones of the pelvis front and rear locking elements. In the thin part of the pelvic bones impose spoke with emphasis, and in a massive part enter the threaded rods. Some spokes are conducted through the front upper iliac spine bones in thickness of the anterior third of the crests of the iliac bones, the other spokes to carry through the middle third of the crests of the Ilium. Some threaded rods injected into Peradeniya spine of the Ilium, the other threaded rods enter into the middle and posterior thirds of the crests of the Ilium. Then carry out the reduction and fixation of bone fragments with compression-distraction device.

However, in cases of sprains, Pereloma-dislocation of sacrum impossible closed reduction and reposition the sacrum. When this is done open operative weatherstations operating blood loss, the possibility of suppuration. In addition, the known method does not account for the correlation of the input direction and output pins and threaded studs on the pelvic bone and was not taken into account the nature of injuries (fractures Malena needle could pass through the area of the fractures), thereby sharply declined repositionned possible way, the quality of reposition.

A device for reposition and fixation of the pelvic bones with multiple fractures of the pelvis, containing a curved frame made in the form of two movably United Poloskov and installed it racks with threaded rods. Racks are installed in curved grooves made on polaskova through the barrel bushing and connected to the screw terminals using the ball pairs.

The disadvantage of this apparatus is to reposition the pelvic bones in the same plane, they cannot reposition of fragments of the pelvic bones in the anteroposterior and vertical directions. There is a real risk of damage to the major branches of the gluteal artery with the introduction of hard rods in muscle arrays gluteal regions.

Closest to the proposed decision on the totality of symptoms is compression-di is the data of the threaded rod, connecting the ends of the arcs placed on arcs bearings, spokes stops installed on the arcs of the through bolt specification and threaded rods installed on arcs through the holders.

The device is not effective in severe injuries of the pelvic ring with a predominance of damage to his posterior, because it does not provide a closed reduction and reposition the sacrum and security in terms of damage to the neurovascular bundles, hip joint, pelvic bones, perforation of the abdominal and pelvic cavities, which is of special importance in injuries of this character for holding closed reposition and fixation.

The main problem to be solved by the invention is the provision of a closed managed reposition and secure fixation of the bone fragment pelvic ring with primary damage rear division (dislocations, Pereloma-dislocations of the sacrum and vertical fractures of the iliac bones), improving the quality of reposition and security, taking into account the optimal anatomisch zones.

To solve the problem in the method of treatment of injuries of the pelvic ring by percutaneous holding the bones of the pelvis front and back fikirtepe rods, some spokes are conducted through peredniene spine of the Ilium in thickness of the anterior third of the crests of the iliac bones, the other spokes to carry through the middle third of the crests of the iliac bones, some threaded rod is introduced into Peradeniya spine of the Ilium, the other threaded rods enter into the middle and posterior thirds of the crests of the iliac bones, the position of fragment fixation with compression-distraction apparatus according to the invention, in addition enter the threaded rods in the upper lateral part of the sacrum at the level between the middle and posterior thirds of the iliac crest at the level of the upper edge of the first sacral vertebra in toward the midline down at an angle to the sagittal and horizontal planes, spokes carried out through peredniene spine of the Ilium in the thickness of the front third of the ridges, bring on the border between the anterior and middle thirds of the crest, spokes drawn through the middle third of the crests of the iliac bones, bring on the border between middle and posterior thirds of the crest, the threaded rod is introduced into Peradeniya spine of the Ilium perpendicular to the vertical axis of the patient's body at an angle to the sagittal plane, in the middle and posterior thirds of the ridges podolny axis of the patient's body at an angle to the sagittal plane.

In contrast to the known method in the proposed enhanced effect reposition posterior pelvis. Marked areas and directions of input and output pins and rods are safe in terms of damage to the neurovascular bundles, hip joint, pelvic bones, perforation of the abdominal and pelvic cavities, which is of special importance in severe damage to the posterior pelvis to conduct a closed reposition and fixation.

The proposed method is carried out in the inventive compression-distraction apparatus containing a support in the form of two arcs, joined on the front surface of the pelvic ring adjusting threaded rods and threaded rods for the reposition of the iliac bones, mounted on the arcs, which according to the invention, is further provided with two pairs of spokes to reposition the iliac bone, the threaded rods for the reposition and fixation of the sacrum, and the adjusting threaded rods connecting the reference arc on a given surface of the pelvic ring with spokes, rods and rod interconnected with brackets fixed on the supporting pillars that are installed on the arcs.

Introduction to machine additional locking elements in the values, as the spokes are intended for introduction into the thin part of the bone, and the creation of the necessary hard commit for the long term for the biological recovery of bone tissue is achieved by means of the threaded rods, put in a massive part of the pelvic ring to a depth sufficient to ensure stabilization of the device.

The use of brackets mounted on the threaded posts, through which the pins, and rods mounted on arches, allows you to install them when applying apparatus at different angles and in different planes for the implementation of the repositioning in three mutually perpendicular planes in the treatment of complex fractures, in particular the front and rear sections of the pelvis.

The connection of the supporting arches on the rear surface of the pelvic ring with additional threaded rods contributes to the formation of a closed ring, as close as possible to the center of the pelvis, which leads to a uniform force distribution on the bone structure of the pelvis, and this is achieved by the correct and complete reposition and provides dynamic stabilization of bone structures.

The fulfillment of these conditions allows for early activation (2 - 5 days) patients with severe head injury kalinya zone with respect to the spatial location of the neurovascular bundles, the pelvic bones of the pelvic and abdominal cavities, and of the joints and poluustav pelvis. This reduces the invasiveness of the intervention and the danger of blood loss, stable fixation.

In Fig. 1 shows a compression-distraction apparatus for treatment of injuries of the pelvic ring; Fig. 2 - the same, top view; Fig. 3 - the same, rear view.

The apparatus comprises a support in the form of two arcs 1, interconnected front and rear adjusting screw rod 2 brackets 3. On the formed support ring secured two pairs of spokes - front 4 and rear 5 - lugs 6, entered in the thin part of the iliac bones and two pairs of threaded rods - front 7 and rear 8 entered in the massive part of the iliac bones, and also threaded rods 9 to the position of the sacrum.

Spokes 4 and 5, the rods 7 and 8 and the rod 2 is fixed to the bracket 3 mounted on the abutment screw of the rack 10 mounted on arcs 1.

The rods 7 and 8 are fixed to the bracket 3 by means of the nuts 11, the spokes 4 and 5 by means of bolts - specification 12.

The threaded rod 9 is connected with arc 1 through interconnected mutually perpendicular arms 3, one of which closed the key 13.

The device is chosen individually for each patient before surgery. It is important that the size of the arc was 10 - 12 cm more than the anteroposterior size of the pelvis of the patient at the level of preneuring awn Ilium front of the rhombus of Michaelis - back. The front threaded rods are chosen according to the thickness of the wings of the Ilium of the patient (for women it is advisable to use a 3 millimeter cores, and for men 4 - 5 mm). The diameter of the rear terminals 4 - 5 mm Adjusting screw rod 2 are selected depending on the frontal size of the pelvis of the patient, usually from 8 to 12 see

When the horizontal position of the patient after treatment of the surgical field enter two spokes 4 with lugs 6 in preneuring ity of each of the Ilium at an angle of 30 - 35oto the sagittal plane and 40 - 45oto the horizontal plane of the open bottom so that the needle passed through the thickness of the front third of the iliac crest and was on the border with the middle third.

This should not stick to 1 - 1.5 cm below the upper edge of the ridge, because below the wing is thinner and reliable fixation of the spokes is reduced.

The second pair of spokes 5 is injected near the point you is, then prodelyvat forward, make stylepanel bending, forming the stop 6, and again return to its original position. Spokes 5 enter almost perpendicular to the vertical axis of the patient's body at an angle 8 to 10oto the sagittal plane. They are on the boundary between the middle and posterior thirds of the crests.

In Peradeniya spine of the iliac bone at a depth of 3 cm enter the threaded rod 7 at an angle of 45oto the sagittal plane perpendicular to the vertical axis of the body of the patient.

Then on the spokes 4, 5 and threaded rods 7 mount the support ring of the two arcs 1, which closes at the front and rear surfaces of the pelvis of the adjusting screw rod 2 brackets 3.

Ring align and center relative to the pelvis of the patient, giving it an angle of 60 - 75oC to the horizontal plane. It is fixed spokes 4, 5 and the rods 7, using the brackets 3, the threaded support rack 10, the bolts specificatory 12, the nut 11.

It is necessary to consider that the distance between the surface of the pelvis and the ring should be at least 2.5 - 3 cm in order to avoid subsequent bedsores from the device.

In violation of the integrity of the front and rear semirings with an offset of half the and then enter the threaded rods 8 in the middle and posterior thirds of the crest of the Ilium at the level of 4 cm above from sagawara spine of the Ilium. Previously conducted skin incisions up to 10 mm and spend the rods 8 at an angle 8 to 10oto the sagittal plane open medially and perpendicular to the axis of the body of the patient at a depth of 5 cm Then injected rods 9 to the position of the sacrum.

The best area of introduction of the metal into the sacrum is the upper part of the lateral mass, corresponding to the first sacral vertebra. The landmarks of this anatomically optimal zones the following: the top border will serve as the point between the middle and posterior third of the iliac crest and the upper edge of the first sacral vertebra, the lower bound is 4 cm below the upper, medial 3 cm from lies lateral to the median crest of the sacrum, lateral - 4.8 - 5 cm laterally from the median crest of the sacrum. Enter rods in the center of this area to a depth of 15 - 16 mm at an angle of 8 to 10oto sagittal and 8 to 10 to the horizontal plane, i.e., the rod should be directed to the midline and down.

The rod 9 is fixed to the arc 1 external support through interconnected mutually perpendicular is all its elements after x-ray control perform the desired reduction. Upper sections of the iliac bones set with spokes with supports. For this purpose, both ends of the spokes 5 and 6 alternately partially released from the rigid fixation, then one end of each of the spokes tensioned with removable spiranthinae (not shown) or by twisting spokes on the bolt head of specificator 12, while the fragments are shifted in the right direction rear-to-front or front to back to align with the stop 6 spokes. The middle and lower parts of the iliac bones of the pelvis set with managed threaded rods 8, entered at considerable depth up to 5 cm In fractures of the middle part of the anterior iliac bones can be reposition of bone fragments using rods 7.

When fresh injuries of the pelvic ring with a dislocated sacrum is a single stage reduction by means of adjustable threaded rod 2, with arc support ring diluted to the required distance in the horizontal plane, the nuts 13 on the rods 9 are relaxed (internal or external depending on the direction of the displacement of the sacrum). By tightening the nuts 13 on the two threaded rods 9 are lumbar sacrum. Fractures of the sacrum and Pereloma-dislocations on the icii fragments of the sacrum is the compression ratio, by approximating arcs 1 support ring by means of the threaded rod 2. This is achieved by the effect of eliminating bias in the sacroiliac joints, which is a prerequisite for successful treatment of severe damage to the ligaments.

The displacement of the pelvic bone width (in the horizontal plane) reposition carried out by changing the distance between the arcs 1 of the device by increasing or decreasing the amount of adjustment of the threaded rod 2.

Offset halves of the pelvis height is eliminated by changing the position of the arcs of the apparatus in the frontal plane, by changing the height of the brackets 3, which are attached to the adjusting threaded rod 2.

The displacement of the pelvis anteroposterior direction (sagittal plane) eliminate the change of the distance between the arcs 1 and the body of the patient by moving the threaded rods 7, 8, 9 and spokes 4, 5.

The order of elimination of offsets as follows: first, eliminate the offset in the front, then in the sagittal and, finally, in horizontal planes.

Most reposition carried out during surgery under General anesthesia, a slight shift usually resolve in 2-3 days the Denia-half outer bearing 1-2 mm until it locks in place.

After the final reposition the device rigidly stabilize.

The term fixation device for fractures of the pelvic bones is 7-8 weeks, and when the gaps of the joints and poluustav hip subluxation his half to 12 weeks. The time of fixing in the apparatus caused by biological time of fusion of the bones, which is equal to 8 weeks. Joints and poluustav grow after 10 - 12 weeks.

The proposed method for the treatment of injuries of the pelvic ring and the compression-distraction apparatus for its implementation have the following advantages compared with prototype:

providing managed closed reposition and secure fixation of the bone fragment pelvic ring with primary damage rear by the Department;

improvement of the dynamic stabilization device in the postoperative period and its fixation capabilities, due to the uniform distribution of dynamic and static effort on the pelvic ring;

the ability to force changes in any need to reposition direction;

increase the possible traumas blending apparatus and reducing the time of its imposition on the pelvic ring;

improving the quality and safety reposition for the account optimizely pelvic ring by transosseous holding the bones of the pelvis front and rear locking elements, in the thin part of the pelvic bones impose spoke with emphasis, and in massive part to impose threaded rods, some spokes are conducted through peredniene spine of the Ilium in thickness of the anterior third of the crests of the iliac bones, the other spokes to carry through the middle third of the crests of the iliac bones, some threaded rod is introduced into Peradeniya spine of the Ilium, the other threaded rods enter into the middle and posterior thirds of the crests of the iliac bones, reposition and fixation of bone fragments using a compression-distraction apparatus, characterized in that the needles are drawn through the front of the upper spine of the Ilium in thickness of the anterior third of the ridges, bring on the border between the anterior and middle thirds of the crest, spokes drawn through the middle third of the crests of the iliac bones, bring on the border between middle and posterior thirds of the crest of the threaded rods is introduced into the lower front spine of the Ilium perpendicular to the vertical axis of the patient's body at an angle to the sagittal plane, in the middle of the posterior third of the iliac crests bone cutting rods enter from above the rear-upper spine of the Ilium perpendicular to the vertical axis of the patient's body at an angle to the sagittal plane and the s ridge of the Ilium at the level of the upper edge of the first sacral vertebra in toward the midline down at an angle to the sagittal and horizontal planes.

2. Compression-distraction apparatus for treatment of injuries of the pelvic ring containing support in the form of two arcs, the ends of which are connected to the adjusting threaded rod through the brackets installed on the arcs, the spokes with the lugs and threaded rods fixed on the arcs of the through bolts-specification and brackets, characterized in that it is provided with a threaded shank for fixing and reposition the sacrum, each of which is connected with the arc of the mutually perpendicular arms, one of which is fixed on the abutment screw rack, attached to the arc, the other is connected with a threaded rod for fixing and reposition the sacrum.

 

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