The method of osteosynthesis of fractures of the sternum

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology, and can be used for osteosynthesis of fractures of the sternum. Produce reposition and fixation of bone fragments device from an alloy with shape memory in the form of an open ring with shoulders and locking legs that before installing cool and deform. The legs of the device arcuate curved in the plane perpendicular to the plane of the ring, and are directed in opposite directions from the center. Form channels in the fragments of the sternum to install the legs of the device through the outer cortical plate and cancellous to the inner cortical plate towards the opposite side of the fracture. Place the legs of the device between the cortical plates of the sternum. Set the plate of porous nitinol under the osseous portion of the device. In the particular case of the plate of porous nitinol has a thickness of 0.05 cm and linear dimensions corresponding to the dimensions of plate of the device. In the particular case to create when osteosynthesis in the zone of fracture compression device after cooling deform, increasing the distance between the legs. In h is comfort, reducing the distance between the legs. In the particular case when osteosynthesis in the neutral position of the device after cooling deform without changing the distance between the legs. The method ensures the stability of the osteosynthesis, to reduce the trauma, to optimize the reparative processes in the fracture area. 4 C.p. f-crystals, 8 ill.

The invention relates to medicine, namely to traumatology and orthopedics.

Fractures of the sternum with displacement of bone fragments are in the structure of closed injuries of the chest 1-1,5% belong to severe skeletal injury and is accompanied by dysfunction of the respiratory and cardiovascular systems, which aggravates the condition of the victims and worsens the prognosis. The main link of pathogenesis: damage to the bone of the skeleton of the chest with the change of pasnosti and biomechanics of breathing. Therefore, in the usual range of therapeutic activities in this pathology, is mandatory reposition and stabilize the fracture (Reut N. I. et al., 1971; Wagner, E. A. et al., 1981; Sapozhnikova, M. A. et al., 1988).

The known method of osteosynthesis of fractures of the sternum with spokes and apparatus for stitching the sternum and ribs cGy-20, which consists in the following. The incision is made vertically prerivaetsa to the bone with metal staples apparatus cGy-20 (Chapot Y. B., Bulletin of the surgery. Grekov, 1981, 5, c.111).

The disadvantages of the method.

1. Trauma: breadth of access, significant damage to the periosteum.

2. Good fixation is achieved by fixation of the sternum in two spokes imposed on the right and left.

3. The necessity of the institution of the apparatus cGy-20 behind the sternum increases the possibility of damage to internal organs.

4. Damage to the internal cortical plate brackets increases the risk of infection of the mediastinum.

The known method of osteosynthesis of fractures of the sternum, which in the open reposition of bone fragments and their fixing plate with screws (cebulak, N., 1995, H. Luhr et al., 1981).

The disadvantages of the method.

1. Trauma: breadth of access, significant damage to the periosteum, the massiveness of the structure.

2. The possibility of damage to the internal organs with the passage of the drill through the inner cortical plate of the sternum.

3. Damage to the internal cortical plate sternum increases the risk of infection of the mediastinum.

4. Inefficiency in osteoporosis due to thinning of the cortical plates of the sternum.

with thermo-mechanical shape memory in the form of an open ring with shoulders (plate portion) and the locking legs (intramedullary part), located in the plane perpendicular to the plane of the ring, and directed to the center (A. C. 850067, M. class. And 61 In 17/18, 1981 ). After exposure and reposition of the fracture by means of a drill or awl in each fragment are formed channels for intramedullary the legs of the clip, directed towards each other. The distance between them should be 1.0-1.5 cm longer than the length of plate portion of the bracket. Design watered-chloroethyl 1-2 min and deformed: increases the distance between the intramedullary legs, and the actual legs unbent. In this form, the legs are inserted into the channels, and bone fixing part of the fixing device is pressed against the bone. The wound is washed with hot saline solution. After contact heating of titanium nickelide shows the shape memory effect, the design tends to assume its original shape, creating a zone of fracture compression (centuries Kotenko. Guidance on the application of clamps to thermo-mechanical memory, 1996, S. 71).

The disadvantages of the method, selected as a prototype:

1. The latch works only in the compression mode, when the oblique fractures of the sternum lead to secondary displacement of bone fragments.

2. Lack of stability in comminuted fractures of the piles of the second plate sternum weakens the strength of fixation.

4. Trauma: channels for intramedullary the legs of the clamps are formed in the direction of the zone of fracture, leading to Dalaman cortical plates of the sternum; the pressure plate clamps parts of the adjacent bone causes a disturbance of microcirculation in this place.

The objective of the invention is to provide a stable osteosynthesis transverse, oblique and comminuted fractures of the sternum, the reduction in the morbidity and operative time, optimization of reparative processes in the fracture area.

This object is achieved in that for osteosynthesis transverse, oblique and comminuted fractures of the sternum is composed of an alloy with shape memory in the form of an open ring with a shrug and an intramedullary locking legs. Before installing the unit cool and deform. Intramedullary legs are arcuately curved in the plane perpendicular to the plane of the ring, and are directed in opposite directions from the center. To install intramedullary legs in the fragments of the sternum channels are formed through the outer cortical plate and cancellous to the inner cortical plate towards the opposite side of the fracture. After installation of the device the plates. To create when osteosynthesis in the zone of fracture compression device after cooling deform, increasing the distance between the intramedullary legs. To create during osteosynthesis of the fracture area of the distraction device after cooling deform, reducing the distance between the intramedullary legs. When the osteosynthesis of bone fragments in the neutral position of the device after cooling deform without changing the distance between the intramedullary legs. Under the osseous part of the device set a plate of porous nitinol thickness of 0.05 cm and linear dimensions corresponding to the dimensions of plate of the device.

The novelty of the method:

1. Intramedullary leg device arcuate curved in the plane perpendicular to the plane of the ring.

2. Intramedullary legs of the device in opposite directions from the center.

3. Channels in the fragments of the sternum to install intramedullary legs of the device are formed without damage to the internal cortical plate and are directed to opposite sides of the fracture.

4. After installing the device and its termovosstanovleniyu intramedullary legs, curving arcuate, fixed what s one form of compression, distraction or a simple commit.

6. Under the osseous part of the device set a plate of porous nitinol.

7. Plate of porous nitinol has a thickness of 0.05 cm and linear dimensions corresponding to the dimensions of plate of the device.

The invention is illustrated by drawings, where Fig.1 shows the device in side view; Fig.2 - the same, top view; Fig.3 - the formation of channels for intramedullary legs of the device in the bone fragments of the sternum; Fig.4 - strain after cooling device for creating a zone of compression fracture (arrows show that the distance between the intramedullary legs increases), and Fig.5 - osteosynthesis transverse fracture of the sternum using devices and plates of porous nitinol, side view; Fig. 6 is a top view of Fig.7 - strain after cooling device for creating a zone of fracture distraction (arrows show that the distance between the intramedullary legs decreases), and Fig.8 - osteosynthesis oblique fracture of the sternum using devices and plates of porous nitinol, side view. Numerals on the drawings indicated the following: 1 - the circle of your device; 2 - shoulders of plate h is CI intramedullary legs of the device; 6 - outer cortical plate; 7 - internal cortical plate; 8 - fracture area; 9 - vinyl porous nitinol. The essence of the method consists in the following.

Under General anesthesia, the patient on the back, the median vertical incision to 5.0-6.0 cm from the middle in the projection of the fracture exposed bone fragments 4, establishes the nature of the fracture of the sternum, is reposition. When using the drill in the outer cortical plate 6 of each fragment are formed holes with a diameter of 0.2 cm for intramedullary the legs 3 of the device. For transverse fractures of the sternum distance between them should be 1.0-1.5 cm longer than the length of plate of the device. Through formed holes with an awl with a diameter of 0.2 cm in the direction opposite to the zone of fracture 8 directions, an angle of 30 degrees to the bone, cancellous formed channels 5 length 2.0 cm without damage to the internal cortical plate 7 (Fig.3), which avoids damage to the organs of the anterior mediastinum and infections. Design watered-chloroethyl 1-2 mines and deformed: increases the distance between the intramedullary legs 3, the actual legs straightened (Fig. 4). In this form the legs 3 without Troyes 9 with a thickness of 0.05 cm (linear dimensions match the dimensions of plate parts latch), pre-Packed on the bone 4. Plate of porous nitinol is set for normalization of reparative processes in the fracture area and reducing the pressure plate of the device to bone. The wound is washed with hydrogen peroxide or hot saline solution. After 30 seconds, due to surface heating of titanium nickelide shows the shape memory effect, and the design tends to assume the original shape. This intramedullary legs 3, curving, its arcuate part rest against the inner cortical plate 7, and ends in the outer cortical plate 6, is securely fixies between them. Reducing the distance between the legs 3 creates compression in the fracture area 8 (Fig. 5 and 6). The wound is sutured, drain, place a sterile dressing.

For oblique fractures of the sternum compression to the fracture area 8 is not needed, as it can lead to secondary displacement of fragments 4. Therefore, the distance between the formed in the bone fragments channels 5 should be 0.5-1.0 cm less than the length of plate of the device. Design watered-chloroethyl and deformed by decreasing the distance between the intramedullary legs 3, the actual legs straightened (Fig.7). In this VI nitinol 9, pre-placed on the bone. After heating titanium nickelide shows the shape memory effect, the design tends to assume its original shape, creating the fracture area 8 a distraction, balancing the thrust of the pectoral muscles (Fig.8).

For comminuted fractures of the sternum necessary fixation of bone fragments 4 in the neutral position. Therefore, the distance between the formed in the bone fragments channels 5 should be equal to the length of the plate part of the device (Fig.1 and 2). After irrigation chloroethyl deformed design: straight intramedullary leg 3, the distance between the legs remains unchanged. After installation and contact heat release shows the shape memory effect, the design seeks to adopt the original form, firmly locking arm 4 in the neutral position. When performing any type of osteosynthesis should be respected main condition: to ensure stable fixation intramedullary leg 3 of the device is to be fixed between the two cortical plates 6 and 7 bone fragments 4. In the postoperative period is assigned to symptomatic therapy, physical therapy, therapeutic exercise, massage. The duration of stay Bolkhov fractures of the sternum it is 7-10 days, working ability is restored through the month.

Here are clinical example

Patient S. , 25 years old, enrolled in the Department of trauma 04.09.00 diagnosed with a closed fracture of the body of the sternum with displacement of fragments. Under General anesthesia surgery: open reduction of fracture, osteosynthesis device with shape memory. In the position of the patient on the back, the median vertical incision up to 5.0 cm in the middle of the projection of the fracture with exposed bone fragments, held reposition. When using the drill in the outer cortical plate of each fragment formed holes with a diameter of 0.2 cm for intramedullary legs of the device. The distance between the holes 4.0 cm, the length of the plate part of the device 3,0 see Through the prepared holes with an awl 0,2, see opposite from the zone of fracture directions, an angle of 30 degrees to the bone, cancellous formed channels to 2.0 see everyone, without damage to the internal cortical plate. The device is washed with chloroethyl for 1 min and strain: increased to 4.0 cm distance between intramedullary legs, the actual legs straightened. In this form the legs put into the formed channels, and osseous part is pressed against the porous plate NIT is defined on the bone. The wound is washed with hydrogen peroxide. After 30 seconds, due to surface heating of the metal and the effect of shape memory device is securely fixed in the bone, creating compression in the fracture area. Operating the wound is sutured in layers, drained imposed aseptic bandage. In the postoperative period were symptomatic treatment, physiotherapy, therapeutic exercise, massage, incentive spirometry. The wound healed by first intention, the sutures were removed after 8 days. Functional characteristics of the respiratory and cardiovascular systems were normal, the patient was discharged to outpatient treatment. Ability to work recovered after 4 weeks since the injury.

The proposed method operated 15 patients with fractures of the sternum. Complications associated with the surgery, was not. All patients at the control examination noted: the absence of pain and visible chest deformity, normal functional characteristics of the respiratory and cardiovascular systems, bone fracture fracture endosteal corn. All patients returned to their former place of work. 10 man of steel easily removed after 2-3 months, although, due to high biological inert the CT:

1. Stable osteosynthesis transverse, oblique and comminuted fractures of the sternum device of the same shape and size.

2. Reducing the morbidity and operative time: the size of the wound is determined by the length of plate of the device; a developing device forces are applied within healthy bones (no fracture).

3. The fracture of sternum fracture endosteal corn due to the normalization of microcirculation and optimization of reparative processes in the fracture area.

4. The decrease in the period of incapacity.

1. The method of osteosynthesis of fractures of the sternum, which includes the reduction and fixation of bone fragments device from an alloy with shape memory in the form of an open ring with shoulders and locking legs that before installing cool and deform, characterized in that the legs are arcuately curved in the plane perpendicular to the plane of the ring, and are directed in opposite directions from the center, to install intramedullary legs in the fragments of the sternum to form channels through the outer cortical plate and cancellous to the inner cortical plate towards the opposite side of the fracture, with vozvrat plate of porous nitinol.

2. The method according to p. 1, characterized in that the plate of porous nitinol has a thickness of 0.05 cm and linear dimensions corresponding to the dimensions of plate of the device.

3. The method according to p. 1, characterized in that building when osteosynthesis in the zone of fracture compression device after cooling deform, increasing the distance between the legs.

4. The method according to p. 1, characterized in that building during osteosynthesis of the fracture area of the distraction device after cooling deform, reducing the distance between the legs.

5. The method according to p. 1, characterized in that when the osteosynthesis in the neutral position of the device after cooling deform without changing the distance between the legs.

 

Same patents:

The invention relates to medicine, treatment of injuries to the musculoskeletal system using software-implemented simulation methods

The invention relates to medical equipment and can be used in traumatology and orthopedics

The invention relates to medical equipment and can be used in traumatology, orthopedics and dentistry

The invention relates to medicine, namely to traumatology and orthopedics, and is intended to prevent instability of the acetabular component of the prosthesis after implantation of an artificial hip joint when the defect of the posterior edge of the acetabulum

The invention relates to medicine, in particular to orthopedics, and can be used for the treatment of patients with bone deformations under imperfect osteogenesis
The invention relates to medicine, namely to traumatology in the treatment of hip fractures

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for clinching the ends of the spokes, in particular in the operating wound with submersible osteosynthesis spokes

The invention relates to medicine and can be used during surgery to reposition and fixation of bone fragments

The invention relates to medicine, namely to traumatology and is intended to reposition the distal tibiofibular of SYNDESMOS and eliminate external subluxation of the foot

Repeater-defender // 2160064
The invention relates to medicine, namely to reconstructive microsurgery, and is used to reposition the bone fragments and protection of soft tissues during autotransplantation of the toes with the foot brush
The invention relates to medicine, in particular to neurosurgery
The invention relates to medicine, in particular for orthopedics and traumatology, and can be used to restore the relationship of the articular surfaces of the knee joint for the rear subluxations and dislocations, reservaciones and other strains that have developed as a result of disturbances of spatial orientation proximal epimetaphyseal tibia (BBK)

The invention relates to medicine, namely to traumatology and is intended for treatment of traumatic injuries of the heel bone with displacement of bone fragments

The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable for the treatment of chronic damage to the symphysis and sacroiliac joint

The invention relates to medicine, namely to traumatology and can be used in the treatment of patients with fractures of the Shin bone

The invention relates to medicine, namely to the treatment of chronic and incorrectly non-Union of femoral fractures vertelney area
The invention relates to medicine, in particular for hand surgery to restore the function of gripping the brush after her injury
The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable for the surgical treatment of bone cysts

The invention relates to medicine, specifically to surgery, can be used in the treatment of chronic osteomyelitis of long tubular bones

The invention relates to medicine, namely to orthopedics in the treatment of hip joint

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

Up!