A method of treating unconsolidated postoperative sagittal cut of the sternum

 

The invention relates to medicine, namely to traumatology, surgery. Through skin punctures at a distance of 10-15 mm outwards from sawing the sternum at the two fragments form the vertical channels and set them in the rods, in this respect Renovationist the location of the rods, the rods connecting screw coupler, and on the area of the sternum set 2 and, if necessary, 4 devices, which provides a high static fragments of the sternum, is controlled management of the fragments of the sternum, the operation traumatic excluded through passage of the sternum, which eliminates the risk of infection and damage to the organs of the mediastinum. 2 Il.

The invention relates to medical equipment, namely for the surgical treatment of postoperative complications on the part of the sternum and mediastinum, developing in the early and late postoperative periods, during operations on the heart and mediastinal performed during thoracotomic cisternal sagittal access (median sternotomy), also may use in traumatology and orthopedics.

In practice, the treatment of paleoeconomy retry the operation with a large skin incision and exposure of the sternum, i.e., open method, similar to heart surgery. Performed operational remedial measures and re-stabilization is sawing the sternum overlay “bone” wire weld or apply designs stabilization of metals with “shape memory” of nitinol titanium. In addition, in the postoperative period to improve the stabilization of the sternum apply outdoor corsets.

It is known that heart operations, access to the breastbone (median sternotomy) is carried out by a skin incision over it, then after display of the sternum her cut with a special saw, sternotomy, saw Gildi or ultrasound, and after the necessary actions at the end of the operation the edge of the sternum map (repairbot) and sew it wire or Mylar seams (Great medical encyclopedia under the General Ed. B. C. Petrovsky, T. 13, M, 1980, S. 522).

However, often in the postoperative period and during a second operation when consolidatednet sagittal cut of the sternum, the method does not provide the implementation of the main conditions for reparation of bone - creation of complete immobility of the bone fragments tissue, because the remains of micro - and macrodyne in the zone of contact between the cutting of the sternum each time breathing the AI chest is relative and does not assist in creating the conditions for stabilization of bone fragments of the sternum and often leads, especially in elderly patients, in violation of external respiration, which in turn leads to various complications (pneumonia and other). Furthermore, the method of operating vysokoaromatichnyj, because it requires a large skin incision at the outcrop of the sternum.

The task is to create conditions absolute stillness and automatic control of the fragments of the sternum in the treatment of consolidatednet sternum in the postoperative period after its sagittal cut and minimal invasiveness of the surgery, is solved as follows.

In the method of treating unconsolidated postoperative sagittal cut the sternum by reposition and stabilize the fragments of the sternum, according to the invention, performed a closed reduction and stabilization of the fragments of the sternum using a core device, which through the skin puncture at a distance of 10-15 mm outwards from the line of cut in fragments of the sternum form the channels to a depth of 5-7 mm, vertically to the plane of the sternum, which enter the stabilization rods, channels on opposite fragments of the sternum have on one horizontal line, the area of the sternum set two, and if necessary, 3-4 device.

The device will win two of the stabilization rod, screw rod and a nut, with the stabilization rod has a support platform, separating the rod to the screw self taping connector part length 10±0.2 mm, insertion into the bone, and the outer part, with a head on the end, which made the hole for the connection of the stabilization rods screw coupler.

Vertical forming channels to the plane of the sternum and the location of channels on opposite fragments of the sternum on the same horizontal allows you to set the stabilization rods perpendicular to the plane of the sternum and parallel to each other, and this in turn allows private automatic smoothawley (autoraporwanie) fragments of the sternum during execution of the operating methods of using the device. The distance of 10-15 mm outwards from the cutting line to form channels and the length of the channels 5-7 mm determined from the condition not to damage the edges of the fragments of the sternum and the inner cortical plate of the sternum. In addition, the surgical technique, the formation of channels through the skin puncture, traumatic in comparison with analogues, requiring a large skin incision with the outcrop of the sternum.

Terms of verticality and ranaganathanandaji installation stabilization, the principle of parallelism of the opposite sides of the rectangle. The implementation of the kinematic scheme when the device is in the formation of the rectangle is achieved through structural laid in the stabilization rod support point (conditionally) separating the rod to the screw self taping connector portion, the insertion into the bone, which is constant in size in height (due to the anatomical size of the bones), and wystawy over the skin of the outer part of the rod with the hole in the head for holding ties and fastening nuts.

The presence of a basic platform stabilization rod excludes its end-to-end trasgredire passage, respectively, eliminates trauma to the tissues of the mediastinum, which is important in the operation of the mounting device by the closed method. The layout of foothold on the stabilization rod is selected so that when the conducting phase of the operation is “insert” in the sternum bone stabilization rod always ended only intraosseous his standing, i.e., the installation of the rod with the data sizes of its screw, self taping connector part (10±0.5 mm) excludes its end-to-end trasgredire passage into the mediastinum and therefore not pavlidou sternum plate allows the operation to exclude primary intraoperative mediastinal infection, and the development, rehabilitation of complications such as inflammation of the soft tissues in the place of standing stabilization rod stored internal cortical lamina of sternum performs the functions of anatomical and physiological barriers contact infection of the mediastinum.

When closing the coupler nuts on one of the heads of the stabilization rod of the thrust vector of the screw rod on the second cylinder opposite to the fixed core provides automatic output of the opposite half of the sternum at repositional level. Installation of two parallel devices on the area of the sternum provides a high static stability of the fragments of the sternum. Depending on the area of the sternum, representing the operative field, it is possible to install up to 3-4 devices, which increases the stabilization of the fragments of the sternum that can be useful in clinical practice.

Thus, the proposed method and device for treating unconsolidated postoperative sagittal cut the sternum enable the absolute stillness and automatic controlled management of the fragments of the sternum with minimal trauma of the operation.

In Fig.1 shows the installation in the bone; in Fig.2 - the stabilization rod.

The stabilization device comprises a pair of rods 1, the screw coupler 2, connecting them together, and the nut 3, which allows to manage using the stabilization rods fragments of the sternum in the modes of compression-distraction. The stabilization rod 1 is inserted through the puncture in the skin and subcutaneous tissue 4 and in the fragments of the sternum 5.

The stabilization rod has a support platform 6 (D=8 mm), dividing the core into two parts: screw self taping connector part 7 (D=6.5 mm, thread pitch 2 mm), insertion into the bone, the length of which is 10 mm, and wystawy over the skin of the outer part of the rod (D=3 mm) with a head 8, which made the hole 9 (D=6.2 mm) for screw couplers 2 and its four fixing nuts 3 (M6 thread).

In treatment technologies for stabilization of the sternum using at least two devices. In addition to improving stabilization, it allows for the development of complications any one of the installed devices to carry out the removal and repositioning of the device in a new place without interrupting the continuity hold bone fragments in parallel standing device.

The method is as follows.

Perform skin puncture size 3-4 mm in place of the planned what Verl diameter of 2.0-2.2 mm or dental drills of the same diameter to form a vertical channel in the breastbone (strictly perpendicular to the plane of the sternum) to a depth of 5-7 mm and establish - “cut” made in the bone channel stabilization rod. In this same sequence, perform installation of the second stabilization rod to the second fragment of the sternum, keeping Renovationist their location and parallel to each other. Spend screw plate 2 through the holes 9 in the heads of the stabilization rods and nuts close 3. The second device, and, if necessary, third and fourth, establish the area of the sternum parallel to the first.

Depth control installation of the stabilization rod 1 in the chest can be performed as a “sidebar” - svorachivanie rod until it stops in the movement of the supporting platform 6. In some cases, when the bone of the sternum thinner anatomical rules, you can control the depth of installation of the stabilization rod is performed by counting the number of complete rotations of the rod when it is installed in the bone. Construction the screw part of the screw stabilization rod performed with a step of 2 mm, This allows you to control the depth of occurrence of the stabilization rod into the bone, because the first time the stability of the rod into the bone one full turn of the head rod 360° corresponds to a depth of 2 mm, with 2 of t is t as follows: distraction - is provided by movement of the inner nut on the screw coupler outwards; the compression movement of the nuts on the screw coupler inside.

The movement of the fragments of the sternum in the horizontal plane is also manageable because one turn of the nut on the screw coupler corresponds to the movement of 1 mm.

The proposed method of treatment of postoperative complications in surgery of the sternum of the proposed device is fundamentally different from the currently accepted and has the following advantages:

1. Performed by the closed method, without large incisions in the skin and easy to execute.

2. Minimum traumatiserede soft tissue and bone.

3. Provides self-mapping (automatically) bone fragments of the sternum.

4. Allows controlled mode control formation of bone regenerate in compression-distraction mode.

5. Ensures a high level of stabilization of the fragments of the sternum in the postoperative period in the long time mode.

6. When complications occur on one of the installed devices allows removal and repositioning it in a new place without interrupting the continuity hold bone fragments in parallel standing device.

7.yle="text-align:center; margin-top:2mm;">Claims

A method of treating unconsolidated postoperative sagittal cut of the sternum, which includes the reduction and stabilization of the fragments of the sternum, characterized in that through a skin puncture at a distance of 10-15 mm outwards from the line of cut in fragments of the sternum form the channels arranged vertically to the plane of the sternum, the channels have on one horizontal line in the channels enter rods with the base platform, the rods connecting screw coupler, and on the area of the sternum set 2 and, if necessary, 3 or 4 devices.



 

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