Method of treating juvenile epiphysiolosis of femoral bone head in children

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to orthopedics. Skin and subcutaneous fatty tissue are cut on anterior surface of iliac region. Muscular tissue is immobilised in obtuse and acute way. Periosteum of iliac bone between anterior-upper and anterior-lower spines is exposed, periosteum is cut longitudinally and separated with raspatory. Two tunnels are made in front plane by means of drill. After that threaded rods with diameter 5-6 mm are screwed to the depth 3-4 cm. In lower third of femoral bone two cuts are made with scalpel. Trocar is introduced to bone. Through trocar bush two tunnels are frilled in bone, fixing threaded rods are screwed into tunnels. After that, by means of "МКЦ" apparatus gradual distraction and rotation inwards on femoral bone axis is performed at the rate 1-2 mm per day by rotation of nut on threaded rods in various planes for two-three weeks. Fixation of head and neck of hip is realised by bundle of wires, which are installed along hip neck, crossing growth zone. After that "МКЦ" apparatus is dismantled and plaster bandage is applied until bones knit completely.

EFFECT: method ensures gradual reposition of epiphysis, possibility to compensate vascular net to changing spatial position.

1 ex, 8 dwg

 

The invention relates to medicine, in particular to orthopedics, and can be used in the surgical treatment of patients with juvenile epiphysiolysis with varying degrees of displacement of the femoral head, and at the femoral neck and femoral head.

The basis of disease is a violation of the relationship between the pineal gland and the neck of the femur in the region of the growth zone. The offset of the femoral component in the proximal direction and posterior relatively shifting epiphysis leads to disruption of relationships in the hip joint, which is clinically manifested pathological external rotation of the hip and shortening, the lack of abstraction and internal rotation. The most important point is the violation of the trophic epiphysis of the femur as a result of displacement relative to the femoral segment. In this condition, the displacement of the epiphysis occurs gradually, less acute as a result of injury. In this regard, there is a possibility of compensation vascular network to the changing geometry. As a one-time reduction of the hip during surgery for the reduction of the femoral head becomes dangerous, there is an opinion that this method is contraindicated in this condition. Should be a gradual reduction, providing the possibility of compensation of the vascular network of the femoral head.

There is a method of treatment of dislocation be the RA (RF patent No. 2139689), including the reduction of the femoral head in the acetabulum with external fixation device, when dosed reduce thigh, then put her in the position of maximum orientation of the articular surface of the epiphysis of the head to the tenderloin acetabular dosed with subsequent movement of the head by cutting hole in the acetabulum. In the method using the apparatus for treatment of hip dislocation, containing the pelvic and thigh support, interconnected repositioning nodes, distraction rods with hinges, spokes and fixation, each repositioning unit is designed in the form of a crank mechanism, a movable element which is fixed on the femoral bearing and fixed on the pelvic support, with the latter pivotally connected to the frame, provided with a distractor.

The disadvantage of this method is the complexity of the structures.

A known method of surgical treatment of youth epiphysiolysis of the femoral head in the absence of serotoninovye (D.M. Dunn, Angel J.C. Replacement of the femoral head by open operettion in severe adolescent slipping of the upper femoral epiphysis // J. Bone Jt. Surg. - 1978. - Vol 60, 3. R-410), which is in the open position of the epiphysis of the femoral head with the prior partial resection of the neck of the femur at the level of paramilitary zone.

However, this method does not guarantee with rannot rear epiphyseal vessels when conducting a partial resection of the femoral neck, and this can lead to avascular necrosis of the femoral head. In addition, suzannet surgical field makes it difficult excision paramilitary zone and, accordingly, the adaptation of the epiphysis of the femoral head and neck in the correct position.

There is a method of treatment of youth of epiphysiolysis (RF patent No. 2256418), which includes the reposition of fragments hips, fixing the last entered on the axis of the neck beam spokes, femoral and iliac bones external fixation device with the creation of conditions of discharge in the hip joint to the consolidation of the fragments during the reposition of fragments after hip external rotation, extension and bring the hips in the position of the epiphysis fix transacetylase entered spokes, then the hip bend, rootroot medially and assign, and then fix the mapped result in fragments with a bunch of spokes, remove transacetylase previously entered in the spokes and giving hip position normokalemia, perform osteosynthesis of femoral and iliac bones external fixation device.

The disadvantage of this method is the additional trauma of the displaced epiphysis of the femoral head as in the time of transacetylase spokes, and during the immediate elimination of the displacement of the epiphysis.

The method chosen for the prototype.

The present invention is who I eliminate displacement of the epiphysis of the femur in a young epiphysiolysis.

The technical result aimed at solving the problem, is the gradual reduction of the epiphysis, which allows to preserve the vascular network.

The method consists in that in the method of treating youth epiphysiolysis of the femoral head in children, including the reposition of fragments after hip external rotation manually, the fixation of the head and neck of the femur with a bunch of spokes, osteosynthesis of the femoral and iliac bones external fixation device, the external fixation device install rod compression-distraction apparatus ICC, pre-on the anterior surface of the Ilium an incision of skin and subcutaneous fat, stupid and badly immobilizing muscle tissue, secrete periosteum of the Ilium, between the front-top and front-bottom awns, longitudinally cut the periosteum and separated by rasputia produce two tunnels in the frontal plane with the drill, then twist the threaded rods with a diameter of 5-6 mm to a depth of 3-4 cm, then in the lower third of the femur produce two incisions with a scalpel, enter the trocar to the bone, through the trocar sleeve in the bone drill two tunnels, the tunnels screw fixing threaded rods and with the help of MCC, then by the apparatus MCC carry out the gradual the mental distraction and rotation medially along the axis of the femur at the rate of 1-2 mm per day by turning the nuts on the threaded rods in different planes within two three weeks the fixation of the head and neck of the femur is performed by the beam spokes, which are mounted along the femoral neck, crossing an area of growth, then the device ICC disassemble, apply a plaster cast to complete the splicing of bones. The method is as follows:

Make the mounting rod of the external fixation device ICC (RF patent No. 2050839) 2 proximal terminals of the Trench is introduced into the region of the lower front spine and the wing of the Ilium, the distal portion over the middle third of the thigh on the 3 rods in different planes. Pre-on the anterior surface of the Ilium an incision of skin and subcutaneous fat, stupid and badly immobilizing muscle tissue, secrete periosteum of the Ilium, between the front-top and front-bottom spines, longitudinal cut through the periosteum and separated by rasputia produce two tunnels in the frontal plane with the drill, then twist the threaded rods with a diameter of 5-6 mm to a depth of 3-4 cm, then in the lower third of the femur produce two incisions with a scalpel, enter the trocar to the bone, through the trocar sleeve in the bone drill two tunnels, the tunnels screw fixing threaded rods and establish core compression-distraction apparatus MCC.

When mounting the device choose the position of the distraction screw is of TERENA apparatus MCC, which contributes to the gradual reposition displaced epiphysis: the direction of installation of the device on clinico limbs and rotated medially.

Next, perform moderate manual elimination of abnormal external rotation, with slight traction along the axis of the limb. After x-ray control apparatus permanently mounted and fixed.

Within seven days after relieving pain spend gradual distraction of the axis of the femur with the rate of 2-3 mm per day by turning the nuts on the threaded rods in different planes within two to three weeks, performing osteosynthesis of femoral and iliac bones. Once a week, perform x-rays.

Then the second stage perform osteosynthesis of the femur beam spokes before dismantling the apparatus. Control is carried out by controlling the x-ray, confirming that the locking pins are installed correctly. Then put a plaster cast and x-ray determines that the displacement of the epiphysis is fixed, the position of the fragments is correct. Spokes removed 6 months after the seam and provide rehabilitation of the patient.

Clinical example: the Boy W., 12 years old, hospitalized in trauma and orthopedic Department of the ncla RAMS 19.03.09, in an emergency with a diagnosis of juvenile epiphysitis head left be the RA. Stage of acute slipping off.

Medical history: according to parents in the last 6 months, the child began to grow limp and fatigue. In connection with increasing pain in the left knee joint was referred to the clinic by place of residence. Performed the control of x-ray images of the knee joint revealed disease Osgood of Slatter. On the background of the disease the child was injured in the street after falling on his back and the area of the hip joint. In the emergency room at the place of residence made radiograph of the hip joint, the results of which the boy aims for a consultation at the ncla RAMS. Recommended surgical treatment in the Department of Orthopaedics and traumatology the ncla RAMS.

Orthopedic status: Walking on crutches because of pain. The left lower limb in the position of the abnormal external rotation to 90°. Marked shortening of the femoral segment 3 see Active movement in the hip joint are severely limited because of pain. Passive extension of 20°flexion 90°abduction 30°, adduction 20°, external rotation 110°, internal 0°. Circulation is not disturbed.

On the radiograph - the offset of the epiphysis of the femur to 1/2 the diameter of the femoral neck to the bottom.

01.04.09 surgery. Under General anesthesia the patient on the back hold the overlay article is rzavogo apparatus MCC. After processing operating margins three times the alcohol/iodine produce a linear skin incision on the anterior surface of the anterior lower spine of the Ilium on the left. Bluntly and sharply reveal the location of the proposed implementation of the rods of the Trench. Drill 4 mm form the channels and introduce two rods in the region of the lower front spine. The rods are fixed to each other by using the slide bar. Layers stitched up the wound. Closed set two rods in the region of the middle third of the anterolateral aspect of the thigh and collecting apparatus MCC in the position of the maximum possible internal rotation of the hip (figure 1). Perform the first radiograph (figure 2). In the postoperative period after relieving pain on the fifth day start reposition displaced epiphysis. Then carry out a gradual distraction and rotation medially along the axis of the femur at the rate of 1-2 mm per day by turning the nuts on the threaded rods in different planes. When experiencing significant pain syndrome reposition reduced to 1 mm per day. The appearance of the patient are presented in (figure 3). Control x-ray images of carry out 1 time per week (figure 4). On the 14th day after the second x-ray control determines that the displacement of the epiphysis removed (figure 5). Further reposition stop. The total duration of reposition is 2 weeks

Next, the second stage 16.04.09 child before Dismounting apparatus perform osteosynthesis of the femur by a bunch of spokes, which are mounted along the neck of the femur, across the growth zone (6). Then the device ICC disassemble. Control radiographs of the hip joint to confirm that the locking pins are installed correctly (Fig.7, 8.). Then put a plaster bandage. Control radiographs of the plaster cast can be seen that the displacement of the epiphysis eliminated. The position of the fragments is correct. The child was discharged to outpatient treatment, and the spokes removed 6 months after the splicing of the bones, which is confirmed by the control x-ray.

The proposed method solves the problem of the gradual reduction of the epiphysis, which allows compensation of the vascular network to the changing spatial position. In addition, after the reduction, you receive the opportunity to further commit to the moment of fusion. However, it is necessary to control the possibility of achieving reposition in order to prevent diastasis fragments.

The method is applicable for children and adolescents, in some cases, the application of adult patients.

The proposed method can be performed in any specialized hospital. Recommended for use in medical practice.

The method of treatment Yun is cheskogo of epiphysiolysis of the femoral head in children including the reposition of fragments after hip external rotation manually, the fixation of the head and neck of the femur with a bunch of spokes, osteosynthesis of the femoral and iliac bones external fixation device, characterized in that in an apparatus for external fixation set of core compression-distraction apparatus ICC, pre-on the anterior surface of the Ilium an incision of skin and subcutaneous fat, stupid and badly immobilizing muscle tissue, secrete periosteum of the Ilium, between the front-top and front-bottom spines, longitudinal cut through the periosteum and separated by rasputia produce two tunnels in the frontal plane with the drill, then twist the threaded rods with a diameter of 5-6 mm to a depth of 3-4 cm, then in the lower third of the femur produce two incisions with a scalpel, enter the trocar to the bone, through the trocar sleeve in the bone drill two tunnels, the tunnels screw fixing threaded rods, then use the apparatus MCC carried out gradual distraction and rotation medially along the axis of the femur at the rate of 1-2 mm per day by turning the nuts on the threaded rods in different planes within two to three weeks, the fixation of the head and neck of the femur is performed by the beam spokes, which are mounted along the femoral neck, crossing an area of the OST, then the device ICC disassemble and apply a plaster cast to complete the splicing of bones.



 

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FIELD: medical engineering.

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3 ex, 3 dwg

Orthopaedic device // 2517605

FIELD: medicine.

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Robot arm apparatus // 2541754

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine. A device for treating bone fractures comprises a number of levers, a number of joint elements, a mechanical device, a controller and a frame. Each of the levers extends from a proximal end to a distal end and is movable in the three-dimensional space. The proximal end of each lever is connected to the frame. Each of the joint elements is connected to the distal end of the respective lever, wherein the joint element encloses and blocks a bone fixation element attached to the respective bone fragment so that each of the levers is connected to the respective bone fragment. The mechanical device makes the lever move for advance each of the levers in relation to the frame. The controller obtains data respective to a desired final position of the bone fragments in relation to each other and controls the mechanical device to advance the levers in relation to each other for achieving the desired final position of the bone fragments in relation to each other. The frame comprises a long element with a number of levers attached thereto. The long element is configured rotatable to rotate a number of levers in relation to the frame. A method of treating the bone fractures involves: attaching a first bone fragment to a first bone fixation element and a second bone element to a second bone fixation element; connecting a distal end of the first lever with the first bone fixation element and a distal end of the second lever with the second bone fixation element; each of the first and second levers extends between the distal end and proximal end connected to the frame; the frame comprises a long element with a number of levers attached thereto; the long element is configured rotatable to rotate the first and second levers in relation to the frame; obtaining the data corresponding to the desired final position of the first and second bone fragments in relation to each other; and controlling the mechanical device to advance the first and second levers in relation to each other to achieve the desired final position of the bone fragments.

EFFECT: inventions enables calculating and controlling the force, direction and rate of the process.

23 cl, 13 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Set for repositioning and external fixation of fragments of bones of extremities and/or pelvis comprising placed in container at least one fiberglass bar of X-ray transparent material, at least two Schantz pins, at least one retainer and T-shaped switch for manual insertion of Schantz pins during operation and tightening of fixator clamp nut. Schantz pins have on proximal end side cortical thread with helical, self-threading and self-tapping sharpening, from distal end - polyhedral shape and annular groove, made on trihedral profile for fixation of Schantz pin in T-shaped switch to prevent spontaneous fall out of Schantz pin from T-shaped switch during operation. Fixator is made solid and includes at least two clamping units, each of them comprises two clamping jaws - internal and external. Clamping units are connected by axial screw provided with retainer, placed on one side of axial screw, and clamping nut, placed opposite side of axial screw on its threaded part. Spring element is placed between clamping units and provides at extreme “free” position of clamping nut arrangement of clamping units on axial screw at distance from each other with simultaneous pressing clamping of jaws of each clamping unit to each other, at opposite clamping nut position with tight pressing of clamping units and their jaws to each other. Each clamping unit allows simultaneous arrangement between its jaws of one Schantz pin and one bar and turn at axial screw at “free” position of clamping nut. Each clamping unit is provided with shaped supports for fingers of surgeon made on opposite side surfaces of clamping jaws in form of slots and oriented along axial screw to provide convenience of grip of fixture. Groove made on one jaw of one unit has extension to second jaw of this unit to make one lodgement. T-shaped switch has handle with perpendicular located bearing bar. Handle at one end has inner hole for clamping nut of retainer. Bearing rod end is equipped with device for locking Schantz pin, which has internal axial channel of distal end of Schantz pin, and ball mechanism arranged in body for fixation of Schantz pin to interact with annular groove on trihedral profile of Schantz pin.

EFFECT: invention provides reduction of pain syndrome, reducing risk of life-threatening complications, considerably easier transportation.

31 cl, 22 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: modular device for extrafocal osteosynthesis of long bone fractures contains at least two annular base supports and several repositional semirings connected by four threaded rods, parts of the standard set of Ilizarov apparatus. The device has U-shaped staples with a threaded hole in the jumper for the threaded rod and the distance between the legs corresponding to the width of the repositional semirings. The repositional semirings are made separable and consist of an outer and an inner segments. The segments are connected together by U-shaped staples and nuts pre-installed on the threaded rods. The outer and inner segments are made with docking cylindrical surfaces along the middle arc-shaped part of the semiring with semicircular notches formed on them forming the holes during the assembly. The inner segments have holes at the ends for bolts with nuts to join semirings into rings.

EFFECT: increased effectiveness of treatment of patients with long bone fractures, especially under conditions of polytrauma, stronger fixation of fragments of long bones in the repositioning position, rotational and axial stability of fragments of fragile compression, if necessary - mounting or dismantling additional modular semirings and rings without complete dismantling of the apparatus of external fixation by Ilizarov while performing repeated operational aids and bandagings.

9 dwg

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