RU2183436C1 - Device for making chest funnel deformity correction - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has two parts and fastening members. The parts are movable relative to each other for increasing device length, one of them being base and the other one being reciprocal part. The reciprocal part is telescopic sectional plate having the right and left sections movable in different directions, each fixable on one of the ends. The left one is fixable on the left side and the right one is fixable on the right side. EFFECT: avoided traumatic complications; high reliability of fixation. 3 cl, 5 dwg

Description

 The invention relates to medical equipment, namely to devices for correction and fixation of the sterno-costal complex in the surgical treatment of funnel chest deformity in children and adolescents with high growth potential.

 Known devices for surgical correction of funnel chest deformity. For these purposes, plate-type endofixers are widely used, for example, in the form of a metal rod of flat section. When installing this device, it is cut into a part of the length from at least one end, the branches are bred in the radial direction and rib cartilages and ribs are fixed to them (A.S. SU 1230592 A1, A 61 B 17/56, 05/15/86).

 A device is also known, which is a titanium nickelide plate with a thickness of 0.1-0.15 cm, a width of 0.5-0.7 cm and a length equal to the width of the anterior chest wall, which works as follows: the plate is heated over a flame of an alcohol lamp and attached the physiological profile of the anterior chest wall is bent to it, then the plate is cooled with chlorethyl, give it a shape convenient for institution behind the sternum, place it behind the sternum in the region of the deformation apex parallel to the ribs. The plate is fixed to the ribs with metal brackets. Warming up to body temperature, the plate assumes a predetermined shape and develops a corrective force (a.s. SU 1466719 A1, A 61 V 17/00, 03/23/89).

 A device is also known, which is a titanium plate with a width of 2 cm and a length of 1-2 cm, which works as follows: the plate is pre-bent into the shape necessary for the patient, held retrosternally and fixed to the bone stumps of the resected ribs (a.s. SU 1703080 A1, A 61 B 17/56, 01/07/92).

 All plates used in the aforementioned treatment technologies do not fundamentally differ and have not undergone major structural changes since use.

 However, these designs limit the excursion of the chest and come into disagreement with the human body during the growth process.

 The closest analogue to the claimed technical solution is a device represented by plates, for example of titanium, with a thickness of 0.1 cm, a width of 0.5-0.7 cm and a length equal to the width of the anterior chest wall, which give a bend in the physiological profile of the anterior chest wall, are interconnected into a single unit and laid on the skeletonized front surface of the sternocostal complex brought to the correction position (patent RU 2145814, А 61 В 17/56, 27.02. 00).

 However, it also has drawbacks. One of them is its massiveness and related trauma during installation and subsequent removal. The design limits the excursion of the chest and inhibits the proportional growth of the costal skeleton.

 The objective of the invention is to eliminate the design mismatch of the human rib skeleton in the growth process while reducing the invasiveness of the operation and increasing the reliability of the fixation of the device.

 The problem is solved in that the device for the correction of funnel chest deformities contains two parts and fixation means, where the parts are arranged to move one relative to the other to increase the total length of the device, while one part serves as the base and the other as the response, with the mating made in the form of a retractable composite plate having left and right parts movable in different directions, each of which accordingly has the ability to be fixed from one of the edges: left - on the left side, and the right on the right.

 In addition, a device is claimed having the above-mentioned features of the main embodiment, the base part of which is made in the form of an elongated case having solid rear and front walls, and the upper and lower serve as guides for moving the sliding plate.

 In addition, a variant of the device with the above-mentioned features of the main variant is claimed, in which the base part has upper and lower sides serving as guides for moving the sliding plate, front and rear walls, the front wall being made with a slot and the rear wall is solid.

 The ability to move parts of the device relative to each other does not prevent the growth of the chest in the axial plane. The rigidity of the structure prevents the recurrence of deformation occurring in the ventrodorsal (anteroposterior) direction.

The device is illustrated using figures, which show:
figure 1, 2 - the implementation of the base part: figure 1 - in the form of a horizontally elongated case; figure 2 - with a slot;
in FIG. 3 - the implementation of the sliding plate in the form of two parts moved in different directions;
figure 4, 5 is a schematic illustration of the use of the device.

 The device for correcting and fixing the funnel-shaped deformation of the chest (Fig. 1-3) has a base part 1, which consists of a continuous back wall 2, the upper side 3 and the lower side 4 for moving the mating part 5. The front wall 6 of the base part 1 is made either continuous (figure 1), or with a slot 7 (figure 2, 3). The mate 5 is made either of an integral plate (Fig. 1, 2), or of two parts 5a, 5b (Fig. 3). Holes 8 are used to fix the device to the rib frame. For convenience, the statements are indicated by 9, 10, 11, respectively, the sterno-rib plastron, supporting ribs, ligature seams.

 The device operates as follows.

 A section of soft tissue exposes the sterno-costal plastron 9 (Fig. 4). They mobilize it by means of a perichondrium resection of deformed ribs and sternotomy. The device is placed on the front surface of the chest (figure 4) or carried out retrosternally (figure 5). The device is pushed apart, the mating part 5 is moved along the base part 1. The optimal length of the device is achieved for reliable fixation on the supporting ribs 10. After this, the extension is stopped. Through the holes 8, the device is fixed with ligature seams 11 to the ribs 10. The wound is sutured in layers.

 Example 1. Patient K., 14 years old, was admitted to the SarNIIITO pediatric orthopedics clinic with a diagnosis of congenital funnel-shaped chest deformity of the III degree in the stage of subcompensation. Gizycko index = 0.4.

 A correction of chest deformation was made using the proposed device, the base part of which is made in the form of a horizontally elongated case 11 cm long, 0.3 cm thick, having continuous back and front walls 1.2 cm wide, and the upper and lower sides serve as guides for moving reciprocal retractable plate 11 cm long, 0.8 cm wide, 0.1 cm thick.

 A section was made with a length of 15 cm along the midline in the projection of the deformation. Percutaneous resection of the deformed ribs with transverse sternum osteotomy was performed and the sterno-rib plastron was mobilized. The distance between the supporting ribs on which the device was installed was 14 cm. By mutual movement of the base and the reciprocal parts, the length of the device was brought into correspondence with this distance, it was laid on the front surface of the chest and fixed to the ribs with a ligature through holes at its ends.

 The sternum body is brought into the correction position and fixed on the device with cross-wise wire seams. Installed drainage in the chest cavity. The wound is sutured.

 Gizycka index after surgery = 0.8, which is normal. Primary healing.

 The device is removed after 8 months. During this time, the patient grew and the circumference of the chest increased by 5 cm. The movement of the parts of the device was 0.7 cm.

 Example 2. Patient M., 13 years old, was admitted to the pediatric orthopedics clinic of SarNIIITO with a diagnosis of flat concave chest.

 A correction of the deformation of the chest was made using the proposed device, the base part of which has front and rear walls 1.2 cm wide, 11 cm long, 0.3 cm thick, and the front wall is made with a slit 0.6 cm wide, and the back wall the solid, upper and lower sides serve as guides for moving the sliding plate 11 cm long, 0.8 cm wide, 0.1 cm thick.

 The patient was operated in the supine position. An incision was made with a length of 18 cm along the midline in the projection of the deformation. The sterno-costal complex was skeletonized and mobilized. The xiphoid process is cut off. The sternal space is revealed. The device was staggered in such a way that its front wall is facing anteriorly (towards the rear surface of the sternum). The distance between the supporting ribs on which the device was installed was 15 cm. By mutual movement of the base and the mating parts, the length of the device is brought into correspondence with the distance between the supporting structures and is fixed to the ribs by the ligature through holes at its ends. Installed drainage in the chest cavity. The wound is sutured in layers.

 The device is removed after 6 months. During this time, the patient grew and the volume of the chest increased by 4 cm, the length of the device increased by 0.6 cm.

 Example 3. Patient S., 14 years old, was admitted to a pediatric orthopedics clinic in SarNIIITO with a diagnosis of congenital funnel-shaped chest deformity of the III degree in the stage of subcompensation. Morphan's syndrome. Gizycko index = 0.3.

 A correction of chest deformity was made using the proposed device, the base part of which has front and rear walls 1.2 cm wide, 6 cm long, 0.4 cm thick, and the front wall is made with a slit 0.6 cm wide, and the back wall is the solid, upper and lower sides serve as guides for moving two reciprocal sliding plates 8 cm long, 0.8 cm wide, 0.1 cm thick.

 The patient was operated in the supine position. A section was made with a length of 15 cm along the midline in the projection of the deformation. The sterno-costal complex was skeletonized and mobilized. The xiphoid process is cut off. The sternal space is revealed. The device was performed retrosternally. The distance between the support ribs on which the device was installed was 13 cm. By moving the components of the reciprocal part left-to-left, right-right and right-to-right, the length of the device is brought into correspondence with the distance between the support structures and is fixed to the ribs by the ligature through holes at its ends . Installed drainage in the chest cavity. The wound is sutured in layers.

 Gizycka index after surgery = 0.9, which is normal. Primary healing.

 The device is removed after 1.5 years. During this time, the patient grew and the circumference of the chest increased by 8 cm, the length of the device increased by 0.9 cm.

 The medical and social effectiveness of the proposed device consists in eliminating the inconsistency of the correcting design with the human rib skeleton during growth while reducing the invasiveness of the operation and increasing the reliability of fixation of the sterno-rib complex by eliminating the possible loss of correction from its displacement relative to the supporting cost structures.

 A prototype of the proposed device was made in SarNIIITO and tested in a pediatric orthopedics clinic in 7 patients with funnel-shaped deformity.

Claims (3)

 1. Device for the correction of funnel-shaped deformations of the chest, containing two parts and means of fixation, characterized in that the parts are made with the possibility of moving one relative to the other to increase the total length of the device, while one part serves as the base and the other as the response, with the mating made in the form of a retractable composite plate having left and right parts movable in different directions, each of which accordingly has the ability to be fixed from one of the edges: left - from the left side , and the right - with the right.  2. The device according to claim 1, characterized in that the base part is made in the form of a horizontally elongated case having solid rear and front walls, and the upper and lower sides serve as guides for moving the sliding plate.  3. The device according to claim 1, characterized in that the base part has upper and lower sides serving as guides for moving the sliding plate, front and rear walls, the front wall being made with a slot and the rear wall is solid.

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