RU2526448C1 - Device for stabilisation of fractures and replacement of defects of ribs and sternum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device contains bone fixers, an upper frame construction and a lower frame construction. The upper frame construction consists of upper bars, connected to each other by means of screw rods and fastening elements. The lower frame construction consists of lower bars, connected to each other by means of screw rods and fastening elements. The bone fixers are made in the form of screws-bolts with stops. Each screw-bolt is fixed in the middle and upper part by means of the fastening elements in the fixing element, which in their turn are fixed on the two bars, the lower and upper ones. The bars are made in the form of plates with holes.

EFFECT: increased stability and reliability of fixation of injured ribs and the sternum, a possibility of transfer of fragments in the desired direction, reduction of trauma to the bone and soft tissues in the process of installation of the device for their fixation, an increase of the patient's life quality, and reduction of the terms of hospital treatment.

3 dwg

Description

The invention relates to medicine, in particular to traumatology, orthopedics and thoracic surgery, and can be used to treat multiple and floating fractures and to replace defects of ribs and sternum formed after injuries, removal of tumors of the bone skeleton of the breast, osteomyelitis.

Multiple and floating fractures and defects of the ribs and sternum belong to the severe consequences of injuries and a number of diseases of the sternocostal complex and are accompanied by a violation of the respiratory and cardiovascular systems, which significantly aggravates the condition of the victim and creates a number of complications and domestic inconveniences. Actual problems in the treatment of this pathology are: the search for methods and methods of stabilization of the sterno-costal complex, plastic materials to replace defects.

There are a large number of devices for fixing the sternum-rib complex: skeletal traction, intramedullary osteosynthesis with metal rods, panel fixation. However, all of them are not without drawbacks: the bulkiness of the structure, the possibility of infection, insufficiently stable fixation, a high degree of trauma or the inability to control and move fragments. All this leads, ultimately, to a decrease in the effectiveness of treatment, especially with multiple and floating fractures of the ribs, defects of the sterno-costal complex resulting from many causes.

Known devices in the form of corsets and frames of various designs for the treatment of fractures of the sternum and ribs (RU 1279623, publ. 12/30/1986; RU 1225560, publ. 04/23/86, A61B 17/58).

The disadvantages of the known devices is that corsets make it difficult to monitor the patient and perform the necessary surgical procedures, and the supports located on the surface of the body do not ensure the stability of osteosynthesis.

A device for the treatment of multiple fractures, developed by NIISP them. I.I. Janelidze (RU 2333730, A61B 17/58, 09/20/2008), which is mounted on the bones of the pelvis and collarbone in the form of an external fixation apparatus, fixes the connecting rod to it and inserts bundles of needles that are attached to the connecting rod into the bone parts of the damaged segments of the sternum frame .

The disadvantage of this device is that the apparatus used for external fixation is very bulky, significantly worsens the quality of life of the patient, does not exclude the possibility of perforation of the pleura and damage to the lung.

A known method of osteosynthesis in multiple fractures of the ribs (SU 1107841, A61B 17/00 of 08/15/1984), in which fragments of the ribs are fixed to the apparatus, laid on the rib frame across the damaged ribs, resting on intact rib bones, and then fragments of the ribs are fixed to to the apparatus with the help of crossed knitting needles.

The disadvantage of this device is that it does not allow simultaneously with the damaged segment of the bone skeleton of the chest to fix unstable damage to adjacent areas. There is a risk of perforation of the pleura and damage to the lung and chest organs with spokes drawn through fragments of the rib.

Known technical solution for fixing the bones of the chest (RU 79029, publ. 12/20/2008, A61B 17/16). With multiple fractures of the ribs, a floating portion of the chest wall is formed. In this situation, two bone fixators are inserted into the whole overlying and underlying ribs from the floating section, as well as two bone fixators into the ribs forming the floating section. Bone retainers are made in the form of cylinders, along the entire length of which there is a thread. For the introduction of fixatives over the necessary ribs cut through the skin, subcutaneous tissue and expose the rib. Then dissect and exfoliate the periosteum. From the upper edge of the rib, a special stop is placed on which the body is worn. Drill a hole in the rib until it stops with a stopper and through the hole in the body enter a bone retainer with a support platform until it stops in the sternum. On the introduced latches, the fixing apparatus is mounted as a rectangle. Bone retainers inserted into intact ribs provide support. Dosed traction for bone fixatives introduced into the flotation area stabilizes the chest.

The disadvantages of this technical solution are the complexity and high morbidity, the duration of the installation of the device to the chest, as well as the bulkiness of the device, which creates a significant inconvenience for the patient.

The specified device is taken as a prototype.

The technical task of the invention is the creation of a device that allows less traumatic and stable fixation of multiple and floating fractures of the ribs and sternum, providing the ability to control and move fragments, creating compression or distraction in the zone of stabilization or replacement of the defect while maintaining patient mobility.

The technical result of the application of the proposed device is to increase the stability and reliability of fixation of damaged ribs and sternum, the ability to move fragments in the right direction, reduce trauma to the bone and soft tissues when installing a device for their fixation, improve the quality of life for the patient, reduce the time of treatment in a hospital.

The specified technical result is achieved due to the fact that a device is used to stabilize multiple fractures of the ribs and sternum, to replace bone defects, for which rod bone fixators are inserted into damaged and undamaged sections of the chest skeleton, which are then combined into an external fixation device, for which previously make planning of the places of installation of the rods and their number, depending on the number and nature of damage. Then, cuts of the skin and subcutaneous tissue over the rib are performed and the outer cortical layer of the rib and sternum are drilled. Then, a screw-screw is screwed into the hole formed with the capture of the external and internal cortical plates of the rib or sternum. To prevent the screw screw from moving inside the chest cavity, there is a special emphasis on it. In order to control the position of the screws relative to the parietal pleura and to exclude the possibility of injury to the lung and mediastinal organs, videothoracoscopy is simultaneously performed. The installed screws and screws are interconnected by means of fixing elements, rods and rods, which allows stable fixation of damaged ribs and sternum. Depending on the number, location of fractures, the direction of movement of bone fragments, impaired external respiration, the apparatus is completed and placed on one or both halves of the chest.

A rod apparatus mounted from screw screws allows you to stably fix and move damaged ribs and sternum, eliminate paradoxical breathing and reduce the severity of traumatic shock, control fragments of the ribs and sternum in the right direction.

Upon reaching consolidation of fractures, the device is dismantled in the reverse order.

The proposed device for the stabilization of multiple fractures of the ribs and sternum, replacing defects that occurred after removal of bone tumors and necrotic bone structures of the chest, includes an external fixation rod apparatus, which contains rods, fixing elements, bone fixators, the latter being made in the form of screw-screws , each of which, in its middle part and in the upper part, is fixed by means of fasteners in a special fixing element, which, in turn, are fixed on two rods x, top and bottom, formed in the form of plates with holes, and rods are assembled in pairs in lower and upper frame structure by connecting the upper and lower rod by means of screw rods and fasteners.

The design of the device for stabilization of multiple fractures of the ribs and sternum and the replacement of defects is shown in figure 1, figure 2 - shows the design of the locking element, figure 3 - screw screw.

A device for stabilizing multiple fractures of the ribs and sternum contains bone retainers in the form of screw screws 1 with a stop 9, each of which is installed in two locking elements 2 located in the middle and upper parts of the bone retainer, and is fixed with fasteners 3. Fixing elements 2 are fixed in the lower rod 4 and in the upper rod 5, made in the form of plates with holes. The rods 4 are interconnected by means of screw rods 6 and fasteners 3, forming a lower frame structure. The rods 5 are also interconnected by means of screw rods 6 and fasteners 3 and form the upper frame structure. The locking element 2 is made in the form of a cantilever strip with a supporting platform 7 and a hole 8.

The specified device for the stabilization of multiple fractures of the ribs and sternum and the replacement of defects of the sternum-rib complex is used as follows. Before the operation, they plan the locations of the rods and their number, depending on the number and nature of the damage. Then, cuts of the skin and subcutaneous tissue over a rib or sternum 0.5 cm long and a drill with a diameter of 3.2 mm are performed, and the outer cortical layer of the rib and sternum is drilled. Then, a screw-screw with a stop 1 is screwed into the hole formed with the capture of the external and internal cortical plates of the bone. In order to control the position of the screws 1 relative to the parietal pleura, videothoracoscopy is simultaneously performed. The installed screws-screws 1 are interconnected using fixing elements 2, rods 4, 5 and screw rods 6. Depending on the number, location of fractures, impaired external respiration, size and size of the bone defect, the apparatus is completed and placed on one or both halves chest To create compression at the junction of the fragments, the distance between the rods 4, 5 is reduced with the help of screw rods 6 and the fixing elements 2. When increasing the distance between the rods 4, 5, it is possible to create distraction at the junction of the fragments. The movement of fragments in the sagittal plane is carried out by moving the screws-screws 1 in the fixing elements 2 along the thread. This technique allows you to dose fragments of bones in the sagittal plane.

Claims (1)

A device for stabilizing multiple fractures of the ribs and sternum and replacing their defects, containing bone retainers, characterized in that it has an upper frame structure of upper rods interconnected by screw rods and fasteners, and a lower frame structure of lower rods connected between each other with the help of screw rods and fasteners, as well as bone clamps made in the form of screw-screws with stops, each screw-screw in the middle part and in the upper part is fixed by ohm fasteners in the locking element, which, in turn, are mounted on two rods, lower and upper, and the rod is made in the form of plates with holes.

Images