RU146659U1 - INTRAMEDOLLARY DEVICE FOR OSTEOSYNTHESIS OF UPPER THREE FEMORAL FRACTURES - Google Patents

Abstract

The utility model relates to medical equipment and medicine, namely traumatology. The device comprises an extended cylindrical body with a proximal and beveled at an angle of about 45 ° to half the diameter of the body with distal ends and a central through channel having an inlet and an outlet. An internal thread is applied to the inner surface of the central channel from the side of its inlet. The proximal end of the body is made curved at an angle of about 20-30 ° to the longitudinal axis of the device. The body is made with a diameter gradually increasing to 1.5-2 times towards the proximal end over 1/3 of the length of the device. From the side of the proximal end there is a through oblique channel through which the fastener is held. The latter is an awl rod, containing, on the one hand, a section tapered to the cone, and on the other hand, a section with an external thread corresponding to the internal thread of the central channel. The through skew channel is located at an angle of 40-45 ° to the longitudinal axis of the housing and is connected to its central channel with the possibility of passage of the fastener through the inlet of the central channel of the housing and exit through the through skew channel. At least one through transverse channel is made in the housing from the side of the distal end to ensure blocking of the device. The utility model allows for stable fixation of fragments of the femur while reducing the invasiveness of surgical intervention. 1 head p. f-ly, 3 ill., 1 ave.

Description

The utility model relates to medical equipment and medicine, namely traumatology, and is intended for the treatment of trochanteric and subtrochanteric fractures of the femur by means of intramedullary osteosynthesis.

There are various designs of intramedullary blocking devices for osteosynthesis of the upper third of the femur [copyright certificate SU for inventions No. 662082, No. 405543, 1595494, patent RU for invention No. 2289351]. All of them have an extended cylindrical body and fixing elements.

Also known fixative for osteosynthesis of long tubular bones [copyright certificate SU for the invention No. 1000027]. The latch contains a curved rod, a thrust screw, elastic elements made in the form of paired brackets, a nut. In the middle part of the rod, a slot is made, as well as a series of pair of holes for the locking screws. At the distal end of the rod, a threaded oblique channel is made for the thrust screw, and screw cutting under the nut is made at the proximal end of the rod.

However, this fixative is intended to be inserted retrograde into the femur, i.e. the blocking of the rod by means of a thrust screw is carried out through an oblique channel in the distal portion of the rod. When using the inventive device for introducing the housing is carried out antegrade, i.e. blocking of the device by means of the awl-rod is performed in the proximal femur. At the same time, the design of the above-described lock due to the presence of elastic elements in the form of paired staples along the longitudinal part of the device and the execution of the thrust screw with slots to ensure its swelling is less stable and difficult to manufacture. When installing this clamp, an additional incision is required to provide access to the pear-shaped fossa of the thigh with the aim of screwing the nut on the proximal end of the shaft for swelling and dynamic self-sealing of the clamp in the lower metaepiphysis of the femur.

The closest analogue to the claimed utility model is the rod for osteosynthesis of the upper third of the femur [Catalog of instruments for performing intraosseous osteosynthesis by Synthes Ins. "PFNA. Proximal Femoral Nail Antirotation. " 12/2011]. The rod is made in the form of an extended body with a central through channel, a proximal and distal pointed ends and a through oblique channel located on the side of the proximal end, through which a screw is passed in the direction of the femoral head. To close the inlet of the Central channel from the side of the proximal end of the housing, a dummy screw is provided. Through holes are provided in the housing from the distal end side to provide lateral blocking of the rod.

However, the use of this rod is accompanied by the need to perform two surgical approaches for insertion of the rod and its proximal blocking: the first from the apex of the greater trochanter of the femur for insertion of the rod body, followed by the installation of the stub screw, the second from the undervert region for the insertion of the screw in the direction of the femoral head which significantly increases the invasiveness of the surgical intervention.

The objective of the claimed utility model is to ensure stable fixation of fragments of the femur while reducing the invasiveness of surgical intervention.

The essence of the claimed utility model lies in the fact that in the intramedullary device for osteosynthesis of diaphyseal fractures of the femur, containing an extended cylindrical body with a central through channel having an inlet and outlet opening, proximal and distal ends and located through the oblique endway through the proximal end, through which a fastening element is provided, wherein at least one through transverse channel is provided in the housing from the side of the distal end to ensure In order to lock the device, the case is made with a diameter gradually increasing up to 1.5-2 times towards the proximal end over 1/3 of the device length, the proximal end of the case is bent at an angle of about 20-30 ° to the longitudinal axis of the device, and the distal end is beveled at an angle of about 45 ° to half the diameter of the body, the through oblique channel is located at an angle of 40-45 ° to the longitudinal axis of the body and is connected to its central channel with the possibility of the fastener passing through the inlet of the central channel to of the housing and exit through the through oblique channel, the fastening element being an awl rod containing, on the one hand, a section tapered onto the cone, and on the other hand, a section with an external thread corresponding to an internal thread applied to the inner surface of the central channel from its side inlet.

A device with the above-described features is also claimed in which at least two through transverse channels are made from the side of the distal end of the housing to provide lateral blocking of the device located in mutually intersecting planes.

The technical result of the claimed utility model.

Such a technique as making the case from the proximal end side curved and combining the inlet of the awl rod with the inlet of the central channel of the case eliminates the need for additional surgical access for the introduction of blocking elements, which significantly reduces the invasiveness of surgical intervention and, consequently, reduces time surgery, reducing the risk of postoperative complications and simplifying the proximal blocking technique stroystva. The possibility of shifting the insertion point of the device to the region of the greater trochanter due to the bending of the proximal end of the body and performing oblique channel at certain angles to the longitudinal axis of the device simplifies the process of installing the awl and device in the medullary canal of the femur. The awl rod acts as a blocking element and, at the same time, a dummy screw, which reduces the number of collapsible parts of the device and reduces the complexity of surgical intervention, as well as saves time. The design features of the implementation of the blocking element in the form of an awl rod allows additional compression along the fracture line when it rests on the Adams arch, which is the most durable zone of the femur, due to the movement of the device body in the cranial direction, which helps to reduce diastasis between fragments of the fracture and accelerate the timing formation of bone regenerate.

The inventive utility model is illustrated using FIG. 1-3. In FIG. 1 shows a general view of an intramedullary device for osteosynthesis of fractures of the upper third of the femur, FIG. 2 is a view of the inventive device installed in the femur, in FIG. 3 is a schematic point of introduction of the inventive device. In FIG. 1 positions 1-12 are indicated:

1 - housing;

2 - the proximal end of the body;

3 - distal end of the housing;

4 - the central channel;

5 - inlet of the Central channel;

6 - the outlet of the Central channel;

7 - internal thread of the central channel;

8 - through oblique channel;

9 - fastener;

10 - tapered section of the fastener;

11 - section with an external thread of the fastener;

12 - through channels to provide lateral blocking of the device.

The intramedullary device for osteosynthesis of fractures of the upper third of the femur contains an extended cylindrical body 1 with proximal 2 and distal 3 ends, as well as a central through channel 4, which has an inlet 5 and an outlet 6 hole. An internal thread 7 is applied to the inner surface of the central channel 4 from the side of its inlet 5. The proximal end 2 of the housing 1 is made curved at an angle of about 20-30 ° to the longitudinal axis of the device. Case 1 is made with a diameter gradually increasing to 1.5-2 times towards the proximal end 2 over 1/3 of the length of the device. On the side of the proximal end 2 there is a through oblique channel 8 through which the fastening element 9 is passed. The latter is an awl rod containing, on the one hand, a section 10 pointed at the cone, and on the other hand, a section with an external thread 11 corresponding to an internal thread 7 of the central channel 4. The through skew-cross channel 8 is located at an angle of 40-45 ° to the longitudinal axis of the housing 1 and is connected to its central channel 4 with the possibility of the passage of the fastener 9 through the inlet 5 of the Central channel 4 of the housing 1 and the exit through the through oblique channel 8. In the housing 1 from the side of the distal end 3 is made at least one through transverse channel 12 to ensure blocking of the device. In some cases, in order to increase the stability of fixation of the device in the distal femur from the side of the distal end 3 of the body 1, at least two through transverse channels 12 are made to ensure blocking of the device located in mutually crossed planes. To facilitate the insertion of the device into the medullary canal of the femur, the distal end 3 is made beveled at an angle of about 45 ° to half the diameter of the body 1.

An intramedullary device for osteosynthesis of fractures of the upper third of the femur works as follows.

An x-ray study is performed to evaluate the location of the fracture, the size and shape of the femur. According to the data obtained from a set of types of sizes of intramedullary devices for osteosynthesis of fractures of the upper third of the femur, a device with the necessary length and diameter is selected. The patient is placed on an operating table equipped with a device for traction, on the back or in a side position. Under the control of the electron-optical transducer, the fracture is repositioned and the position of the fracture fragments, as well as the direction of introduction of the guide, the inventive device and the locking screws, are intraoperatively monitored. After processing the surgical field, surgical access is performed. A longitudinal skin incision is performed, about 5 cm long, passing near the top of the greater trochanter along the long axis of the thigh. Reaching the fascia, cut it along the cut line of the skin. Stupidly dividing the muscle fibers, they access the greater trochanter. After this, the localization of the point of introduction of the device is determined 5-10 mm lateral to the apex of the greater trochanter. Using a drill, a guide pin is inserted into the medullary canal through a previously defined device insertion point at an angle corresponding to the bending angle of the proximal end of the body. An opening and processing of the medullary canal is performed using a guided spoke using a cannulated drill with a diameter of 17.0 or a curved femoral awl of 8.0. To the inventive device, a guide body is mounted. The device body is introduced along the guide needle into the medullary canal of the femur. Then the guide needle is removed. A distal guide is attached to the guide body and the distal end of the housing is blocked in the transverse direction by introducing locking screws into the through channels to provide lateral blocking. The correctness of the introduction is controlled using an x-ray machine or an electron-optical converter. Remove the guide from the existing section. After this, the casing is blocked from the side of its proximal end with the help of an awl rod, which is inserted through the inlet of the central channel with the exit through the cross-channel channel of the casing. The introduction of the awl rod is carried out in the direction of the Adams arc along the internal thread deposited on the inner surface of the central channel and corresponding to the external thread existing on the awl rod. When screwing, the awl rod abuts against the Adams arc and simultaneously pulls the inventive device in the proximal direction, creating compression conditions along the fracture line. Carry out x-ray control. Wounds are sutured in layers and are treated with antiseptic solutions. Stick aseptic dressings.

Example.

The inventive utility model is implemented in an experimental sample. The product is being prepared for practical testing in a medical institution. Found constructive improvements are practically justified and justified constructive expediency.

Claims (2)

1. An intramedullary device for osteosynthesis of fractures of the upper third of the femur, comprising an extended body with a central through channel having an inlet and an outlet, proximal and distal ends and located at the side of the proximal end through an oblique channel through which the fastener is passed, and in the case with at least one through transverse channel is made to the side of the distal end to ensure blocking of the device, the casing is made to gradually increase to 1.5 -2 times the diameter towards the proximal end for 1/3 of the length of the device, characterized in that the through oblique channel is connected to the central channel of the device, while the proximal end of the body is bent at an angle of 20-30 ° to the longitudinal axis of the device, and the oblique channel is located at an angle of 40-45 ° to the longitudinal axis of the housing, ensuring the passage of the fastener through the inlet of the central channel of the housing and exit through skew-cross channel; the distal end of the body is beveled at an angle of about 45 ° by half the diameter of the body; the fastening element is an awl rod containing, on the one hand, a section tapered onto the cone, and on the other hand, a section with an external thread corresponding to an internal thread deposited on the inner surface of the central channel from the side of its inlet. 2. The device according to claim 1, characterized in that from the side of the distal end of the housing, at least two through transverse channels are made to ensure blocking of the device located in mutually intersecting planes.

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