RU2802250C1 - Method of fixation of mandibular fractures - Google Patents

Abstract

FIELD: medicine; maxillofacial surgery.

SUBSTANCE: invention can be used to fix fractures of the lower jaw. Using a dental drill and burs, a horizontal H-shaped groove is formed on the fracture line, 2–4 mm deep, 5–8 mm wide, the trapezoidal edges of which are displaced by 10–15 degrees vertically. The H-shaped horizontal groove is filled with Rekost liquid porous bone-replacing material and the fragments of the broken bone are placed in a compatible position either manually or using a bone clamp. 15–20 minutes after the hardening of the bone substitute material, the edges of the wound are sutured with muscles, fascia and mucocutaneous membranes in layers. X-ray control is carried out 1 day after fixation, then after 2 weeks and 4 weeks.

EFFECT: method provides rigid fixation, reduced trauma due to good visualization of the fracture line and features of its fixation.

1 cl, 2 dwg

Description

The invention relates to medicine, namely to maxillofacial surgery, and can be used to immobilize fragments in case of jaw fractures.

There are various methods of intraosseous and extraosseous surgical fixation of mandibular fragments and their combinations. The device for fixing fragments can be connected by its ends, cross the fracture gap, pass through the bone, cover bone fragments at a certain distance from the fracture gap, and be fixed outside the bone wound. The most common among such devices is the apparatus of Ermolaev and Kulagov (EK-1, EK-2). It consists of needles inserted percutaneously into bone fragments using a drill, a frame of various shapes and devices for attaching these fragments. [T.G. Robustova, I.S. Karapetyan and others. Surgical dentistry. Publishing house "Medicine, M., 1996, pp. 406-407].

However, a particular disadvantage of this device is that the fast rotation of the pin can burn the bone, and the possibility of rotation of the pin around its axis cannot be ruled out.

Kirschner spoke [T.G. Robustova, I.S. Karapetyan and others. Surgical dentistry. Publishing house "Medicine, M., 1996, pp. 401-402], is a piece of metal wire 395 mm long, 2 mm in diameter, with a 7 mm long body flattened on both sides and with a flattened tip made of medical steel. The shape is equilateral triangle with a side of 2 mm Kirschner's needles are introduced into both parts of the fragments, exposing them either percutaneously using a drill, drill, or a special device.The pin protects the parts well from displacement in the vertical plane, but does not exclude their rotation.To avoid this, enter 2 knitting needles, which sometimes complicates the method.

The disadvantages of Kirchner spokes include:

- Unreliable fixation

- Possibility of dropping spokes

- The possibility of bone burns due to the introduction of the needle with a drill at high speeds.

Known "Spoke for fixing bone fragments in fractures of the angle of the lower jaw" (Patent RU No. 36960, IPC A61B 17/24 - 10.04.2004, Bull. No. 10), consisting of a working part and a shank, characterized in that the total length of the spokes is 120 mm with a diameter of 2 mm, and the working part of the knitting needle 15 mm long has a conical shape with a thread, ending with a self-tapping screw 1.7 mm long, and the length of the shank is 105 mm.

The disadvantage of this needle is that when opening the entrance to the bones with a needle, the roots of the molars, the nerve of the lower jaw and the vessels in the canal can be damaged. In addition, it is difficult to fix bone fragments when making a hole with the help of rapidly rotating instruments, since other devices are additionally required. At the same time, since it is very deep, it is impossible to cool it with a jet of water directed from a syringe. If cooling is not achieved, the risk of bone necrosis is inevitable. Removal of the wire requires an additional difficult operation during the postoperative recovery period. When removing the spoke, the risk of breakage is very high.

Known "Method of immobilization of fragments in fractures of the jaws" (Patent RU No. 2269318, IPC A61B 17/56, A61B 17/24 - 10.02.2006, Bull. No. 4). At least two symmetrical sutures are applied in the position of central occlusion, made with wire ligatures, which cover the lower jaw and pass through the holes located in the alveolar process of the upper jaw. Impose chin-parietal bandage. In a particular case, protective tubes are installed in the holes in the alveolar process, through which wire ligatures are passed.

Disadvantages of the method: Since this method completely limits the opening of the patient's mouth, postoperative problems with the temporomandibular joint, ankylosis or other complications associated with immobility are inevitable. Possible injury to the nerves, blood vessels of the face and jaw area. Patient comfort worsens after surgery.

Known "Method of fixing fragments in fractures within the body of the lower jaw with complete or partial edentulous using a designed device made of metal spokes, ligature wire and plastic" (Patent RU No. 2193361, IPC A61B 17/24 - 27.11.2002, Bull. No. 33 ), produce reposition of fragments after preliminary anesthesia. Carry out fixation with knitting needles. Fasten them with ligature wire. Apply a roller of fast-hardening plastic until complete polymerization.

The disadvantage of this method is the large volume and trauma of the intervention, which is associated with the risk of damage to blood vessels, circulatory disorders, infection, slowing down reparative processes. The adhesion of the metal wire to the jaw bone can be unstable, sometimes jaw movements can be disturbed, which requires a more complex operation. There is a high risk of an allergic reaction to fast-hardening plastic, as this plastic will contain more germs after a few days and cause poor hygiene.

Known "Device for osteosynthesis of fractures of the lower jaw" (Patent SU No. 1149954, IPC A61B 17/56 - 04/15/1985), containing a body made in the form of collapsible slats, with sliders mounted on it with knots for fixing spokes with spoke holders, and one of fixation units are movably mounted on a slider, characterized in that, in order to ensure simultaneous fixation of fragments in the area of the body and branches of the lower jaw, the body is curved along the average curvature of the chin region and the angle of the lower jaw, and the fixing angles are movably mounted and made in the form of a bracket with two semi-arcs movably mounted on it with an internal slot for spoke holders.

Disadvantages of this device:

The device is technically very complex, which requires large industrial conditions for manufacturing.

It gives the patient discomfort to wear it, sleep, eat and talk with it.

Requires the use of additional tools and skills.

Inappropriate use of this device for multiple fractures.

Sufficiently high weight of the structure.

Known "Method of fixing bone fragments in the treatment of fractures of the lower jaw" (Patent SU No. 1673066, IPC A61B 17/56 - 30.08.1991), before the introduction of fixing elements, soft tissue incisions are made at two points located mirror relative to the fracture line, then holes are drilled at these points, which are mirrored relative to the fracture line, holes are then drilled at these points orthogonally to the bone surface, then fixing elements are inserted.

Disadvantages of the method:

This method of fixation can be performed very primitively in the case of simple fractures. The impossibility of using this method for multilinear and comminuted fractures. It is impossible to completely prevent vertical and lingo-buccal displacement of fragments. Maintaining the stability of the screws during the treatment period will also be a separate issue.

The objective of the claimed invention is to create a method for fixing fractures of the lower jaw, providing a more rigid fixation, less trauma, while being able to combine ease of manufacture and not require the use of additional devices.

The technical result of the claimed invention is to reduce invasiveness and most stably match the edges of the mandible fragments.

The technical result of the claimed invention is achieved due to the fact that the method of fixation of fractures of the lower jaw, includes the organization of access to the fracture site and the introduction of fixing elements, the peculiarity lies in the fact that a horizontal H-shaped groove is prepared with a depth of 2-4 mm, a width of 5-8 mm, the vertical edges of this gap are formed more concave, trapezoidal, the edges of the groove are prepared 10-15 degrees more concave using a dental drill and burs, then the H-shaped groove is filled with liquid porous bone-replacing material Rekost and the fragments of the broken bone are tightly compared in a compatible position with each other manually or using a bone clamp; 15-20 minutes after the hardening of the bone-substituting material, the edges of the wound are sutured with the corresponding muscles, fascia and mucocutaneous membranes in layers; x-ray control is carried out after 1 day, then after 2 weeks and 4 weeks.

The advantage provided by the given combination of features is the absence of the need to remove elements after healing.

Details, features, and advantages of the present invention follow from the following description of the implementation of the claimed technical solution using the drawings, which show:

Fig. 1 - General view.

Fig. 2 - Side view;

The figures indicate the following positions: 1 - fracture line, 2 - H-shaped groove, 3 - transverse section of the H-shaped groove, 4 - skin-periosteal flap.

Implementation of the invention.

After establishing a mandibular fracture using diagnostic methods (Fig. 1), the patient is subjected to general anesthesia or local anesthesia. In order to access the fracture site, the incision is made extraorally or intraorally. After peeling off the periosteal flap (4) in a blunt way, the ability to clearly see the boundaries of the broken part of the bone - the fracture line (1) and the intact bone tissue surrounding this line (Fig. 2) is achieved.

With the help of a dental bur, a horizontal H-shaped groove (2) is prepared, 2-4 mm deep, 5-8 mm wide. The vertical edges of this slot are formed more concave, trapezoidal, and not at an angle of 90 degrees, to increase the possibility of their mechanical fixation. The edges of the groove (3) are prepared 10-15 degrees more concave. To do this, use standard dental drills and burs. Next, the H-shaped groove (2) is filled with liquid porous bone-replacing material Rekost. Then reposition is carried out: the fragments of the broken bone are tightly compared in a position compatible with each other manually or using a bone clamp. When the bone graft solidifies, due to its self-expanding capacity, it expands and completely fills the H-slot (2), resulting in a more stable connection (permanent immobilization). 15-20 minutes after the hardening of the bone-substituting material, the edges of the wound are sutured with the corresponding muscles, fascia and mucocutaneous membranes in layers. X-ray control is carried out after 1 day, then after 2 weeks and 4 weeks. The Recost material is not radiopaque (a bone defect was visualized within 1-3 months after the operation). 3-5 months after the operation, CT showed signs of incipient replacement of the bone defect (consolidation). Complete or partial osseointegration of the bone occurred within 5-9 months, when the X-ray structure of the graft approached the density of normal bone.

The method is minimally invasive, less traumatic and sufficient stabilization of fracture fragments is achieved. Reduces the likelihood of damage to nearby structures: arteries, veins, nerves and teeth.

This method does not require long-term restoration of the structure and function of the operated bone, which allows the patient to quickly return to the usual rhythm of life, provide sufficient oral hygiene (since there is no restriction on mouth opening), rehabilitate faster, restore chewing function and maintain articulation.

Claims (1)

A method for fixing fractures of the lower jaw, including organizing access to the fracture site and introducing fixing elements, characterized in that using a dental drill and burs on the fracture line, a horizontal H-shaped groove is formed with a depth of 2-4 mm, a width of 5-8 mm, trapezoid the edges of which are displaced by 10-15 degrees vertically, then the horizontal H-shaped groove is filled with a liquid porous bone-replacing material Rekost and the fragments of the broken bone are compared in a compatible position with each other manually or using a bone clamp; 15-20 minutes after the hardening of the bone-substituting material, the edges of the wound are sutured with muscles, fascia and mucocutaneous membranes in layers; X-ray control is carried out 1 day after fixation, then after 2 weeks and 4 weeks.