RU75302U1 - SUPPORT FOR DEPARTMENT OF THE LOWER EXTREMITY AT HIP JOINT - Google Patents

Abstract

The utility model relates to medicine, in particular to traumatology and orthopedics, and can be used for total or revision hip arthroplasty. The support for lower limb abduction during hip arthroplasty consists of two metal plates: a lower width of 240-250 mm and a length of 440-450 mm, which is a stand on the operating table, and an upper width of 240-250 mm and a length of 290-310 mm, on which the operated lower limb is laid. The upper plate has two metal sides along the length, a height of 1/10 of the width of the plate. The sides are necessary for more stable fixation of the operated lower limb. Metal tubes are mounted in both plates perpendicular to their planes. Using the third part - a metal pipe with a length of 300-310 mm and an inner diameter 1 mm larger than the outer diameter of the tubes on the plates, the structure is assembled into a single whole. The device is assembled in a sterile form by surgeons on the operating table. Fixation on the device of the operated lower limb at a height of 300-310 mm creates its necessary abduction for adequate tissue repair and the formation of the necessary muscle tension, as well as prevention of intra- and postoperative dislocation of the endoprosthesis.

Description

The utility model relates to medicine, in particular to traumatology and orthopedics, and can be used for total or revision hip arthroplasty for adequate tissue repair and the formation of necessary muscle tension, as well as prevention of intra- and postoperative dislocation of the endoprosthesis.

With anterolateral access to the hip joint, the surgeon performs a partial cut-off of the middle and small gluteal muscles to access the front of the capsule of the hip joint. After implantation of the endoprosthesis, it is necessary to suture these muscles to the greater trochanter to create a certain degree of tension, which is necessary for the further functioning of the hip abductors and the prevention of dislocation of the endoprosthesis, since the tension of these muscles creates a force that holds the head of the endoprosthesis in the artificial acetabulum. To create such a tension, it is necessary that the leg was in the abduction position during hemming, which facilitates the hemming of abductors to the greater trochanter.

The known method of rigid fixation of the hip joint for the prevention of dislocation (RF patent No. 2306894 of 03/27/2007, Kuzmin II, Kuzmin OI). This method involves unloading the hip joint in the external fixation apparatus, while the proximal support base is made in the form of a rigid bandage that is fixed on the body without breaking the skin, and rods are introduced distally to the hip joint. Through this design, traction is created along the lower limb until its normal length is restored.

Known stand for orthopedic table MAQUET 1417, which allows you to fix the operated lower limb for the foot,

create the necessary traction and abduction of the leg. www.8a.ru/print/7866.php

However, this device fixes the lower limb when the patient is on the back and is too cumbersome to use. The device is not suitable for total hip arthroplasty. For the implementation of the anterolateral and posterolateral access to the hip joint, it is more convenient to position the patient on a healthy side.

The objective of the utility model is a stand for abduction of the lower limb during hip joint replacement.

The problem is solved by a prefabricated device consisting of two rectangular metal plates: bottom (1), 240-250 mm wide and 440-450 mm long, which is a stand on the operating table, and upper (2), 240-250 mm wide and long 290-310 mm, on which the operated lower limb is laid. The upper plate has two metal sides (3) in length and a height of 1/10 of the width of the plate. The sides are necessary for more stable fixation of the operated lower limb on the plate. Metal tubes are mounted in both plates perpendicular to their planes (4). Using the third part - a metal pipe (5) with a length of 300-310 mm and an inner diameter 1 mm larger than the outer diameter of the tubes on the plates, the structure is assembled into a single whole.

Fixation of the operated leg at a height of 300-310 cm allows you to provide the necessary abduction and adequate closure of the postoperative wound with the creation of the necessary tissue tension. The collapsible nature of the design makes it easy to sterilize in an autoclave and provides ease of use, surgeons easily assemble it on the operating table.

Clinical example.

Patient G., 58 years old, was admitted to the 26th trauma unit of the City Clinical Hospital named after S.P. Botkina March 7, 2007 with complaints of pain in the right inguinal region.

Anamnesis: trauma as a result of an accident, a car driver in September 1996 - a fracture of the posterior edge of the right acetabulum. Treated conservatively on skeletal traction, then in a hip plaster cast for 6 months. After the plaster cast was removed, pain in the right hip joint was constantly disturbed during exercise. Over the past 8 months, he has noted an increase in pain, he is forced to use an additional support when walking - a cane. Hospitalized in a planned manner for surgical treatment.

On examination, a relative shortening of the right lower limb is noted - 3 cm, movements in the right hip joint are painful, flexion-causing contracture. On the presented radiographs - deforming arthrosis of the right hip joint 3 tbsp.

Clinical diagnosis: right-sided post-traumatic coxarthrosis 3 tbsp.

March 21, 2007 the operation was performed: Total endoprosthesis replacement of the right hip joint with a cementless fixation prosthesis.

Operation progress: anterolateral access opens the right hip joint in layers. After dislocation of the femoral head, its filing was performed. Pronounced degenerative changes in the articular cartilage of the hip joint, large ossification in the projection of the posterior edge of the acetabulum were found. After removal of scars and ossification, the acetabulum and femoral canal are designed for the components of the cementless fixation endoprosthesis. Done

implantation of the acetabular and femoral components of the endoprosthesis. Implemented reduction of the endoprosthesis and checking its stability. After that, on an operating table of three parts: a lower plate with dimensions of 250 * 450 mm, an upper plate with dimensions of 240 * 310 mm and a connecting pipe with a length of 300 mm, a sterile stand for the removal of the lower limb was assembled. On it, to a height of 300 mm from the plane of the operating table, the operated leg is laid. Then, with the required tension, the capsule of the hip joint is sutured, the gluteal muscles are hemmed, the wound is sutured tightly.

In the postoperative period, already on the 3rd day, the patient could actively remove the operated lower limb. A course of exercise therapy was carried out, the patient was discharged for outpatient observation. 1.5 months after the operation, walking without additional support is allowed. At the control examination, after three months, the patient’s gait is even, lame, there is no pain, a satisfactory amount of active and passive movements in the hip joint. The Harris score was 92%, which is in excellent condition. On the control radiographs - stable fixation of the components, visible signs of osseointegration in the projection of the acetabular and femoral components.

Claims (1)

Stand for abduction of the lower limb during hip replacement, consisting of two parallel-shaped rectangular metal plates, the lower - 240-250 mm wide and 440-450 mm long and the upper - 240-250 mm wide and 290-310 mm long, with the upper the plate has two metal sides in length 1/10 of its width, the plates are interconnected by means of metal tubes inserted into a metal pipe 300-310 mm long and with an inner diameter 1 mm larger than the outer diameter of the tubes on the plate stines.