RU177229U1 - Bone plate for lengthening limb bones with an external fixation device - Google Patents

Abstract

The utility model relates to medicine, namely to implantable bone plates for osteosynthesis, is intended for use in lengthening the limb by the method of combined osteosynthesis. The osseous plate for lengthening the limb bones contains a proximal section, a middle part 2, a distal section 3, through holes of a round shape 4, a through hole of an elongated shape 5, in the form of a groove. The osseous plate is made of titanium alloy: VT6. The middle part 2 is made continuous (without holes and grooves). Along the surface 6 of the plate intended to fit to the bone, two stiffeners are made 7. Chamfer 8 is made from the end face. The technical solution is aimed at shortening the time of fixation of the bone by the external fixation apparatus when it is elongated. The technical result consists in reducing the patient’s stay in the external fixation apparatus when lengthening the limb. Bone plate provides the ability to stabilize bone fragments during the lengthening of the bone by the external fixation device and their stable fixation after removal of the external fixation device. 11 s.p. f-ly, 13 ill.

Description

The utility model relates to medicine, namely to implantable bone plates for osteosynthesis, is intended for use in lengthening the limb by the method of combined osteosynthesis.

Known osseous plate ([1], RU 2006127215), with limited contact for stable osteosynthesis in fractures of the lower third of the humerus. The plate has two ribs equipped with a solid shelf and fixing elements in the form of supports located between arched recesses. The plate has holes and iodine screws located along the middle axis, which can be staggered. Plate thickness 2.0 mm, width 8.0-16.0 mm. It is made of titanium alloy VT 1-0. It has an L-shape, including the osseous and blade parts with arched recesses, and along the body of the osseous part of the plate there are three stiffeners. A bend of the osseous plate is formed according to the relief of the bone surface, the plate is fixed with spongy screws.

A known extension plate for osteosynthesis ([2], RU 2011136903). Extension plate, contains a housing with holes for mounting screws. One end of the housing is made with an element to enable fixation with emphasis on a previously fixed plate, and the other end is made with holes for mounting screws. The end with holes for mounting screws is made rectilinear or arcuate.

These analogues [1; 2] do not allow the implementation of combined osteosynthesis, ie lengthen the bone with an external fixation device when a bone fixer is installed on it, since the plate [1; 2] does not have

holes for screws of elongated shape or made in the form of a groove, which does not allow the screw shaft to move along the plate during elongation.

A known method of lengthening the thigh ([3], RU 2211001) using the external fixation apparatus and the osseous plate. The method [3] describes a flat osseous plate containing 32 and 34 round holes for bone screws and one elongated hole in the form of a groove. When lengthening using a plate [3], in the final stage of regenerate buildup, diastasis is at the level of an elongated hole.

In the source [3], the design of the plate is not disclosed with the completeness sufficient for implementation. The dimensions and material of the plate are not indicated. A large number of holes (32 and 34) reduces the strength of the plate, increases the number of dangerous cross sections. The plate [3] does not have stiffeners and does not provide the necessary stiffness of fixation of bone fragments after removal of the external fixation apparatus. When lengthening using a plate [3], in the final stage of regenerate buildup, the diastasis is at the level of the elongated hole, i.e. a weak, non-formed regenerate that is not capable of carrying a full load is located at the level of the weakest, most dangerous cross section of the plate. This design of the plate, after removing the external fixation apparatus, does not provide the rigidity of fixation of the bone and preservation of the regenerate, as a result of which angular deformations occur. The analogue [3] does not have a geometric shape adapted to the geometric shape of the bone. The shape of the implant surface [3] adjacent to the bone is not congruent with the curved geometry of the outer surface of the diaphysis of the tibia or femur, of a single individual (patient).

The technical solution is aimed at reducing the time of fixation of the bone by the external fixation apparatus when it is elongated.

The technical result consists in reducing the patient’s stay in the external fixation apparatus when lengthening the limb. Bone plate provides the ability to stabilize bone fragments during the lengthening of the bone by the external fixation device and their stable fixation after removal of the external fixation device.

The technical result is achieved by the fact that the osseous plate for lengthening the limb bones (hereinafter the osseous plate) contains through holes of a round shape, a through hole of an elongated shape. It differs in that it is made of a titanium alloy, contains a continuous section (without holes) in the middle part, along the surface of the plate intended to fit to the bone, two stiffeners are made.

This entity allows you to achieve the claimed technical result. The continuous portion of the plate, located when using the plate at the diastasis level, where regenerate is formed, stiffeners and plate material, together provide the necessary stiffness of the plate and allow to maintain a stable position of the bone fragments during bone elongation (period of distraction) and after removal of the external fixation apparatus ( fixation period). As a result, the patient’s stay in the external fixation apparatus is reduced when the limb is lengthened, since it can be removed for the fixation period.

The author provides that the osseous plate in cross section has the shape of a channel, thus, two stiffeners are formed. Along the surface of the plate intended to fit to the bone, the cross section of the plate may also have a concave shape, in which case the protruding edges are stiffeners. The oblong through hole is preferably made in the distal portion of the plate, in the form of a groove extending 1/3 of the total length of the plate. The length of the continuous portion in the middle portion is preferably 1/3 of the total plate length.

The osseous plate is preferably made in the shape of a rectangle and for various bones can have a length of 90 to 200 millimeters, a width of 8 to 20 millimeters, and a thickness of 1 to 8 millimeters. Round through holes can be in an amount of 2 to 6 pieces. The osseous plate is preferably made curved in length and geometrically corresponds to the anatomical curvature of the bone surface for which it is intended to be applied.

It is envisaged that an elongated through hole in the form of a groove in the distal portion of the plate is made with round indentations under the head of the bone screw.

It is envisaged that a chamfer is made at the distal and / or proximal end of the plate.

It is assumed that the osseous plate is made of VT-6 titanium alloy with a roughness of 0.63 Ra.

The utility model is illustrated by graphic materials.

FIG. 1 - osseous plate for tibia, with two round holes, general view;

FIG. 2 - an osseous plate for a shin, with three round holes, a general view;

FIG. 3 - an osseous plate for the shoulder, an option with two round holes, an oblong through hole in the form of a groove in the distal section of the plate, made with round indentations under the head of the bone screw, general view;

FIG. 4 - an osseous plate for a shoulder, an option, with two round ones; holes, an oblong through hole in the form of a groove in the distal portion of the plate, made with round indentations under the head of the bone screw, top view;

FIG. 5 is a cross-sectional view of a channel plate in the shape of a channel; stiffeners are shown;

FIG. 6 is a cross-sectional view of a concave shaped osseous plate; stiffeners are shown;

FIG. 7 - an osseous plate for the thigh, with four round holes, one of the round holes is made in the distal section of the plate, top view;

FIG. 8 - side plate for the hip;

FIG. 9 - a osseous plate for the thigh, concave in shape, general view;

FIG. 10 - an osseous plate for the thigh, in the form of a channel, a general view;

FIG. 11 - an osseous plate for the lower leg, mounted on the tibia, the external fixation apparatus is shown, view before distraction;

FIG. 12 - an osseous plate for the lower leg, mounted on the tibia, the external fixation apparatus is shown, view after distraction;

FIG. 13 - an osseous plate for the lower leg, mounted on the tibia, view during fixation.

Implementation of a utility model.

Bone plate for lower leg (Fig. 1) is made of VT6 titanium alloy. It has an oblong shape, 155 mm long, 10 mm wide, 4 mm thick. Contains the proximal section 1 (Fig. 1), the middle part 2 (Fig. 1), the distal section 3 (Fig. 1). On the surface of the plate there are two through holes of round shape 4 (FIG. 1) and one through hole of an oblong shape 5 (FIG. 1). The through hole of the elongated shape 5 is made in the distal section 3, in the form of a groove with a length of 50 mm. In the middle part 2, the plate is continuous, has no holes or other elements weakening the cross section of the plate. The osseous plate (Fig. 1) in cross section has the shape of a channel (Fig. 5), thus, two stiffeners 7 (Fig. 1) are formed along the surface of the plate 6 (Fig. 1), intended to fit to the bone. From the end plate contains a chamfer 8 (Fig. 1).

In FIG. 2 shows an ankle plate for lower leg with an increased number of through holes 4. Made of VT6 titanium alloy. It has an oblong shape, 170 mm long, 8 mm wide, 5 mm thick. Contains the proximal section 1 (Fig. 2), the middle part 2 (Fig. 2), the distal section 3 (Fig. 2). At the proximal section 1 of the plate there are three through holes of round shape 4 (Fig. 2). In the distal section 3 there is one through hole of an oblong shape 5 (Fig. 2)., In the form of a groove with a length of 45 mm. In the middle part 2, the plate is continuous, has no holes or other elements weakening the cross section of the plate. The osseous plate (Fig. 2) in the cross section has the shape of a channel (Fig. 5), thus, along the surface of the plate 6 (Fig. 2; 5), intended to fit to the bone, two stiffeners 7 are formed (Fig. 2; 5). From the end plate contains a chamfer 8 (Fig. 2). Holes 4 and 5 are made with chamfer 9 (Fig. 2)

In FIG. 3; 4 shows a shoulder plate made of VT6 titanium alloy. It has an oblong shape, 130 mm long, 10 mm wide, 3 mm thick. Contains the proximal section 1 (Fig. 3; 4), the middle part 2 (Fig. 3; 4), the distal section 3 (Fig. 3; 4). At the proximal section 1 of the plate, two through holes of round shape 4 are made (Fig. 3; 4). In the middle part 2 (Fig. 3; 4), the plate is continuous, has no holes or other elements weakening the cross section of the plate. In the cross section, the plate has the shape of a channel (Fig. 5), thus, along the surface of the plate 6 (Fig. 3; 4; 5), designed to fit to the bone, two stiffeners 7 are formed (Fig. 3; 4; 5) . At the end, the plate contains a chamfer 8 (Fig. 3; 4). A through hole of an elongated shape 5 (Fig. 3; 4), made in the distal section 3, in the form of a groove length of 43 mm with round recesses 10 (Fig. 3; 4) under the head of the bone screw. The recesses 10 contribute to the fixation of the head of the bone screw.

In FIG. 7; 8; 9; 10 shows a hip plate made of VT6 titanium alloy. It has an oblong shape, 200 mm long, 12 mm wide, 6 mm thick. Contains the proximal section 1 (Fig. 7; 9; 10), the middle part 2 (Fig. 7; 9; 10), the distal section 3 (Fig. 7; 9; 10). At the proximal section 1 of the plate there are three through holes of round shape 4 (Fig. 7; 9; 10). In the middle part 2 (Fig. 7; 9; 10), the plate is solid, has no holes or other elements weakening the cross section of the plate. In the distal section 3 (Fig. 7; 9; 10), a through hole of an oblong form 5 (Fig. 7; 9; 10) is made, in the form of a groove with a length of 50 mm. In the distal section 3 (Fig. 7; 9; 10), between the end face and the through hole of the elongated shape 5, a fourth round hole 4 is made (Fig. 7; 9; 10). In cross section, the plate has two versions. As shown in FIG. 9 in cross section, the plate has a concave shape (Fig. 6), thus, two stiffeners 7 (Fig. 6; 9) are formed along the surface of the plate 6 (Fig. 6; 9), designed to fit to the bone. As shown in FIG. 10 in cross section, the plate has the shape of a channel (Fig. 5), thus, along the surface of the plate 6 (Fig. 5; 10), designed to fit to the bone, two stiffeners 7 are formed (Fig. 5; 10). At the end, the plate contains a chamfer 8 (Fig. 7; 8).

The osseous plate for the shoulder, in order to ensure congruence and tight fit to the bone, is curved in the form of a repeating surface of the humerus. The thigh plate is curved in the shape of a femur following the surface. The ankle plate for the tibia is curved in the shape of a tibial surface. The curvature of the plate is provided immediately before the operation with a special tool for bending the plates.

Using a technical solution.

The use of the osseous plate is shown on the lower legs, for other parts of the body it is used in a similar way.

An Ilizarov apparatus 11 (Fig. 11; 12) or another apparatus of external fixation is applied to a limb (lower leg), providing the ability to apply distraction efforts to the tibia 12 (Fig. 11), for this bone fixators 13 (knitting needles, Fig. 11) are carried out in the proximal and distal metaphyses, the outer ends of the bone fixators are fixed to the supports 14 (Fig. 11) of the apparatus and connect the supports to each other. Through a small incision (10 mm) an osteotomy of the tibia 15 (Fig. 11) is performed, the proximal 16 (Fig. 12; 13) and distal 17 (Fig. 12; 13) fragments of the tibia 12 are obtained. In the proximal tibia metaphysis with the medial surface of the lower leg produce a small incision of soft tissues (10 mm wide). Penetrating through the incision with a surgical instrument, the tibia 12 exfoliates soft tissues along its length to the distal metadiaphysis. Soft tissues exfoliate to the width and length of the osseous plate forming a pocket in the tissues. Apply the plate to the lower leg, check the conformity of the shape of the plate to the shape of the bone surface on which it is applied. If necessary, the bony plate is bent to the required shape ensuring its tight fit to the bone. The distal section 3 is inserted into the incision and pushed it further into the pocket, laying the plate with surface 6 on the surface of the tibia 12. The plate is set so that the level of osteotomy 15 is at the level of the middle part 2 of the plate, preferably at the level of the proximal (upper) part of the middle section 2. This ensures, during distraction and at the final stages of distraction, the location of the regenerate 18 (Fig. 12; 13) at the level of the middle part 2 of the plate having high rigidity and flexural strength. The proximal section 1 of the plate is fixed to the proximal fragment 16 of the bone with bone screws 19 (Fig. 11; 12; 13), for this they are screwed into the bone through holes 4, I press the head firmly against the plate. One bone screw 20 is screwed into the distal fragment 17 of the bone through the upper part of the through hole of the elongated shape 5 (Fig. 11; 12; 13), not completely, so that the head of the bone screw 20 is 0.5 ... 1 mm from the surface of the plate, this allows the bone screw 20 to slide in the through hole of the elongated shape 5 during distraction. For greater stability of bone fragments at a distance of 10 ... 20 mm from the first screw into the through hole of an elongated shape 5, the second bone screw 21 is similarly screwed (Fig. 11; 12; 13). Using an external fixation apparatus 11, distraction efforts are applied to bone fragments 16, 17 at a rate of 0.25 mm 4 times during the day. During the planned period, the regenerate 18 is distilled and grown to the required value (the length of the regenerate is limited by the long through hole of an elongated shape 5). The regenerate 18 formed in the diastasis during elongation is located in the projection of the solid part of the plate, which reduces the likelihood of angular deformations. After the end of distraction, through the punctures above the heads, the bone screws 20, 21 are tightened, tightly pressing them to the plate, an additional fixing bone screw 22 is screwed in (Fig. 12; 13). The external fixation device 11 is removed (Fig. 13) and for the period of fixation, the osseous plate provides shunting of the diastasis from excessive loads, preserving its integrity and ensuring the formation of a healthy bone. Bone plate allows you to maintain a stable position of the bone fragments 16.17 in the period of bone elongation (period of distraction) and after removal of the external fixation apparatus 11 (period of fixation). As a result, the patient’s stay in the external fixation apparatus is reduced when the limb is lengthened, since it can be removed for the fixation period.

The osseous plate can be made on modern industrial equipment for metalworking from titanium alloys intended for the manufacture of implants. Bone plate was tested by the author on the basis of the Ilizarov Center in Kurgan.

Claims (12)

1. Bone plate for lengthening the bones of the limb by an external fixation apparatus, containing through holes of a round shape, a through hole of an elongated shape, characterized in that it is made of a titanium alloy, contains a continuous section in the middle part, along the surface of the plate intended to fit to the bone, made two stiffeners. 2. The osseous plate according to claim 1, characterized in that two stiffeners are made along the surface of the plate intended to fit to the bone, so that in the cross section the plate has the shape of a channel. 3. The osseous plate according to claim 1, characterized in that two stiffeners are made along the surface of the plate intended to fit to the bone, so that the cross-section of the plate has a concave shape. 4. The osseous plate according to claim 1, characterized in that the through hole of an elongated shape is made in the distal portion of the plate, in the form of a groove extending 1/3 of the total length of the plate. 5. Bone plate according to claim 1, characterized in that the length of the continuous section in the middle part is 1/3 of the total length of the plate. 6. The osseous plate according to claim 1, characterized in that it is made in the form of a rectangle, with a length of 90 to 200 millimeters, a width of 8 to 20 millimeters, a thickness of 1 to 8 millimeters, with round through holes in an amount of 2 to 4 pieces , with one oblong through hole in the form of a groove in the distal portion of the plate. 7. The osseous plate according to claim 2, characterized in that it is made in the form of a rectangle, 155 millimeters long, 10 millimeters wide, 4 millimeters thick, contains two round through holes in the proximal section, one oblong through hole in the shape of a groove with a length of 50 millimeters per the distal portion of the plate, and one circular through hole located in the distal portion closer to the distal end of the plate. 8. The osseous plate according to claim 1, characterized in that it is made curved along the length and geometrically corresponds to the anatomical curvature of the bone surface for which it is intended to be applied. 9. The osseous plate according to claim 1, characterized in that the elongated through hole in the form of a groove in the distal portion of the plate is made with round indentations under the head of the bone screw. 10. The osseous plate according to claim 1, characterized in that two circular through holes are located in the proximal portion, an oblong through hole in the form of a groove in the distal portion of the plate is made with round recesses under the head of the bone screw, a chamfer is made at the distal end of the plate. 11. The osseous plate according to claim 1, characterized in that it is made of titanium alloy VT-6 with a roughness of 0.63 Ra. 12. The osseous plate according to claim 1, characterized in that bevels are made at the distal and proximal ends of the plate.

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