RU186276U1 - DEVICE FOR PREPARING AND COLLECTING AUTO-LAST-PLASTIC MATERIAL CONTAINING MEMORY PEPTIDS AND ENRICHED WITH A CONCENTRATED BLOOD BLOOD WITH PRP FACTOR, FOR IMPLEMENTATION OF A TREATMENT - Google Patents

Abstract

This utility model relates to the field of medicine, in particular maxillofacial surgery.

Our technical support requires a rotary power tool - a shaver with an adjustable speed, as well as a device specially developed by us - a multifunctional osteotome.

This effect is achieved through the method of processing the taken autograft using MO. When using only a dome-shaped cutter, bone blocks are obtained (possibly with inclusions of the red bone marrow under the cortical plate), and when using a dome-shaped cutter with a cross-shaped osteotome blade, bone mass is obtained in the form of chips (also with possible content of red bone marrow tissue).

Known osteotome (Patent RU 2306879) for a tubular bone containing a handle that is designed to strike at it, and the working part. The working part is fixed on the handle and has a spike and an elongated restrictive guide plate with a convex part. The convex part of the plate extends beyond the tenon on all sides. The cutting part of the spike is made concave. The spike tip and the end of the bounding guide plate are bent towards each other. The osteotome allows you to perform a transverse bone intersection.

Known by the osteotome (Patent SU 1297826), containing a concave-convex working part, the end of which is equipped with a pointed tenon on the concave side, and a plate with the edges protruding above the tenon on the convex side.

Known by an osteotome (Patent SU 1801385), containing a handle with a coaxially located main ring and a working part with a pointed spike, over which a restriction plate is placed on one of its sides.

A device for cutting a round bone flap from the bones of the cranial vault, adopted for the prototype, in the form of a crown milling cutter with a body in which there is a center finder and focus, and the cutting part is represented by a fine-toothed blade located around the circumference. (EI Kandel "Functional and stereotactic neurosurgery" M., Medicine, 1981, S. 70-71).

The technical result of our utility model is to improve similar designs by changing the configuration of the proposed multifunctional osteotome, the technique of sampling autocostoplastic material containing memory peptides and enriched with concentrated blood convolution with a PRP factor.

Description

This utility model relates to the field of medicine, in particular maxillofacial surgery.

In case of impression fractures and other traumatic lesions of any localization of the bone or its lysis during destructive processes, a deficiency of bone tissue (bone defect) occurs. It appears during the operation in the form of a void, for example, in a bone cyst or under a repaired articular surface, or in a defect area in the area of the bone bed or in another situation requiring replenishment (compensation for lost bone mass) - bone grafting of the defect. It is generally believed that with free plastic surgery it is of fundamental importance to fill the defect with material capable of incorporation, and the method of laying the osteoplastic material, as well as the graft collection technique, in principle does not affect the outcome of the operation, and therefore the guidelines give minimal attention to this issue.

Known osteotome (Patent RU 2306879) for a tubular bone containing a handle that is designed to strike at it, and the working part. The working part is fixed on the handle and has a spike and an elongated restrictive guide plate with a convex part. The convex part of the plate extends beyond the tenon on all sides. The cutting part of the spike is made concave. The spike tip and the end of the bounding guide plate are bent towards each other. The osteotome allows you to perform a transverse bone intersection.

Known by the osteotome (Patent SU 1297826), containing a concave-convex working part, the end of which is equipped with a pointed tenon on the concave side, and a plate with the edges protruding above the tenon on the convex side.

Known by an osteotome (Patent SU 1801385), containing a handle with a coaxially located main ring and a working part with a pointed spike, over which a restriction plate is placed on one of its sides.

However, these technical solutions have several disadvantages, namely:

1) The pointed spikes do not protect the surrounding soft tissue on all sides from damage when crossing the bone; 2) They require a mechanical impact on the device in the form of hammer blows to cross the bone; 3) Do not exclude the damaging device of the anvil of the hammer on the soft tissues and the bone itself.

A device for cutting a round bone flap from the bones of the cranial vault, adopted for the prototype, in the form of a crown milling cutter with a body in which there is a center finder and focus, and the cutting part is represented by a fine-toothed blade located around the circumference. (EI Kandel "Functional and stereotactic neurosurgery" M., Medicine, 1981, S. 70-71).

This device does not allow you to quickly and efficiently cut holes larger than 25 mm in diameter, the design of the device is not strong and durable in use. Sawed bone flap is difficult to use for bone autoplasty due to its failure in the cranial cavity.

Our technical support requires a rotary power tool - a shaver with an adjustable speed, as well as a device specially developed by us - a multifunctional osteotome (note: hereinafter MO).

This effect is achieved through the method of processing the taken autograft using MO. When using only a dome-shaped cutter, bone blocks are obtained (possibly with inclusions of the red bone marrow under the cortical plate), and when using a dome-shaped cutter with a cross-shaped osteotomy blade, bone mass is obtained in the form of chips (also with possible content of red bone marrow tissue).

The invention is illustrated by drawings.

FIG. 1. Osteotome casing, side view in direct projection.

1a - casing body;

1b - handles-holders of the casing of the osteotome;

1c - inlet fitting for coolant;

1d - outlet for coolant.

FIG. 2. Osteotome casing, side view of an oblique vertical-lateral projection.

2a - casing body;

2b - handles-holders of the casing of the osteotome;

2c - inlet fitting for coolant;

2d - outlet for coolant.

FIG. 3. The casing of the osteotome is a sectional view in an oblique vertical-lateral projection.

3a - casing body;

3b - handles-holders of the casing of the osteotome;

3c - inlet fitting for coolant;

3d - coolant outlet fitting.

Fig 4. The casing of the osteotome is a top view in direct projection.

4a - casing body;

4b - handles-holders of the casing of the osteotome;

4c - inlet fitting for coolant;

4d - outlet for coolant.

FIG. 5. Dome-shaped milling cutter with flare nut.

5a is a side view of the cutter body in a direct projection;

5b is a straight cone top view nut;

5c - flare nut side view in direct projection;

5d is a section of a dome-shaped cutter in the region of its apex with a thread under a flare nut to change the geometry of the cutter dome;

5e - slotted grooves (4 pcs. At an angle of 90 degrees to each other) in the body of the dome of the cutter to change its geometry;

5f is a restrictive retaining ring to prevent excessive deepening of the osteotome cutter and the extension of the walls of the dome-shaped cutter body to the outside.

FIG. 6. Dome of the osteotome cutter, bottom view in direct projection.

6a - working walls of the cutter dome, cut by grooves;

6b is the “lower” surface of the contact area of the cutter dome with the rod (in the center is a hexagonal hole to create engagement of the cutter dome with the rod);

6c - split grooves in the walls of the dome of the cutter to change the geometry of the latter;

6d is a restrictive retaining ring to prevent excessive deepening of the osteotome cutter and extension of the dome walls of the dome-shaped cutter outside.

FIG. 7. Bottom view of the dome-shaped cutter in direct projection with emphasis on the walls of the dome.

7a - working walls of the cutter dome, cut by grooves with "removal" of the retaining ring and the "lower" surface of the contact area of the cutter dome with the rod (indicated by a dotted line);

7b - the cutting edge of the wall of the dome of the cutter in a 4-fold increase.

FIG. 8. A cruciform osteotome knife for a cutter with an outer diameter of 46 mm, a general view from above.

FIG. 9. Cross-shaped osteotome knife for milling cutters with an outer diameter of 46 mm, general side view.

9a - teeth on the cutting edges of the blades (have a horizontal direction) and on the base of the knife (2 mm high, have a vertical direction);

9b - knife support sleeve, coming from the base of the knife with a through hole of square section 4 × 4 mm in vertical projection for passing the rod and through hole of circular cross section 2 mm in diameter - for fixing the knife to the rod with a screw;

9c is a side view of a knife blade in a 5-fold magnification;

9d is a view of the cutting edge of the blade of a blade of a knife with teeth in a 5-fold increase.

FIG. 10. The osteotome stock with a multidisciplinary cross-section is a side view and nut for fixing the dome-shaped cutter on the osteotome stock in vertical and lateral projections.

10a is a side view of the osteotome stock laterally;

10b — spear-shaped tip of the osteotome rod in vertical projection (section perpendicular to the axis), bottom view, 3-fold increase;

10c is a view of the stem seat for a cross-shaped knife of square (tetrahedral) cross section in a perpendicular projection with a through hole through the screw for fixing the knife — 3-fold increase;

10d is a view of the stem stem neck for a dome-shaped hexagonal cross-section mill in a perpendicular projection - an increase of 1.5 times.

10e - nut for fixing the dome-shaped cutter in the vertical and lateral projections.

FIG. 11. Dome-shaped milling cutter with an outer diameter of 30 mm, side view in direct projection.

FIG. 12. Dome-shaped cutter with an outer diameter of 20 mm, side view in direct projection.

FIG. 13. A cross-shaped knife (“small”) for a dome-shaped cutter with an outer diameter of 30 mm.

13a - cross-shaped knife "small", top view;

13b is a small cross-shaped knife, side view;

13c - cruciform knife “small” general view in oblique upper lateral projection, 5-fold increase.

The device consists of the following components:

- the steel tube-casing is a metal cylinder with an outer diameter of 52 mm, an inner diameter of 50 mm, with a wall thickness of 2 mm and a height of 80 mm with perpendicular holders-handles in the form of metal plates with a length of 40 mm, a width of 20 mm and a thickness of 6 mm with a raised upper surface attached to the casing by welding; fittings for supplying and discharging coolant in the form of two tubes with a diameter of 5 mm, a wall thickness of 1 mm (inner diameter of 4 mm) and a length of 20 mm, also attached to the casing by welding.

- dome-shaped osteotome cutter with a flare nut to change the diameter of the "dome":

the milling cutter is made of titanium steel in the form of a bell with a truncated upper part with a diameter of 16 mm, in which a hole of a hexagonal shape “internal diameter” 10 mm is pierced, and a 15 mm thread along an external diameter; Further, the thin-walled dome goes into the open part, ending with a serrated edge with cutting edges in the area of split grooves in an amount of 4, machined from the open edge and not reaching 5 mm to the upper edge of the dome. A restrictive snap ring is soldered 7 mm above the serrated edge. Similar dome-shaped milling cutters are additionally made in 2 sizes of the lower (open toothed) edge with an inner diameter of 26 mm and 16 mm, respectively, with an outer diameter of 30 mm and 20 mm and a wall thickness of a dome-shaped mill of 2 mm.

- a steel rod of variable cross-section with a spear-shaped tip 7 mm long and 4 mm wide, having a 4 × 4 mm square cross-section with a through hole for the screw — the location and fixation of the osteotome cross-shaped knife; and hexagonal “neck”, continuing thread - a place for fixing the dome-shaped cutter. The length of the stem with a multidisciplinary variable cross-section (key places: a neck for landing a dome-shaped cutter, a place for landing a cross-shaped knife of an osteotome and a spear-shaped tip are described above), which serves to set in motion a dome-shaped cutter, as well as to install and fix a cross-shaped osteotome inside the dome is 112 mm, maximum diameter 14 mm, in the area of a hexagonal neck turning into a circular part with a thread - 10 mm and a square part 4 × 4 mm;

- A cruciform osteotome blade with cutting faces of a complex profile of two sizes: the first with an external blade dimension of 40 mm, 10 mm wide and 10 mm thick with a complex serrated shape of the cutting edge of the blade and a 45 ° cutting edge sharpening, as well as cutting teeth with a height of 2 mm in the region of the lower surface of the base of the cross-shaped knife between the blades; the cross-shaped knife for an additional dome-shaped cutter with an inner diameter of 26 mm is made in the form of a star with four asymmetric beams, smooth cutting edges of the blades and cutting teeth with a height of 2 mm in the region of the lower surface of the base between the blades.

- Nuts and grader washers for fixing the complete assembly.

All components of the osteotome are made of titanium steel grade VT5 or steel X18H9T. Sharpening of all cutting surfaces is carried out using laser instruments and tools.

Our proposed utility model is as follows.

An osteotomy is performed by bringing the osteotome into circular motion with a power tool at a speed of 120-150 rpm for 1 minute with little effort in a vertical plane, perpendicular to the bone surface. The manipulation continues until the limiter of the dome-shaped cutter stops in the outer cortical plate of the bone (thus, grinding into bone chips of bone tissue is performed to a depth of not more than 4 mm). The conical nut of the dome-shaped cutter, in its upper part, is tightened to the stop and the cutter is slowly, without excessive efforts, removed from the bone and the lumen of the steel casing together with the bone material filling the dome of the cutter. The latter is carefully and completely removed from the cutter dome and mixed with 3 ml of the patient’s own blood plasma obtained by preliminary centrifugation of autologous blood for 5 minutes at a speed of 2300 rpm and repeated centrifugation, after removing the “upper” plasma layer, for 5 minutes at a speed of 4000 rpm. The obtained osteoplastic material is placed back to the fence and carefully sealed in the form of a “seal” and closed with a PRP layer obtained from a convolution of centrifuged autologous blood. The periosteum is sutured over the formed “seal” coated membrane with a PRP factor. Layered closure of the wound leaving drainage in the form of a rubber strip graduate.

4 weeks after the injury, surgery is performed on the bones of the facial or craniofacial parts of the skull. The autograft is taken as described above through access through scars. The resulting defect is closed by a hemostatic sponge. Layer wound closure is performed. The collected autograft in the form of bone-chip mass is again enriched with centrifuged autologous plasma and convolution of shaped elements and placed in the engineering structure or between the restored bone and an additionally installed PRP-membrane. In the case of using a bone block obtained as a result of an osteotomy without using a cruciform osteotome knife, the resulting bone block is formatted to the desired size and configuration. The remaining fragments are crushed using a bone mill, enriched with concentrated blood bundle obtained by preliminary centrifugation of autologous blood for 5 minutes at a speed of 2300 rpm and re-centrifugation, after removal of the “upper” plasma layer, for 5 minutes at a speed of 4000 rpm minute, with the addition of a small amount (0.5-1.5 ml) of a plasma centrifuge. The obtained enriched bone-chip mass is placed between the bone block of the autograft and the operated site of the bone of the facial or craniofacial-facial section of the skeleton. The tissue is sutured over the defect.

Claims (6)

A device for the preparation and collection of autocostoplastic material in the form of bone-chip mass, consisting of: a steel tube-casing, which is a metal cylinder with perpendicular holders-handles in the form of metal plates with a raised upper surface and attached to the casing by welding; fittings for supplying and discharging coolant in the form of two tubes, also connected to the casing by welding; a dome-shaped osteotome cutter with a flare nut to change the diameter of the “dome”, while the cutter is machined from titanium steel in the form of a bell with a truncated upper part, in which a hexagonal hole is pierced, and a thread along the outer diameter, while the thin-walled dome goes into the open part, ending with a serrated edge with cutting edges in the area of four split grooves, machined from the open edge and not reaching the upper edge of the dome, a restrictive retaining ring is also soldered 7 mm above the serrated edge; a steel rod of variable cross-section with a spear-shaped tip having a square cross-section with a through hole for a screw for fixing the osteotome cross-shaped knife and a hexagonal “neck”, continuing thread for fixing the dome-shaped cutter; a cruciform osteotome blade with cutting faces of a complex profile of two sizes: with a serrated shape of the cutting edge of the blade and a tilt of the sharpening of the cutting surface of 45 ° and cutting teeth in the region of the lower surface of the base of the cross-shaped knife between the blades; nuts and engraving washers for fixing the dome-shaped cutter.

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