RU2266065C2 - Device for skeletonizing tubular bones - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has straight raspatory and has polyhedral conic handle having rounded thickening base. Blade has 20 mm wide end face and one of lateral working surfaces concave with an sharpening angle between them reaching 60°. The angle is of double-edged type.

EFFECT: reduced risk of postoperative complications.

2 cl, 2 dwg

Description

The device relates to medical equipment, namely to instruments used in operative orthopedics and traumatology.

In orthopedics and traumatology, intraoperative skeletonization of bone sites, for example, the ends of bone fragments during osteosynthesis, is widely used to free the fracture zone or pseudoarthrosis from granulations, adhesions and scar tissue, which delay the formation of bone marrow by the bone graft, with bone grafting and removal of the lesion , sequestration or bone tumor, etc. Skeletalization of bone sites is carried out with a surgical instrument with a hard coarse blade. As a prototype device, we chose a direct Farabef raspator (Fig. 1), which has a double-edged blade, the end surface of which makes an angle of 100 degrees with both side working surfaces, and a flat handle with a width of 20 mm and a thickness of 6 mm (G. Ostroverkhov E., Bomash Yu.M., Lubotsky D.N. Operative surgery and topographic anatomy). The width of the end of the working part of the raspator is only 12 mm, which when manipulating the tool in the direction “away from you” determines the likelihood of the blade slipping off the rounded surface of the bone and the risk of an uncontrolled failure in the underlying soft tissues. An angle of 100 degrees between the end face and both side surfaces of the raspator blade is not sufficient to form a pointed tenon, and its identity on both sides of the working surface of the tool is irrational due to the lack of an alternative. Due to the fact that the thickness of the handle of the raspator is only 6 mm, when manipulating the instrument, the orthopedist often requires significant physical effort, due to the need for strong compression of the hand into a fist for tight grip and holding its flat handle. Such a seizure is irrational due to the rapid fatigue of the muscles of the forearm and especially the hand of the surgeon with a decrease in his “muscular sense”, i.e. ability to dose their efforts. Insufficient ability to dose muscle effort can lead to technical errors in surgical manipulation and a number of intraoperative complications.

Therefore, the prototype device has the following disadvantages:

1) The insufficient length (12 mm) of the end face of the raspator blade, causing the risk of its slipping from the rounded surface of the bone with an uncontrolled dip into the underlying soft tissue;

2) The angle between the end and side surfaces of the raspator blade is 100 degrees, which is irrational, because the obtuse angle does not provide the formation of a pointed spike for dissection of dense tissues;

3) The identity of the values of both angles between the end and side surfaces of the tool blade determines their mutual duplication and leaves no choice of the optimal form (degree of pointedness) of the double-edged spike of the raspator in each case;

4) The insufficient thickness of the handle of the raspator (6 mm) during manipulations with the instrument often requires a significant amount of physical effort from the orthopedic surgeon, due to the need for a firm grip of the hand into a fist for tight grip and holding the tool. This is accompanied by a decrease in the "muscular sense" of the surgeon and can lead to technical errors and complications during the operation.

To prevent these disadvantages, a device is proposed, which is a direct raspator, different from the traditional tool in the shape and size of both the blade and the handle (figure 2). The blade has a wider, in comparison with the prototype, the end surface of 20 mm, and the concavity of one of the side surfaces. The large length of the end surface makes the tool more convenient for skeletonization of bones, more resistant to slipping from the rounded surface of the bone and reduces the risk of an uncontrolled failure in the underlying tissue. The concavity of one of the sides of the raspator blade determines the following advantages of the tool. Firstly, it facilitates the skeletonization of long tubular bones due to the greater correspondence of the lateral surface of the blade to the rounded contour of the bone perimeter. Secondly, it determines the sharpness of the angle of the raspator to 60 degrees with the formation of a double-edged spike, optimal for dissecting the periosteum, cicatrices and other dense tissues, as well as applying incisions on the bone surface. Thirdly, it makes possible the separation of bone fragments welded together with scars or regenerated not only by the end surface of the blade by pressure with the tool ("away from you"), but also by its concave surface with a pointed spike with a pull from the bottom up and "towards you", which is easier and more rational.

The handle of the proposed device is a hollow cone-shaped polyhedron 10 cm long, with a thickened and rounded base, with a diameter of 35 mm. This shape and increased handle volume make the tool more convenient and manageable in comparison with a traditional flat raspator for the following reasons. The roundness and thickening of the base of the handle creates a good emphasis for the surgeon's palm, and its increased volume makes it possible to grip the instrument hard and manipulate it without much tension and, consequently, without fatigue and reducing the “muscular sense”.

As an example of the application of the proposed device, the following observation.

Patient D., 39 years old, was admitted to the orthopedic department of the Republican Orthopedic and Traumatology Center (RTC) in the city of Makhachkala on September 13, 02, in a planned manner with a diagnosis of Improperly healed fracture of the upper third of the left thigh.

From the anamnesis: on July 8, 2002, as a result of an accident in the city of Kizilyurt, the patient received a combined injury, which, along with a moderate traumatic brain injury and bilateral fracture of the pubic and ischial bones of the pelvis, included a closed comminuted fracture of the upper third of the left thigh with a displacement. For three weeks, the patient was in the traumatology department of the Kizilyurt CRH on skeletal traction, and before leaving for outpatient treatment, she was given a hip plaster cast.

On examination, the patient had a shortening of the left lower limb by 4 cm and varus ("breeches") deformation of the upper third of the thigh. X-ray verification of the complete displacement of bone fragments along the width, length and axis with the presence of excess periosteal callus in the fracture zone.

09/15/02, the operation was performed: open reduction and retrograde intramedullary osteosynthesis of fragments of the left thigh. During the operation, a device was used, which is a raspator, characterized by a multifaceted conical handle with a thickened rounded base, a wider end surface of the blade and the presence of concavity on one of its two lateral working surfaces. After exposure of the fracture zone, bone fragments separated by a tight-to-touch regenerate (periosteal callus) and scar connective tissue were separated. The large, in comparison with the traditional tool, length of the end surface of the raspator made it more resistant to sliding off the rounded surface of the femur, and the concavity of one of the sides of its blade optimized the process of skeletal bone fragments due to the greater correspondence of the lateral surface of the blade to the rounded contour of the bone perimeter. In addition, the sharpness of the angle of the raspator with the formation of a double-edged spike made it more effective to separate bone fragments welded together by scars or regenerated not only by the end surface of the blade by pressure from the tool, but also by pulling it from the bottom up and towards itself. Due to the rounded shape of the handle, the tool has become more manageable in comparison with the traditional flat raspator due to the convenient palm rest for the surgeon’s palm, and its increased volume and versatility made it possible to grip the instrument hard and manipulate it without much tension and, therefore, without fatigue and reduction of muscle intuition. "

The postoperative wound healed initially. The sutures were removed on the 9th day, and the patient was discharged for outpatient treatment. Walking without crutches began 2.5 months after the operation. The result of treatment is regarded by us as good.

Distinctive features of the prototype and the advantages of the proposed device are the following:

1) The large width of the end face of the raspator blade, namely 20 mm, which reduces the likelihood of it slipping off the rounded surface of the bone and the danger of an uncontrolled failure in the underlying soft tissue;

2) The concavity of one of the side surfaces of the raspator, which corresponds to the convexity of the rounded perimeter of the surface of long tubular bones;

3) The angle between the end face and one of the side surfaces of the raspator blade, namely, the concave side, is 60 degrees with the formation of a pointed double-edged spike, optimal for dissecting dense tissues;

4) The difference in the magnitude of both angles between the end and side surfaces of the tool blade determines the choice of the optimal shape for the double-edged spike of the raspator in each case;

5) The cone-shaped polyhedral handle with a rounded thickened base has made the instrument more convenient and controllable due to the provision of an adequate palm rest for the surgeon and the possibility of hard grip of the instrument without significant tension and, therefore, without fatigue and reduction of the surgeon’s “muscular sense”.

Thus, the proposed device can reduce the number of intraoperative complications, improve the quality of bone operations, and hence the effectiveness of surgical treatment of traumatologic and orthopedic patients.

Sources of information

1) Boychev B., Conforti B., Chokanov K. Operative orthopedics and traumatology. - 2nd ed., Revised. and add. - DI "Medicine and physical education", - Sofia, 1958. - 832. - P.76-92;

2) Movshovich I.A. Operative orthopedics: (Manual for doctors). - 2nd ed., Revised. and add. - M .: Medicine, 1994 .-- 448 p. - S. 28-47;

3) Ostroverkhov G.E., Bomash Yu.M. Lubotsky D.N. Operative surgery and topographic anatomy. - Kursk; Moscow: AOZT Litera, 1996 - 720 s.-S.207-225. - prototype device.

Claims (2)

1. A device for skeletonization of tubular bones in the form of a straight raspator, characterized in that it has a polyhedral conical handle with a rounded thickened base, the blade having an end surface width of 20 mm and a concave shape of one of the side working surfaces with an angle between them of up to 60 ° made in the form of a double-edged type. 2. The device according to claim 1, characterized in that the handle is hollow, has a length of 10 cm and a rounded base with a diameter of 35 mm

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