RU2271169C2 - Method and device for carrying out reparative bone tissue regeneration - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: device has supporting rings and pins manufactured from electric conductive material, fixing threaded rods manufactured from electric conductive material for clamping and fixing the supporting rings fastened on supporting rings with plug-type connection members and dielectric members and/or telescopic rods manufactured from electric conductive material for clamping and fixing the supporting rings. At least one of supporting rings is electrically insulated from the rods by means of dielectric members connected thereto.

EFFECT: accelerated bone tissue repair.

3 cl, 2 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of patients with diseases of the musculoskeletal system, bone fractures by transosseous osteosynthesis.

Measurements on long tubular bones show that the electric potential difference between the ends of the tubular bone has an amplitude of the order of several millivolts. The amplitude and distribution of the biological potentials of the bone depend on the viability of the cells. In particular, their amplitude decreases near the lesion sites, although there is a significant electric charge at the site of a fracture or bone formation. Any damage to bone tissue is accompanied by a violation of electrical properties and a change in the amplitude and distribution of biological potentials. In osteoparaction, a change in electrical parameters, as a rule, corresponds to the dynamics of the anatomical and functional restoration of the damaged segment, with a tendency to the initial state.

A known method for the formation of bone fusion and functional recovery during compression-distraction osteosynthesis using the Ilizarov apparatus, consisting of support rings, telescopic rods, threaded rods, spokes, spokes, which allows you to rigidly fix fragments with low trauma and not limit the function of joints and limbs as a whole [1].

The disadvantage of this method is that the apparatus together with bone fragments form a closed electrical circuit, which leads to equalization of electrical potentials in the bone and a decrease in electronegativity in the area of damage, i.e. the natural conditions of osteoparasis are violated due to the effect on natural reparative electrogenesis.

There is also a method of treating patients with complicated fractures of tubular bones by applying an Ilizarov apparatus, including applying an electric current to the fracture zone through the needles of an external fixation apparatus (Ilizarov apparatus) and / or additional electrodes with bipolar pulse packets with an amplitude of the positive part 3-8 times greater, than negative, with a frequency of 5-15 kHz for 30-60 seconds and pauses between packets of pulses with a length of 10-15 seconds [2].

The disadvantage of this method is the short duration of exposure compared with the period of osteosynthesis, which does not significantly reduce the time of external fixation of bone fragments.

The technical result of the invention is the creation of conditions close to natural, to accelerate the process of reparative regeneration of bone tissue during compression-distraction osteosynthesis.

To achieve this technical result, in the known method of reparative regeneration of bone tissue during compression-distraction osteosynthesis using an apparatus for external fixation of bone fragments, in which the electric potential in the fracture region is affected, it is proposed to restore the electric potential in the fracture region to a natural biological value by breaking closed electrical circuit created by the external fixation apparatus.

In an external fixation apparatus for implementing the method of reparative regeneration of bone tissue, including support rings made of an electrically conductive material, with spokes, detachable connections fixed to the support rings, fixing telescopic conductive threaded rods for tightening and fixing the support rings with knitting needles, at least one of the support isolate the rings from the fixing rods connected to it by means of dielectric elements, for example, bushings. In this case, the support rings, spokes, fixing rods of the external fixation apparatus can be made of metal.

The invention is illustrated by drawings, which depict a diagram of the Ilizarov apparatus with insulating elements between the support ring and threaded rods. Figure 1 shows a longitudinal section of the apparatus (the apparatus is shown as part of two support rings, variants with three or more rings are possible), figure 2 is a transverse section.

The external fixation apparatus contains knitting needles 1 and 2, mounted on supporting rings 3 and 4, respectively. Support rings 3 and 4 are fixed to each other by rods 5.

At the junction of the rods and the support rings, insulating elements are put on the rods - dielectric bushings 6. Spokes 1 and 2 fix bone fragments 7 surrounded by soft tissues 8. Spokes 1 and 2 are fixed to the support rings 3 and 4 with the help of holders 9.

The implementation of the method:

In the operating room, external fixation of bone fragments is carried out by means of the Ilizarov apparatus, while metal spokes 1 and 2 are passed through the fixed fragments, the ends of which are fixed on separate support rings 3 and 4 made of conductive material. The support ring 3, on which the spokes 1 are fixed, is fixed relative to the support ring 4 with the spokes 2 by means of threaded and / or telescopic conductive rods 5. At least one of the support rings. 3, 4 are electrically isolated from the rods 5 connected to it by means of dielectric elements, for example bushings 6. Dielectric bushings 6 are installed between the support ring and the fixing rod.

In one embodiment, dielectric bushings are mounted on a support ring as close to fracture 10. It is also possible to install dielectric elements on two or more support rings. After installation, the dielectric elements remain for the entire period of osteosynthesis.

As a result of the installation of insulating elements between the support rings and the fixing rods of the external fixation apparatus, the electrical circuit created by the constituent elements of the apparatus opens, which leads to the restoration of the electric potential in the fracture area and its distribution along the bone to a natural biological value. As a result of creating conditions close to the conditions of natural reparative electrogenesis that induces osteoreparation, the bone itself and the body as a whole cope with damage. Thus, the proposed method allows to eliminate the forced alignment of electrical potentials in the bone and a decrease in electronegativeness in the area of damage, which leads to an acceleration of the process of reparative regeneration of bone tissue during compression-distraction osteosynthesis.

The effectiveness of the method is confirmed by the following examples.

Example 1

Patient J., 30 years old, and / b No. 1323, was admitted on May 17, 2001 for surgical treatment with a diagnosis of viral deformity of the lower extremities. 05/22/2001, corrective osteotomies of both tibia were performed at the level of proximal metaphyses, Ilizarov apparatuses were installed on both legs. In the operating room, insulating sleeves were installed on the left lower leg apparatus, and the proximal support ring was isolated from telescopic rods. Correction in the apparatus was carried out from 05/22/01 to 06/04/01. It began to walk without additional support from 06/18/01. Dismantling of apparatuses: from the left leg was performed on 06/03/01, from the right leg on 05/06/01. In the postoperative During the period, the patient noted a less pronounced pain syndrome in the area of the postoperative wound of the left lower leg, objectively, swelling of the left lower leg was less than the right. Less pain on the left allowed the patient to activate the left leg earlier.

By the time the apparatus was removed, the x-ray picture was as follows. The resulting wedge-shaped defect in the tibia correction zone is filled with a clearly defined regenerate, uniformly densified in the lateral direction and passing into the bone fusion along the outer surface of the tibia, which is defined as continuous bone bundles passing from one fragment to another. On the inside, at the base of the regenerate wedge, a clear boundary is defined between the transition from regenerate tissue to soft tissues, and, on the left, the border is more pronounced than on the right.

Example 2

Patient Z., 21 years old, and / b No. 1291, was admitted on May 14, 01 for surgical treatment with a diagnosis of "Viral deformation of the lower extremities." 05/17/01, corrective osteotomy of both tibia was performed at the level of proximal metaphyses, Ilizarov apparatuses were installed on both legs. In the operating room, insulators were installed on the left shin apparatus, and the proximal support ring was isolated from telescopic rods. Correction in the apparatus was carried out on 05/22/01 to 06/01/01. The patient began to walk without additional support from 06/14/01. Dismantling of the apparatus: on the left leg was performed on 06/01/01, on the right leg on 06/04/01. In the postoperative During the period, the patient noted a less pronounced pain syndrome in the area of the postoperative wound of the left lower leg, objectively, swelling of the left lower leg was less than the right. Less pain on the left allowed the patient to activate the left leg earlier.

By the time the apparatus was removed on radiographs, the resulting wedge-shaped defect in the tibia correction zone was filled with a clearly defined regenerate, uniformly densified in the lateral direction and passing into the bone fusion along the outer surface of the tibia, which is defined as continuous bone beams passing from one fragment to another. On the inside, at the base of the regenerate wedge, to the soft tissues, moreover, on the left the border is more pronounced than on the right.

Clinically, after dismantling the apparatus, patients noted the absence of pain in the osteotomy of the left tibia. Painful sensations persisted in the right lower leg in the osteotomy area, the load on the limb was sparing for 10-14 days.

Thus, the use of this method helps to create optimal conditions for reparative regeneration of bone tissue during compression-distraction osteosynthesis.

Sources of information used:

1. Ilizarov G.A. "Orthopedics. Traumatology and prosthetics." M., 1971, No. 11, pp. 7-15.

2. USSR copyright certificate No. 1438047, MKI: A 61 N 1/36, 1986 - prototype.

Claims (3)

1. The external fixation apparatus, including support rings made of an electrically conductive material with spokes, detachable connections fixed to the support rings, fixing threaded rods made of an electrically conductive material for tightening and fixing the support rings and dielectric elements, characterized in that at least one of the support rings is electrically isolated from the rods by means of dielectric elements connected to it. 2. The apparatus according to claim 1, characterized in that the support rings, spokes and fixing rods are made of metal. 3. The apparatus according to claim 1, characterized in that the dielectric elements are made in the form of bushings.

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