RU2343866C1 - Internal fixative for artificial ankylosis of humeral joint - Google Patents

Abstract

FIELD: medicine; orthopedy and traumatology.

SUBSTANCE: internal fixative for artificial ankylosis of humeral joint contains onbone plate and fixing knot. The fixing knot is executed in the form of plug with planes of teeth parallel each other for placing between them scapular arista. The mentioned planes are executed with gear edges and coaxial carving apertures under screws for through bracing of a scapular arista. The plug basis is supplied by the channel under a spoke for specification of the rotatory equipment of a shoulder. The site of a plate corresponding to area of joining of a shoulder with glenoid is executed by the bent. The plate is executed with round and longitudinal apertures under cortical screws.

EFFECT: high reliability of bracing at any artificial ankylosis of humeral joint.

7 dwg

Description

The invention relates to medical equipment, namely to traumatology and orthopedics, and can be used in surgical treatment of the consequences of severe injuries and diseases with indications for surgical closure of the shoulder joint - arthrodesis.

Most often, fixation is used with knitting needles and a bone block, which is hammered through the head and glenoid into the neck of the scapula (1). The disadvantages of using these devices are the need for external immobilization in the thoracobrachial dressing, unreliable fixation and a high probability of erroneous installation of axial ratios in the shoulder joint (abduction, deviation and rotation).

A device is known - a 3.5 mm DCP plate - AO-ASIF systems (M.E. Muller, M. Allgover, R. Schneider, H. Willeneger. Guide to internal osteosynthesis. - Springer - Verlag. - Berlin- ... -Moscow, 1996. - S.434-435), which are taken for two shoulder joint arthrodesis and laid after appropriate modeling on the body of the scapula along the outer edge and upper (3, 4).

The disadvantage of this analogue is its low reliability of fixation, associated with the risk of loosening screws in the scapula during functional treatment, the need to deform plates at dangerous angles that threaten a fracture of the fixator, and a significant increase in the volume and morbidity of the intervention.

The closest analogue is the device according to a. SSR No. 906551 (2) for compression arthrodesis of the shoulder joint, containing a curved plate with fastening elements and a fixing unit containing a T-shaped expansion, with fastening elements installed on both sides, the proximal end of the plate being bent in the region of the acromial process of the scapula, and the other end of the plate is made with a L-shaped protrusion. The device is attached by the proximal end to the acromion and has a bend for setting the angle of abduction in the shoulder joint. Its disadvantage is unreliable fixation to the scapula.

The technical result of the present invention is the provision of high reliability fixation for any arthrodesis of the shoulder joint.

The technical result is achieved by the fact that in the known device containing a osseous plate with holes and a fixing unit, the latter is made in the form of a fork with parallel tooth planes for placing a scapular spine between them, said planes are made with serrated edges and coaxial threaded holes for screws end-to-end fixation of the scapular spine, the base of the fork is provided with a channel under the spoke to clarify the rotational installation of the shoulder, the portion of the plate corresponding to the area of the joint of the shoulder with glen idom, is curved, the plate is provided with circular and longitudinal openings for cortical screws.

The drawings show:

figure 1 - clamp for arthrodesis of the shoulder joint, front view;

figure 2 - clamp for arthrodesis of the shoulder joint, side view;

figure 3 - clamp for arthrodesis of the shoulder joint, top view;

4 is a clamp for arthrodesis of the shoulder joint in a perspective view of the bone;

figure 5 - the relative position of the retainer and the spine of the scapula (projection along the spine);

6 - the location of the retainer and the spine of the scapula on the skeleton (photograph in projection along the axis of the humerus: the retainer is pressed against the shoulder with a bone holder);

Fig.7 - held arthrodesis after aseptic loosening of the endoprosthesis.

The internal retainer for arthrodesis of the shoulder joint (Figs. 1-5) consists of a bone plate 1 with holes 2. In the part corresponding to the scapula, two teeth 3 extend from it, forming the scapular fork 4. The teeth 3 have 5 tooth planes that are parallel to each other each other has serrated edges 6. In the teeth 3 there are threaded holes 7, the thread of which is identical to the threads of the screws 8 screwed into the holes 7 to fix the spine 9 of the scapula 10. In addition to the circular holes 2 for the cortical screws 11, the plate contains a longitudinal hole 12 for simultaneous mpressii compresses and several sliding holes 13, whose number depends on the size (length of plate). The section of the plate corresponding to the area where the shoulder joins the glenoid has a bend 14 at an angle of optimal installation of the shoulder 15. In the distal part of the plate there is a channel 16 under the marking needle of Kirchner 17, which is temporarily inserted there to control the rotational installation of the shoulder.

The complex shape of the scapula and the peculiarities of the orientation of the shoulder during docking determine the manufacture of mirror-symmetric left and right options, and the variety of degrees and extent of shoulder damage - several sizes that differ in plate length and number of holes.

This device is used as follows. Surgical access is carried out along the line connecting the outer edge of the biceps of the shoulder and the posterior edge of the scapular awn. The joint is opened and the articular surfaces of the scapula and head are resected (if the latter is preserved) or the metadiaphysis remains are modeled for docking with the scapula, the edge of the neck of the scapula is skeletonized to contact the grafts. Autografts for bone grafting are prepared (in the absence of a head, this moment is mandatory). After preparation of the surfaces to be compared, the supraspinatus and infraspinatus muscles are removed from the spine with the Buyalsky spatula. The teeth 5 are oriented in the direction of the upcoming introduction on the surface of the spine 9 of the blade 10 and with a certain effort put on the spine. The plane of the teeth 5 is located along the recesses of the infraspinatus and supraspinatus fossae. For final landing, the latch is pounded with a light hammer blow. The location of the blade forks 4 is refined by a trial reposition of the shoulder, laying the plate on its front outer surface, and upon reaching the optimal position, compress the planes with a clamp (for example, Mikulich or a screw bone holder), pushing the serrated edges 6 into the spine 9. Through holes 7 in the teeth 3 of the blade forks 4 drill holes in the blade spine 9 and screw the screws 8 into them, achieving their jamming in metal threaded pairs. Kirshner's marking needle 17 is inserted into channel 16 and the humerus rotational installation is specified: the forearm, installed in the elbow joint at an angle of 90 °, should be parallel to the marking needle. The humerus is compared with the glenoid and pressed against the plate 2 by any bone holder. A cortical screw 11 is inserted into the humerus through an oval compression opening 12 and compression is performed. The marking needle is removed. At the same time, the contractor pulls the humerus into the glenoid by pulling on the screw head in the hole 12, after which additional compression is carried out while screwing the screws into the compression sliding holes 13. Screws are inserted into the remaining round holes 2. After osteosynthesis, the contact area is covered with bone-plastic material on all sides , which is supplemented with an osteotomyromic acromial process on the supply leg, which is fixed with a screw with overlapping contact surfaces. The wound is sutured in layers with drainage. In the postoperative period, limb function begins after cessation of postoperative pain. External immobilization is not indicated.

The device allows you to:

- to increase the reliability of osteosynthesis due to the high strength of fixation of the scapular fork to the spine and axial compression;

- use the weight of the limb to enhance compression and transfer the load to the latch from a more dangerous bending to a less dangerous tensile;

- minimize trauma at the stage of fixation to the scapula due to the absence of dissection of the muscles along its outer edge;

- standardize the installation angles in the shoulder joint, since the abduction and deviation are set by the shape of the osseous part of the device, and the rotation is set by the temporary marking needle.

Literature

1. Harmful P.P. A practical guide to orthopedics. - L., 1936. - OGIZ. - 606 s. - S.285;

2. USSR author's certificate No. 906551, 1982, 3 pp.

3. Beltran J.E., Trilla J.S., Barjau R.A. Simplified compression arthrodesis of the shoulder. // J. Bon and Joint Surgery. - 1975. - V.57 - A. - N.5. - P.534-539.

4. Stark D.M., Bennett J.B., Tullos J.S. Rigid Internal Fixation for Shoulder Arthrodesis. // Orthopedocs. - 1991. - V.14. - N.8. - P.849-855.

Claims (1)

An internal fixator for shoulder joint arthrodesis, comprising a osseous plate and a fixing unit, characterized in that the fixing unit is made in the form of a fork with parallel tooth planes for placing the scapular spine between them, said planes are made with serrated edges and coaxial threaded holes for screws end-to-end fixation of the shoulder blade, the base of the fork is provided with a channel under the spoke to clarify the rotational installation of the shoulder, a section of the plate corresponding to the area of the joint of the shoulder with the glue oidom is curved, the plate is provided with circular and longitudinal openings for cortical screws.

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