SU1225558A1 - Compression-distraction apparatus - Google Patents

Description

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The invention relates to medical technology, and TO4Eiee to traumatology and orthopedics.

The aim of the invention is to provide controlled alignment of bone fragments during angular deformations.

FIG. 1 shows a compression-distraction apparatus, a frontal projection I of FIG. 2, a horizontal projection; FIG. 3 is the same as the profile projection; FIG. 4 the same imposed on the dislocated shoulder; FIG. 5 is the same superimposed on the set shoulder; in fig. 6 fragment of the apparatus superimposed on the humerus with a helical fracture; in fig. 7 - a fragment of the apparatus superimposed on the humerus with rotational displacement of bone fragments; Fig, 8 - a fragment of the apparatus, superimposed on the forearm at the turn of the galeation; 9 - corrected: Fracture of the galeation; on. FIG. 10 - a fragment of the device superimposed on the forearm with ulnar fractures and ray of the bones ..

The apparatus is primarily used in the treatment of fractures of the upper limbs.

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The apparatus contains a frame I welded

from metal tubes across the soybean soybean merim region with arm length. For convenience of positioning the apparatus relative to the chest, the front ribs 2 and 3 of the frame are arcuate with a concavity from the chest. The two upper longitudinal ribs 4 serve as guides. At the other end of the frame 1, a movable grass 1) sa 5 with a screw thread 6 is fixed. Each screw of the screw rod 6 has a nut 7 and a clip 8 for holding the cable 9. Screw rod 6, nuts 7 clips 8 and cables 9 form a knot distributions. The device has up to four reposition nodes. Each reposition assembly includes a collapsible frame 10, in which the ring 11 is fixed by three adjustment screws 12 with nuts 13, pillars 14, sp 15, and the hinges consisting of the fixing base 16, the clamping strip 17, the fastening screws 18. The frame 10 is connected to the skeleton by means of a hinge by means of bolts 19 and is rigidly fixed when they are screwed on. Racks 14 are fastened to the ring with 11 nuts and serving as a hinge for adjusting

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screws 12 with a ring 11, 10 have an additional kinematic connection with the frame through extensions 20 and tires 21 located on the other side of the hinges. This is necessary for the gradual and metered inclination of the unit of reposition, depending on the complexity of the bone fracture. All the frames 10 are connected by means of an orange bolt 22 with nuts 23. In each ring 11, the number of spokes 15 is determined depending on the complexity of the fracture. The frames 10 may additionally be connected to each other by means of a threaded rod 24, and the rings 11 by a threaded rod 25 may be interconnected in a similar way.

The device works as follows.

Each reposition assembly can be moved along the longitudinal ribs 4 and over the worm bent rods 22. To do this, unscrew the nuts 23 in the direction of the proposed reposition of the reposition assembly and with the arms simultaneously or gradually - but also metered screws 123 on the other side of the hinge frame 10 moves to the required Position. Then the nuts 23 are screwed on both sides of the hinge.

The one-time tilt of the reposition assembly is as follows.

In the hinge, bolt 19 is unscrewed one or two turns. In this case, the frame 10 rotates freely on the bolts 10 around their axis. By imparting the required inclination to the frame 10, the bolts 19 are tightly screwed in, and therefore, the reposition assembly is fixed at the set angle of inclination. For The gradual and dosed tilt of one of the frames 10 uses stretching 20. Rotating the stretching 20 in one direction or another, the frame 10, and consequently, the entire reposition assembly gradually or gradually dispenses the inclination relative to its initial position and the adjacent reposition assemblies.

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Each ring 11 or bracket can be rotated around the axis of the hand simultaneously, gradually or metered. With the simultaneous moment of rotation, the fragments of the bone of the rack 14 are fixed on the ring adjacent to the adjusting screws 12. If a gradual or metered rotation of the fragments is envisaged, then only two adjusting screws 12 are used. At the same time, in the initial position of the axis of rotation

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the adjusting screws 12 pass through the center of the ring 11. The nuts 13 on these two screws 12 are unscrewed several turns and the ring 11 rotates simultaneously to the supposed angle of rotation in the direction opposite to the rotation of the bone fragment, carrying it along the spokes. The nuts 13 fix the adjusting screws 12 in the reached position. In a similar way, it is possible to break the incorrectly accrete bone and further reposition fragments of bone by correct matching. The ring 11 can simultaneously tilt in any direction relative to the plane of the frame 10.

In the practice of reposition of fragments, it becomes necessary, except for the simultaneous tilting of the ring 11, to make a gradual or dosed tilt. Such manipulation is achieved as follows. Of the two adjacent rings 11, one is fixed in the frame 10 rigidly, and the other is held in the frame by two horizontally placed adjustment screws 1 2. These two rings 11 are connected in the tops of the threaded rod 25 using racks 14. By pushing the nuts on the threaded rod 25, the second ring 11 is tilted gradually or metered relative to the first ring 11.

The apparatus is used as follows.

For dosed reduction of the chronic dislocation of the shoulder (Figs. 4 and 5), after preparation of the operative field, two 2 mm cross-spoke spokes 15 are held in the sagittal plane through the acromion of the scapula on the damage side, which are fixed in the tensioned state with one ring 11 after separating them from the skin napkins

and rubber corks. The two other Kirschner 15 cross spokes are conducted through the mid-upper part of the humerus in the plane of its cross section and fixed in the tensioned state by the second ring 11. The third pair of Kirschner spokes 15 are similarly held in the lower third of the humerus and fixed in the tensioned state in the third ring 11. The second and third rings 11 are connected by three threaded rods 25. The patient is placed on his back (li

com up), the damaged arm is located in the compression-distraction apparatus. The first ring 11 is rigidly fixed with adjusting screws 5 to 12 in the frame 10. With a braided cable 9, the ring 11 closest to them is connected to the crossmember 5. Tightening the nuts 7 on the braided cables 9, which carry the link from the middle

10 and the outermost rings 11, the humerus is fixed. With such gradual distraction, congestive retraction is overcome and the scar tissue is stretched; Humeral head with

5) this is shifted down under the edge of the articular vpal. The final reduction of the dislocated head of the shoulder is achieved by using a reposition node on the middle frame 10. For this

20, the ring 11 of the frame 10, which is close to the end ribs 2 and 3, is fixed to this frame 10. Using the adjusting screws 12 gradually and meteredly move the linking of the rings, including the middle ring 11 and the ring 11 connected to the cables 9 in the frontal plane and sagittal to complete centering of the head of the shoulder in the articular cavity.

2Q At the final stage, when the reduction is set on radiographs, the coupling of the rings 11 by three threaded rods is connected to the other extreme ring 11. As a result of this connection, a system is obtained from the ring 11 with the coupling of rings 11, in which the shoulder blade and shoulder are securely fixed bone in normal position. This completes the metered reduction of the chronic dislocation. A system of rings 11 with a damaged arm is released from the apparatus and placed on a diverting tire made of plywood and gypsum screws. The patient wears this splint for six weeks, followed by a gradual development of movements in the shoulder joint.

In the case of a helical fracture of the humerus (Fig. 6), the injured arm is fixed in the apparatus and gives traction along the length of the ulnar process of the injured arm. In a conventional manner, the operative field on the shoulder is indented from the fracture line.

5 humerus about 3 cm. To the distal end of its proximal fragment in the cross-sectional plane of the shoulder, taking into account the topography of the vessels and ner

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BOBs are held by two cross-spokes 15 2 mm thick, which are fixed in a tight state by a ring 11. Similarly, the spokes 15 are held in a distal fragment of the humerus and fixed in a tight state by another ring 11. A damaged arm with rings 11 is placed in the proposed an apparatus for final matching and holding fragments of the humerus in the position reached. The ring 11 closest to the shoulder joint is fixed to the first frame 10 of FIG. 1 with three adjusting screws 12. The clamp is taken in a known manner by a distraction unit (screw 6, nut 7, clip 8, cable 9) and is lengthwise what is the elimination of coarse angular displacement of fragments of the humerus and length offset. The ring 11 with the distal fragment is fixed in another frame Yu at first only by two horizontal adjusting screws 12. The rotational (or rotational) gradual or dosed displacement of the distal fragment of the humerus is achieved by rotating the ring 1 1 with the distal fragment by two adjusting screws 12. In this case in the initial position, the horizontal screws 12 hinge but are connected to this ring 11 in its upper and lower parts so that when they return to the horizontal position, the ring 11 will rotate to the desired angle l After the rotational displacement is eliminated, the ring 1I is additionally fixed by the vertical adjustment screw 12, the transverse displacement in the frontal and. The sagittal plane is eliminated by turning the nuts 13 on the adjusting bolt screws 12 in the frames of the apparatus 10. To eliminate the remaining shifts, depending on the circumstances, you can apply: tilting the second frame 10 relative to the first frame 10 using a rod 24 (Fig. 1): tilting the ring 11, located in the second frame 10, relative to the ring 11, located in the first frame 10, using a threaded rod 25, the inclination of the ring 11 relative to the plane of the second frame 10 in which this ring is fixed, using various hinges from version

in racks 1D; the inclination of the second section number 1 10 together with a rigidly fixed ring 11, using tension 20.

Compression and distraction of fragments of the humerus in the frontal plane is achieved by moving the ring 11 with the distal fragment in the second frame 10 with two adjusting screws 12. The vertical adjusting screw 12 is released. Compression and dist) action in the sagittal plane is achieved by moving the same ring 11 with a vertical adjusting screw 12 while at the same time loosening the stiffness of fixing the horizontal adjusting screws 12.

Helical fracture of the humerus. Can be treated with a device without plaster dressings. In this case, each pair of humeral bone is held by two pairs of Kirchner spokes (Fig. 7), subsystems A and B are created from rings 11. Subsystems A and B are then placed into the apparatus of the proposed design, in which the bone fragments are repositioned. by traction of trozik.mi 9 over the outer ring 1 1 of system A and the subsequent manipulation of the inner rings 11 of both systems A and B, eliminating all types of displacement of fragments of the humerus. After comparing fragments and monitoring radiographs, a single system is created from subsystems A and B by connecting Neni their worm rods 22. The hand is released from the device and the proposed construction is suspended on kosynochnoy ZEC Brokers.

With the fracture of the radius bone and the dislocation of the ulnar head (Galeation fracture) (Fig. 8.9), the injured arm is placed in the apparatus and traction is given by the hand, giving a certain position to the forearm. The midphysiological position of the forearm is attached to fractures of the beam in the middle third and the position of supination when the fractures of the beam are in the lower or upper third. After treatment, the operative field is held by one Kirschner 15 needle through the proximal metaphysic of both bones of the injured. Prevention and is fixed in a tight state by the ring 11 after separating it from the skin with napkins with alcohol and rubber stoppers. Another needle 15 Kirchner is conducted through the distal7

the metaphysis of the beam and is fixed in the tensioned state by the second ring 11. The distance from the place of the fracture of the beam about 3 cm into each of its fragments is held by two spokes 15. Each pair of the spokes 15 is fixed in the tensioned state by rings 11 after delimiting them from leather wipes and rubber stoppers. Two rings 11, which fix the spokes 15 on the proximal beam fragment, are connected by three threaded rods, creating subsystem A. In a similar way, a subsystem B is created which includes two other rings 11 on the distal beam fragment. The injured arm is removed from the apparatus and placed in the proposed compression-distraction apparatus, retaining one of the positions of the forearm 7. The extreme ring 11 of subsystem A is fixed in the first frame 10 from the blade by a vertical adjusting screw 12. The inner ring 11 of subsystem A is fixed firmly by three adjustment screws 12 to the second frame from the shoulder joint 10. The distal ring 11 of the subsystem B there are two distraction cables 9 with a cross-piece 5 of the proposed apparatus. Screw nuts 7 (Fig. 1 on the screw rods 6, gross angular displacements of the beam are eliminated, the displacement of the head of the ulnar bone causes a displacement in length. The inner ring 11 of subsystem B is fixed by two adjustment screws 12 to the third frame 10 (one vertical and one horizontal). Accurate reposition of the beam with elimination of the remaining angular, rotational and transverse displacements is achieved by manipulating the inner ring 11 of the subsystem in frame 10, as during reposition of the fractured humerus. After matching the fragments of the beam and controlling The genograms hold another needle 15 with a thrust pad on the side of the ulnar bone head, with tension at the opposite end of which, in the ring 11, the ulnar bone head is fixed in its bed. The subsystems A and B are joined into one system. The hand is removed from the proposed compression-distraction and is suspended from the stitching.

With the reposition of fractures of both bones of the forearm (Fig. 10 and 11) under conduction anesthesia according to Kulenkam255588

The pfu damaged hand is placed into the apparatus and traction is carried out along the length of the hand. The distal part of the forearm is given a mid-physiological position for fractures of both bones of the forearm in the middle third, a position of supination for fractures of the beam in the lower or upper third. After needle marking of the fracture sites

10 bones of the forearm are made of control radiographs. Then an indent of 3 cm from the places of fractures perpendicular to the axis of the forearm through the ends of the proximal fragments of the forearm introduces 5 s along one spoke 15 of Kirchner. At the same level, a third of the needle 15 is held across both bones of the forearm. The tips of the spokes above the skin are delimited from the skin with napkins with

2Q with alcohol and rubber stoppers, after which all three spokes 15 are fixed in a tight state by ring 11. An indent of 2 cm from the place of a beam fracture is held by two needles 15 with mutually opposite sides, which are delimited from the skin with napkins with alcohol and rubber stoppers, after which they are fixed in the tensioned state in the ring 11. Two needles 15 with stop pads 26, similar to the previous ones, are held at the end of the damaged ulnar bone (its sdistal fragment) about 4 cm indent from the site of its fracture. The spokes are fixed in the tensioned state by the ring 11. One spoke

 15 we carry out through proximal and

the distal metaphysis of both bones of the forearm, which, after being separated from the skin with tissues and rubber stoppers, are fixed in the tensioned state by rings 11. The rings 11 are connected by three threaded rods 25 into subsystem A. The damaged forearm is removed from the apparatus and placed into the proposed distraction apatata, keeping the position of the forearm, which was in the apparatus.

The rings 11 of the subsystem A are fixed to the first and second from the humeral suspension frames 10 (Fig. 1) of the apparatus by adjusting screws 12. The traction along the length is carried out by cables 9 over the outer ring 11, thereby eliminating coarse angular displacements and shifting along

55 length. In a diastasis between the ends of the distal and proximal bone fragments, the forearm of the frame 10 with the rings 11, which are close to the traverse 5, over 40

placed in the direction of the elbow joint as connected by threaded rods

turning the nuts 23 on the worm rods 22 (Fig. 1). After checking the places

fractures by radiographs of the ring 11, of the apparatus, and suspended from the scarves mounted on the proximal break-off band.

25 with subsystems A into a single system. The hand is removed from the proposed

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Editor S.Patrusheva

Compiled by L.Povarov

Tehred V.Kadar Proofreader A.Obruchar

Order 2017/4 Circulation 660Subscription

VNIIPI USSR State Committee

for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Production and printing company, Uzhgorod, st. Project, 4

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Claims (1)

COMPRESSION-DISTRACTION APPARATUS containing a frame with frames, to which rings with knitting needles are connected, which can be rotated, frames can be moved in the longitudinal direction relative to the frame using worm rods, as well as a screw rod mounted on the frame, characterized in that , in order to ensure controlled alignment of bone fragments during angular deformations, the frames are connected to the frame using hinges on one side and stretch marks on the other. KZ KZ SI SP SL 00