WO2014182189A1

WO2014182189A1 - External bone fixation system

Info

Publication number: WO2014182189A1
Application number: PCT/RU2013/000381
Authority: WO
Inventors: Михаил Ефимович КУПИТМАН; Игорь Александрович АТМАНСКИЙ
Original assignee: Kupitman Mikhail Yefimovich
Priority date: 2013-05-06
Filing date: 2013-05-06
Publication date: 2014-11-13
Also published as: RU2015111297A; RU2605497C2

Abstract

The invention relates to the field of medicine, and more particularly to medical technology, and even more particularly to surgical devices for treating the human musculoskeletal system, which devices are positioned along a bone for the osteosynthesis of bone fragments. Specifically, the invention can be used in traumatology for treating various bone and joint injuries. An external bone fixation system (1) comprises a set of standard-sized supports, in the form of plates, washers, attachments, connecting elements and pins, which, during assembly, are arranged according to the treatment required. In each set, a supporting plate (2) is configured in the form of a stepped prism which is provided with equally spaced fastening apertures (5, 6). The washers (7) are cylindrical, one of the end surfaces thereof being provided with at least one channel. Further washers (9) are prismatic, one of the surfaces of each of said washers being provided with serrations (10). A cantilevered reconstructive attachment (11) is configured in the form of a stepped plate. One step (12) of the plate is shaped and is provided with apertures (13). The other step (14) of the cantilevered reconstructive attachment (11) is prismatic and is provided with a shaped rectangular slot (15). Furthermore, pins (16) are fastened in cantilever fashion to one end of the supporting plate (2) by means of fastening elements (17, 18) and prismatic and cylindrical washers (7, 9). The cantilevered reconstructive plate (11) is fastened to the other end of the supporting plate (2) by means of the steps, and fastening elements (17, 18) are disposed in the fastening apertures (5, 6). Furthermore, the fastening elements are configured in the form of screws and locking bolts, and the fastening apertures in the plate (24) are provided with a thread.

Description

PLASTIC FIXATION SYSTEM

Technical field

The invention relates to medicine, in particular to medical equipment, namely to surgical devices for the treatment of the musculoskeletal system of a person located along the bone and intended for osteosynthesis of bone fragments, namely, it is used in traumatology for the treatment of various injuries of bones and joints.

State of the art

The known method of osteosynthesis, including the use of plates with angular stability LCP together with plates LISS and PHILOS, which contains the bone plates, plates with angular stability, screws, locking screws (E. Gautier, C. Sommer. The main recommendations for the clinical use of the LCP system // MARGO ANTERION /.- jN 1-2.- 2004.- S. 3-14).

A device for osteosynthesis and fixation of the bone is known, having a bone plate (12) including an edge, a protrusion, an edge, a threaded protrusion, a threaded rod, a threaded edge or a threaded hole (16), as well as a bone screw provided with a head. The leveling sleeve (4) has a single-thread external thread and is screwed into the edge, protrusion, edge, threaded protrusion, threaded rod, threaded edge or threaded hole. There is a bone screw head in the alignment sleeve. The leveling sleeve is screwed in with an internal thread. The threaded hole includes a multi-thread internal thread (18) (DE 102010042930 (A1) - 2012-04-26).

Known adjustable bone plate, which is made longitudinally curved, including a description of the use as the first plate having an end defined by at least two spaced teeth, and an end having means for attaching the plate to the body structure, i.e., to the bone ; and a second plate, a second plate having an end defined by at least two straight holes for introducing the teeth, and an end having means for attaching the plate to the body structure, i.e., to the bone; and a locking assembly for blocking the teeth in the holes and fixing the plate along the entire length (EP1807011 (A1) - 2007-07-18).

Known bone plate and the method of its use for the reposition of bone fractures, this bone plate has a longitudinal axis, a bone plate, includes upper surface, lower surface, first opening for introducing the head of the first bone anchor. The first hole is configured and adapted to fix the shaft of the first bone anchor along the first axis. The second hole is located at a distance from the first hole along the longitudinal axis. The second hole serves to introduce the head of the second bone anchor, it is configured and adapted to fix the rod of the second bone anchor along the second axis. The first hole and the second hole are configured so that the first axis and the second axis define one plane and intersect at a point below the bottom surface. The rods of the first and second bone anchors can touch each other or almost touch at the point of intersection, so that the first and second bone anchors form a ligament (EP1633260 (A2) - 2006-03-15).

A known bone plate (1), which has an upper side (2), a lower side (3) facing the bone, a first end (11), a second end (12) and several holes (4) located between both ends (11, 12 ) and connecting the upper side (2) with the lower side (3), these holes serve to insert bone screws. Two of the aforementioned holes of the plate (4) are created by combining two partially overlapping drilled holes (5, 6) of different types. The first (5) of the two holes is round and cylindrical, having an internal thread (7) and a cylindrical axis (9). The second drilled hole (6) has a conical axis (10) and tapers from the upper side (2) to the lower side (3) in the form of a truncated cone. The named second drilled hole (6) has an internal thread (8). The cylindrical axis (9) is located at a distance A from the conical axis (10), which is not equal to zero (EP1677693 (A1) - 2006-07-12).

Known bone plate (1) for osteosynthesis, which has an upper surface (2), a lower surface (3) on the side of the bone and several holes (5) connecting the above upper and lower surfaces (2; 3), these holes are located along the longitudinal axis (4) plates and have central axes (6) for insertion of bone screws (10). In two of these holes (5), a department (8) is created in the form of a hollow cone, which extends beyond the bottom surface (3) and which is concentric with respect to the central axis (6). The bone plate provides angular and axial stability, even ate the plate is relatively thin (EP 1294298 (A1) - 2003-03-26).

A known bone plate and a bone plate system containing a plate equipped with holes for installing screws (WO2012042592 (A1) - 2012-04-05). A set of bone plates for orthopedic injury is known, which for the construction of a block of bone plates (100) for fixing broken bones includes many plate elements (104,116), a connecting element (108) for storing many plate elements in the desired configuration and many blocking elements (140) for attaching plate elements to the connecting element (EP1958580 (A1) - 2008-08-20).

Known bone plate with an elongated hole with a partial thread, which includes the upper part (1), the lower part (2) to create contact with the bone and several holes (4) created along the longitudinal axis of the plate (3) and connecting the upper part and the lower part (1) and (2) for holding bone screws (11). the diameter di of at least one of these holes (4) is larger along the longitudinal axis of the plate (3) than the diameter d _q transverse to the longitudinal axis of the plate (3). at least one of these holes (4) has an internal thread (5). this internal thread (5) tightens the arc by at least 180 °. this bone plate can be applied as a compression plate, as well as the so-called internal system that does not cause risk (Pat. Jf2 2 367 085 sa. publ. 2007/08/07).

Known bone plate with dynamic compression suitable for internal fixation and stabilization of bone fractures, includes: an elongated structure capable of shortening in the longitudinal direction and having at least two ends, a structure having at least two fixation points adapted to fix to broken bones with fixation points on the opposite side of the fracture. An elastic polymer cable stretches longitudinally and connects when tensioned to an elongated structure that can cause longitudinal contraction of the structure (WO2007149325 (A2) - 2007-12-27).

However, the known bone plate has a complex structure and, in addition, there are no needles (thin rods) for reinforcing articular surfaces and creating dynamic fixation.

It is known to use UHN pins, in the form of nails for osteosynthesis without drilling a channel with blocking, and titanium flexible TEN pins, in which the tip is bent, and acts as an “anchor” that allows you to hold the nail in the bone (A. A. Volna, A. Vladykin B. Fractures of the proximal shoulder: possibilities the use of pins // MARGO ANTERION /.- No 5-6.- 2001.- S. 2-4). In addition, it relates to technologies of intramedullary osteosynthesis.

However, despite the simplicity of the design, the known technique of bone osteosynthesis does not allow to combine the use of knitting needles for reinforcing bone fragments and pins, and does not allow creating the effect of damping dynamic fixation of bone fragments.

Known plate with angular stability for the proximal shoulder (LPHP), containing screws, cerclage wire (Plate with angular stability for the proximal humerus (LPHP) // MARGO ANTERION /.- N ° 5-6.- 2001.- C. 13-16).

However, the design of the known plate does not provide for the use of knitting needles to reinforce bone fragments and pins, and does not allow the creation of damping dynamic fixation of bone fragments.

The prior art described above did not allow to identify the closest analogue of the claimed invention, the design of which allows the use of knitting needles for reinforcing bone fragments creating damping dynamic fixation of bone fragments, and pins for fixing the bone plate.

Disclosure of invention

The basis of the present invention is the creation of a damping dynamic fixation of bone fragments by combining the reinforcement of the articular surfaces with beams of cantilever knitting needles and screws fixed to the bone plate.

The problem is solved in that the osseous fixation system contains a set of standard sizes of supports made in the form of support plates, washers, attachments, connecting elements, and knitting needles, while in each set the support plate is made in the form of a stepped prism equipped with evenly spaced connecting holes , part of these holes has a thread, part without a thread, the washers are cylindrical, at least one groove is made on one of the end surfaces of the holes, in addition, the washers are made of prisms ical on one of its surfaces formed sipe, reconstructive console console is formed as a step plate, wherein the plate is formed one step shaped and is equipped with a threaded hole, and the other formed prismatic and equipped with a rectangular figured groove divided into several threaded half-openings, in addition, on the base plate by means of connecting elements, prismatic and cylindrical washers, spokes are cantileverly fixed at one end, a cantilever reconstructive attachment is fixed at the other end, which is made stepwise and curly in the form of polyhedra interconnected by jumpers, one of the sides of the jumper is equal to the side of the polyhedron, in addition, in the connecting holes are placed tional elements.

For ease of use when performing surgery, it is advisable to make each connecting hole in the base plate shaped, from interconnected holes having different diameters, and to equip one of them with thread.

It is advisable in the system that each of the connecting element is made in the form of a compression screw for the possibility of fixing bone fragments with a screw at the location of the compression screw.

It is advisable for the convenience and strength of fixing the cantilever ends of the knitting needles on one of the surfaces of the prismatic washer to be arranged in mutually opposite directions parallel to the one and the other sides of the prism forming protrusions.

It is advisable to maintain the strength of the cylindrical washer and the convenience of fixing the cantilever ends of the spokes on the end surface of the cylindrical washer to make no more than four grooves located in mutually perpendicular planes.

In an embodiment of the invention, to expand the range of use depending on the medical task, the support plate can be shortened, containing at least two steps, with each step having one connecting figured hole.

In an embodiment, it is advisable to make the connecting elements in the form of shortened compression screws, which will prevent migration in the postoperative period.

For self-regulation under the location of the holes on the base plate, due to slipping of the clamping screw and its exact location in the curly groove of the console reconstructive attachment, the curly groove is equipped with limiters, which perform, if necessary, in the form of rounded protrusions. In this case, the groove and stops form holes equipped with threads for compression screws.

For the variability of the choice of the diameter of the spokes, it is advisable to carry out the connecting element in the form of a compression screw with a neck.

In addition, both screws and spokes can be used as fixing elements in the system, which increases the range of its use.

Brief Description of the Drawings

The present invention is illustrated by a detailed description, a specific example of its use and schemes in which:

Figure 1 - characterizes the layout of the osseous fixation system according to the invention;

FIG. 2 - illustrates a connecting element made in the form of a screw;

Fig.Z - illustrates a connecting element made in the form of a screw equipped with a neck;

FIG. 4 - shows a shortened compression bolt;

FIG. 5 - characterizes cylindrical washers equipped with one groove and four, located opposite each other on opposite sides of the central hole;

6 - shows a prismatic washer, one side of which is made with notches located in mutually opposite directions and forming protrusions;

FIG. 7 illustrates a cantilever reconstructive attachment in the form of a stepped plate, one step of which is equipped with threaded holes, and the other is a rectangular figured groove equipped with limiters in the form of rounded protrusions forming several threaded holes;

FIG. 8 - shows a base plate made of shortened two steps equipped with one connecting curly hole;

FIG. 9 - shows a lockable screw with a thread on the head;

Fig, 10 - shows a cortical screw

The best embodiment of the invention

Bone fixation system 1 contains a set of standard sizes of supports made in the form of support plates, washers, attachments, connecting elements, and knitting needles (Figure 1). In this case, in each set, the support plate 2 is made in the form of a stepped prism having a step 3 higher in height and a step 4 smaller in height. Step 3 is equipped with evenly spaced connecting holes 5 of complex shape made of two connected holes, one of which has a tapered thread and the other has no thread, but is made in the form of an oval shape, the number of which depends on the length of the step 3. Step 4 is equipped with a hole 6 , the execution of which is similar to the hole 5. The washers 7 are made cylindrical, on one of the end surfaces of which no more than four grooves 8 are made (Fig. 1, 5). In addition, the washers 9 are made prismatic and equipped with holes located along its longitudinal axis (Fig. 1, 6). Notches 10 are made on one of the surfaces of each washer 9. The latter are made in mutually opposite directions parallel to the one and the other sides of the prism forming protrusions. Console reconstructive prefix 11 is made in the form of a stepped plate, which consists of protrusions (steps) 12 connected by prismatic jumpers. One of the sides of such a jumper is equal to the side of the hexagon. Moreover, each protrusion 12 of the cantilevered reconstruction plate 11 is made shaped, in particular in the form of a hexagonal prism. Each protrusion 12 is equipped with a cylindrical hole 13. The latter are evenly spaced along the axis of the reconstruction plate 11 (Figs. 1, 7). The reconstructive plate 11 may have protrusions 12 from one or more. The number of protrusions 12 depends on the treatment task. Another stage 14 is made prismatic and equipped with a rectangular figured groove 15. The latter is divided by several stops in the form of rounded protrusions, forming several holes with threads. The height of the step 14 is two times less than the height of the reconstructive plate 11. In addition, on the base plate 2 by means of a cylindrical 7 and prismatic 9 washers, spokes 16 are cantilevered at one end (FIG. 1). A cantilever reconstructive attachment 11 is fixed at the other end via a step 14 and a fastening connecting element 17. Cortical screws 23 are placed on the supporting plate 2 in the connecting holes 5. Locking screws 22 are placed on the supporting plate 2 in the connecting holes 24. The connecting elements 17 and 18 can be structurally made in the form of screws (Fig. 2, 3, 4, 9). In the middle part of the plate with a washer 7 and a compression connecting screw 21 to the plate 2, a spoke is fixed. For ease of use when performing surgical intervention, it is advisable to make each connecting hole 5 in the base plate 1 shaped, from interconnected holes having different diameters. In this case, one of these holes has a tapered thread 24 corresponding to the thread in the tapered part of the elements 17, 22, 21, 18. (Fig. 1, 8).

It is advisable in the system that each of the connecting element 17, 18 is made in the form of a compression screw to prevent the bone fragment from escaping from the cortical layer and fixation strength (Figs. 2, 3, 4, 9).

It is advisable for convenience and strength of fixing the cantilever ends of the knitting needles 16 of the notch on one of the surfaces of the prismatic washer 9 to be arranged in mutually opposite directions parallel to the one and the other sides of the prism forming protrusions 10 (Fig. 1, 6).

It is advisable to maintain the strength of the cylindrical washer 7 and the convenience of fixing the cantilever ends of the spokes 16 on the end surface of the cylindrical washer to make no more than four grooves 8 located in mutually perpendicular planes (Fig. 5).

In an embodiment, it is advisable that the connecting elements 17, 18 be made in the form of shortened compression screws, which will prevent migration in the postoperative period (Fig. 4).

For self-regulation for the location of the holes on the base plate 2 due to slipping of the connecting element (screw) 17, 18 and its exact location in the figured groove 15 of the console reconstructive console 14, the figured groove 15 is equipped with stops 19, which, if necessary, are made in the form of rounded protrusions (Fig. . 7). These stops divide the figured groove 15 into several half-openings having a tapered thread corresponding to the thread of the tapered part of the elements 21,17,18.

For the variability of the choice of the diameter of the spokes, it is advisable to each connecting element 17, 18 in the form of a screw to perform with the neck 20 (Fig. 3).

Bone fixation system is used as follows.

In the operating room under anesthesia, a support plate 2 is attached along the bone fragment (Fig. 1). To do this, use figured connecting holes 5, which are obtained by connecting two holes of different diameters. In this case, one of them is smooth and oval, and the other with an internal thread 24 corresponding to a thread on the conical part of the elements 21, 9,17,18. In the holes 24 are placed the connecting elements 17, 18, 21, 9 which can be used either with compression or lockable screws. In another oval part of the holes 5 are placed screws 10, which are used as cortical screws. In addition, if necessary, use washers 7 or an additional cantilever reconstructive plate 1 1. Each of the connecting elements 17, 18, at the end at the head, is performed, depending on the treatment tasks and the difficulty of fastening, with the neck 20 (Fig. 3). The connecting elements 17, 18, screwing their threads into the threads of the holes 24 of the support plate 2, are pressed against the last washer 7 or the cantilever reconstruction plate 11, while the connecting element 18 acts as a locking screw (Figure 1). Depending on the treatment task, a shortened connecting element 21 is used to fix the supporting platinum 2 (Fig. 4). Then, one ends of the spokes 16 are inserted into the inert tissue to reinforce the articular surfaces or to fix the bone fragments (Figure 1). The free ends of the spokes 16 are fixed with a prismatic 9 washer and cylindrical washers 7 to the step 3 of the support plate 2 or the holes of the cantilever reconstruction plate 11. In this case, the free end of each spoke is fixed in one of the grooves 8 of the cylindrical washer 7, which can be from one up to four, and in the notches 10 of the prismatic washer 9 (Fig. 5, 6).

The design of the support plate 2, in particular the stage 4, allows to fix the stage 14 of the cantilever reconstruction plate 11 in the cylindrical part equipped with a thread 24 of the figured hole 5 (Fig. 1). The step 14 has a prismatic shape and a rectangular figured groove 15. Moreover, for self-adjustment to the desired location of the connecting element 17 and its fixation, the figured groove 15 is equipped with limiters 19 (Fig. 7). Each of the stops 19 is made in the form of rounded protrusions forming a cell-holes. In addition, each of the three cell-holes has a thread corresponding to the thread of the conical part of the element 17, 18, 21, 22 (Fig. 2, 3, 4). The stage 12 of the cantilever reconstruction plate 11 is made shaped, in the form of 3 (several) hexagonal prisms that connect the prismatic bridges, one of the sides of such a bridge is equal to the side of the hexagon. Hexagonal steps 12 are equipped with connecting holes that are axially evenly spaced relative to each other 13. The connection of the base plate 2 and the cantilever reconstructive prefixes 1 1 using steps, respectively, 4 and 14 allows you to assemble the support plate 2 and the console reconstructive console 1 1, with a minimum vertical size (Fig. 1). If necessary, depending on the treatment tasks, due to the prismatic sections, the cantilever reconstructive prefix 11 can be bent to reduce its length, or bent at the required angle to fix the bone fragment.

Clinical use of osseous fixation system.

After a diagnosis is made, an individual set of the required number of standard sizes of parts is preliminarily prepared: base plate 2, cylindrical washers 7 and prismatic 9, connecting elements: screws / bolts, including shortened ones, 17 and 18, 21 of the console reconstructive attachment 1 1 and 16 spokes, planned to build the design on the limbs of the patient in the process of performing a surgical intervention.

In the operating room under anesthesia, surgery is performed. After opening the area of interest, in particular, the articular surface, put the support plate 2 on the bone in the periarticular region, fix the support plate 2 on the bone using the connecting elements in the form of screws 22, 23 inserted into the bone fragment. Insert one end of each spoke 16 into the damaged articular end of the bone or its fragments, placing the spoke 16 at an angle to each other. The free ends of the spokes 16 are fixed by pressing them to the plate 2 with cylindrical washers 7 or washers 9, by means of connecting elements 18 and one of the connecting holes 5. In this case, the spoke 16 is elastically deformed due to its position in the bone and pressing the free end 7 by the washer 7. Such a fixation creates a damper tensile structure that stimulates internal stresses in the bone during fixation. The spokes 16 can be fixed without creating tension. In this case, due to their multidirectional location in the bone, bone fragments are fixed.

Industrial applicability

"The proposed osseous fixation system allows reinforcing joint surfaces and bone fragments with knitting needles, carried out in different directions and strained or stretched using this system; fixing them to the osseous plate superimposed on one of the bone fragments. This connection allows you to create a damping dynamic fixation of bone fragments through the use of fixation elements in the form of a console mounted on the osseous plate by means of connecting elements.

The proposed osseous fixation system expands the fixation capabilities of the known osseous fixators, depending on the treatment tasks, and allows more reliable fixation of comminuted, intraarticular fractures and fragments of various sizes by changing the shape of the osseous system by a combination of its various elements.

The proposed system with the movement of the limb and dynamic loads on its fragments allows you to create a deformation of the spokes, causing micromotion at the fracture level and stimulating osteogenesis.

The proposed bone system is easy to manufacture, has a low cost and is easy to use during surgical intervention in the treatment of various injuries and diseases of bone tissue and articular ends.

In addition, the proposed osseous fixation system is universal, can be easily converted depending on the medical tasks and the capabilities of the medical institution and has a minimum size.

Claims

CLAIM

1. Bone fixation system, characterized in that it contains a set of standard sizes of supports made in the form of support plates, washers, attachments, connecting elements, and knitting needles, while in each set the support plate is made in the form of a stepped prism equipped with evenly spaced connecting holes complex shape made of two combined holes, one of which is oval, the second conical and has a tapered thread, the washers are made cylindrical, on one of the end surfaces of which at least one groove is made, in addition, the washers are made prismatic on one of the surfaces of which the notches are made, the cantilever reconstructive attachment is made in the form of a stepped plate, while one step of the plate is shaped and equipped with holes with a tapered thread, and the other is made of prismatic and equipped with a rectangular a curly groove, in addition, on the base plate by means of connecting elements, prismatic and cylindrical washers, spokes are cantilevered on one end, on the other gom end fixed cantilever reconstructive prefix, which is stepped and shaped in the form of polyhedra, interconnected webs, one side of the bridge is a polyhedron, in addition to the connecting openings are arranged connecting elements.

2. The system according to p. 1, characterized in that each connecting hole in the base plate is made curly, of interconnected holes having different diameters, while one of them is equipped with a thread.

3. The system according to claim 1, characterized in that each of the connecting element is made in the form of a compression screw.

4. The system according to claim 1, characterized in that the notches on one of the surfaces of the prismatic washer are located in mutually opposite directions parallel to the one and the other sides of the prism, forming protrusions.

5. The system according to claim 1, characterized in that on the end surface of the cylindrical washer there are no more than four grooves located in mutually perpendicular planes.

6. The system according to p. 1, characterized in that the base plate is made shortened, containing at least two steps, with each step having one connecting curly hole with a thread.

7. The system according to p. 1, characterized in that the connecting elements are made in the form of shortened compression screws.

8. The system according to p. 1, characterized in that the rectangular shaped groove of the console reconstructive console is equipped with limiters made in the form of rounded protrusions that divide the groove into several half-openings with threads.

9. The system according to p. 4, characterized in that the screw is made with a neck.

10. The system according to claim 1, characterized in that both the screws and the spokes are used as fixing elements.