RU203005U1 - DEVICE FOR FORMING METAR BONE STUMPS - Google Patents

Abstract

The utility model relates to medical technology, namely, to surgical instruments for processing the end of the tubular bone, and can be used in the formation of amputation stumps of the metatarsal bones. The device consists of four parts: guide, holder, clamp, paired knife. The guide is a hollow cylinder with a handle. At one end there is a sharpening for peeling the periosteum from the bone, as well as a soft tissue protector. On the opposite side of the working part there is an opening in which a multistage cylindrical holder with a paired knife fixed in it by means of a four-section clamp moves. The cutting edge of the knives with its middle part is directed perpendicular to the axis of the bone, and the outer part is directed at an angle of 45 degrees. The use of the device makes it possible to form the most physiological shape of the stumps of the metatarsal bones (one bone) with minimal trauma to the surrounding soft tissues.

Description

The utility model relates to medical technology, namely, to surgical instruments for processing the end of the tubular bone, and can be used in the formation of amputation stumps of the metatarsal bones.

The formation of stumps of the metatarsal bones during foot amputations is accompanied by technical difficulties in execution associated with the structural features of the bone in comparison with large tubular bones (tibia, femur). The metatarsal bones are more fragile, which is manifested by their frequent longitudinal cracking during the formation of the stump with the Liston nippers during the traditional operation. In addition, the resulting sharp uneven edges of the bone require mandatory intraoperative correction to avoid skin perforation. To prevent this, a Jigli file can be used for cutting, however, this is also traumatic for the surrounding soft tissues, mainly the periosteum.

The closest is a device for processing the end of the bone sawdust, consisting of a body in the form of a cone with a shank (Device for processing the end of the bone sawdust. RF patent 2452415. Author: Fomin AA, 2012). Trapezoidal cutting knives are installed in the body. The top of the body cone is closed tightly and is made in the form of a seal to prevent bleeding and the outflow of bone marrow from the cavity of the tubular bone.

The main disadvantages of the device are:

great trauma of the surrounding soft tissues, especially the periosteum, which leads to postoperative bleeding with the formation of hematoma and soft tissue necrosis;

inability to use in the presence of sharp and / or long protruding edges of the stump of the amputated tubular bone;

the formation of a cone-shaped stump with the worst supportability properties;

dubious tamponade of the lumen of the medullary canal, since centrifugal force cannot concentrate bone chips to the center of the cone, therefore, in conditions of wound infection, it inevitably turns into an additional source of suppuration.

Obtaining a useful result during foot amputation at the metatarsal level is achieved by using the proposed technical device, which allows you to form the most physiological shape of the stumps of the metatarsal bones (one bone) with minimal trauma to the surrounding soft tissues. The device is simple to manufacture, sterilize and process, convenient for direct work in the operating room.

The device consists of four parts, illustrated as: a rail - FIG. 1, the holder - FIG. 2, the clamp is shown in FIG. 3, paired knife - FIG. 4. Each part consists of numbered items. The guide is a hollow cylinder (1) with a handle (2). On one end (working part) there is a sharpening (3) for peeling the periosteum from the bone. With the help of an annular tide-protector (4), soft tissues are protected, delicately moved away from the outer surface of the bone. On the opposite side of the working part there is a hole (5) in which the shank (6) of the holder moves. The holder is a multistage cylinder, the elements of which are: a shank (6), a rotation support (7) (ensuring stable rotation of the cutter about its longitudinal axis), a clamping tube (8) with four holes (9) and countersunk bolts (12) in the amount of four pieces. The bolts are threaded into the threaded holes of the clamping tube, securing the clamp, which consists of four quarters of a solid cylinder (10). Each quarter has a recess (11) for a countersunk bolt (12). Bone processing is carried out with a paired knife, consisting of two blades perpendicularly installed in the clamp in the form of a retaining plate (13) with a groove (14), a working part (15) and a cutting edge (16) with a sharpening angle of 85 degrees. The cutting edge with its middle part is directed perpendicular to the axis of the bone, and the outer part (17) is directed at an angle of 45 degrees. Both knife blades in working order are connected through the grooves and installed in the clamp.

The device operates as follows. The paired knife is assembled from two blades through the grooves and in a perpendicular position is inserted into the clamp, which is then installed in the holder until it stops, so that the recesses on the clamp surface coincide with the bolt holes on the clamping tube. Using a hex wrench, countersunk bolts are screwed into the holes of the holder until they stop, tightly fixing both knife blades in the structure.

The assembled part of the device is inserted into the guide so that the shank goes out through the hole, where it is attached to the drive (screwdriver or drill).

For practical use, it is convenient to manufacture the device in two sizes. The smaller version (20 mm in the inner diameter of the guide) is used for operations on the II-III-IV-V metatarsal bones, and can also be used for the treatment of all metacarpal bones of the hand. The larger size of the device (40 mm in the inner diameter of the guide) corresponds to the 1st metatarsal bone, but can also be used when processing the stumps of the radius and ulna.

The effectiveness and ease of use of the device was confirmed by the successful use of the surgical department in clinical practice in 27 patients who underwent amputation at the level of the metatarsal bones of the foot.

Clinical example.

Patient D. was admitted to the Department of Purulent Surgery and Rescue of the Lower Extremities of the State Budgetary Healthcare Institution of the Public Healthcare Institution "City Hospital 33" with a diagnosis of diabetes mellitus, type 2, complicated course - diabetic foot syndrome, gangrene of the II toe, vicious stumps of III-IV fingers (Fig. 5). A history of amputation two years ago with a complicated course. At the operation, detachment was performed with Liston nippers at the level of the metatarsal bones. As a result, uneven sharp edges of the bone stumps were formed, unsuitable for subsequent support. Operation - amputation of the second toe, reamputation of the third and fourth toes with resection of the heads of the metatarsal bones. The proposed device was used for processing the bone edge: the assembled paired knife was firmly fixed with countersunk fastening bolts in a clamp, the shank of which was inserted into the hole of the guide cylinder and clamped into an electric drill. The assistant kept the foot motionless, and the surgeon performed the treatment of the stumps of the metatarsal bones with the device while working with the drill at high speeds. As the stump was trimmed, the speed of the drill decreased. Only the bones were treated, while the soft tissues remained protected by the protector. As a result, the ends of the stumps of the metatarsal bones were given an even perpendicular shape with a lateral edge of 45 degrees, and sharp and uneven edges were smoothed (Fig. 6). The wounds were washed with antiseptics and sutured, leaving rubber graduates. Antiseptic dressings, plaster immobilization. Postoperative course without complications. Outcome - relief of the inflammatory process, formed the supporting stump of the foot.

Claims (1)

A device for processing the stumps of the metatarsal bones, including four parts connected in series in a single structure, characterized in that it consists of a guide in the form of a hollow cylinder with a handle and a soft tissue protector inserted into it a multistage cylindrical holder with a paired knife, consisting of two blades perpendicularly installed in the clamp in the form of a holding plate with a groove, a working part and cutting edges having an angle of sharpening of 85 degrees, one of which is perpendicular to the axis of the bone, and the second is directed at an angle of 45 degrees to this axis.

Images