RU219877U1 - fixing washer - Google Patents

Abstract

The utility model relates to medicine, namely to traumatology and orthopedics, and can be used for fixing a muscle tendon from the opposite side of the hole in the bone. The washer is represented by a flat metal ring. The inner diameter of the washer is 2.0-2.5 mm, the outer diameter is 12.0 mm, the thickness is 0.8-1.5 mm, while the opposite edges of the washer are truncated by 3.0-3.4 mm to prevent gathering knots of ligatures, with which these ligatures are fixed on the wall of the washer, at one point. The use of a washer makes it possible to ensure the safety of ligatures from displacement of their knots at one point, the strength of fixation and tension of the tendon suture, and also to avoid postoperative complications. 2 ill.

Description

The utility model relates to medicine, namely to traumatology and orthopedics, and can be used to fix a large muscle tendon from the opposite side of the hole in the bone.

A device for skin fixation of a tendon suture on the hand is known (patent for utility model RU 109651 U1, publ. 27.10.2011), which is a button with two holes and a jumper between them, characterized in that the jumper around the holes is covered with a sheath made of medical silicone rubber with a thickness of 2-3 mm, which is fixed on the jumper with the help of gluing silicone brand 617 H 46 (Germany), and the bottom surface of the jumper is ground off by 2 mm. Its disadvantages are the complexity of manufacturing, the high cost and the inability to use for external fixation of tendons.

In addition, there is a bracket for fixing the tendon (utility model patent RU 157220 U1, publ. 11/27/2015), consisting of an extraosseous and intraosseous part, made of a material with thermomechanical shape memory, characterized in that the extraosseous part of the bracket is made in the form of an open loop, from which the intraosseous part is bent at an angle in the form of two vertical legs intersecting in the middle, diverging from the level of the cross in opposite directions, the ends of the legs are bent outward in the form of hooks. Its disadvantages are the complexity of execution (a refrigerator is needed to cool the structure), the structure cannot be removed, the fixation is weak (fixation in the sponge and through one cortical), and high cost.

Also known is a cortical fixation washer for the muscle tendon on the opposite side of the hole in the bone (Catalog of OOO PTO MEDTEHNIKA, 2018, found from the Internet on November 22, 2022 https://www.medtech.ru/catalog/traumatology/section-202/ ), represented by a flat metal ring. However, the disadvantages are either its completeness with a cortical screw, which contributes to the expansion of the bone tunnel over time; or, when using only a washer to tie the ends of the ligatures, slipping the knots of the ligatures into one point on the washer with contraction of the biceps and the corresponding tension in the tendon, turning the washer and cutting it into the bone.

Thus, there is a need for a locking washer free from the above disadvantages.

EFFECT: improved reliability of fixation due to the size and configuration of the washer.

This is achieved by the proposed utility model, namely the washer for fixing the muscle tendon on the opposite side of the hole in the bone, represented by a flat metal ring, while the inner diameter of the washer is 2.0-2.5 mm, the outer diameter is 12.0 mm, the thickness 0.8-1.5 mm, while the opposite edges of the washer are truncated by 3.0-3.4 mm to prevent the assembly of knots of ligatures, with which these ligatures are fixed on the wall of the washer, at one point.

The utility model is shown in the diagram, where

in fig. 1 - general view of the device;

in fig. 2 - side view.

The washer consists of a body in the form of a flat ring (1). The inner diameter (2) of the ring (1) is 2.0-2.5 mm. The outer diameter (3) of the ring (1) is 12.0 mm. The opposite edges (4) of the ring (1) are ground down by 3.0-3.4 mm (Fig. 1). The thickness (5) of the ring (1) is 0.8-1.5 mm (Fig. 2). It is preferable to use titanium for the puck.

The washer is used as follows.

The damaged large tendon is brought out into the wound. The tendon is stitched with two nylon threads, leaving 4 ends of the ligatures free. The damaged tendon is passed from the operating wound of the shoulder to the wound of the forearm in the tendon canal. Form a hole in the bone. Perform fixation of the muscle tendon using the proposed washer as follows. Nylon threads are brought out into the previously made hole in the bone with the help of a conductor. In this case, two ligatures are carried out in the center and two along the cut-off edges of this washer, fixing each pair of ligatures with knots on the wall of the washer. Cutting off a smaller washer wall thickness can lead to the collection of ligature knots at one point and displacement of the tendon, the contact of the tendon with the bone is disturbed, while the washer can turn perpendicular to the bone; cutting off a greater width of the wall of the washer can lead to damage to the washer itself (bend of the structure, breaks), as well as ligature knots in the future, and, accordingly, to the failure of the surgical intervention.

The proposed utility model can be used quite widely: when fixing the tendon of the long head of the biceps, when fixing the tendon of the pectoral muscle, fixing the cruciate ligaments.

The effectiveness of the use of this washer is confirmed by the following clinical examples of use.

Example 1. Patient H, born in 1979 (44 years old), was admitted to the 1st orthopedic-traumatology department of GBUZ MO Podolsk OKB 15.01.23, with a diagnosis of damage to the anterior cruciate ligament, left knee joint. On January 27, 23, an operation was performed - plasty of the anterior cruciate ligament of the left knee joint with a tendon graft of the peroneus longus muscle with fixation of the latter with an interference screw and the proposed utility model - a washer with truncated edges. In the position of the patient on the back with the knee joint laid at an angle of 90 degrees, arthroscopy of the left knee joint was performed from typical approaches. The revision revealed a rupture of the anterior cruciate ligament. Through an additional linear incision along the outer surface of the left ankle joint, up to 2 cm in size, a long tendon of the peroneal muscle was found, mobilized, cut off from the site of attachment, 21 cm long. A 10 cm ACL graft was formed from the tendon, installed according to the accepted method, fixed in the lateral condyle of the femur using the proposed fixing washer with truncated edges, while the inner diameter of the washer was 2.5 mm, the outer diameter was 12.0 mm, the thickness was 1.5 mm, while the opposite edges of the washer were truncated by 3.4 mm. The distal ends of the graft were passed through the formed channel in the tibia and fixed with an interference screw.

ACL is well-founded, there is no pathological mobility of the lower leg, Lachman's symptoms, anterior drawer are negative. Washing the joint to clean water. Layered sutures for wounds. Suture of arthroscopic accesses. Aseptic bandage. The limb is fixed in an orthosis with a given angle of 155 degrees for a period of 3 weeks. Full recovery of limb function and work capacity associated with physical labor occurred after a course of FTL, exercise therapy 5-6 weeks after the operation.

Example 2. Patient A., born in 1987 (36 years old), was admitted to the 1st Orthopedic and Traumatology Department of GBUZ MO Podolsk Regional Clinical Hospital on 06/22/22 with a Diagnosis: Subcutaneous rupture of the long head of the biceps on the left. Injury 04/29/22, domestic. 05/12/22, the operation was performed - fixing the long head of the biceps on the left to the coracoid process on the left with a washer.

In the position of the patient on the back, after introducing the patient into anesthesia and treating the surgical field with a solution of a skin antiseptic, a longitudinal linear incision up to 3 cm was made along the anteroexternal surface of the upper third of the left shoulder, the skin, subcutaneous fat, own fascia of the shoulder were dissected; contracted tendon of the long head of the biceps. The latter was stitched according to Cuneo with nylon No. 4 in the form of 4 ligatures and taken on a holder.

Through an additional incision of the skin, subcutaneous fat, own fascia along the anterior surface of the left shoulder joint above the projection of the coracoid process, the coracoid process was isolated, a hole was made using a guide and a 3.2 mm drill. The conductor is wound up in the last. The long head of the biceps was passed from the wound in the upper third of the shoulder to the wound in the area of the shoulder joint, with the help of a ligature conductor, it was passed through the coracoid process. The long head of the biceps is brought to the lower surface of the coracoid process of the scapula and fixed with a double interrupted suture through the proposed utility model - a locking washer, the inner diameter of the washer was 2.0 mm, the outer diameter was 12.0 mm, the thickness was 0.8 mm, while the opposite edges of the washer made truncated by 3.0 mm. The strength of fixation was checked by palpation and passive movements in the elbow joint.

The upper limb was fixed in a position with the elbow joint bent at an angle of 90 degrees for a period of 3 weeks. Full recovery of limb function and work capacity associated with physical labor occurred after a course of FTL, exercise therapy 5 weeks after the operation.

The use of a washer makes it possible to ensure the safety of ligatures from displacement of their knots at one point, the strength of fixation and tension of the tendon suture, and also to avoid postoperative complications.

Claims (1)

Washer for fixing the muscle tendon on the opposite side of the hole in the bone, represented by a flat metal ring, characterized in that the inner diameter of the washer is 2.0-2.5 mm, the outer diameter is 12.0 mm, the thickness is 0.8-1.5 mm , while the opposite edges of the washer are made truncated by 3.0-3.4 mm to prevent the assembly of ligature knots, with which these ligatures are fixed on the wall of the washer, at one point.

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