RU23755U1 - BONE TRANSPLANT - Google Patents

Description

Bone graft

The utility model relates to medicine, namely to traumatology, orthopedics, neurosurgery and can be used to stabilize the spine with its various diseases and thrush at any level, including in the acute non-period of the spinal - spinal injury.

A prerequisite for the restoration of reversibly nullified functions of the spinal cord in the acute period of the spinal cord injury is the restoration of the normal anatomical shape of the spine and spinal canal with subsequent reliable fixation. Currently, in clinical practice for the non-frequent fixation of vertebral bodies (spinal fusion), various configurations (rectangular, oval, combined, etc.) are widely used (Movshovich I.A., Operative orthopedics.M., "Medicine, p.315-345, 1983)

The disadvantage of using such transplants is the need to prepare special grooves for introducing them, while the integrity of the anterior vertebral bodies is impaired, which requires external immobilization (gypsum beds, hammocks, etc.) And with acute injuries of the vertebral bodies, when neurosurgical procedures are necessary, the formation of transplant grooves is almost impossible.

When using a rectangular graft in 15-20% of cases, its resorption and displacement are noted, which contributes to the progression of compression of the vertebral bodies with the formation of angular deformation.

The patient needs a long bed rest for up to 6 months, which causes a violation of phosphorus-calcium metabolism, deterioration of the cardiovascular system and the progression of cardiovascular failure, the formation of pressure sores, atrophy of the muscular system and requires prolonged after lifting spinal immobilization with a plaster or leather corset. Known forms of bone graft in the form of a fork with different-sized teeth. (A.S. No. 1152581, class A 61B17 / 56, published in Bulletin No. 16 of 04.30.85), in the form of a shamrock (A.S. No. 929071, class A 611317 / 00.1982), in in the form of an elongated bar with double-toothed forks at the ends (A.S. No. 1158182, class A 61B17 / 56, published in Bulletin No. 20 of 05/30/85).

The bone implant described in A.S. No. 1662534, cl. A61B17 / 56, publ. in bull. No. 45 dated 12/07/92 is a cylindrical body, the ends of which are pointed by reducing the diameter of the cylinder and making samples at the end to the formation of pointed circular trepans. Holes or flats are made on the cylindrical surface for turning the implant during installation. Finely crushed sapphire is applied to the cylindrical body and the bottom of trepans.

The disadvantages of the above forms of transplants are the following

when using them, external immobilization is required (gypsum beds, hammocks, etc.) special tools are needed;

the patient is in a forced position when using these forms of transplants.

The T-shaped graft is also known (A.S. No. 902732, class A 61/3 17/00, bull. No. 5 of 02/07/82)

This form of transplant has the same disadvantages as those listed above. In addition, using this form of transplant requires bone suturing.

A bone graft according to A.S. was adopted as a prototype. No. 833226, class A 61 17/00, bull. No. 20 dated 05/30/81.

For its manufacture, cortical-spongy bone grafts are taken (an autograft from the iliac wing and an allograft from the tibia metaphysis) and form them in the form of blocks of a rectangular shape with a length corresponding to the anteroposterior size of the nasal vertebral bodies, 1/2 of the front size of the groove the vertebrae are small, and the height of the grafts is 0.6-1.0 cm higher than the previously measured groove height.

On the cranial and caudal surfaces of the grafts, pyramidal-shaped protrusions are made 0.3-0.5 cm high and have an acute angle at the apex. The disadvantages of the prototype are the following: the possibility of rotational displacement of the graft in the postoperative period; the transplant consists of two parts, which complicates its use;

the formation of grooves for the transplant and wedging

vertebrae with a tool;

the need for external immobilization (gypsum beds, hammocks and

special position of the patient after surgery;

strict bed rest after surgery for a long time;

one of the parts of the transplant is an allograft from

metaphysis of the tibia, which leads to rejection, suppuration,

prolonged reconstruction of the transplant into a full bone marrow;

difficulty in the manufacture of allograft a (special

laboratory);

contact area of two parts of a transplant from foreign materials

harmful to the body.

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the aforementioned disadvantages of the prototype ensured a decrease in the invasiveness of the approach to the vertebrae and transplantation, accelerated the stabilization process while providing optimal conditions for spinal cord function during neurosurgical operations in the acute period of spinal-spinal cord injury, and simplified immobilization.

The essence of the utility model is that a bone graft from the metaphysical part of the tibia is proposed, at the ends of the central part of which there are pyramidal-shaped protrusions having an acute angle at the vertex.

The difference from the prototype of the proposed bone graft is that the central part of the graft is made in the form of n allelepiped 3-5cm long, 2.5-Zcm wide, and 2-Zcm high. more defect of the distant vertebral body. The ends of the graft are pyramids, at the base of which are rectangles, the side faces of the pyramids are pacloped to the apex at an angle of 20-30 degrees and rh, and the front surface of the pyramids has a crest 1 to 3 cm high along the chain. The proposed bone graft is presented in the drawing. It consists of their central part 1, made in the form of a parallelepiped 3-5 cm long., 2.5-Zcm wide., And the height - 2-Zcm.

more defect of the distant vertebral body. The ends of the graft are PNR 2, at the base of which there are rectangles, the lateral faces of the pyramids are inclined to the apex at an angle of 20-30 degrees and are equal, and on the front surface of the pyramids 2 there is a ridge 3 in the center of 3 cm high.

A bone graft is taken from the metaphysical part of the tibia using a cutter or chisel.

We use a transplant from the tibial crest for anterolateral spinal fusion. The anterior surface (cortical layer) is smooth, the posterior surface after graft collection is spongy. To give the desired shape of the graft, only the front part, smooth from the cortical layer, is processed. According to the histological structure of the bone (the crest of the metaphyseal part of the tibia), it has several advantages: smooth restructuring in the process of reorganization into a full callus, without losing supportability, plasticity when processing when setting the desired shape. With a bone knife, the ends of the material taken are processed in the form of pyramids. The inclination of the side surfaces to the top, thanks to which a ridge forms on the middle surface of the pyramids, is 25-3 degrees. The posterior and anterior surfaces of the graft remain untreated and represent

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spongy bone with preservation of the cortical layer. The central part of the transplant is processed in the form of p allelened, whose height is 2-3 cm greater than the defect of the removed vertebral body to give a wedging effect and prevent compression of the roots and vessels of the spinal cord.

After removal of the damaged vertebral body into adjacent vertebral telac, adjacent to the defect, holes up to 0.1 mm deep are made in the bodies in the center. to direct the axis of the graft entry into the vertebral bodies and to avoid displacement of the graft during implantation. After this, the spine is wedged using the roller operating table. The fabricated graft is inserted into these openings. After elimination of the regenerative position, the graft itself enters the vertebral bodies due to the cutting surface of the lateral faces.

The central part of the graft is made in the form of a parallelepiped 3-5 cm long.

With a length of less than 3cm. there is a deformation of the spine, fusion of vessels and roots of the spinal cord.

With a length of more than 5 cm, the roots and vessels of the spinal cord rupture. The width of the box is 2.5-3 cm. With a width of less

2.5 CM. a transplant fracture occurs, and with a width of more than 3cm. it goes beyond the bodies of the vertebrae.

The height of the box is 2-Zcm. more than the distant vertebral body in order to give a wedging effect, which in turn provides decompression of the spinal cord, its vessels and roots. Such a distance creates optimal conditions for the vessels and roots of the spinal cord and leads to a more rapid restoration of its lost function.

The white height of the allelepiped is less than 2 cm. Of the distant vertebral body, spinal deformity occurs, ori is greater than 3 cm. Spinal cord rupture occurs. The height of the graft crest is selected 1-Zcm., Depending on the size of the vertebral bodies.

Thus, the execution of the central part of the graft in the form of a parallelepiped of the above sizes corresponds to the average size of the vertebral bodies and therefore the graft fits tightly into the above and below vertebrae from the site of the removed vertebral body and takes root more quickly.

The lateral surfaces of the ends of the graft provide a cutting surface, and after eliminating the regenerative position of the spine, the graft independently forms a bed for itself in the vertebral bodies. Crest 1-Zmm high., Located on the front cortical

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the surface of the graft, which is formed as a result of processing this surface of the graft at an angle of 20-30 degrees, prevents rotational displacement of the graft in the vertebral bodies. Its height depends on the departments of the spine of the vertebral bodies. The lateral faces of the pyramids in the proposed transplant are inclined to the top of the nodes at an angle of 20-30 degrees.

When tilted less than 20 degrees, the graft does not enter the vertebral body, because there is no cutting surface in such a graft.

When the slope is greater than 30 degrees, the vertebral body is destroyed. The optimal angle of inclination of the pyramid to the top is 25 degrees. In this case, the transplant is easily inserted into the vertebral body, forming its own bed, there is no softening of the spongy part of the vertebral body during implantation of this graft, i.e. optimal conditions are created for the transplant plantation itself, for the reconstruction of full bone marrow,

rotational displacements are prevented and healing is much faster. Due to the above-described shape of the ends of the graft and the depth of entry into the vertebral bodies without instrumental formation of a bone bed in the vertebral bodies, the proposed transplant is self-immersed and forms a bed for itself

due to the formed cutting surfaces on the lateral faces of the ends of the transplant.

The depth of implantation of the ends of the graft depends on the level of the spine:

-Our section of the spine, it is 1-2cm;

- chest section 1.5-2.5cm;

- on the chest and lumbar 2-3 cm;

-on the lumbar 2-Zcm;

-on the lumbosacral region.

The listed depth is optimal and should not be less than the specified minimum values, otherwise transplant displacements appear in the horizontal, frontal and sagittal planes.

The proposed transplant has the following advantages:

- excludes the movement and displacement of the vertebrae in the area of operation in the sagittal, frontal, horizontal planes, thereby providing case stabilization of the spine;

when using it, there is no need to form grooves in the vertebral bodies by the instrumental method adjacent to the area of the vertebral body, which provides the transplant with a more rigid, stable position in the vertebral bodies;

a complete restructuring of the transplant occurs without losing it

support ability;

the graft is plastic during processing;

transplant use does not require special conditions and

equipment in the operating room;

the introduction of this graft can be performed in the first hours

or a day after receiving trshmy spine and spinal cord that

prevent terrible complications from spinal cord injury and prevent irreversible

changes in the spinal cord from compression of the brain by fragments of the body

vertebra;

after surgery, the patient does not need a forced position in

beds and external immobilization;

after the introduction of this graft, you can start early

rehabilitation measures, which in turn leads to

the maintenance of associative connections between the brain and spinal cord.

Claims (1)

A bone graft containing a metaphysical part of the tibia, at the ends of the central part of which there are pyramidal protrusions having an acute angle at the apex, characterized in that the central part of the graft is made in the form of a parallelepiped 3-5 cm long, 2.5-3 cm wide, and a height of 2-3 cm more remote defect vertebral body, the ends of the graft are pyramid, the base of which are rectangles, the side faces of the pyramids are inclined at an angle to the top and 20-30 ^o are equal, and the front surface pi amide in the middle there is a crest height of 1-3 mm.