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a way of treatment of splintered intraarticulate fractures of a calcaneus (the demand for the invention № 2004131078/17 (033825)

The essence of the given way consists that through carinate and kuboyovidnuju foot bones are spent by two crossing spokes with an emphasis to planes, a perpendicular long axis II pljusnevoj bones. Spokes zakrepyoljajut on the extended arc leg bridged by means of carving hinges, supplied with the axial hinges located in a projection veryohushki of an articulate process tarannoj of a bone in such a manner that the conditional line bridging axial hinges among themselves settles down in a horizontal plane of perpendicularly long axis of a calcaneus, with possibility oseyovyh and angle movings with a base ring leg of the apparatus, raspoloyozhennoj at level of the bottom third of diaphyses bertsovyh bones and fixed to the last by means of two crossing spokes, one of which proyohodit through both bones of an anticnemion, and another only through big bertsovuju a bone in parallel its internal side.

Through a hillock of a calcaneus from shift spend a spoke with upoyorom in a horizontal plane of perpendicularly long axis calcaneal kosyoti which extremities fix on arms in sharnirno established P - the figurative leg having possibility of axial and angle moving poyosredstvom of carving hinges concerning arc and base ring legs, and, after elimination of all kinds of shifts, carry out stabilisation.

Carrying out of two crossing spokes with an emphasis through ladevidyonuju and cuboidal bones of foot in a plane, a perpendicular long axis II pljusnevoj bones, provides stable bracing and possibility vosstayonovlenija a foot crest practically at all kinds of fractures, including at serious damages of forward department of a calcaneus, reduces probability of damage by spokes of neurovascular fascicles of foot, muscles and tendons.

Bond of the extended arc leg by means of carving sterzhyonej, supplied with axial hinges, with possibility axial and angle ps -

remeshcheny, with a base ring leg of the apparatus allows to carry out repoyozitsiju a calcaneus, provides the dosed out decompression podtarannoyogo a joint.

Bracing by a base ring leg of the apparatus to the bottom third of diaphyses bertsovyh bones by means of two crossing spokes, one of which passes through both bones of an anticnemion, and another only through big bertsovuju a bone in parallel se an internal side, warns her zaprokidyvanie at bringing down of a hillock of a calcaneus.

Carrying out of a spoke with an emphasis through a hillock of a calcaneus from the party smeyoshchenija in a horizontal plane of perpendicularly long axis of a calcaneus allows to put to a calcaneal hillock of force, the return to action ikroyonozhnoj and plantar muscles (equally effective these forces soogvegstvueg axes of a normal calcaneus), that facilitates a reposition and provides stayobilnuju fracture bracing.

Bracing of a spoke with an emphasis, the calcaneus spent through a hillock on arms in sharnirno established P-obrazioj to a leg having vozmozhyonost axial and angle movings by means of carving hinges otnoyositelno arc and base ring legs, provides restoration normal are long a calcaneus and frames conditions for definitive repoyozitsii, allows to carry out the dosed out compression-distraction fragyomentov a calcaneus in the course of treatment.

Configuration of the apparatus of external bracing for realisation of a way leyochenija splintered intraarticulate fractures of a calcaneus is presented naris. 13.

The way is carried out as follows. CHreskostnyj an osteosynthesis begin with installation of a base ring leg 1 in the bottom third of anticnemion on two crossing spokes 2 and 3, one of which 2 spend through both bertsoyovye bones, and another 3 - only through big bertsovuju a bone in parallel ss an internal side.

Fig.

13. Configuration of the apparatus of external bracing for realisation of a way of treatment of wasps of annulate intraarticulate fractures of a calcaneus the Explanation in the text.

To a base ring leg 1 by means of carving hinges 4 and 5,

16 18 2 4 3 4 6$

Supplied with axial hinges 6 and 7, mount the extended arched leg 8 on which with an emphasis 9 both 10 through carinate and cuboidal bones of foot two crossing spokes spend to planes, perpendicular long axis P pljusnevoj bones in position of a plantar flexion of foot to 110 °. An angle of a flexion of foot if necessary korregirujut by a compression or a distraction on a carving hinge 5.

The scheme of carrying out of spokes through carinate and cuboidal bones of foot is presented on fig. 14.

Fig.

14. The carrying out scheme

Spokes through carinate and cuboidal KOS¶N stops.

To axial hinges 6 krepjat carving hinges 11, means kotoyoryh with an arched leg 8 bridge the P-shaped leg 12 consisting of a lath of 13 and two arms 14. The Important point is the locating of axial hinges 6 in a projection of an apex of an articulate process tarannoj bones, thus the conditional line bridging axial hinges 6 among themselves dolzhyona to settle down in horizontal planes of perpendicularly long axis of a calcaneus. Through a hillock of a calcaneus from shift in gorizonyotalnoj planes of perpendicularly long axis of a calcaneus spend a spoke with an emphasis 15 and fix it to arms 14 P-shaped legs 12. By means of a carving hinge 16 with the two-axial hinge 17 bridge P - a figurative leg 12 to a lath 18 mounted on a base ring leg 1 in its back part.

For a reposition of fragments of a calcaneus carry out a distraction of 8 10 mm on carving hinges 11. An internal or external curvature pjayotochnoj bones (on axial рентгеноірамме) korrigirujut by a distraction

io to a hinge 11 from deformation and a compression on kontralateralnomu to a hinge And.

After "reklinatsii" the driven fragments of a calcaneus, posredstyovom distractions on a carving hinge 16, reduce a calcaneal hillock to vosyostanovlenija normal angle Bellera then carry out the dosed out compression of fragments of a calcaneus by means of carving hinges 11.

By a distraction to carving hinges 4 on 3-5 mm make doziroyovannuju decompression podtarannogo and talocrural joints. By means of a compression on one of carving hinges 4 and distractions on kontralateyoralnomu to a hinge 4, correction of rotatory shift of fragments of a calcaneus is possible. After end of all stages of a reposition of a calcaneus osuyoshchestvljajut stabilisation by means of a tightening of nuts on carving hinges 4, 5, And and 16.

The given way is used at operative treatment of 25 patients of II investigated group (29 calcaneuses).

4.4.

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Scientific source Ivanov PETER VALENTINOVICH. OPTIMIZATION of TACTICS of SURGICAL TREATMENT And POSTOPERATIVE AFTERTREATMENT of PATIENTS With CALCANEUS FRACTURES. The dissertation on competition of a scientific degree of the candidate of medical sciences. Kazan -.

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