SET OF TOOLS AND METHOD FOR BIOLOGICAL RECONSTRUCTION OF LONG BONES FOR ONCOLOGICAL REVISION KNEE ARTHROPLASTY Russian patent published in 2023 - IPC A61B17/92 A61F2/28 A61F2/46 

FIELD: medical equipment.

SUBSTANCE: invention can be used for surgical treatment during oncological revision knee arthroplasty in patients with internal diaphyseal and metaepiphyseal defects of femur and tibia. The set of instruments for biological reconstruction of long bones in oncological revision knee arthroplasty contains a personalized impactor, guide and hammer. The impactor is manufactured using additive technologies individually for each specific patient; it has a conical end at one end and a hammer pad at the other end. The impactor has a central end-to-end longitudinal channel with outward slotted groove, passing through the entire body of the impactor, including the impact pad, and the slotted groove narrows outward from the longitudinal channel. The guide is made of medical steel and contains a rod, at the working end of which there is a centralizer head with a diameter of 12 mm with an external right-hand thread, and at the other end there is a T-shaped handle. The hammer is cylindrical in shape and contains a central through longitudinal channel with a slotted groove outward. The diameter of the impactor channel corresponds to the diameter of the guide rod, allowing the impactor to slide smoothly along the guide rod. The diameter of the channel and the width of the hammer groove are equal and 10% greater than the diameter of the guide rod. The method of biological reconstruction of long bones for oncological revision knee arthroplasty includes the use of the above set of tools, and first, based on the analysis of radiographs and computed tomograms of the reconstructed bone in each individual patient, a three-dimensional model of the bone defect is created and, in accordance with its size, using 3D printing, a personalized impactor is manufactured from a polymer material; then a guide is inserted into the prepared cavity in the area of the bone defect, placing its centralizer head at the level of the intact medullary canal; then the space between the guide rod and the walls of the bone defect is filled with crushed bone cancellous allograft, thereby forming the walls of the bone defect; next, the impactor is placed on the guide rod so that its conical end faces the bone defect, then a hammer is placed on the guide rod between the T-shaped handle and the impactor platform, then the impactor is advanced with longitudinal successive blows of the hammer on the impactor platform until it stops its conical end into the centering head of the guide, after which the hammer is removed from the guide rod; after this, the impactor is removed from the canal it has formed and reoriented on the guide rod with the impact pad towards the bone defect, then, holding the impactor with the impact pad at the end of the formed canal, the guide is removed from this channel, rotating it using a T-shaped handle counterclockwise, compacting the crushed cancellous bone allograft in the zones bordering the unchanged diaphysis of the reconstructed bone, and after contact of the centralizer head of the guide with the impactor platform, they are removed from the formed bone canal, after which cement fixation of the endoprosthesis component, equipped with a hinge mechanism with a rotation platform, is performed, and in the postoperative period, the patient is prescribed antiresorptive bone therapy using osteomodifying agents.

EFFECT: use of the group of inventions makes it possible to provide optimal conditions for stable fixation of the endoprosthesis in the femur and/or tibia with restoration of cancellous bone mass without loss of the length of the preserved bone fragment.

2 cl, 16 dwg, 1 ex