Gavriil Abramovich Ilizarov (June 15, 1921, Bialowieza of the Belostok Voivodeship of the Second Polish-Lithuanian Commonwealth (now Podlaskie Voivodeship of Poland) - July 24, 1992, Kurgan) - an outstanding Soviet orthopedic surgeon, inventor, doctor of medical sciences (1968), professor. Academician of the USSR Academy of Sciences (1991; Corresponding Member 1987). Hero of Socialist Labor (1981). Honored Inventor of the USSR (1985). Honored Doctor of the RSFSR (1965). Honored Scientist of the RSFSR (1991). Winner of the Lenin Prize (1978).
The compression-distraction apparatus (the Ilizarov apparatus, the Shevtsov-Matsukatov apparatus) is a medical apparatus designed for long-term fixation of bone tissue fragments, as well as for its compression (“compression”) or stretching (“distraction”), that is, for carrying out the so-called “ transosseous osteosynthesis ". The device is used to treat injuries, fractures of limbs, congenital deformities of bone tissue. It is also used for “aesthetic” operations in anthropometric (orthopedic) cosmetology for lengthening and straightening the legs. The device is a metal "ring", which are attached to the "spokes", passing through the bone tissue. The rings are connected by mechanical rods, allowing them to change their orientation at a speed of the order of one millimeter per day. For the first time the compression-distraction apparatus was developed by the Soviet surgeon G. A. Ilizarov (inventor's certificate No. 98471 dated June 09, 1952).
With the help of the Ilizarov apparatus, the limbs are extended, various deformities of the limbs are corrected, and bone fragments are fixed for fractures. The device is constantly being improved and it finds new applications in the treatment of various bone ailments.
The history of the creation of the device by doctor G. A. Ilizarov
Since ancient times injuries have occurred in people's lives, for example, their legs, arms, and so on are breaking. The doctors could treat relatively mild fractures, but when the person broke the bones unsuccessfully, they did not know what to do. And they tied around the perimeter of the bed, and they pushed the wire into the bone, and wrapped the leg in magical sheets, but nothing helped. As a result, the fracture healed poorly, not to mention its appearance.
So it was almost to this day. The decision in the middle of the XX century found Gabriel Abramovich Ilizarov. He first proposed his apparatus as a treatment for severe fractures. Subsequently, his invention allowed not only to effectively treat fractures, but also to lengthen bones, correct leg curvature, and heal many other complex diseases.
In the Kurgan Specialized Research Institute dealing with orthopedics and traumatology, they tell about the history of the invention of this device as follows. First, Ilizarov conducted experiments on broken cuttings of a shovel, piercing them with ordinary knitting needles. As a result, a real medical device for the treatment of fractures was gradually invented. Its essence is as follows. Iron spokes pierce the bone. Further, these spokes are fixed on the iron rings, and the rings themselves are interconnected by several bolts. Thus, the leg was fixed and had the opportunity to better grow together.
What is the modern Ilizarov machine?
For several decades now, constant work has been carried out to improve the apparatus. At present, the varieties of this design have both similarities and differences with the original sample. Now, instead of spokes, rods made of inert materials — titanium or carbon fiber — are often used. Hard rings replaced by semicircles, plates and triangles. The device has become much easier and smaller. It is increasingly used not only for the treatment of fractures, but also for the purpose of lengthening limbs. To do this, initiate a very slow stretching of the bone, which creates tension in it and surrounding tissues. As a result, bone marrow is gradually forming - a new tissue, due to which the limb becomes longer.
Usually the proportions of the patient’s body are measured before the operation. This is done in order to find out how much bone can be enlarged without significantly disturbing the ratio of individual parts of the body. Lengthen or lower leg, or hips. At the same time it is impossible. The doctor decides with the patient what to lengthen.
Included Ilizarov apparatus, there are 30 parts. Parts are manufactured at an experienced enterprise of our center and can be supplied at cost in the required quantity.
The main supports of the device:
- Rings are non-separable (Fig. 2a).
- Half rings (fig. 2b).
- Arcs with holes (Fig. 2c).
Rings and half rings are made in 11 sizes, depending on their internal diameter from 100 to 160 mm every 10 mm, and then 180-200-220 and 240 mm. The width of the plane of the annular support is 15 mm. The ring is the main support of the Ilizarov apparatus and is used in the treatment of pathology of the bones of the upper and lower extremities.
Half rings can be interconnected by means of slats, brackets and screw rods. In addition, to enhance the rigidity of fixing the support, they can be interconnected with the overlay on each other.
Arcs as the main supports are used mainly in the proximal extremities, have 7 sizes depending on the radius of the inner surface of the arcs. At the same time by the size of the radius, they are 80-90-100-110-120-140 and 160 mm. The width of the arc plane is 30 mm. The material for the manufacture of external supports is steel 20x13 GOST 563272.
Employees of the laboratory of biomechanical research conducted a study on the identification of the dependence of the deformation of the rings and arcs of the apparatus on their rigidity and tension force of the spokes. The study subjected to rings and arcs of all diameters with a tension force of the spokes from 10 to 170 kg every 20 kg. It is revealed that the rigidity of the arcs is 5 times lower than the rigidity of the rings. The forces arising in the rings of the Ilizarov apparatus, from the action of the force of the spokes and the forces of compression and distraction, essentially depend on the method of arrangement of the apparatus, on the angle of crossing of the spokes, on the radius of the rings, on the number of rods and their location. The greatest margin of safety of the rings occurs when the spokes cross angle 90 ° and the symmetrical arrangement of the 4 rods.
Additional external supports of the Ilizarov apparatus (Fig. 3a - c).
Arms with a threaded shank and a threaded hole (Fig. 3a) are 2, 3, and 4 hole. Designed for mounting and tensioning the needles, creating articulated joints, derotational nodes and systems for controlling the position of fragments, segments, fragments. The planks are flat, spiral-shaped and radial with the number of holes from 2 to 10 (Fig. 3b. Most often they are used to connect supports of different diameters, attach the rods, connect the supports installed in different planes, create corresponding supports taking into account the segment anatomy and to increase the circumference of the semiring) when installed in the proximal limb. Beams without and with threaded shanks are most often used to connect the main external supports (rings, arcs), fasten the needles with the help of special fixing elements and distra Ktsionnyh rods, strengthening the stiffness of fixing supports and nodes in the layout of devices with pathology that requires great effort.
Washers: cushioning, grooved, grooved. They are used to correct the position of the spokes held in different planes, the fastening of the spokes and other mounting options for the apparatus (Fig. 4).
Threaded couplings and bushings (Fig. 5) are designed to facilitate the installation of the device for orthopedic pathology, namely: to extend the rods, fasten additional supports (brackets, slats), followed by installation and fastening of the spokes or devices to perform the corresponding medical task.
The rods with continuous thread are designed to connect the main supports of the Ilizarov apparatus and to mount various functional repositioning units in order to eliminate the displacement of fragments in width, periphery, as well as the installation of hinged and other joints. They are available in length in 6 sizes: 60, 80, 100, 120, 150 and 200 mm.
Telescopic rods are manufactured in 4 sizes depending on the length: 190, 220, 290, 380 mm. They are designed to connect the main supports, located at a great distance from each other. Connecting them to the main external supports, the rigidity of fixation is significantly enhanced and most often used for lengthening limbs, eliminating deformations and re-assembling the apparatus at the stage of changing the rigidity of fragments fixation (Fig. 6).
Threaded rods with a hole and a distraction groove are used in cases when it is necessary to move osteotomized fragments to replace defects, reposition bone fragments for incorrectly coalescing and long-standing fractures. The length of these rods varies from 40 to 120 mm every 10 mm.
At the stages of the development of parts, various special fixators were used, which are presented in Figure 7.
At present, bolts are used, with a slot or hole , bolts , they are intended for fastening and tensioning the spokes to the main or auxiliary supports. With the help of bolts of special gauges, it is possible not only to fasten, but also to tighten the spokes, as shown in the following figures.
In addition to the above-described parts, keys (end and rozhkov), round-nose pliers, nippers and spicant pliers (fig. 8) for tensioning the base and reposition-fixing needles are necessary for applying the device.
In addition, bolts, nuts and a set of bits are needed to perform compacttomies and corticotomies.
Spokes (Fig. 9) are the link between the bone and the external supports of the device. To perform transosseous osteosynthesis, the spokes most commonly used are 1.5 and 1.8 mm in diameter. To enhance the stiffness of fixation can be used spokes 2.0 mm. When using the method of transosseous osteosynthesis for fractures and pathology of small tubular bones, needles of 1.0 mm diameter are used. The length of the spokes can be from 250 to 400 mm. Holding the spokes through the metaphysical department presents no difficulties, and for this purpose the needles with triangular sharpening are most often used. In order to reduce the morbidity when holding the spokes through the diaphyseal parts of the bone, the needles with a special sharpening, most often in the form of a spear-shaped, are used. Research was carried out with platinum, silver, graphite coated needles, but they have only historical, not practical significance. Currently, to stimulate osteogenesis use knitting needles with different coatings.
To enhance the rigidity of fixation of bone fragments, to achieve their exact reposition, and also to move osteotomized fragments in order to replace bone defects, needles are used with stop pads in the form of a bayonet, spin-shaped bend, soldered with silver solder or stop due to flattening of the needles. The location of the thrust pads may be at different distances from the point of the spokes. For fractures of the bones of the pelvis, clavicle, sternum, the thrust pads are located at a distance of 1.5-2.0 cm from the point of the spokes. For fractures of the neck and the helical area of the femur, the thrust pads are located at such a distance that prevents the spokes from penetrating into the hip joint. Most often the thrust pads are located in the middle of the spokes, which are called reposition-fixation.
The spokes in relation to the bone marrow canal and the cortical bone can be transmedully, transcortically, paraosno, and they can pass through both or one semicircle of the limb. Currently developed methods of intramedullary injection of the spokes.
The Ilizarov apparatus relates to compression-distraction mechanisms. Therefore, its intended purpose is the distraction or stretching and compression or compression, and, of course, long-term fixation of individual bone fragments.
Any fracture involves the displacement of the edges of the bone, as the muscles pull them in different directions. Use at the fracture of the limbs of the Ilizarov apparatus the risk of displacement of the bony edges is reduced to a minimum. The device reliably fixes not yet accrete fractures and false joints, without requiring additional immobilization with gypsum.
Together with the therapy of false joints and not yet accreted fractures, this device is applicable with a positive effect if it is necessary to correct the length of the limb.
At limb fracture, the installation process of the Ilizarov apparatus proceeds as follows: With the help of a drill, the apparatus spokes are held in two pieces through each bone fragment in the fracture region, and the spokes are crossed at an angle of ninety degrees. Each pair of knitting needles in each bone fragment is fixed with a special key with a ring or half ring.
Decrease in force of compression occurs due to deformation of the spokes.
The tension of the spokes is under constant control and daily regulation. With the skillful manipulation of moving rods, any displacement of bone fragments along the axis, angular deformations are eliminated and the bone fragments are closed repositioned.
The process of lengthening the legs using the Ilizarov apparatus is a step-by-step process. The first stage is the application of a device to the patient, the second stage is osteometry (bone dissection), the third stage is the fixation of bone fragments using the Ilizarov apparatus. Approximately seven days after this operation, a gradual process of distraction, that is, lengthening of the legs, begins.
Limb lengthening occurs at a rate of one millimeter per day. The speed of stretching depends on the individual sensitivity of the procedure tolerance. An extension of five centimeters takes about fifty to seventy five days. After a period of lengthening, a period of fixation occurs. And its duration, as a rule, is twice the stretching period.
No less than thirty days later, an operation begins to lengthen the second limb. All operations of this nature are carried out under general anesthesia. Already on the second day the patient can walk with crutches. The rehabilitation period must be accompanied by walking and swimming.
The curvature of the limbs is also corrected with the help of the Ilizarov apparatus. An operation is performed to dissect the bone at the site of its deformation. Then the fixation is carried out in the correct position of the bone using the Ilizarov apparatus.
The installation of the apparatus lies in the insertion of the rods and the holding of the spokes through the bones. Correction of the curvature of the lower extremities can take place gradually, with daily correction, or simultaneously, that is, the correction is carried out during surgery. Daily correction is carried out by the patients themselves.
The Ilizarov apparatus is removed after the bones are joined in the correct position.
Since the modern Ilizarov apparatus has small overall dimensions, the patient has access to full movements almost immediately after the operation.
Advantages and disadvantages
The advantages of using the Ilizarov apparatus include the fact that this can significantly reduce the time to bone healing in fractures and minimize the risk of developing a false joint at the fracture site. Moreover, a partial load is allowed on the injured limb already on the second day after the operation and the procedure for installing the device.
The disadvantages of using the Ilizarov apparatus include such facts as:
- with rings it is inconvenient to lie down and sit;
- in the places of punctures remain the scars of a point character, after the removal of the device;
- during use of the device, edema and pain interfering with sleep of a whining character appear.
The removal of the Ilizarov apparatus is carried out exclusively by a specialist. The device is removed, as a rule, without anesthesia and anesthesia.
The wounds that remain after the removal of the Ilizarov apparatus heal quickly enough. In order to speed up their healing process, disinfectants can be used. Scars in the field of removal remain, but they are usually small, and almost invisible.
Take the bone.
Stainless steel spokes carried through the bones. One end of the spokes is sharpened trihedral, the second end of the spokes is inserted into the cartridge of the guide vane. All this looks like a drill is drilling a hole in the bone, and the needle is a drill.
Then the needles are attached to the rings. The final rigidity of this design is given by threaded rods. In general, as you can see, everything is simple, in the factory. Reminds Soviet children's designer.
Further, a fracture is made surgically (and in some cases two, depending on how much the limb is lengthened). Despite the anesthesia, during blows with a chisel to the bone, you feel well in the spine (I remind you that only the lower half of the body is anesthetized by anesthesia), so this is hellishly unpleasant.
Distraction. The purpose of this stage is to lengthen the Ilizarov apparatus and, accordingly, lengthen the bone. The process is elementary - several times a day the nurse turns the nuts on your device, turning the nuts forward along the thread of the rod, pushing the rings, they in turn push the needles, and the spokes push the bones. Feelings after the "twist" are not the most pleasant, you feel your leg stretched to the limit of the string. I note that there are special electronic boxes that automatically and very smoothly do a twist (and as usual it will be, many tales go as the electronics crashed, the boxes went crazy and literally tore limbs). In the turn between the bone fragments, a jelly-like substance is formed, which hardens every day, so time cannot be lost. Distraction stage is not particularly pleasant - but tolerable.
Regeneration. Sweet stage, when compared with the service, you become a scoop, and report the days to the demob. The extension is complete, and most importantly help the bones to grow as quickly as possible. To do this, you eat heavily with calcium-containing products, go to physical therapy, go to massage, and recover in the pressure chamber. Already nothing hurts, the device becomes a native integral part of you.
Removing the device. The solemn moment for which you are preparing and waiting as the climax, before which you worry as before an important exam. Someone is removed under anesthesia, someone so, always goes differently. Control X-ray, the doctor gives the nod to the removal of the device. Having turned off all nuts, having removed all rings, in a leg there are only spokes. This feeling of lightness cannot be conveyed - it is so unusual that having lost 3-5 kilogram cargo the leg itself takes off upwards. Spokes bite the usual nippers and pull out with pliers. Then the limb is cast, and the next day it is released on all four sides.
Recovery. It would seem that everything is over. But a new life begins - you learn to walk, you struggle with the temple, you suffer pain, you learn to be a new person.