Method for surgical approach to upper and lower cervical spines
SUBSTANCE: planned skin incision is first configured on an anteriolateral neck surface by projection zoning of a clavisternomastoid and a neck median line to be marked with colour graphic lines. A first line extends along a medial border of the clavisternomastoid. A second line extends from a suprasternal notch to the middle of a hyoid shaft. Both of the lines are then combined by drawing a perpendicular third line from a lower border of the middle of a hyoid shaft to the medial border of the clavisternomastoid, thereby forming a projection triangle. Cutaneofascial layers, platysma and subcutaneous fat are incised along the first and third lines to cut out a musculocutaneous flap, which is brought outwards. Underlying soft tissues are dissected to an anterior surface of cervical spinal bodies by splitting subcutaneous fat between a neurovascular bundle and a pharynx, detaching an intracervical fascia, splitting perioesophageal subcutaneous fat and displacing midline organs of the neck in the medial direction, and the neurovascular bundle - in the lateral direction.
EFFECT: method enables reducing a risk of treatment-induced traumatic injuries of the midline organs of the neck, an upper laryngeal nerve, upper and lower thyroid arteries, as well as a parenchyma and an excretory duct of a submandibular salivary gland with optimising topographo-anatomical relations of the incision wound structures, thus providing a surgical angle approaching 90 degrees.
The invention relates to medicine, namely to neurosurgery, vertebrology, orthopedics and traumatology. This solution can be used in the implementation of surgical interventions in neoplastic and inflammatory lesions and traumatic injuries that require to perform the main stage of surgical intervention skeletonname bodies of C2-C7 vertebrae.
The complexity of the topographic-anatomical relations of the cervical spine with surrounding vital organs of the neck greatly limits the possibility of surgery on the vertebral bodies. The most difficult challenge remains the implementation of a rational surgical approach to carry out essential stages of radical interventions performed in inflammatory, neoplastic diseases of the vertebrae and traumatic injuries.
Individual topographic-anatomical conditions and the diversity of forms of pathology of the cervical spine define a differentiated choice of surgical approaches. At a pathology of bodies of the cervical vertebrae are used front and Antero-lateral approaches: top-corner, lower corner, the lower-middle corner, T-shaped, Samoobrona combined multi-zone, ecoreality. Of these accesses when performing expansion�enny volumes of surgical procedures applied bottom-corner, T-shaped, Samoobrona and combined accesses, allowing you to perform operational manipulation not only multiple abnormal vertebrae, but also the adjacent parts of the neck [Ramic E. A. trauma to the lower cervical spine: diagnosis, classification, treatment // Surgery of the spine. 2005. No. 3. Pp. 8-24; Ramic E. A. Injuries of the upper cervical spine: diagnosis, classification, characteristics and therapy/ spine Surgery. 2005. No. 1. P. 25-44].
The closest analogue to the claimed invention is an anterior cervical Samoobrona access [Kushkhabiev V. I. Surgery of the cervical vertebrae. Nalchik: Elbrus, 1976. P. 62-65], in which an incision along the medial edge of sternocleidomastoid muscle, then from the ends medially in the transverse direction cut through the skin and fascial layers at the top - the neck and submandibular folds, down - to the sternal end of the opposite clavicle. This cut surface and its own fascia of the neck together with platysma, third fascia of the neck, scapular-hyoid, Sterno-thyroid and Sterno-hyoid muscles, nutricianal the fascia. In the upper part of the wound also cross awl-hyoid, awl-pharyngeal muscle and the posterior belly of digastric.
However, this access, as all of the above, characterized obra�lo g an extensive area operating distance, that makes them, despite the convenience of meeting operational skills very traumatic. Trauma is determined by a significant number of cross muscles, work on all of the fasciae of the neck, extensive dissection of the deep cellular spaces, the possibility of intraoperative injury of the neurovascular bundle and submandibular salivary glands.
The objective of the claimed invention is to provide an anterior cervical surgical access to the bodies of C2-C7 vertebrae, which allows to reduce the risk of iatrogenic traumatic injuries of the midline of the neck, upper laryngeal nerve, upper and lower thyroid arteries and parenchyma and ductless podniesinski salivary glands in the optimization of topographic-anatomical relationships of structures of the wound, providing the angle of operative activity, approaching 90°.
The essence of the claimed invention is characterized in that in the method of surgical access to the upper and lower cervical spine determine the configuration of the planned incision of the skin on the anterior-lateral surface of the neck by setting projection zones of sternocleidomastoid muscle and the midline of the neck with the application of color codes marking the first line, passing through mediaremote sternocleidomastoid muscle, and the second line from the level of the jugular notch to the middle of the body of the hyoid bone, which are then connected by conducting perpendicular to the third line from the bottom of the mid-body of the hyoid bone to the medial edge of the sternocleidomastoid muscle, forming a flat triangle, perform the incision of the skin and fascial layers, platysma and fatty tissue of the first and third lines with cutting out a skin-muscle flap, which is removed outwards, carry out a dissection of soft tissues to the anterior surface of the bodies of the cervical vertebrae by delamination of fiber between the neurovascular bundle and throat, separation nutricianal fascia, bundles amlopidine tissue and displacement of midline of the neck medially and the neurovascular bundle laterally.
The technical result of the claimed invention.
By this technique, the incision specific configuration on the previously applied colour labelling in accordance with subcutaneously placed anatomical landmarks allows to form musculocutaneous flap without additional damage to the muscles, vessels, nerves and submandibular glands, as well as provide convenience to the mobilization of these structures, dissection of the cervical fascia, cellular spaces of the neck and stellerovaya bodies of C2-C7 call�s, including manipulation on the basis of the odontoid process of the C2 vertebra. The implementation part of the section in accordance with a third projection line held in the form of the perpendicular from the bottom edge of the mid-body of the hyoid bone to the medial edge of the sternocleidomastoid muscle, limits the possibility of iatrogenic traumatic injuries of the contents of the submandibular triangle, namely parenchyma podniesinski salivary gland and its capsule, by intactness soft tissue located above the short arm of the incision, forming a bed for the above cancer and preventing its "dislocation" in the surgical wound (unlike analog). This type of cut allows to exclude the execution of unwanted instrumental manipulation, in particular excessive traction retract the capsule and parenchyma of the submandibular gland, ligation of feeding this gland afferent and efferent blood vessels, as well as obdelavo vein, superior thyroid arteries and veins, the intersection of awl-hyoid, awl-pharyngeal muscle and the posterior belly of the digastric muscle. In connection with the foregoing described in this application surgical access is less harmful in terms of maintaining a sufficient amount of wound, her index and angle of operative activity, approaching 90°, which makes it�splash zones to perform the main stage of surgical intervention not only on the adjacent vertebrae, but on the level of the upper and lower cervical spine.
Performance of the proposed surgical approach allows to preserve the integrity of the sternocleidomastoid muscle, to avoid damage to the neurovascular bundle of the neck and its case, to eliminate impacti adjacent to the wound anatomical structures can be achieved only temporarily compromising the integrity of the small muscles of the median of the neck with the passage of the wound channel through the fascial-cellular layers without further restriction of the functions of the midline of the neck in the process of formation of postoperative scar.
Method of surgical access to the upper and lower cervical spine is as follows.
The indications for the use of the inventive surgical access are: multiple and combined neoplastic, inflammatory lesions and traumatic injuries of the upper and lower cervical spine, in which to perform the main stage of surgical intervention required stellerovaya bodies of C2-C7 vertebrae.
Before performing main stage surgery determine the configuration of the planned incision of the skin on the anterior-lateral surface of the neck. To do this, set the projection zones of sternocleidomastoid mystii the midline of the neck. Put colour-coded lines. The first line carried by the medial edge of the sternocleidomastoid muscle. The second line is carried out from the level of the jugular notch to the middle of the body of the hyoid bone. The first and second lines connect by holding perpendicular to the third line from the bottom of the mid-body of the hyoid bone to the medial edge of the sternocleidomastoid muscle, forming a flat triangle. Carry the incision of the skin and fascial layers, platysma and fatty tissue of the first and third lines with cutting out a skin-muscle flap, which is removed outwards. Carry out the dissection of soft tissues to the anterior surface of the bodies of the cervical vertebrae by delamination of fiber between the neurovascular bundle and throat, separation nutricianal fascia, stratification amlopidine tissue and displacement of midline of the neck medially and the neurovascular bundle laterally. If necessary, due to individual anatomical variability, mobilize the superior laryngeal nerve, the upper and the inferior thyroid artery. After you complete the basic stage of surgical intervention on the affected/damaged the cervical vertebrae surgical wound sutured in layers.
Patient M., 43 years old, was admitted to the neurosurgical Department with a diagnosis�m: "complicated Closed injury of the cervical spine. Compression-comminuted fracture of the bodies of C4-C5 vertebrae injury and spinal cord compression at this level. Upper paraparesis, lower paraplegia. Infringement of functions of pelvic organs."
After clinical and intratropical examination established indications for decompressive-stabilizing interventions on the cervical spine with surgical access by the above procedure.
Perform this surgical approach provided good visualization of the bottom of the wound because of the wide availability zone to the bodies of C2-C7 vertebrae and the operating angle of 90° in the absence of "dislocation" submandibular gland, eliminating the need to perform additional unwanted instrumental manipulation.
The postoperative period is smooth, the wound healed by primary intention, the cosmetic result is good.
Method of surgical access to the upper and lower cervical spine, characterized by the fact that determine the configuration of the planned incision of the skin on the anterior-lateral surface of the neck by setting projection zones of sternocleidomastoid muscle and the midline of the neck with the application of color codes marking in the form of a first line passing through the medial edge of the sternocleidomastoid muscle and the second line from the level of the jugular notch to the middle of the body of the hyoid bone, which are then connected by conducting perpendicular to the third line from the bottom of the mid-body of the hyoid bone to the medial edge of the sternocleidomastoid muscle, forming a flat triangle, perform the incision of the skin and fascial layers, platysma and fatty tissue of the first and third lines with cutting out a skin-muscle flap, which is removed outwards, carry out a dissection of soft tissues to the anterior surface of the bodies of the cervical vertebrae by delamination of fiber between the neurovascular bundle and throat, separation nutricianal fascia, bundles amlopidine tissue and displacement of midline of the neck medially and the neurovascular bundle laterally.
SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.
EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.
SUBSTANCE: invention relates to medical equipment, namely to sealing device for reparation of heart defect and vessel diseases in the process of performing surgical operations for treating such diseases as patent foramen ovale (PFO) or heart stunt, vascular system diseases, etc. Sealing device contain stretchable frame ad sealing element. Frame contains multitude of wires, each of which passes from proximal end to distal end of frame. First and second segments from multitude of wires form wound proximal loop and distal loop respectively. Multitude of wires form proximal disc and distal disc when sealing devise is extended. Proximal disc and distal disc are located between proximal and distal loops. Each wire from multitude of wires forms respective petal of proximal disc and respective petal of distal disc. Respective petals form zones of overlapping and unsupported sections. Sealing element, at least, partially encapsulates extending wire frame.
EFFECT: invention has improved compatibility with heart anatomy, it is easier to extend, reposition and return into initial condition in the place of opening.
25 cl, 16 dwg
SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.
EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.
3 dwg, 2 ex
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: surgical management of colon cancer is required in low colonic obstruction. A midline laparotomy and abdominal organs inspection is followed by colon mobilisation. A colonic segment with a tumour is resected. The segmented intestine is decompressed with an electric suction machine. The rectal stump is stitched with a stapling apparatus. A superposed segment of the segmented intestine is mobilised to be brought down. A tunnel is formed behind the rectal stump from the side of the anus as close as possible to the oral end of the stump. A hole is formed along the posterior wall with an electric knife and used to bring down the mobilised segmented intestine by means of a guide. The intestine is fixed to the hole borders with four stitches. The excessive intestine is brought out through the anus and fixed to the perineal skin. A dioxidine solution is administered into the abdominal cavity. The rectal stump is daily washed with antiseptic solutions until the excessive brought out intestine is dissected away on the 10-14th day.
EFFECT: method enables applying the primary stitch-free colorectal anastomosis, requires no rehabilitation stage of treating colon cancer by the natural formation of the anastomosis and prevention of its leakage; it also reduces the length of disability and improves the patient's quality of life.
1 ex, 2 dwg
SUBSTANCE: axial line of two enclosing incisions is marked by connecting the centres of outer mouths of fistula sequentially from up to down by a wavy line. That is followed by making two wavy enclosing incisions parallel with the axis: right and left at 20 mm from the axial line. The left incision starts 15 mm above the proximal outer mouth of fistula, and ends 15 mm below the distal outer mouth of fistula, whereas the right incision starts at the level of the proximal outer mouth of fistula and ends at the level of the distal outer mouth of fistula. Thereafter, RPF is excised in the radial direction. Two L-sutures relaxation incisions are made. The upper relaxation incision originates from the point at the beginning of the right enclosing incision and extended to the point at the beginning of the left enclosing incision and 20 mm further, turned at a right angle 25 mm upwards, and an upper triangular adipocutaneous flap is formed. The lower relaxation incision originates from the point at the end of the left enclosing incision and extended to the point at the end of the right enclosing incision and 20 mm further, turned at a right angle 25 mm downwards, and a lower triangular adipocutaneous flap is formed. That is followed by closing a wound defect by adipocutaneous repair by shifting the formed upper and lower triangular adipocutaneous flaps onto the wound defect and fixing them with interrupted sutures. The lower edge of the upper adipocutaneous flap is fixed to the right enclosing incision, and its upper edge - to the left enclosing incision. The lower edge of the lower adipocutaneous flap is fixed to the left enclosing incision, and its upper edge - to the right enclosing incision; thereafter, the wavy s are closed.
EFFECT: more effective surgical management of recurrent pilonidal fistulas, reduced number of complications and recurrences and improved aesthetic effect of the operation.
SUBSTANCE: own finger artery, dorsal vein and own finger nerve of the fifth finger are cut and bandaged. A common finger artery of the transplant is sutured with own finger artery of the third finger stump. The dorsal vein of the transplant is sutured with the dorsal vein of the stump. Own finger nerve of the transplant is sutured with own finger nerve of the stump.
EFFECT: method improves results of treatment due to the correspondence of dimensions of the transplanted finger vessels to the dimensions of the vessels of the recipient area.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex