Method for two-staged surgical treatment of spinal deformity with using autopreserved resected rib autograft and dry vertical halotraction

FIELD: medicine.

SUBSTANCE: ventral release from a toracotomy approach at an apex is accompanied by excising the seventh, or eighth, or ninth rib to gain an access in the form of an autograft 15-20 cm long. An excised rib autograft is placed into a pocket bed pre-formed from the toracotomy incision in subcutaneous fat and fixed to the subiculum to be used as the autograft; the excised rib autograft is underrun for a period from the moment of the final stage of dorsal correction. The second stage of the surgical treatment is preceded by vertical dry halotraction under the patient's body standing in the space of a therapeutic four-wheel frame equipped with a telescopic arm for the patient's head suspension. At the stage of the dorsal correction, the excised rib autograft is removed through a 2-3-cm incision along the postoperative toracotomy scar from the pocket bed in the subcutaneous fat, cleaned from soft tissues, treated in the antiseptic solution, and placed onto the decorticated posterior elements of the operated spine.

EFFECT: adequate spinal fusion involving the configuration recovery of the spinal canal.

4 cl, 3 ex

 

The invention relates to the field of medicine, namely to traumatology and orthopedics, to method a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction and can be used in the treatment of patients with deformities of the spine, including scoliosis and kyphoscoliosis, in surgical, trauma and other hospitals.

The known method of two-stage surgical treatment of spinal deformity, comprising executing at the position of the patient on the side opposite the apex of deformity of the spine, the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib and resection of part of it by placing it in an antiseptic solution for subsequent use as an autograft, conducting discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia, then, after removal of the drainage from the pleural cavity and enhance the patient 2-3 days after completion of the first phase operational in�of Estella, the implementation process of the halo-traction prior to the beginning of the second phase of surgery - dorsal correction of the spine, then through 12-17 days after the completion of the first stage to the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements and the placement of autograft material on decorazione the posterior elements of the operated spine (see Kuleshov A. A. "Severe forms of scoliosis. Surgical treatment and functional features of some organs and systems", Thesis for the degree of doctor of medical Sciences, Moscow, 2007).

However, the known method of two-stage surgical treatment of spinal deformity when its use has the following disadvantages:

- ensures the provision of high posterior fusion with restoration of the configuration of the spinal canal,

- not enough provides reliable biointegration,

- does not ensure the absence of antigenic properties,

- provides insufficient strictly vertical halo-traction of the patient,

- not enough provides continuous monitoring of a given degree of halo-traction,

- does not provide the performance of a control x-ray images during the execution process of the halo-traction,

- not about�offers early social rehabilitation of the patient.

- does not provide sufficient improvement in the quality of life of the patient.

The object of the invention is to provide a method of two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction.

The technical result is to ensure reliable protection of the dural SAC with its contents from trauma, providing a full posterior fusion with restoration of the configuration of the spinal canal, ensuring reliable biointegration, ensuring the absence of antigenic properties, ensuring a reliable fusion, providing a strictly vertical halo-traction of the patient, ensuring constant monitoring of a given degree of halo-traction, as well as ensuring monitoring of x-ray images during the execution process of the halo-traction. In addition, the technical result is to ensure early rehabilitation of the patient with sufficient improvement of the quality of his life.

The technical result is achieved in that a method of two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction, including when the patient on the side opposite�false top of the spinal deformity, the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib and resection of part of it by placing it in an antiseptic solution for subsequent use as an autograft, conducting discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia, and then, after removal of the drainage from the pleural cavity and enhance the patient 2-3 days after completion of the first phase of surgery the implementation process of the halo-traction prior to the beginning of the second phase of surgery - dorsal correction of the spine, then through 12-17 days after the completion of the first stage to the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements and the placement of autograft material on decorazione the posterior elements of the operated spine, while in the process of implementation of ventral release torakotomnogo access on the apex of deformity resected seventh, or eighth, or ninth rib, which carry out DOS�NC in the form of autograft length of 15-20 cm, then after performing a discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia are placed resected rib-autograft in preformed made from thoracotomies cut the box-pocket in the subcutaneous tissue until the locking to be tissues for later use as an autograft, while the resected rib-autograft sutured to the period before completion of the final stage dorsal correction, then before the second stage of surgical treatment are in the process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head, while the patient's head previously placed sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends,�eat altractive rods move in the holes of the halo rings, down to the bones of the skull of the head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screwed into the cortical bone layer of the skull of the patient under the stress of 0.54 to 0.9 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the patient's head, and two front halotestin rod is placed on the anterolateral surface of the skull 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod is placed horizontally in pairs left and right on the back of the patient's skull in the parietal tubercles at 1 cm above the upper level of the ear of the patient, then placed on the head of a halo-ring hung patient using the damper spring from a material with a predetermined elasticity to telescopic rods medical frame on wheels and perform the specified session vertical halo-traction for 240-480 minutes a day, during which the patient can move through space, medical space, is then runtime dorsal correction of the spine resected rib-autograft is removed through a 2-3 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, cleaned of soft tissue and, after treatment in an antiseptic solution is placed on dekorrelirovannyih elements of the operated spine. In this portion of the resected rib-autograft in the final stage dorsal correction is placed in the form of ground autocracy on decorazione the posterior elements of the operated spine. In the process of implementing vertical dry halo-traction patient use is made of titanium or its alloys metal galatolo and altractive rods. In the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.

The method is carried out as follows. Performed by standard x-ray pictures of the spine in 2 projections, and determine with the use of multilayer spiral computed tomography and magnetic resonance imaging rotation and the presence of anomalies of the vertebrae, as well as dysplasia of the spinal cord.

When positioning the patient on the side opposite the apex of deformity of the spine, perform the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib. Resection of the seventh or eighth or ninth rib, which access, in the form of autograft length of 15-20 cm and Then perform the discectomy and resection zamykanie�of intelligent plates with subsequent filling interbody spaces hemostatic sponge sutured to the parietal pleura restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia.

Resected rib-autograft is placed in preformed made from thoracotomies cut the box-pocket in the subcutaneous tissue. Commit resected rib - autograft to be tissues for subsequent use as an autograft, while the resected rib-autograft sutured to the period before completion of the final stage dorsal correction.

Then, after removal of the drainage from the pleural cavity and enhance the patient 2-3 days after completion of the first phase of surgery and before the second stage of surgical treatment, undergoing the process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head. Thus a head of a patient previously placed sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed to�nzami. Then altractive rods move in the threaded holes of the halo rings, down to the bones of the skull of the head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screwed into the cortical bone layer of the skull of the patient under the stress of 0.54 to 0.9 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the head of the patient. Moreover, two front halotestin rod is placed on the anterolateral surface of the skull to the right and to the left 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod is placed horizontally in pairs left and right on the back of the patient's skull in the parietal tubercles at 1 cm above the upper level of the ear of the patient. Then placed on the head of a halo-ring of the patient is suspended in a vertical position standing in the medical space frame on four wheels using the damper spring from a material with a predetermined elasticity to the telescopic rods of the frame and perform the specified session halo-traction for 240-480 minutes a day. During the execution session of halo-traction, the patient can be moved using a medical frame on four wheels in therapeutic space of the room. In the process of implementation of the process of vertical dry halo-traction patient use �ispolnenie of titanium or its alloys metal halo-ring and halo-traction rods.

After 12-17 days after the completion of phase one and phase dry vertical halo-traction, in the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements and the placement of autograft material on decorazione the posterior elements of the operated spine. This runtime dorsal correction of the spine resected rib-autograft is removed through a 2-3 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, cleaned of soft tissue and, after treatment in an antiseptic solution is placed on decorazione the posterior elements of the operated spine. In this portion of the resected rib - autograft in the final stage dorsal correction in the form of ground autocracy post on decorazione the posterior elements of the operated spine. In the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.

Among the essential features characterizing the proposed method of two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction,�socialnymi are:

- implementation in progress ventral release torakotomnogo access on top of the warp resezione seventh or eighth or ninth rib, which access, in the form of autograft length of 15-20 cm,

- placement, after performing a discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia, resected rib - autograft in preformed made from thoracotomies cut the box-pocket in the subcutaneous tissue,

- commit resected rib - autograft to be tissues for later use as an autograft, while the resected rib-autograft sutured to the period before completion of the final stage dorsal correction,

- implementation of the second stage of surgical treatment process vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for hanging the patient by the head,

- preliminary placement on the head �of Azienda sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends,

- move halotestin rods in the threaded holes of the halo ring and wrap the bones of the skull head, subjected to halo-traction of the patient after a triple treatment with antiseptic,

- screwing halotestin rods in the cortical bone layer of the skull of the patient under the stress of 0.54 to 0.9 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the patient's head,

- placement of the two front halotestin rods on the anterolateral surface of the skull to the right and to the left 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod is placed horizontally in pairs left and right on the back of the patient's skull in the parietal tubercles 1 cm above the upper level of the patient's ear,

- hanging by placed on the head halo ring patient using the damper spring from a material with a predetermined elasticity to telescopic rods wheelchairs and execution of the specified session halo-traction for 240-480 minutes a day,

- the ability to move the patient during the execution of a session of halo-traction in therapeutic space of the room.

- extracting runtime dorsal correction of the spine resected rib - autograft �through a 2-3 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, the cleansing soft tissues and, after treatment in an antiseptic solution, placement on decorazione the posterior elements of the operated spine,

- a portion of the resected rib - autograft in the final stage dorsal correction in the form of ground autocracy on decorazione the posterior elements of the operated spine,

the use in the process of implementing vertical dry halo-traction, the patient is made of titanium or its alloys metal halo-ring and halo-traction rods.

- use in the process of implementation of the final dorsal correction of the spine is made of titanium or its alloys metal fixing elements.

Experimental studies of the proposed method a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction showed its high efficiency. The proposed method is two-stage surgical treatment of spinal deformity using auto-preservation of the resected autorepo and dry vertical halo-traction when its use provides reliable protection of the dural SAC with its contents from trauma, provides a full posterior spondylodesis� with the restoration of the configuration of the spinal canal, provides reliable biointegration and the lack of antigenic properties, provides reliable fusion, ensures the achievement of strictly vertical halo-traction of the patient, provides continuous monitoring of a given degree of halo-traction, and also allows control of the x-ray images during the process of halo-traction. In addition, the proposed method provides early social rehabilitation of the patient with sufficient improvement of the quality of his life.

Implementation of the proposed method a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction is illustrated by the following clinical examples.

Example 1. Patient K., aged 18, arrived in 7 trauma and orthopaedic Department of the fgbi "PITOT them. N. N. Priorov", with a diagnosis of Kyphoscoliotic deformity of the thoracic spine III".

Performed preliminary x-ray study of the affected spine in 2 projections standing and lying, and have performed with the use of multilayer spiral computed tomography and magnetic resonance imaging the control of the rotation and the presence of anomalies of the vertebrae, as well as dysplasia of the spinal cord. Confirm to�awarded with the diagnosis: "Kifo-solutionsa deformity of the thoracic spine III".

The patient performed a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and performing the vertical halo-traction.

Under endotracheal anesthesia with the position of the patient on the side opposite to the apex of the curve, completed the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib. Performed resection of the eighth rib, which has implemented the access, in the form of autograft length of 20 cm and Then performed a discectomy and resection of vertebral end plates and filled interbody space hemostatic sponge, took the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia.

Made from thoracotomies slit shaped box-pocket in the subcutaneous tissue, where they located the resected rib-autograft. Performed the fixation of the resected rib - autograft to be tissues for subsequent use as an autograft, while the resected rib-autograft hem for a period before completion of the final stage dorsal correction.

Then, after removal of the drainage from the pleural cavity and and�tividale patient on day 2 after completing the first stage of surgery, undertook a process of halo-traction prior to the beginning of the second phase of surgery - dorsal correction of the spine.

Undertook a process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head. Thus a head of the patient pre-placed sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends. Then altractive rods moved in the threaded holes of the halo rings, led them to the bones of the skull of the head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screw in cortical bone layer of the skull of the patient under the force of 0.72 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the head of the patient. Moreover, two front halotestin rod placed on the anterolateral surface of the skull to the right and to the left 1 cm above and outwards from the upper edge of the orbit, and four rear g�atraktivnih rod placed horizontally in pairs left and right on the back of the skull of the patient in the parietal tubercles at 1 cm above the upper level of the ear of the patient. Then placed on the head of a halo-ring the patient hung using the damper spring from a material with a predetermined elasticity to telescopic rods chairs on wheels and perform the specified session halo-traction for 240 minutes per day. During the execution session of halo-traction, the patient moved freely in space medical facilities. In the process of implementation of the process of vertical dry halo-traction of the patient has used made of titanium or its alloys metal galatolo and altractive rods.

14 days after the completion of the first stage to the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements. This runtime dorsal correction of the spine resected rib-autograft extracted through a 2 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, cleaned from soft tissues and, after treatment in an antiseptic solution, placed on decorazione the posterior elements of the operated spine. In this portion of the resected rib - autograft in the final stage dorsal correction placed in the form of ground autocracy on decorazione the posterior elements of the operated pozvonocna�ka. In the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.

As a result of a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo ensures a reliable protection of the dural SAC with its contents from trauma received full posterior spinal fusion with restoration of the configuration of the spinal canal, provided with a reliable biointegrated, provided the absence of antigenic properties. In addition, provided early social rehabilitation of the patient with sufficient improvement of the quality of her life.

Example 2. Patient R., aged 22, was admitted in 7 trauma and orthopaedic Department of the fgbi "cyto them. N. N. Priorov", with a diagnosis of CIPO-solutionsa deformity of the thoracic spine III".

Performed preliminary x-ray study of the affected spine in 2 projections standing and lying, and have performed with the use of multilayer spiral computed tomography and magnetic resonance imaging the control of the rotation and the presence of anomalies of the vertebrae, as well as dysplasia of the spinal cord. Confirmed the diagnosis of Dysplastic breast scales III".

The patient fulfilled got�apnea surgical treatment of spinal deformity using autoconstrain the resected autorepo and performing the vertical halo-traction.

Under endotracheal anesthesia with the patient on the side opposite to the apex of the curve, completed the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib. Performed resection of the seventh rib, which has implemented the access, in the form of autograft length of 18 cm and Then performed a discectomy and resection of vertebral end plates and filled interbody space hemostatic sponge, took the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia.

Made from thoracotomies slit shaped box-pocket in the subcutaneous tissue, where they located the resected rib-autograft. Performed the fixation of the resected rib - autograft to be tissues for subsequent use as an autograft, while the resected rib-autograft hem for a period before completion of the final stage dorsal correction.

Then, after removal of the drainage from the pleural cavity and enhance the patient on day 3 after the completion of the first stage of surgery, undertook a process of halo-traction prior to the beginning of the second phase of surgery - dorsal� correction of the spine.

Undertook a process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head. Thus a head of a patient pre-placed sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends. Then altractive rods moved in the threaded holes of the halo rings, led him to the bones of the skull head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screw in cortical bone layer of the skull of the patient under the force of 0.9 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the head of the patient. Moreover, two front halotestin rod placed on the anterolateral surface of the patient's skull to the right and to the left 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod placed horizontally in pairs left and right on the back of the patient's skull in the parietal tubercles at 1 cm above the upper level of the ear of the patient. Then placed on �tin halo-ring of the patient hung using the damper spring from a material with a predetermined elasticity to telescopic rods chairs on wheels and perform the specified session halo-traction for 300 minutes per day. During the execution session of halo-traction, the patient is moved freely in the space of therapeutic areas. In the process of implementing vertical dry halo-traction of the patient has used made of titanium or its alloys metal halo-ring and altractive rods.

12 days after the completion of the first stage to the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements. This runtime dorsal correction of the spine resected rib-autograft learned through a 3 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, cleaned from soft tissues and, after treatment in an antiseptic solution, placed on decorazione the posterior elements of the operated spine. In this portion of the resected rib - autograft in the final stage dorsal correction placed in the form of ground autocracy on decorazione the posterior elements of the operated spine. In the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.

As a result of a two-stage surgical treatment of spinal deformity with and�use of autoconstrain the resected autorepo ensures a reliable protection of the dural SAC with its contents from trauma, received full posterior spinal fusion with restoration of the configuration of the spinal canal, provided with a reliable biointegration and the lack of antigenic properties. In addition, provided early social rehabilitation of the patient with sufficient improvement of the quality of his life.

Example 3. Patient K., 23 years old, admitted to 7 the Department of pathology of the spine of the fgbi "PITOT them. N. N. Priorov", with a diagnosis of right-sided thoracic scoliosis".

Performed preliminary x-ray study of the affected spine in 2 projections standing and lying, and have performed with the use of multilayer spiral computed tomography and magnetic resonance imaging the control of the rotation and the presence of anomalies of the vertebrae, as well as dysplasia of the spinal cord. Confirmed the diagnosis of Dysplastic breast scales 4 degree."

The patient performed a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and performing the vertical halo-traction.

Under endotracheal anesthesia with the position of the patient on the side opposite to the apex of the curve, completed the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib. Performed resection of the virgins�in the ribs, which has implemented the access, in the form of autograft length of 15 cm and Then performed a discectomy and resection of vertebral end plates and filled interbody space hemostatic sponge, took the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia.

Made from thoracotomies slit shaped box-pocket in the subcutaneous tissue, where they located the resected rib-autograft. Performed the fixation of the resected rib - autograft to be tissues for subsequent use as an autograft, while the resected rib-autograft hem for a period before completion of the final stage dorsal correction.

Then, after removal of the drainage from the pleural cavity and enhance the patient on day 2 after completing the first stage of surgery, undertook a process of halo-traction prior to the beginning of the second phase of surgery - dorsal correction of the spine.

Undertook a process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head. Thus on g�ing the patient's pre-placed sterile halo ring is made in his body perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends. Then altractive rods moved in the threaded holes of the halo rings, led them to the bones of the skull of the head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screw in cortical bone layer of the skull of the patient under the stress of 0.54 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the head of the patient. Moreover, two front halotestin rod placed on the anterolateral surface of the skull to the right and to the left 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod placed horizontally in pairs left and right on the back of the skull of the patient in the parietal tubercles at 1 cm above the upper level of the ear of the patient. Then placed on the head of a halo-ring the patient hung using the damper spring from a material with a predetermined elasticity to telescopic rods chairs on wheels and perform the specified session halo-traction for 480 minutes per day. During the execution session of halo-traction, the patient moved freely in space medical facilities. In the process of implementation of the process of vertical dry halo-traction of the patient has used made of titanium or its alloys metallic� galatolo and altractive rods.

17 days after completion of the first stage to the second stage of surgical treatment performed dorsal correction of the spine using metal fixing elements. This runtime dorsal correction of the spine resected rib-autograft extracted through a 2 cm incision on postoperative thoracotomy scar from from bed-pocket in the subcutaneous tissue, cleaned from soft tissues and, after treatment in an antiseptic solution, placed on decorazione the posterior elements of the operated spine. In this portion of the resected rib - autograft in the final stage dorsal correction placed in the form of ground autocracy on decorazione the posterior elements of the operated spine. In the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.

As a result of a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo ensures a reliable protection of the dural SAC with its contents from trauma received full posterior spinal fusion with restoration of the configuration of the spinal canal, provided with a reliable biointegrated, provided itsoutstanding properties. In addition, provided early social rehabilitation of the patient with sufficient improvement of the quality of her life.

1. Method a two-stage surgical treatment of spinal deformity using autoconstrain the resected autorepo and dry vertical halo-traction, including when the patient on the side opposite the apex of deformity of the spine, the first stage of surgical intervention - ventral release on the apex of deformity torakotomnogo access subperiosteal separation of the rib and resection of part of it by placing it in an antiseptic solution for subsequent use as an autograft, conducting discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia, then after the drains are removed from the pleural cavity and enhance the patient 2-3 days after completion of the first stage of surgical intervention implementation process of the halo-traction prior to the beginning of the second phase of surgery - dorsal correction of the spine, then through 12-17 days after the completion of the first stage to the second stage of surgical treatment performed� dorsal correction of the spine using metal fixing elements and the placement of autograft material on decorazione the posterior elements of the operated spine, characterized in that in the process of implementation of ventral release torakotomnogo access on the apex of deformity resected seventh, or eighth, or ninth rib, which access, in the form of autograft length of 15-20 cm, then after performing a discectomy and resection of the endplates with subsequent filling interbody spaces hemostatic sponge, suturing the parietal pleura with restoring the integrity of the pleural cavity and layer-by-layer suturing the dissected muscles and fascia are placed resected rib-autograft in preformed made from thoracotomies cut the box-pocket in the subcutaneous tissue until the locking to be tissues for later use as an autograft, thus resected rib-autograft sutured to the period before completion of the final stage dorsal correction, then before the second stage of surgical treatment are in the process of vertical dry halo-traction of the patient under the weight of his own body when it is standing in the medical space frame on four wheels, equipped with telescopic rods for suspending the patient's head, while the patient's head previously placed sterile halo ring is made in ehotel perpendicular to the axis of the threaded holes defined therein with a threaded connection metal screws - altractive rods with pointed ends, then altractive rods move in the holes of the halo rings, down to the bones of the skull of the head, subjected to halo-traction of the patient after a triple treatment with antiseptic, and screwed into the cortical bone layer of the skull of the patient under the stress of 0.54 to 0.9 N/m to the level of the internal cortical bone to provide reliable and stable fixation of a halo-ring on the patient's head, and two front halotestin rod is placed on the anterolateral surface of the skull 1 cm above and outwards from the upper edge of the orbit, and four rear halotestin rod is placed horizontally in pairs left and right on the back of the patient's skull in the parietal tubercles 1 cm above the upper level of the patient's ear, then placed on the head of a halo-ring hung patient using the damper spring from a material with a predetermined elasticity to telescopic rods medical frame on wheels and perform the specified session vertical halo-traction for 240-480 min a day, during which the patient can move through space, medical facilities, then runtime dorsal correction of the spine resected rib-autograft is removed through a 2-3 cm incision on postoperative thoracotomy scar from from bed-pockets in in�skin tissue, cleaned of soft tissue and after treatment in an antiseptic solution is placed on decorazione the posterior elements of the operated spine.

2. A method according to claim 1, characterized in that the portion of the resected rib - autograft in the final stage dorsal correction is placed in the form of ground autocracy on decorazione the posterior elements of the operated spine.

3. A method according to claim 1, characterized in that in the process of implementing vertical dry halo-traction patient use is made of titanium or its alloys metal galatolo and altractive rods.

4. A method according to claim 1, characterized in that in the process of implementation of the final dorsal correction of the spine using titanium or its alloys metal fixing elements.



 

Same patents:

FIELD: medicine.

SUBSTANCE: slightly arciform incision is created along the anterior edge of the deltoid. The coracoids with attached muscles is exposed. The rotator cuff is incised along the intertubercular groove. A tendon of the caput longum of the biceps brachii is separated. The tendon of the caput longum of the biceps brachii is displaced inwards, and two ligatures are delivered under it. Sponge forceps are used to create a passage behind the subcapular muscle with two ligatures delivered through it, and tensioned to the coracoids. The wound is sutured in layers and covered with a retentive bandage for 4-5 weeks.

EFFECT: method enables reducing surgical injuries with using the reliable reinforcement of the anterior rotator cuff taking into account biomechanical features of the proximal shoulder.

2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to traumatology and orthopaedics. A set of instruments for the protection of the popliteal artery in the operation of arthroscopic reconstruction of the posterior cruciate ligament includes a guide-pin, which is sharpened from both ends, with a sharpening from one end being trihedral; the device for the protection of the popliteal artery, consisting of a working part and a handle, rigidly fixed at the right angle to each other, with the working part representing a cylindrical rod, which at the free end has a flattened section with through holes, located at an equal distance from each other, at an angle to the longitudinal axis of the working part, the flattened section of the working part is smoothly curved at an obtuse angle; a limiter on a cannulated drill, representing hollow cylinders of the different height with an internal diameter, corresponding to the drill diameter. A step-by-step formation of the tibial bone tunnel is realised. The operated extremity is bent in the knee joint at the right angle. Beginning of the tibial tunnel is determined more laterally and lower than the tibial tuberosity and formed at an angle of not less than 55° to the articulate surface of the tibia. The guide-pin is passed with the sharp trihedral sharpening forward, then removed and introduced with the other end forward. After that, the device for the protection of the popliteal artery is introduced through the posterior-medial access, and the guide-pin is wedged in the closest to it hole of the flattened section of its working part. Limiters are successively put on the drill, with the number of limiters being selected in such a way that the part of the drill, free from the limiters, corresponds to the tibial tunnel length. The cannulated drill is passed along the guide-pin, fixed in the device for the protection of the popliteal artery, and the tibial tunnel is formed.

EFFECT: group of inventions makes it possible to reduce a risk of injuring the popliteal artery, reduce a risk of purulent-inflammatory complications.

2 cl, 1 ex, 10 dwg

FIELD: medicine.

SUBSTANCE: osteotomy is performed with exposing the distal ulnar metaphysis by a long linear incision 3.0-4.5 cm along the ulnar surface. Distal ulnar osteotomy and intraoperative single-step redressment are performed through the approach created at 3.0 cm above the ulnar styloid at an angle of 45°. The radiocarpal joint is fixed with an orthosis for 2-2.5 weeks.

EFFECT: method enables reducing the number of intraoperative injuries, gaining in the radiocarpal motions as much as possible, avoiding metal structures to be applied, and reducing the immobilisation length.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: musculocutaneous vascularised and innervated island flap comprising the active greater teres muscle, a descending branch of the circumflex scapular artery, and the subscapular nerve is separated. The above flap is moved towards the elbow joint, with its muscular portion placed between the caput mediale and caput longum of the triceps muscle of the arm and anchored to a transition point of the tendon portion of the triceps muscle into the muscular one. The greater teres muscle is preserved attached to the humerus. As it may be required to bring the above flap down, it is possible to dissect away its attachment point of the greater teres muscle from the humerus. A tendon auto- or allograft is used to anchor the flap to the transition point of the tendon portion of the triceps muscle into the muscular one if the muscular portion does not appear to be long enough.

EFFECT: eliminating flexion contracture in the elbow joint and recovering the active flexion of the forearm in the motor unit deficiency.

4 cl, 7 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for realisation of periacetabular triple osteotomy of pelvis in teenagers. Access to ischial and pubic bone is realised in projection of adductor muscles - longitudinal adductor access, in position of bending and abduction in hip joint. Tenomyotomy of adductor muscles is performed. In intermuscular space in blunt way performed is access to femur trochantin, where tendon part of iliolumbar muscle is exposed and its tenotomy is carried out. Branch of ischial bone, covered from outside with external obturator muscle, is identified under acetabulum. External obturator muscle is perforated. Ischial bone is bypassed with raspatories from inside and outside and oblique osteotomy is performed in front-to-back direction. Osteotomy of upper branch of pubic bone is performed. Osteotomy of ilium is performed from front access.

EFFECT: method makes it possible to reduce access trauma, provide realisation of surgery under conditions of hip head compression or its high position in case of dislocation.

8 dwg

FIELD: medicine.

SUBSTANCE: tendons of flexors and extensors of additional and basic rays are cut at the level of medium third of metatarsal bone and medium third of second instep bone respectively. Underdeveloped metatarsal bone of additional ray and underdeveloped first finger of base ray are removed. Anatomically correctly developed finger of additional ray is transferred on anatomically correctly developed metatarsal bone of basic ray. Flexor and extensor tendons of formed first ray are sutured at the level of medium third of formed ray. Fixation of transferred fragments is realised due to K-wires and gypsum bandage in medium position of foot to knee joint.

EFFECT: method ensures normal growth of first ray and support ability of foot.

9 dwg

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the treatment of purulent arthritis. Arthrotomy is carried out. Necrotised tissues, injured elements of the joint are ablated. Primarily a spacer from bone cement with an antibiotic is installed. The wound is sutured layer-by-layer. Drainage is carried out in portions, with the periodical closure of draining tubes in such a way, that drainage is realised for 5-10 min each hour on the first 2-3 days after operation. The spacer is replaced for the joint endoprosthesis after cupping the infectious process.

EFFECT: method makes it possible to reduce a risk of endoprophesies septic instability.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely orthopaedics, and aims at treating a long-term rotator cuff injury. An incision 5-8 cm long is made from an inferior edge of a clavicle along an anterior surface of a shoulder along sulcus deltoideus (Ollier type) to access a rotator cuff. In an inner rotation position, the rotator cuff is sutured two or three times successively with the stitches transversely directed under each other to form a duplex rotator cuff segment.

EFFECT: invention enables reducing tissue injuries potentially accompanying a surgical intervention and the lengths of treatment and rehabilitation.

1 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: point skin incision is made in a projection of a base of the 5th metacarpal bone, and a pin is inserted into a canal of the 5th metacarpal bone to reach a fracture level. That is followed by closed reduction of the fracture, and the pin is inserted transarticularly up to the level of a lower one-third of a proximal phalanx of a little finger.

EFFECT: more effective treatment ensured by the stable fixation of comminuted, spiral fractures and eliminating purulent-septic complications.

1 ex, 3 dwg

FIELD: medicine.

SUBSTANCE: formed concave spherical cutters are used to process end faces of bone fragments of the forearm to enlarge a contact area to a graft. An open reduction of the fragments involves measuring an existing defect in between. The graft of the required dimensions is created; the end faces of the graft are processed with convex spherical cutters of the similar radius. After the open reduction is completed and the graft is embedded between the fragments, the optimum contact area of the bone and graft is aimed. External or internal fixation is carried out to create compression between the fragments and graft and to ensure an extra stability of the maximum contact by shaping the end faces of the graft and fragments spherical.

EFFECT: method enables increasing fixation stability, providing the early functional load, and recovering the adjoining joint function.

4 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.

EFFECT: higher efficiency of therapy.

5 dwg, 1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.

EFFECT: increased accuracy of reposition, improved conditions for fusion.

3 dwg

FIELD: medicine.

SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.

EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.

2 dwg

FIELD: medicine.

SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.

EFFECT: complete repair of mobility in articulation.

1 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.

EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.

3 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.

EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.

47 cl, 11 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.

EFFECT: higher efficiency of fixation, decreased traumaticity.

3 cl, 2 dwg, 1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should form a transplant out of femoral biceps' tendon, form an oblique-cross-sectional transfemoral canal in isometric area upon external femoral condyle, right to the front against insertion fibular collateral ligament, apply proximal end of crossed femoral biceps' tendon through this canal, fix the end of crossed femoral biceps' tendon upon internal femoral condyle. The method enables to prevent tendinous rupture at the site of its new fixation and avoid the loss of articular bending function.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

Up!