Method of prosthetics of intervertebral disc nucleus pulposus
SUBSTANCE: ablation of nucleus pulposus and sequestrectomy are carried out; implant is introduced into enucleated disc. As implant applied is nitinol thread, folded in form of spherical ball, diameter of which is 4-6 mm larger than height of disc cavity. Preliminarily cooled implant is pressed, and after its placement into disc, work spherical shape is given by heating to 40-45°C.
EFFECT: method makes it possible to reduce complications, which is reached due to elasticity of nitinol, providing protection of over- and underlying vertebrae from increased load from implant, with nitinol shape-memory effect ensuring support of given shape of intervertebral disc.
The invention relates to medicine, namely to neurosurgery, and can be used for prosthetics of nucleus pulposus of intervertebral disc degenerative-dystrophic diseases of the spine in all its departments.
The known method of prosthetics of nucleus pulposus of intervertebral disk hydrogel predetermined shape Hydraflex (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 52, 407-410). The disadvantage of this method: when the hydration of the implant, after prolonged pressure maintaining range of motion and height of the vertebral-motor segment is provided in part (Zelenkov V. P. Functional reconstruction of the intervertebral disc in the surgical treatment of discogenic lumbodynia. Abstract. Moscow - 2010 page 13).
The known method of prosthetics of nucleus pulposus of intervertebral disk injectable silicone with fixings PNR (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 57, 435-441). From transsacral access perform a partial discectomy, and then make the installation of clamps, and then using a special needle with silicone fill located in denuclearising of the disc implant. The disadvantages of this method: it is applicable for the prosthesis at the level of LV-SI, LIV-LV; requires the use of specially designed tool�Riya.
A method of intervertebral disc prosthesis with metal of Nickel-titanium in the form of a spiral (shelyakin S. Y. Percutaneous discectomy in the complex treatment of patients with discogenic lumbosacral radiculitis. Dissertation. St. Petersburg, 1996, p. 62). Through the working cannula located in the space in the cavity formed after partial removal of nucleus pulposus, enter snap ring from titanium nickelide. The disadvantage of the method: the use of only the lumbar spine.
The closest to the claimed is a method of prosthetics of nucleus pulposus of the intervertebral disc (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 59, 452-461), adopted as a prototype. To of nucleus pulposus prosthesis use sphere of cobalt, chromium, molybdenum or PEEK (polyetheretherketone). Posterior perform hemilaminectomy, flavoconia, after mobilizatsii dural SAC and root produce dissection longitudinal ligament and the annulus fibrosus, make a removal of nucleus pulposus. The increase in the interbody space or provide a temporary distractor, or giving the patient a kyphotic position. Next, a set of known fields carry selection of the desired diameter sphere. Using cure�TCI predetermined diameter to produce the final preparation denuclearising part of the disk, in this space is placed a spherical implant.
The disadvantages of the prototype: the scope is limited to the levels LIII-SI; application of the method is contraindicated in osteoporosis and chronic administration of steroids because of the risk of fracture of the vertebral end plate; trauma due to additional intraoperative distraction level for the vertebral-motor segment.
The invention is directed to a method of prosthetics of nucleus pulposus of intervertebral disk, allowing the prosthesis in any of the vertebrae, even in the face osteoporotics modified vertebrae, to reduce intraoperative trauma.
Said technical result of the invention is achieved in that in the known method of prosthetics of nucleus pulposus of intervertebral disk, comprising the removal of nucleus pulposus, sequestrectomy and introduction to denuclearising disc implant, the peculiarity lies in the fact that fix the implant from nitinol strands, folded in the form of a spherical ball whose diameter 4-6 mm greater than the height of the disc cavity, the implant is pre-cooled compress, and after installation give working a spherical shape by heating to 40-45°C.
The method is as follows. Access damage�nomu spinal motion segment at a predetermined level. Produce dicotomia, removal of nucleus pulposus of intervertebral disk, sequestrectomy. In Limbe endplates above and underlying vertebrae in the projection of the remote pulpous nucleus, under the control TUBE, a curette prepare dome-shaped grooves to prevent migration of the installed implant. Measure the height of the cavity formed after removal of nucleus pulposus. To of nucleus pulposus prosthesis using the implant from nitinol filament having a diameter of 0.3-0.4 mm, folded in the form of a spherical ball. The spherical diameter of the implant is selected according to the height of the cavity, increasing by 4-6 mm. It is necessary to continue to provide such a height of the intervertebral disc, in which the bony part of the vertebral bodies will not touch that prevents the formation of a bone block in a given spinal motion segment. Spherical implant is cooled in sterile saline solution with a temperature of +5°...0°C, after which deform (compress) with the clamps so as to reduce the diameter to fit the defect in the fibrous ring, and place it in denuclearising disk. After that, spherical implant, installed between the vertebral bodies, water heated to +40°...+45°C saline solution, under the action of which he restore�infuses working spherical shape. The layers are sutured the wound. Over time around the implant is formed of connective tissue scar ("false joint") that provides sufficient mobility in a given spinal motion segment.
The claimed method was developed and clinically tested in the Polenov research neurosurgical Institute them. Prof. A. L. Polenov on the basis of City hospital №3 in the treatment of 3 patients with degenerative disease of the spine.
Here is an example, an extract from the medical history.
Patient S., 45 years, IB No. 19335. Diagnosis: Dorsopathy. Common degenerative disc disease of the cervical spine. Acquired stenosis of the spinal canal at the level of the cervical spine. Hernia MTD CV-CVI; CVI-CVII with compression of the anterior chamber and the spinal cord and nerve roots C5, C6, C7 from both parties at these levels, compression-ischemic cervical myeloradiculopathy.
Surgery performed: Anterior decompression of the spinal cord at the level of PDS CV-CVI: CVI-CVII. Remove disks CV-CVI and CVI-CVII and marginal bone growths at these levels. Installation of spherical implant nitinol filament instead of the remote disk, CV-CVI and CVI-CVII. The height of the cavity after removal of nucleus pulposus was 8-9 mm, were set spherical implants with a diameter of 12 mm. In the postoperative period, there was regression of pain and radicular syndromes.
The use of the claimed �of p allows the prosthetic nucleus pulpous of the intervertebral disc in all parts of the spine, does not require additional intraoperative distraction that is less traumatic surgery. The superelasticity of the nitinol causes protection upstream and downstream of the vertebrae from the increased load on the vertebral end plate from the side of the implant, which is particularly important in the context of osteoporotics modified bone, and the shape memory effect maintains the predetermined height of the intervertebral disc.
The method of prosthetics of nucleus pulposus of intervertebral disk, comprising the removal of nucleus pulposus, sequestrectomy and introduction to denuclearising disc implant, characterized in that set the implant from nitinol strands, folded in the form of a spherical ball whose diameter 4-6 mm greater than the height of the disc cavity, the implant is pre-cooled compress, and after installation give working a spherical shape by heating to 40-45°C.
SUBSTANCE: biocompatible implant (BI) made of magnetic material in a biocompatible matrix (BM) is placed loosely along a posterior surface of an injured spinal cord of an experimental animal (EA) The EA is immersed periodically into a constant magnetic field. Its magnetic vector is aligned with a craniocaudal direction of spinal tracts. The BM of the BI is animal or herbal gelatine, wherein ferromagnetic magnetite or ferromagnetic ferrite nanoparticles 18-42 wt % with a particle size of 2.0-38 nm and at a magnetic field intensity (N) of 5-10 mT are immobilised as a magnetic material of the BI. The magnetic exposure covering the traumatic spinal injuries involves the combined effect of the magnetic field of the BI and the external rotating magnetic field at a magnetic induction of 0.15-0.35 T. The external magnetic exposure frequency is 1 or 2 times a day; the length is from 2 to 8 minutes per one session; the number of sessions is from 2 to 4. Animal gelatine in the BM of the BI can represent agar-agar, whereas herbal gelatine is pectin. The BM of the BI can additionally contain polyamines contributing to cell growth and proliferation, e.g. spermine or spemidine, in an amount of 1-5 wt %.
EFFECT: method enables recovering the spinal cord function sufficiently completely in the distal direction from the injury region, providing the favourable conditions for the adequate neuroglial growth with recipient's long neuron penetration from the intact proximal portion of the spinal cord into the distal one to ensure its conductive function, reducing the cicatrisation within the spinal injury, and eliminating the cerebral tissue oedema.
3 cl, 8 ex
SUBSTANCE: device for inguinal hernia repair in the form of synthetic mesh prosthesis with formed branches has a removable frame attached thereto to make it flat. The frame shape and size after having been attached to the synthetic mesh prosthesis enable leaving edges of the latter free to keep a width required to fix the synthetic mesh prosthesis to the body organs, including along the section line forming the branches. The removable frame of the synthetic mesh prosthesis pores of which are elastically extensible and contractible; it is trident-shaped and made of a metal wire of specific thickness depending on pore size of the synthetic mesh prosthesis; the removable frame is fixed to the synthetic mesh prosthesis with delivering the dent ends more than once through the synthetic mesh prosthesis in parallel with long edges of the latter toward its branches. Each frame dent has a rounded thickening at the end.
EFFECT: device simplifies the fixation procedure in tissues of the synthetic mesh prosthesis when repairing the inguinal hernia.
2 cl, 2 dwg
SUBSTANCE: titanium implant surface is thermally treated with an argon-plasma jet with arc current 150-250 A, length 2.5-3.0 min at a treatment distance of 80-120 mm followed by thermally activated surface blasting with a bioceramic powder having particle size 150-500 mcm at jet pressure 0.6-0.7 MPa for 10-15 sec.
EFFECT: method is technologically simple, enables modifying the titanium implant surface with bioceramic particles and provides creating the high-effective osteointegration surface structure of implants.
2 cl, 2 ex
SUBSTANCE: method consists in oxidising an implant in overheated water vapour mixed with silver nanoparticles at temperature 500-550°C, mixture feed pressure 1.2-1.3 atm for 1.5-2.0 h preceded by de-aerating a work volume of a furnace by delivering overheated vapour at pressure 3-4 atm. The oxidised implants are cooled down in the furnace first in the pure vapour medium to temperature 250-300°C, and then in the air to temperature 20-30°C.
EFFECT: method is technologically simple and enables producing the biocompatible oxide coating with the bactericidal properties on the metal implants for external transosseous osteosynthesis.
2 cl, 2 ex
SUBSTANCE: invention refers to medicine, namely to surgical devices and aims at increasing the reliability of inguinal hernioplasty. The device comprises of two rectangular portions of the same length and different width, one of which, a wider one, made of a non-absorbable material, is used to reinforce the posterior wall of the inguinal canal, while the other one, more narrow, having a width of 1 cm is used to form an inferior wall of the inguinal canal. The portion of the device, which is used to form the inferior portion of the anterior wall of the inguinal canal is made of an absorbable material or presented with an ultra-light-weight non-absorbable mesh containing 10-25 mg/m2 of polypropylene. Each of the portions of the device is connected to the other one by one of its longer edges or along a line parallel to its longer edges so that the portions of the device project over the shorter edges of each other.
EFFECT: invention provides reducing the contact area of the spermatic cord with a foreign material.
5 cl, 4 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to medicine, more specifically to an implanted device comprising a biologically compatible, biologically degradable polymer mixed with TMC278 (rilpivirine) and with one or more release-enhancing agents specified in a group consisting of poloxamers, polysorbates and a combination of dimethylsulphoxide (DMSO) and poly(vinylpyrrolidone) (PVP).
EFFECT: device provides the extended release of the active ingredient for long periods of time.
17 cl, 3 dwg, 5 tbl, 7 ex
SUBSTANCE: invention relates to medicine. Surgical implant for treatment of incontinence contains biocompatible mesh and centering device. Biocompatible mesh has first and second ends. Mesh length is greater than its width. Centering device includes solid button element, which has opposite first and second surfaces, has size and shape, corresponding to user's finger or thumb, to make it possible for user to grip said button element, and passing between them peripheral external edge. Centering device additionally includes thread-like element, which has first and second ends, immovably fixed on said peripheral edge of button element in such a way that loop is formed between them. Thread-like element of centering device is woven into mesh in the area of its longitudinal centre and in direction, perpendicular to mesh length.
EFFECT: invention provides possibility of correct placement or tightening mesh inside patient's body, applying only tactile control.
10 cl, 5 dwg
SUBSTANCE: bioactive porous 3D-matrix for tissue engineering involves a resorbed partially crystalline polymer having a porosity of 60-80% and a pore size of 2 to 100 mcm. A biopolymer gel having a particle size of 30-100 mcm is incorporated into a portion of the pores. A polymer/gel ratio makes 99:1 to 50:50 wt %. The matrix is prepared by grinding a mixture of gel and polymer powder having an average particle size of 100 mcm, and the prepared mixture fills prepared moulds to be placed in a high-pressure chamber wherein the temperature is increased to 25-40°C first, and then the CO2 pressure is increased to 4.0-25.0 MPa. The system is kept in the above environment for 1 hour, and then the chamber pressure is discharged to an atmospheric one for 30-120 minutes; thereafter the temperature is decreased to a room value, and the patterns are removed.
EFFECT: ensuring flexibility of using the matrix in various organs and systems, no toxicity, higher ability to tissue regeneration stimulation, prolonged effect of biostimulation.
6 cl, 5 ex, 1 tbl, 4 dwg
SUBSTANCE: method for making implants involves multilayer plasma spraying of biologically active coating onto metallic substrate of implants; titanium is sprayed remotely as first and second layers; the third layer represents a mechanical mixture of titanium powder and hydroxyapatite, while the fourth layer is formed of hydroxyapatite. The implants with the multilayer biologically active coating is placed in a container with silver nitrate solution with the concentration of 0.04% AgNO3 placed in an auxiliary water tank, and the sprayed multilayer biologically active coating is exposed to ultrasound for 35 seconds at ultrasound intensity 9.6 W/cm2 and frequency 22 kHz.
EFFECT: invention enables making implants having the coating promoting fast and reliable osteointegration of the implant with biological tissues, and possessing bactericidal effect.
2 cl, 2 dwg, 1 tbl
SUBSTANCE: described is a matrix of a biocompatible non-absorbable spatially linked polymer, obtained by exposure to UV light of a photopolymerised composition, which contains oligomers of a methacryl line, is made in the form of an elastic transparent for light two-layered film, a continuous layer of which is smooth, and the other layer, in the form of a relief pattern, is made with the height, equal to half of the matrix thickness, with forming a ring-shaped element, which does not have any common side with adjacent elements.
EFFECT: matrix possesses an adsorbing ability, contributes to regeneration of tissues, isolates an operation wound from the oral cavity side, has elasticity and shape-stability in case of long exposition on the wound surface with a possibility of visual control of the wound state and a possibility of removal from the post-operation area without destruction of regenerated tissues.
2 cl, 4 dwg, 1 tbl, 5 ex
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
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
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
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
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
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.
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.
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.
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
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, 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