Method of restoration of integrity of the rear spinal complex in the case of acute resectional laminectomy
SUBSTANCE: invention refers to medicine, particularly to spinal surgery. They perform distraction and reclamation in injured vertebral-motor segments with the help of a transpedicular design established above and below the resected area. They apply a thin layer of Bio Glue two-component adhesive to the bare part of the dura mater. Titanium mesh, modeled according to the shape of the spinal canal, is placed on the bone defect, it is placed under the heads of the pedicle screws with grooves formed on the share sides.
EFFECT: method stabilizes the spine and prevents adhesion in the epidural space.
1 cl, 1 ex
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.
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: pre-operative fasting venous blood 1 ml is sampled at room temperature 20-24°C into an anticoagulant-free vacuum system (test tube). The test tubes are delivered in a sealed container at temperature 2-8°C for 2 hours to a laboratory for immunoenzyme assay and analysed to determine anti-thyroid stimulating hormone receptor antibodies. If the antibody level is 1.5 units/l or more, a thyroidectomy is performed, whereas the antibody level of less than 1.5 units/l requires performing a subtotal thyroid resection according to standard techniques.
EFFECT: invention enables reducing a probability of recurrent thyrotoxicosis in the patients after subtotal thyroid resection.
SUBSTANCE: group of inventions relates to medicine. A laparoscopic surgical device contains a detachable instrument. The instrument contains an external rod and an internal drive plunger, which can be connected to each other in a detachable or a non-detachable way. The handle of the device contains a two-button mechanism for the engagement and release of a detachable, tool-containing rod. The two-button mechanism is made with a possibility of engagement with matching holes of the external rod and the internal plunger, which extends through the external rod.
EFFECT: handle contains a convenient in operation locking device, which provides the reliable fixation and convenient detachment of the tool end unit.
20 cl, 5 dwg
SUBSTANCE: left total nephrectomy is performed. A kidney is approached by forming an oval window into a mesocolon of a descending colon. The window area is limited by: v. mesenterica inf, arcus Riolani, a. colicae sin and a tail of pancreas. A ligament of Treitz, a peritoneum and mesocolon tissues are incised. A free oval area of the mesocolon and peritoneum are left on the kidney. The kidney is evacuated through the mesocolon window. The mesocolon is left open. A strand of a greater omentum is placed into a retroperitoneal cavity formed after the kidney has been removed. In specific case, the kidney is mobilised together with an adrenal gland.
EFFECT: method enables optimising the surgical procedure by eliminating the stage of intestinal mobilisation, leads to the fastest postoperative intestinal functional recovery.
3 cl, 2 ex
SUBSTANCE: peritoneum and mesocolon tissues of a descending colon are incised above an involved region and above a vascular renal pedicle to perform a left partial nephrectomy. Through the local mesocolon incision above the vessels, a renal artery is filopressed and compressed for thermal ischemia. A new growth is incised and evacuated through the mesocolon incision made above the involved region of the kidney.
EFFECT: method provides the ergonomic approach through a minimum thickness of the mesocolon tissues, minimises the risk of intestinal and splenic injuries and development of complications, ensures the fast postoperative intestinal functional recovery.
2 cl, 2 ex
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.
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: 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