Treatment of spondylolisthesis
(57) Abstract:The invention relates to medicine, specifically to orthopedics. Approved for treatment of spondylolisthesis. The purpose of the invention: atraumatic lumbar displaced vertebra with restoration of function and elimination of neurological disorders. The invention consists in the fact that carry out longitudinal distraction of the spine and traction of a displaced vertebra in the back with threaded rods and elastic loops attached to the external fixation device (AVF). The second step after the reduction of the vertebra and removal of neurological disorders simultaneously with the removal of AVP carry back corporates vertebrae. The invention relates to medicine, namely to orthopedics, and is intended for the treatment of spondylolisthesis.There is a method of treatment of spondylolisthesis by performing a decompressive laminectomy. However, this surgery has a significant drawback, since an unstable form of spondylolisthesis significantly affects the clinical course of the disease. This has forced surgeons to Supplement the operation posterior spinal fusion. These surgical interventions exacerbate netlet reduction of a displaced vertebra.Closest to the offer is accepted by us as a prototype method setting in spondylolisthesis, based on the principle of direct pressure on the front body of a displaced vertebra. However, surgical intervention is required allocation anterior or anterior-lateral surface of the body is shifted and located below the vertebrae, resection of the intervertebral disc with closing plates, which is of great technical difficulties for the surgeon and lead to severe complications for the patient due to the closely located to major vessels and nerve plexus.The essence of the invention is expressed in a set of key characteristics, sufficient to achieve provided by the invention the technical result consists in that the dorsal side through the base of the handles in body shifted, up - and underlying vertebrae enter threaded rods, around the lateral parts of the bows hold loops of elastic tissue, the Foundation of the threaded rods and the ends of the hinge is fixed on the elements of external fixation device, then produce a measured distraction of the spine along its axis and traction of a displaced vertebra posterior to, and after that eliminate the des vertebrae.The method is based on the fact that when using the proposed external fixation device is created dosed stretching rods (distraction) along the longitudinal axis between the displacement and the underlying vertebra and at the same time in the sagittal plane of the traction rod and loops (traction) of a displaced vertebra posterior. Thus, use "Effect Ilizarov", i.e. when creating measured the tensile stresses occur conditions for purposeful managed recovery and morphogenetic processes in the area of injury.The physiological way, because when dosed stretching restores metabolic and vascular processes, the conditions for reparative regeneration.When applying our external fixation device dosed extension of the spine as along the longitudinal axis, and in the sagittal direction is carried out over a sufficiently large bone structure (the roots of the arcs with the bodies of the vertebrae and the lateral surface of the bows), which eliminates the possibility of separation of the spinous processes, the pulling out rods with traction backwards, as when using other external fixation devices that do not contain loops.The proposed method osushestvljali over the spinous processes in the field of a displaced vertebra and skeletonize the rear sections of the vertebrae on both sides until the Foundation of the roots of the bows. In body shifted, up - and underlying vertebrae through the base of the arms enter the threaded rods, and around the lateral parts of the bows hold loops of elastic thread. Remove the studs and thread through the skin. Impose layered sutures, after which the Foundation of the threaded rods and the ends of the hinge is fixed on the elements of the external fixation device and is created in the stress state. On the second day after the operation start dosed traction of the spine as along the longitudinal axis and the sagittal direction 2-3 times a day and continue this pattern until you obtain a favorable clinicopathologically results. Distraction of the spine with the conservation of the stress state in the system depending on the magnitude of listeth and nature of the clinical-neurological disorders requires from 6 to 10 weeks. These terms are already sufficient for you without fear of relapse slippage of the vertebra to dismantle the apparatus and to carry back the interbody corporates.Clinical example. Patient K., aged 52, history N 3142, was treated at the research centre of Tatarstan "Restorative traumatology and Orthopaedics" with 23.12.92, 18.02.93, about spondeo radicular syndrome. Complaints about persistent pain in the lumbosacral region with irradiation in the lower limbs, more in the right. Progressive weakness in both legs paresis of the right foot. Difficulty walking, sometimes incontinence during walking. First felt pain in the back in 1989 occurred for no apparent reason. Since that time, the pain almost did not stop, especially amplified when lifting weights. In 1991, the pain began to give in feet, by the end of the year there is a weakness in them. In September 1992, developed paresis of the right foot, it became difficult to walk. Objective: analgesia pose crooked torso to the right. Reinforced lumbar lordosis. Moves independently, but gets tired quickly. Knee reflexes quickened. Ankle reflex on the right is missing. Paresis of the right foot. Gipostesia in the area of innervation of L3-5Koreshkov. When natureway periodic incontinence. On spondyliosoma: body L4vertebrae shifted forward by half of its sagittal size. 9/XII-92, the patient had an operation: after exposure of the posterior structures of the lumbar spine put the rods through the roots of the arcs in the body L3-4-5vertebrae and held tight elastic loops through the side sections of these arms. After uchiwa same fixed ends of the loops, and the system created a stress state. On the second day after the operation began producing metered traction of the spine as along the longitudinal axis and the sagittal direction 2-3 times a day until the occurrence of lung pain in the area of a displaced vertebra. On the background stress state in the system of stretching of the spine lasted for 8 weeks. All this time the patient was served by itself. Range of motion in the lower extremities, increased gradually recovered fully, came regression of neurological symptoms. The control spondyliosoma: offset body L4vertebra halved, greatly expanded intervertebral slit L4-5the vertebrae. 3/II-93, due to the regression of neurological symptoms and pain to the patient, the external fixation device dismantled and carried back interbody corporates plates Roy-Camille. The patient was discharged in good condition. Works in a former post of fireman. Treatment of spondylolisthesis, including the reduction of a displaced vertebra and its stabilization, characterized in that the dorsal side through the base of the arches in the body shifted up - and underlying vertebrae enter R rods and the ends of the hinge is fixed on the elements of external fixation device, then make dosed the distraction of the spine along its axis and traction of a displaced vertebra posterior to, and after eliminating displacement of the vertebra, the second stage removes the external fixation device, performing one-stage rear corporates vertebrae.
FIELD: medical engineering.
SUBSTANCE: device has reposition sliding bars having members for fixing bones and connecting unit. The connecting unit has at least one member for fixing bones, lead screws and rods. The connecting unit is combined from base and clamp member connected with hold-down screw allowing rotation. Radial corrugated elements are available on base and clamp sides facing each other. Holes are available in base and clamp casings for receiving the attached rods and rotatably anchored hold-down screws. Through holes are produced in reposition sliding bars having smooth internal surface for the rods and internal screw thread for holding lead screws.
EFFECT: enhanced effectiveness of treatment; accelerated treatment course.
9 cl, 25 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves introducing a pair of fastening members into each vertebra. Controllable elastic force is applied to the pairs of fastening members as unit- or bilateral load in particular cases. It enables one to support forces in continuous way in loading and relaxing vertebral muscles. Device has movable supporting beams connected to each other in specific way with threaded rods each manufactured from plates attached to each other. Two plates are outer and one of them is intermediate. Each plate has two members for fixing vertebra manufactured as screw rods. The plates are connected on one side with elastic member having spring and clamp mounted on threaded rod, one rod end being freely arranged on the plate and the other one being fixed in the plate with single-axle hinge; on the other side with elastic member having spring having hooks and threaded rod, one rod end being fixed in the plate with nuts and the other one is connected to opening in the plate.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
5 cl, 10 dwg
FIELD: medical engineering.
SUBSTANCE: device has proximal and distal ring-shaped support members connected to each other by means of threaded rods fixed in proximal ring-shaped support member. A pair of T-shaped threaded uprights is mounted on the distal ring-shaped support member in diametrically opposite points along one axis allowing axial displacements and fixation to take place. Cut bushings are movably and fixably mounted on smooth uprights cross-members. The bushings are connected to the rods and a pair of U-shaped uprights having threaded cross-bars are diametrically movably mounted along parallel axes and fixable on pedicles and bushings mounted on the uprights and fixable with nuts. The bushings are pivotally connected to the rods. Axes of all hinges are arranged on distal rod ends in parallel to each other in the same plane.
EFFECT: avoided bone deformities.
FIELD: medical engineering.
SUBSTANCE: device has rod having at least two fastening members for the fixing rods, the members being movably mounted on the rod and fixable in posterior positions; and removable compression-distraction device having casing and fastening member fixable on the rod and with pusher screw having hexagonal head at one end handled with wrench and thrust member pivotally connected to the screw at the other end and engageable to fixing rod tail in indirect way via a bar having longitudinal T-shaped slot on one side and guiding slot on the opposite side for receiving the fixing rod. The bar is arranged in parallel to the fixing rod and is movable along allowing distributing pressure over maximum available length of Schanz screw and avoid its deformation during distraction.
EFFECT: enhanced effectiveness of distraction and reduction of bone fragments.
FIELD: medical engineering.
SUBSTANCE: device has hollow rod having two telescopic parts enclosed one into the other by means of feed screw having members for fixing threaded rods screws on each of them engageable with pelvic bones. One of the members is spring-loaded in axial direction. The device has at least one additional rod mounted on in parallel to and at some distance from the main rod, the additional rod being extensible by means of power mechanism having two half-rods one of which is connected to the main rod by means of two holders coaxially arranged in perpendicular to longitudinal axes of both rods allowing rotation relative to each other and fastened to each other to prevent from axial displacement with locking member. Threaded rods engageable with femur are fixed on the second half-rod. Each holder has transverse opening for setting into it the main and additional rod fixed in holders with clamps, respectively.
EFFECT: enhanced effectiveness of combined treatment.
5 cl, 3 dwg
FIELD: medicine; orthopedics.
SUBSTANCE: apparatus has pin holders, needle lockers, needles and nut connected together by thread ties of rectangular frames. Apparatus is additionally equipped with thread rods and ties. Any pin holder is made in form of a cube which has through, parallel channels for thread pins or thread ties. Channels are symmetrically remote from opposite faces of cube. Frames are integrated into units. Units are connected by thread ties at central parts of frames. Ties are fixed in channels of pin holders mounted onto pin of frames for dosed movement of units.
EFFECT: widened reposition properties; improved reliability of locking; adjusted rigidity of carcass.
2 cl, 6 dwg
FIELD: medical engineering.
SUBSTANCE: device has two coaxial threaded pins provided with control nuts. The pins are connected to each other via elastic parallelogram having bases rigidly connected to the pins. Elastic bearing beams are arranged across the pin axes. The beams are bound to each other by a pair of elastic sensitive beams arranged in parallel and symmetrically relative to pin axes. The sensitive beams have strain gages joined into bridge circuit connectable to tensometer.
EFFECT: high accuracy and reliability of loading data; high accuracy of bone fragment reposition and recovery.
FIELD: medical equipment, in particular, instruments used in traumatology.
SUBSTANCE: apparatus has para-articulation rings equipped with wires and connected through telescopic bars. Apparatus consists of standard set parts of Ilizarov' apparatus and is equipped with para-fracture outer support with wires for additional designing of apparatus, said support including semi-ring connected with plates and threaded bar by means of bolts, nuts and brackets so as to define closed circle. Outer support is secured by means of threaded bars and nuts to plates preliminarily set on telescopic bars. Perimeter of para-fracture outer support is adjusted in accordance with perimeter of cross section of shin, at the level of positioning the support.
EFFECT: increased efficiency and reduced time of treating patient with shin fracture.
6 dwg 1 ex
FIELD: medicine, in particular, surgical dentistry, maxillofacial surgery.
SUBSTANCE: apparatus has curved base formed as threaded bar with two diametrically opposite flats, wire holders mounted on base and made in the form of plates equipped with wires, and retaining units comprising couplings with screw arranged in projection of flat and adapted for displacement and fixing on base. Wire holder consists of two plates, one of said plates being made integral with retaining unit and having two 6-mm long grooves for receiving of wires, and other plate being made detachable and equipped with wire fixing screw positioned perpendicular to retaining unit. Threaded wires have at their sharpened end 15-mm long thrust thread for cortical bone.
EFFECT: reliable retaining of fractured bone fragments, provision for correcting position of fragments in oral-vestibular direction, simplified construction allowing apparatus assembling time to be reduced and time of keeping patient under anesthesia to be decreased.
FIELD: surgical instruments used in orthopedics and traumatology, in particular, for open setting of displaced cervical vertebrae of spine.
SUBSTANCE: apparatus has spring-loaded branches connected with one another through pivotal lock with shaft and mating opening. Arms and working jaws are provided on branches. One of working jaws is equipped with adjustment retainer provided on first outer supporting surface and other working jaw has pusher adapted for cooperation with displaced vertebral body and disposed on second outer supporting surface. Opening mating with said shaft is made in the form of guiding slot oriented at an angle to plane where working jaws adjoin one another. Length and angle of inclination of guiding slot correspond to maximal height of lift of vertebral body of joint having maximal size. Pusher for cooperation with displaced vertebral body is made in the form of step. Branches are loaded by means of spring formed as branch shifting means which are provided with angular bend for preliminary passage of branches before deformation of spring. Apparatus of such construction ensures injure-free setting of displaced vertebra by one hand for minimal time.
EFFECT: simplified construction, provision for trauma-free cooperation of instruments with vertebral body, convenient use and reduced time for performing setting of displaced vertebra body.
5 cl, 7 dwg