A device for correction of spinal deformity

 

(57) Abstract:

The invention relates to techniques for orthopedic surgery. The device includes an elongated supporting frame of the two mikeledimitrij rods, bent in the shape of the spine, movably interconnected at each end and at intermediate stations. Before installing the frame is cooled and bent in the form of pathologically deformed spine, set in the prepared bed and fasten with a spine-shaped clamps and cuts the wire spiral with shape memory effect. With otogrevaniya rods is their return to the original form and corrective action on the spinal curvature. The technical result of the invention is to improve the efficiency of correction of different types of spinal deformity, including combinations thereof. 5 C.p. f-crystals, 5 Il.

The invention relates to medical equipment, namely to the technique of orthopedic surgery.

Diseases of the spine are the fundamental causal links of internal diseases of the body and therefore the study and development of methods of treatment, including surgery, are urgent task of modern medicine. As provable common types of deformation are scoliosis - curvature of the spine in the frontal plane, abnormal increase in the natural curvature in sagitally plane /kyphosis and lordosis/, torsional /rotational/ shifts sections of the spine, and combinations thereof. In turn, the deformation of the spine transmitted through the neuro-vascular mechanisms in dysfunction of internal organs. Therefore, correction of spinal deformity is a necessary step in the treatment of many diseases.

Radical correction of deeper forms of spinal deformity perform surgery using various technical means, the development of which has its own history.

A device for correction of spinal deformity /1/ containing supporting frame 1 /Fig. 1/ in the form of a metal rod and moving the fastening elements 2 - hooks with the holes in the rod.

During the operation skeletonize the deformed region of the spine and in the extreme vertebrae curvature install the fasteners. Temporarily installed in the holes of the fastening elements screw distractor slowly stretch the spine and stretching mobilize twisted plot. The final correction is in the prepared bone bed 1.5 - 2.

The drawbacks - the complexity and invasiveness of the surgery, long recovery time, the lack of growth of the spine in children.

A device for correction of spinal deformity /2/ containing a supporting framework in the form of curved form of the natural curvature of the spine rod and the fastening elements to the spine, grouped in pairs of adjacent mechanisms of distraction - contractions. When Kolisnyk the spinal fixing element is fixed to skeletonname the spine behind the arc legs arcs or transverse processes of the vertebrae. Into the holes of the fastening elements hold the rod with the orientation of its curvature in the frontal plane mechanism of distraction on the concave curvature of the spine and the mechanism of contraction is on the convex side of the correction of the spine to a predetermined shape of a rod. The final correction is performed by the pivot rod 90othat is until his orientation curvature in sagitally plane. The fastening elements are fixed to the terminal screws. If necessary, in parallel, symmetrically set the second rod and fasten it with the first 3 - 4 levels threaded couplers.

Know more in relation to adaptation to the growing body device (prototype) for the correction of spinal deformity [3], which uses a shape memory effect material. It contains a frame in the form of an oblong plate of Nickel-titanium shape memory effect. The center plate is made lengthwise through the slots, in which are installed with the possibility of moving the fastening elements to the spine. Over the arch of the vertebrae skeletonising deformed section having hooks fastening elements in quantities depending on the nature of the curvature. The plate frame is cooled in the refrigerant, Flex form of spinal curvature, combined with the fastening elements and is fixed with the possibility of their moving in the slots of the plate. As warming to body temperature of the patient plate is returned to its original form and begin corrective action. Correction of curvature is slow. The first signs of it appear 2 weeks after surgery, and it is smoothly completed in 3 - 4 weeks restoring the natural shape of the spine.

Thus, in contrast to the analogues [1, 2] device - prototype performs the correction of spinal deformity of sati form. The most important of them - the biomechanical and biochemical compatibility, abrasion and cyclotourist, the optimal combination of weight and size characteristics, quasi-static, uniform nature of force. The consequence of these technical properties is soft, gentle correction mode, the relative simplicity of operation, reducing injuries, with a corresponding increase in the viability and effectiveness of rehabilitation. The mobility of the fastening elements creates the possibility of growth of the spine in children.

The drawbacks causally linked to its design and material of the supporting frame.

1. Plastic form the supporting frame restricts the direction of its deformation and, consequently, the direction of correction of the spine. Typically, the device is applicable for scoliosis and does not allow to correct the combined types of deformation.

2. The device is installed on one side of the scoliotic arc and asymmetrically relative to the spine, between the transverse and spinous processes. The result is an uneven impact on the vertebra, high specific pressure and potential damage to the bone.

3. Form netocny strength in the device is forced to the increased weight of the material of the frame.

4. The fastening elements made in the form of hooks, do not provide sufficient strength of attachment to the vertebrae. Instead of a single hook set for insurance at each point on the pair of elements.

5. Material used - nickelide titanium - source (and therefore in the end after recovery) the shape of the frame is inelastic. Thus, after the correction of the spine is corrected on the site does not have elastic mobility.

The technical result of the proposed solutions improve efficiency correction of different types of spinal deformity, including combinations thereof.

This technical result is achieved in that the device for correction of spinal deformity, containing an elongated supporting frame Nickel-titanium and the fastening elements to the spine of titanium nickelide connected to the frame with the possibility of longitudinal displacement, load-bearing frame is made in the form of two parallel rods, bent in the shape of the spine and movably interconnected at each end and at intermediate sites.

The preferred contour of each terminal on one end 180oand connect it to the unbent end of stechenii and fixation of their large size in the plane of the device.

Preferably, the connection terminals on the intermediate sections of the framework ellipsometry unclosed rings Nickel-titanium shape memory effect.

Preferably the location of the fastening elements to the spine in the plane of the supporting frame on either side of him, and execute each of them in the form of a C-shaped bracket, oriented along the rod, and cut cylindrical wire spiral covering bornerbroek terminal and C-shaped bracket in its middle part.

The preferred choice of material for the supporting frame of the super-elastic.

During the operation, the support frame (Fig. 4) refrigerated curve shape curved skeletonising spine, placed symmetrically on either side of the spinous processes (Fig. 5) and secured thereto by fastening elements 2, 3. With the thawing device begins its corrective action, once completed, i.e., the return of the armature to the natural curvature of the spine, the skeleton becomes his stabilizer.

Somerest efforts termovosstanovleniyu rods makes it possible to adjust the curvature of the spine in the frontal and sagitally planes, as well as their combination is tion of the spine form the supporting frame causes a uniform distribution of compensated effort by the volume of the vertebral body, consequently, the reduction of pressure on the bone and reduce the possibility of its destruction.

The specified spatial uniformity of the compression efforts can also reduce the size and weight of the supporting frame while maintaining a relatively prototype efficiency correction.

The mobility of the connecting rods at the ends of the frame necessary to ensure the adaptability of the device to the growing spine. The connection terminals on the intermediate sections of the framework (also stationary) is necessary to rebut a possible extension when they are of considerable length.

Additional advantages of the offer compared to the prototype are provided detailing the signs.

1. The connection rods interconnected at their ends may be used with different elements. The proposed connection of each terminal 1 movable sleeve 5 (Fig. 4) with a folded 180oby the end of the second rod is advantageous from the point of view of the contingency of this node with the relief of the spine.

2. The flattening of the rod cross-section and orientation of their large size in the plane of the device suitable for the correction of spinal curvature in by the possibility of protrusion of the circuit device beyond the prepared bed, harder to stabilize the natural shape of the spine in the frontal plane.

3. Ellipsometry form an open ring 4 (Fig. 4) and their implementation Nickel-titanium shape memory effect provide convenience to the surgeon when fixing the lateral dimension of the frame at the intermediate stations. To install them enough to cool ellipsometry open ring, dilute its ends to the desired value, to have coverage for both rod and when heated to monitor the proper installation.

4. The shape of the fastening elements to the spine 2, 3 (Fig. 4) and their location ensures their durability, ease and speed of installation, reliability in operation. C-shaped bracket 2 is used to secure the fastening element on the spine, to which the legs of the bracket is slid over the arm or lateral processes of two adjacent vertebrae (Fig. 5). A segment of a cylindrical wire spiral cool down, stretch and spiral movement impose with coverage of one of the rods and at the same time C-shaped bracket approximately in its middle part. When thawing the spiral back to the original (zamknutoi) form, bringing together the bracket and the rod and thus assuring zadeistvovannye titanium) this property is reversible elastic deformation, which reaches 2%, in contrast to the elasticity of metals (Hooke's law), having a value of less than 0.2%. Sverkhelastichnosti material is achieved specified alloying alloys.

Sverkhelastichnosti the selected material of the frame gives it an important additional advantage - provides elastic mobility of the corrected spine. The patient has the ability to bend the spine.

Presented on the pictures:

Fig. 1. A device for correction of spinal deformity (Harrington) 1 - carrying frame, 2 - fastening elements to the spine.

Fig. 2. The scheme of installation of the device Harrington.

Fig. 3. A device for correction of spinal deformity (prototype) 1 - carrying frame, 2 - fastening elements to the spine, 3 - slots.

Fig. 4. The proposed device for correction of spinal deformity: 1 - carrying frame, 2 - C-shaped bracket, 3 - cut a wire helix, 4 - ellipsometry open ring, 5 - movable clutch.

Fig. 5. Installation diagram of the proposed device.

Achievable technical result confirmed a concrete example of the clinical use of the proposed device in the Centre of Voss is P> Patient S. , aged 14, was hospitalized at CUTO 12.12.95 was diagnosed with S-shaped right-hand Grodno-lumbar idiopathic progressive scoliosis IV degree, the rib hump on the right. Quantitative characteristics of spinal deformity: deviation breast vertices of scoliosis to the right by 4 cm from the plumb line at the level of vertebra Th3(angle on Koba 47o), the deviation of the top of the lumbar scoliosis to the left by 3 cm from the plumb line at the level of vertebra L1(angle on Koba 47o), the tilt of the pelvis to the left by 3 cm and severe torsion of the III degree.

16.12.95, under General anesthesia performed operation (correction of scoliotic deformities. Used the device with the following characteristics: the rods of the supporting frame with a diameter of 4 mm is made of titanium nickelide VT-10. The length of each rod form in sagitally plane corresponds to the normal physiological curves of the spine. The length of the C-shaped brackets for different levels of the spine from 20 to 50 mm, wire diameter of 3 mm with flattening; a segment of a cylindrical spiral element attaching to the spine with a diameter of 7 to 9 mm, 3 - 4 turns from necesitaremos wire TN-10 diameter 1 mm; ellipsometry open-loop ring - length 20 mm from necesitaremos about the and): sellerbuyer of the spine at the site of the vertebrae C7S1prepare a bed for the frame of the device. With the spinous processes and parts of the arches of the vertebrae Th1to L5remove the cortical layer. On a pair of vertebrae Th1- Th2left and right, a pair of vertebrae Th4- Th5Th8- Th9Th11- Th12, L4- L5the right set with the institution behind the arc, using the shape memory effect material, a C-shaped bracket 2. A similar bracket set left behind the arc adjacent vertebrae Th3- Th4Th9- Th10, L1- L2, L4- L5. For an arch of a vertebra L1to the right and behind the arc vertebra Th1the left set of C-shaped clips 2 reduced size. United movable couplings 5 rods of the supporting frame are formed in a cooled state to the pathological curvature of scoliosis, immediately set in the prepared bed and is fixed to the C-shaped brackets. Fixation perform a spiral movement of the segments of the wire helix 3, pre-cooled and stretched in the axial direction to convenient for installation of discharge of the coils. The rods of the supporting frame are connected ellipsometry rings 4, conducted through the prepared holes of the spinous processes of the stack of bone chips, taken from the posterior wing of the Ilium. After drainage tube drainage of the wound is sutured in layers and cover an aseptic bandage.

The postoperative results of the surveys indicate the viability of the operation. Wound healing by primary intention. 4-th day - lifting the patient on orthoscope, with the 12th - removal of stitches, from the 13th - beginning of the walk, on the 19th day statement from the center.

The state corrected scoliosis according to x-ray: a deformity of the spine at the thoracic level with arc on Koba - 7oon the lumbar - 5o. A follow-up examination 6 months after surgery revealed deformation at these levels, respectively, 12o- 10oheld the bone block. The growth of the patient before surgery 162 cm, at the time of inspection - 167 see Complaints patient no.

Sources of information:

1. I. A. Movshovich "Operative Orthopaedics, M.: Medicine, 1983, pp. 363 - 365.

2. With eN.

3. A. S. N 1410965, USSR A 61 B 17/60 Zivian J. L. et al. Device for correction of spinal deformity" (prototype).

1. A device for correction of spinal deformity, containing an elongated supporting frame Nickel-titanium and the means of attachment to the spine is a mere frame is made in the form of two parallel rods, the curved shape of the spine and movably interconnected at each end and at intermediate sites.

2. The device under item 1, characterized in that each pin on one end bent 180oand connected to the bent end of the second rod through the movable clutch.

3. Device according to any one of paragraphs.1 and 2, characterized in that the rods are made of flattened cross-section and oriented the large size in the plane of the supporting frame.

4. Device according to any one of paragraphs.1 to 3, characterized in that the connection terminals on the intermediate sections made ellipsometry unclosed rings Nickel-titanium shape memory effect.

5. Device according to any one of paragraphs.1 to 4, characterized in that the fastening elements to the spine are located in the plane of the supporting frame on either side of him, and each made in the form of a C-shaped bracket, oriented along the rod, and cut cylindrical wire spiral covering bornerbroek rod and a C-shaped bracket in its middle part.

6. Device according to any one of paragraphs.1 to 5, characterized in that the material of the supporting frame of the selected super-elastic.

 

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