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 , 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.
FIELD: medical engineering.
SUBSTANCE: device has two elastic plates and unit for fastening the plates to vertebral arches by means of two hooks placed under the arches on both sides of spinous process, two pins attached to corresponding hook with threaded connection and thrown over the hook with support given by its thrust journal for fastening arches in corresponding hook. The pins have restricting rest means. Connection strap is manufactured as a whole with elastic plate holders building U-shaped clamp having locking protrusions at pedicle ends turned inward. Plate holders are formed by clamp pedicles and locking protrusions. Elongated slot is available in clamp crossbar. The clamp is put over the pins via the elongated slot of the crossbar thrusting against restricting rest means of pins and connected to the pins by means of two nuts screwed over the corresponding pin from the external clamp side. Catching cells are produced in thrust journal of each hook for making additional fixation of the pins.
EFFECT: increased rigidity; fixation stability; accelerated operation process; reduced risk of traumatic complications.
2 cl, 3 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: device is rectangular and has four or more slits for fixing means to pass through each of them. Two slits have exit to lateral side of plate to enable one to set the plate at required position and fix it without preliminarily removing the instrument for correcting orientation relative to vertebral column. Lateral plate surface runs from edge pointing the same direction with longitudinal plate direction. The latter exactly coincides with the vertebral column direction. The system comprises several vertebral column osteosynthesis plates to keep orientation correction relative to the vertebral column unchanged. Correction is carried out by means of the instrument for correcting orientation.
EFFECT: less number of holes to be drilled for mounting the device.
11 cl, 10 dwg
FIELD: medical engineering.
SUBSTANCE: device has plates having longitudinal segmentally counterbored slots and fastening members manufactured as bone screws with clamps. The clamps are manufactured as cramps having threaded openings in lower shelf. Locking members are mounted in threaded openings of the clamps. The locking members have threaded heads, hexagonal slot and smooth conic part set in hexagonal bone screw head slots. The bone screws are set in longitudinal segmentally counterbored slots of the plates. Their narrow parts under the heads pass through slits in the lower shelves of the clamps. The plates are connected to each other with cross-bar manufactured as rod ending with hook on one end which upper shelf has threaded hole for receiving locking member having threaded head, hexagonal slot and smooth thrusting part for fixing the cross-bar to a plate, the other free cross-bar end having corrugated part, has cross-bar clamp manufactured as cramps having threaded opening in upper shelf for receiving locking member having threaded head, hexagonal slot and smooth thrusting part supported by corrugated surface of the cross-bar to fix the cross-bar to the second plate. A hole is available in the upright connecting crossbar clamp shelves. The corrugated free crossbar end is movable and fixable in the hole.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; avoided blood deposit under plates.
FIELD: medical engineering.
SUBSTANCE: device has supporting frame and threaded rods mounted thereon to enable their transpedicular introduction into displaced vertebra body to take place with triangular structure being formed which apex is directed towards vertebral body. The supporting frame has screws introduced in transpedicular way into vertebral bodies adjacent to the displaced one, and connective bars building rigid structure by means of crossbars. The device has additional removable reposition frame resting upon the connective bars and joined to the threaded rods by means of transverse beam serving as triangular rigid structure base movable relative to the supporting frame. The screws and threaded rods have two threaded parts separated with spherical head, one of which is used for being introduced into bone tissue, and the other one is used for making connection to the connective bars. The connection is made as detachable floating fixing members having concave spherical surface for receiving rod and screw heads with variable connection angle. The detachable floating fixing members of the threaded rods have slots for receiving fingers connecting the threaded rods to the supporting frame allowing variable connection distances from the connective bars.
EFFECT: enhanced effectiveness of treatment.
FIELD: medicine; medical engineering.
SUBSTANCE: device has at least one connection member shaped as rod, at least two fixing means each fixable on vertebra body. The means have fork-shaped head parts which two branches determine U-shaped receiving space for the connection member to fit into it. Head is, as a rule, saddle-shaped, has locking screw for screwing-in into receiving space for fixing the connection member between two fork-shaped head branches. The head is guiding member for independent locking piece usable for carrying out fixation on the head after having set connection member into head fork. The locking piece is usually U-shaped, its branches being engageable with fork-shaped head part branches and its bottom part having opening with internal thread engageable with the locking screw. The guiding member available on the head part is formed with arc-shaped flanges available on lateral external surfaces of fork-shaped area. Fixing member has fork head, two branches of which determine receiving space of strictly U-shaped form for receiving connection member. Head is, as a rule, saddle-shaped. It serves as guiding member for independent locking piece usable for carrying out fixation on the head after having set connection member into head fork. The locking piece is usually U-shaped, its branches being engageable with fork-shaped head part branches and its bottom part having opening with internal thread engageable with the blocking screw. The guiding means available on the head part is formed with arc-shaped flanges available on lateral external surfaces of fork-shaped area. Auxiliary member has two end pieces positionable in slots available on implant head part and a means for applying force to the rod for causing lateral or vertical displacement to allow rod to be positionable in the slot.
EFFECT: retained correction degree and final fixation and tightening of screws selected by surgeon during operation.
12 cl, 4 dwg
FIELD: medical engineering.
SUBSTANCE: device has ball and socket joint casings having cylindrical and supporting parts, transpedicular screws having spherical heads, axial rods and transverse tie rods. Lower unseparable lips are available on external surfaces of supporting parts of ball-and-socket joints. The upper lips are separable and they are mounted on cylindrical parts of the casings. Cylindrical grooves which radii are equal to the axial rod radii are available on opposite surfaces of the upper separable and lower unseparable lips of the ball-and-socket joints. External thread is available in cylindrical parts of the casings with fastening nuts mounted thereon for fixing the separable lips. Locking members controlling angular displacements of spherical heads along transpedicular screw axes are manufactured as fixing screws having ring-shaped cutting edge on contact side to enable one to introduce them into internal threaded openings of the cylindrical parts. The axial rods are manufactured as pivot levers having rod part on one end and bushings on the other end arranged in perpendicular to each other. Locking member for controlling bushings rotation of pivot levers relative to each other is manufactured as radial teeth on plug plane and locking screws for positioning in bushing holes.
EFFECT: rigid fixation of injured vertebral column segment; small-sized fixing members; reduced risk of traumatic complications.
FIELD: medicine; neurosurgery; traumatic surgery.
SUBSTANCE: holder can be used for stabilization of damaged sectors of spinal column. Holder has transpedicular screws, longitudinal and lateral beams, fixing unit with two mutually perpendicular holes for screws and longitudinal beam. Longitudinal beams are made of shape-memory-effect material, which provides flexural rigidity of holder within 10 to 80 H/mm.
EFFECT: reduced risk of post-operational complications; stabilized traumatized segment of spinal column.
5 cl, 1 dwg
FIELD: medicine, in particular, equipment used in traumatology and orthopedics.
SUBSTANCE: apparatus has connection member 5, sealing cap 12, tightening means 13, locking means 21 for fixation, fixation means 35 used for securing of screw head 30 of bone fixation means in cavity 8 of connection member 5. Connection member 5 is positioned coaxially relative to central axis 2 and has upper end 6, lower end 7, cavity 8 arranged coaxially relative to central axis 2 extending through connection member 5 from its upper end 6 to its lower end 7, said cavity converging to its lower end 7 formed as at least one flange 9, and channel 10 extending through connection member 5 transverse to longitudinal axis 2 for receiving of longitudinal holder 11. Sealing cap 12 has front end 20, rear end 19, second cavity 18 open at its front end 20 for locating therein of connection member 5, and second channel 17 extending transverse to central axis 2 and opening toward front end 20 of sealing cap 12. Tightening means 13 may be fixed at rear end 19 of sealing cap 12 for retaining of longitudinal holder 11 located in channel 10 in connection member 5. Locking means 21 are positioned outside connection member 5 and in second cavity 18 of sealing cap 12 so as to mate each other and serve for fixation of sealing cap 12 on connection member 5.
EFFECT: increased efficiency owing to reduced space for implantation which is due to the possibility of introducing surgical instrument having diameter smaller than that of implant for preventing surrounding tissues from injury.
7 cl, 6 dwg
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: the present innovation deals with fixing affected segment in thoracic, lumbar and sacral vertebral departments. One should apply supporting elements of transpedicular system of bars which should be crossed in frontal plane and connected together with a fixing knot to regulate the angle of bars' crossing depending upon the requirements appeared, moreover, supporting elements should be applied through pedicles of vertebral arches that increases reliability of fixation at achieving osseous ankylosis.
EFFECT: higher efficiency.
2 dwg, 1 ex
FIELD: medicine; traumatic surgery; orthopedic devices.
SUBSTANCE: device for applying lengthening or stretching force to patient's body has aid for fastening first and second components to bones or to adjacent bones. Mentioned components are connected by increasing-length connecting aid. Device also has magnet connected with connecting aid and drive unit disposed outside patient's body for generating moving or changing electromagnetic field which results in rotation of magnet and elongation of connecting aid. Connecting aid has screw and nut. Magnet is connected with screw and nut by means of transmission box to generate relative rotation for elongating the device. Endoprosthesis replacement device to be elongated has first and second components that are connected by increasing-length unit. The first component has fraction of extremity joint. The second component has aid for fastening to resected long bone, magnet connected with connecting unit, and aid adjusted for disposition outside patient's body for generation of moving electromagnetic field which results in rotation of magnet and elongation of connecting unit. Magnet is connected with connecting unit by means of reduction gear. Device for correcting curvature of the spine has first and second shafts for elongation. Any shaft has its end to be connected with aid for fastening to corresponding vertebra. Connecting unit is adjusted in such a way that ends provided with fastening means were relatively movable. Mentioned connecting unit is connected with drive mechanism, which has rotated magnet, reduction gear, and drive aid for disposition outside patient's body. Generated moving or changing electric/magnetic field induces rotation of magnet and motion of fastening aid, disposed onto one shaft, relatively fastening aid, disposed at the other shaft.
EFFECT: elongation of bones or implants without surgical operation.
15 cl, 5 dwg