The method of stabilization of the spine

 

(57) Abstract:

The invention relates to medicine, more specifically to traumatology and orthopedics. Entity: form a channel through the base of the preliminary osteotomies the transverse process or the root arcs of the vertebra at an angle of 15-45owith respect to an axis of the spine, without compromising the integrity of the opposite reflex plate, through the bodies of two adjacent to the damaged vertebrae. As a transplant use a ceramic rod which is introduced into the channel, and before or after the formation of the channel along an area of the spine, subject to surgical intervention, establish distractor or contractor, which reduces the trauma to the tissues, reduces blood loss and provides a more reliable stabilization of the affected segment.

The invention relates to medicine, more specifically to traumatology and orthopedics, and can be used in the treatment of unstable spinal segments post-traumatic or degenerative origin.

When traumatic lesions or progression of degenerative-dystrophic process by reducing the carrying capacity of the bone, cartilaginous, and ligamentous elements R and spine, the development of pain and radicular syndromes, and sometimes neurological complications. For the treatment of these patients suggested a large number of different methods aimed at stabilizing the damaged segments of the spine. The most widespread way of Ziviani [1] in various modifications. All of these methods are performed from the front of accesses, which are very complex, vysokoaromatichnyj and can be accompanied by severe complications (severe bleeding, purulent complications of wounds, pneumonia, pleurisy, peritonitis, intestinal paresis, urinary disturbances, and so on).

Closest to the claimed method is corporatese by Barnes [2] , taken as a prototype, in which front access, unobrusive are highlighted in the front sections of the bodies of the fifth lumbar and first sacral vertebrae, the graft is inserted through the front closing plate L5 obliquely downwards and backwards into the body of the first sacral vertebra. The proposed method only for spondylolisthesis and, in addition, when forming the channel have to tie transverse veins on the body of the fifth vertebra, which is technically difficult in execution. Since the transplant, according to this method, is injected under elevation is bcia, that is a serious disadvantage of this method. Furthermore, the method-prototype fixation of only two vertebrae and provides long-term (>4 weeks) in bed in the postoperative period.

The technical result of the present invention is to simplify access to the damaged segment, which reduces the morbidity and shortening the treatment time.

This result is achieved by the fact that in the known method of stabilizing the spine by fixing the damaged segments of the spine by the introduction of the graft according to the invention as graft use a ceramic rod which is introduced into the channel, the pre-formed by drilling two bodies adjacent to the damaged vertebrae angle of 15-45 degrees relative to the axis of the spine, with the channel formed through the base pre-osteocartilaginous the transverse process or the root arcs of the vertebra, without compromising the integrity of the opposite reflex plate, and before or after the formation of the channel along an area of the spine, subject to surgical intervention, establish distractor or contractor.

Use as tra and the tibia and its modeling in the process of surgery, but only to find him on the diameter of the existing set of grafts. This reduces the operation time, it reduces the trauma, blood loss and the probability of postoperative complications.

Forming a channel from the rear access through the base of the preliminary osteotomies the transverse process or the root of the arc vertebra reduces the risk of intraoperative complications associated with the front is extremely traumatic access.

The choice of angle formation of the channel - from 15 to 45 degrees - depending on the number of damaged segments and the anatomical location of the damage. The entire range of angles provides a minimum load on the graft, reducing the risk of postoperative complications.

Installing contractor or distractor provides reliable stabilization of the damaged segment of the spine in the postoperative period and creates optimal conditions for engraftment with robust bone block in the affected segment along an area of the spine, subject to surgical intervention. Moreover, the presence of invalid segment in the field of physiological lordosis is distractor, and kyphosis, or huts CLASS="ptx2">

One of the longitudinal slit in the projection of the spinous processes expose the posterior elements of the vertebral bodies affected and two or three adjacent segments. Through the arch root (lumbar spine) or through the base osteotomies transverse process of the thoracic Department) adjacent to the damaged segment of the vertebra form a channel through the damaged and later in the intact vertebra, without violating the integrity of his reflex records. In this channel, enter the graft is bigger than the channel diameter of 1 mm, up to the stop opposite the entrance of the switching plate. Along an area of the spine, subject to surgical intervention, the contractor shall establish or distractor.

The essence of the method is illustrated by examples.

Example 1. And/b N 2627. Patient I. Afanasyeva Century, 20 years.

Diagnosis: compression, comminuted, unstable, uncomplicated fracture of the body of L1 (kyphotic deformity 26 degrees).

14 may result in katuramu (falling from the second floor) received a fracture of the body L1, was hospitalized in Alexandrovsky hospital, where he conducted conservative treatment. After consultation with experts, RIICO was 26.05.97 transferred to the mark and poor prognosis in the case of conservative methods of treatment. 4.06.97 operation stabilization of the spine by the claimed method, where the channel was formed at an angle of 40 degrees in the bodies of Th12-L1-L2, where he was initiated graft. With regard to severe kyphotic deformity of the damaged vertebra was performed his reclinate with simultaneous additional fixation of the two contractors, the hooks are installed at the rear elements tel Th 11-12 - L4. Total blood loss of 300 ml of the Patient is raised to his feet on the 3rd day. Removing cosmetic seams on the 12th day, healing by primary intention. Issued on the 22nd day of hospitalization. At the control examination after six months marked the formation of the bone block Th12-L1-L2, the patient returned to normal activities - learning.

Example 2. And/b N 2657. Patient Sukhov Mikhail Viktorovich, 22 years.

The diagnosis of dysplasia of the lumbosacral spine, widespread osteochondrosis with the II stage of degeneration of the intervertebral disks, the disk instability Th12-L1 and hernia of disk L5-S1 pain syndrome. The misalignment of the pelvis to the left, analysesi scoliosis, spastic Shebalino-causing contracture of the left hip joint.

Was actively involved in kettlebell sport. Sick since 1989, when first appeared kodel annual conservative treatment in different honey. institutions without effect. 1994 developed spastic flexion contracture of the left hip joint, a pronounced asymmetry of the muscles of the hips with decreasing diameter of the left femur 5 see

23.08.94 was done dosed longitudinal traction of the spine distractor, stabilization described Th12-L1 (the channel at an angle of 45 degrees) and L1-S1 (channel at an angle of 15 degrees) segments, posterior cervical fusion. The 5th day was held metered vertical load. Removing cosmetic seams on the 12th day after surgery. Discharged 2 weeks after the operation without external immobilization. As a result of treatment eliminated the distortion of the pelvis, pain disappeared, normalized gait. The patient proceeded to regular employment (accountant) at 6 months.

To date, the proposed method has operated 15 people with unstable spinal segments of the thoracic and lumbar regions with a positive result. Two years of clinical testing of this method has not been a single unsatisfactory result. In neither case did not require a blood transfusion during the operation, because the blood loss did not exceed 300 ml, and any complications were noted. Homie advantages:

- the period of a hospital stay is not more than 2 weeks, which may not ensure none of the known methods; however, bed rest is not more than 3 days;

the method provides the possibility of using it in both the thoracic and lumbar spine, while the prototype method is applied only on the lumbosacral;

- through rear access is provided by extremely low traumatism of the way.

The method developed at the Department of pathology of adolescents, RIICO them.R. R. Vreden and was clinically tested in 15 patients with a positive result.

Used books

1. Zivian J. L. "Reconstructive surgery of chronic spinal cord injuries". Orthopedics, traumatology and prosthetics. 1966, N6, S. 17-26.

2. Movshovich I. A. Operative Orthopaedics. -M.: Medicine, 1983, S. 335.

The method of stabilization of the spine, including fixing the damaged spinal segments with the introduction of the graft, characterized in that as a transplant use a ceramic rod which is introduced into the channel, the pre-formed by drilling two bodies adjacent to the damaged vertebra on totomanova the transverse process or the root arcs of the vertebra, without compromising the integrity of the opposite reflex plate, and before or after the formation of the channel along an area of the spine, subject to surgical intervention, establish distractor or contractor.

 

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