The device for stabilization of the spine

 

(57) Abstract:

Device for stabilizing the spine refers to medicine, namely to traumatology and orthopedics, and can be used for the correction or prevention of severe scoliotic deformities of the spine, stabilization of spinal segments in their instability degenerative or post-traumatic etiology, and recovery support ability of the spine in tumor lesions of the vertebral body. Distractor made with annular grooves throughout the length of the rod and includes brackets for installation on the sacrum, hooks and money fixing them on the shaft. The hooks have a pointed shape at the working end on top of them working end is perpendicular to the plane of longitudinal symmetry axis of the body of the hook, and the rest (2-6 units)-shifted relative to it. The technical result consists in the fixation device, including those with severe spinal deformities. 1 C.p. f-crystals, 1 Il.

The invention relates to medicine, more specifically to traumatology and orthopedics, and can be used for correction, stabilization or recovery support ability of the spinal column.

For herolist, of which the most widespread are static devices submersible type. The most famous distracters Kazmina [1], Ziviani [2], Paja [3], Harrington[4], Cotrel-Debussy [5].

Device Kazmina and Ziviani consist of two anchor plugs connected to the body of the distractor, made in the form of a hollow rod with threads on the inside. They are used for the correction of deformities of the lumbar arch.

Their main disadvantage is that it is threaded design with closed cavities based on spongy bone elements (transverse vertebral processes), which can be a source of complications such as: samarasekera design, fistula formation due to the instability arising from bedsores supporting elements, secondary infectious complications.

The device Rayet consists of a distractor rod with tapered grooves in its upper third and two anchor hooks.

It is not possible to develop a great effort in the correction of the deformation due to the fact that the risk breakdown structure in place to start ratcheting mechanism due to the uniform depth of the grooves on the distractor and the presence of only two hooks for fixing structure, and the deformation. The possibility of using only two points of fixation significantly reduces the correction of the deformity and increases the risk of secondary displacement design in the postoperative period.

Multisupport design Cotrel-Debussy for fixation of the spine uses Sumiregusa screws, svorachivayushiysya in the body of the vertebrae.

However, the use of screws in dysplastic, anatomically modified and osteoporotic vertebrae technically difficult, especially in the thoracic region, which increases the time of surgery and can lead to complications such as an offset screw in spenomegaly channel and the destruction of the vertebral body. Use as fastening elements screws on the rod distractor additional screw and sleeve connections may lead to their zamorakian and secondary offset the loss of correction. The use of additional temporary devices (such as andconnector) to install the basic structure is significantly technically difficult operation and is time consuming.

Closest to the proposed device is distractor Harrington [4] , taken as a prototype. It consists of a rod of the distractor with the conical grooves and stiffness it exclude the possibility to deform the rod distractor, that reduces the effectiveness of its application. In this regard, it is often necessary to use two or more of these distracters for the correction and stabilization of all arcs deformation. This complicates the process and increases the risk of secondary complications due to the large number of implanted metal. Device only two hooks is not possible to develop a great effort in the correction of the deformation due to the possibility of fracture design or bone structures that underpin distractor. There is a particularly high risk of fracture design or bone support with kyphotic component deformation. In addition, the design of the hooks is not possible to install them on the bone support without prior formation of the bed acute way that increases the invasiveness and duration of the operation. Thus, this device does not provide a reliable fixing it, what caused prolonged postoperative bed rest and the need to use external immobilization (corset). This increases the time of inpatient treatment and rehabilitation of patients.

The technical result of the present invention is to increase the reliability of fixation of the distractor by increasing the number of hooks on it and vozmojnostiami distractor with hooks, in which, according to the invention, the distractor rod provided with a bracket with a hole to install and made with annular grooves along the length and with the possibility of giving it forms the spine, and the hooks have a fixation means on the rod and a pointed shape at the working end on top of them working end is perpendicular to the plane of longitudinal symmetry axis of the body of the hook, and the rest (2-6 units) - offset.

Suitable means for fixing the device to perform in the form of a cylindrical hole in the hook with the axis perpendicular to the longitudinal axis of symmetry of the body of the hook and undercut along generatrix of the cylinder to accommodate fixation of the wire.

Supply distractor bracket with hole for lock provides secure installation at the lateral mass of the sacrum, causing her resorption and subsidence of the structure.

The implementation of the distractor rod with annular grooves along the length allows you to quickly and securely locking the hooks in any part of the rod without the use of additional devices.

Execution hooks pointed at the working ends can be installed on bone support without prior formation of enoy the axis of symmetry of the body of the hook, allows you to record segments of the spine even when I cannot find an exact match of the distractor rod and the bone bed.

The use for the manufacture of rod distractor plastic material, such as titanium alloys, makes it easy to give him during the surgical intervention the shape of the spine and determine the number of hooks (2-6) for fixing it to the spine.

We offer funds commit hooks protect against possible displacement of the structure during and after surgery.

For a better understanding of the design distractor here is the image on the drawing, where 1 is the core of the distractor, 2 - straight-hook, 3 - hook with an offset center, 4 - gauge, 5 - locking device.

Working with this device is as follows:

From the slit in the projection of the spinous processes intended for the operation of the site emit a subperiosteal the posterior elements of the vertebral bodies. Hooks, a number from 2 to 6, placed under articular processes of the vertebrae and the lateral mass of the sacrum install the bracket. The rod shape of the spine, and slid it into the hole hooks and perform metered traction along the axis of the stem is to stick then layers are sutured the wound. Hemostasis during the operation.

Clinical examples:

and/b N 2628 Patient Enina E. N. 14.

Diagnosis: Congenital kyphoscoliosis IV Art.

Scoliosis since childhood. The first operation at the age of 9 - the correction of the deformity by the method of Harrington in them. Turner. After that, until 1997 endured 11 surgeries, loss of correction of the displacement of the structure in the closest (up to 2-4 months) period after the operation.

In April 1997, he entered RIICO them. R. R. Vreden in connection with the offset set her designs. The patient offered surgery - correction of deformation by means of the inventive device. Under endotracheal anesthesia incision in the projection of the old postoperative scar allocated to the posterior elements of the vertebral bodies from 5 to breast 1 sacral. Defined space to install hooks and staples, the rod is bent relative to the shape of the spine. After installing the 3 hooks and staples in their holes was wound rod and made a metered traction along the axis of the spine. Hooks fixed on the rod distractor and after checking the reliability of fixing the wound was sutured in layers. The estimated blood loss was 250 ml In the operation succeeded. The patient is lifted to his feet on the 6th day after surgery suture removal 10-day rehabilitation therapy 7 days. External immobilization corset was not applied. Discharged after 3 weeks in a satisfactory condition. At the control examination after six months, the design is stable. Patient has an active way of life, adhering to the General guidelines, the characteristic in the treatment of scoliosis any metal structure.

To date, with the help of this device has operated to 5 people. We have not observed any complications in the postoperative period with the observation period up to 8 months. Obtained during the operation correction is preserved in all patients. 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. The in-hospital period was 4-6 weeks.

The proposed device has the following positive qualities:

- allows you to get the maximum possible correction during surgery,

- provides reliable stabilization of the spine at all stages of treatment,

- ability to use it against the background of significant osteoporosis of the vertebral bodies,

- easily and quickly the situation pathology of adolescents, RIICO them. R. R. Vreden and it was clinically tested in 5 patients with a positive result.

Used books

1. Kazmin, A. I. the Use of metal distractor in the treatment of severe forms of scoliosis. Orthopedics, traumatology and prosthetics. N 6, 1961 , pp. 11-16.

2. Ziviani J. L. Surgical treatment of scoliosis. Novosibirsk, 1964

3. Paja. Correction of scoliotic spinal deformities in children and adolescents. Bulletin of the surgery, so 123, pp. 123 - 127, 1979

4. Harrington, P. R. - Treatment of caused by. Correction and internal fixation by spine instrumentation. J. Bone Jt. Surg. 1962: 44A, 591.

5. The company's catalog Waldemar Link 1995

1. Device for stabilizing the spine, containing distractor with hooks, characterized in that the distractor rod provided with a bracket with a hole to install and made with annular grooves along the length and with the possibility of giving it forms the spine, and the hooks have a fixation means on the rod and a pointed shape at the working end on top of them working end is perpendicular to the plane of longitudinal symmetry axis of the body of the hook, and the rest (2-6 units) - offset.

2. The device under item 1, characterized in that the means for fixing WIPO undercut along generatrix of the cylinder to accommodate fixation of the wire.

 

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