A method of surgical treatment of scoliosis

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology, and can be used for the treatment of scoliosis. Perform a laminectomy and opening of the spinal canal. Measure capillary blood flow in the spinal cord using a needle intraoperative sensor on top of deformation, cranial and Caudalie from it. Perform discotomy and re-measured capillary blood flow. Enter rods-screws in the vertebrae located cranially and Caudalie from dichotomie. Produce a mounting device for external transpedicular fixation. When the value of capillary blood flow to 20 ml/min 100 g at the top of deformation and the amount of blood flow from 18 to 40 ml/min 100 g of cranial her perform intraoperative distraction on the concave side are not more than 5 mm and spend conservative therapy aimed at improving the microcirculation of the spinal cord. When the amount of blood flow on top of deformation above 25 ml/min 100 g and the amount of blood flow in the caudal segment of more than 40 ml/min 100 g provide distraction from 5 to 20 mm. Way helps to prevent neurological complications. table 2.

The invention relate to medicine, namely the blood flow to the spinal cord for the prediction and prevention of neurological complications in the surgical treatment of scoliosis in the course of surgery, and after it.

The known method of intraoperative electrophysiological studies of the condition of the damaged segment and adjacent segments of the exposed spinal cord (Zhuravleva, N. By the Technique of intraoperative electrophysiological testing security structures travmaticheskii damaged spinal cord /spine Pathology. Sat. the scientific. Tr. - L.:, 1990. - S. 54-59).

The known method of prevention of neurological disorders in the surgical treatment of patients with dysplastic scoliosis by an accurate assessment of the structure and the research status of spinal cord and spine using magnetic resonance (Voronovich I. R. et. al. Peculiarities of the spinal canal state in severe scoliotic deformities Management of spinal disorders: ST-PETERSBURG: 1999. - P. 76).

The known method electrophysiological evaluation of postoperative neurological disorders associated with surgery and metered traction loads in patients with dysplastic scoliosis treatment device for external transpedicular fixation, which in the surgical treatment of scoliosis after imposition of cutaneous electrophysiological sensors tested neurological disorders in the postoperative lane is to airavat and prevent neurological complications, because it is available only to state (Shein A. P. and other Electrophysiological characteristics of the morbidity of surgical treatment of scoliosis. Ischemia of the brain. The Intern. Symposium: St. Petersburg, 1997, - S. 283-286).

The objective of the invention is to develop a method of treatment of scoliosis in conjunction with the forecasting and prevention of neurological complications in the surgical correction of spinal deformity by intraoperative determine the status of spinal cord blood flow.

The problem is solved in that in the method of treatment of scoliosis, including the imposition of the device for external transpedicular fixation and correction of deformation, after performing a laminectomy and opening of the spinal canal using intraoperative needle gauge, measure capillary blood flow in the spinal cord at the apex of deformity, cranial and Caudalie from it, then do discotomy and re-measured capillary blood flow, then enter rods-screws in the vertebrae located cranially and Caudalie from dichotomie produce a mounting device for external transpedicular fixation, when the value of capillary blood flow to 20 ml/min g on top of deformation and ve is largely a distraction on the concave side are not more than 5 mm, but values of blood flow on top of deformation above 25 ml/min g and the meanings of blood flow in the caudal segment of more than 40 ml/min g provide distraction from 5 to 20 mm

Patenting an invention to explain a detailed description of the implementation method, tables, and clinical examples.

The method is as follows.

Operating under endotracheal anaesthesia surgery. Perform a laminectomy of the vertebrae at the apex of deformity. After opening the spinal canal produce a measurement of the volumetric capillary blood flow of the spinal cord, which used laser Doppler flowmeter (BLF-21, "Transonic System, USA) and intraoperative needle gauge (type N18) with the diameter of the needle 1,2 mm

Measurement of the volumetric capillary blood flow of the spinal cord carry on the apex of deformity of the spine, cranial and Caudalie from it.

Comparison of capillary blood flow at different levels shows (table.1) that in the zone of maximum bending of the spinal cord at the apex of deformity of the spine, blood flow is discounted by an average of 39,33,8% relative to the values obtained in the cranial region and 50,46,1% relative to coudlnt blood on top of deformation (or in the zone of maximum bending of the spinal cord at the apex of deformity of the spine) cranial and Caudalie from it. Then enter the rod screws into the vertebral body located cranially and Caudalie from dichotomie produce a mounting device for external transpedicular fixation.

When the values of spinal cord blood flow on top of deformation up to 20 ml/min g and the range of cranial blood flow region from 18 to 40 ml/min g (table.2) to introduce medications and perform intraoperative distraction on the concave side are not more than 5 mm, with subsequent fixation of the achieved position of the spine by applying the device for external transpedicular fixation. If indicated blood flow on top of deformation above 25 ml/min g and Caudalie segment more than 40 ml/min g, provide distraction from 5 to 20 mm (with subsequent fixation of the achieved position of the spine device for external transpedicular fixation).

In table. 2 shows the dependence of the performance of spinal cord blood flow and intraoperative distraction of the spine.

Clinical example 1. Patient S., aged 15, the diagnosis of Dysplastic S-shaped thoracolumbar scoliosis stage III. Left rib hump. Thoracic deflection axis of the spine to the left, Vechna arc of curvature falls on the D8right, the top of the arc falls on the L3vertebra, the angle of deformation -15o.

When conducting electromyographic studies revealed a moderate decrease in performance. Temperature and pain sensitivity is not compromised.

The patient was vipiteno surgical treatment. The operation included laminectomy D10vertebra, partial resection of the arcs of D9-D10discotomy D9-10D10-11the overlay device for external transpedicular fixation. In the postoperative period was made gradual correction of scoliosis (distraction on the concave side).

During surgery after laminectomy and opening of the spinal canal made the study of spinal cord blood flow. Volumetric capillary blood flow in the zone of maximum bending of the spinal cord was 17-18 ml/min g, above the zone of maximum bending - 23-25 ml/min g, below - 68 ml/min, After mounting the device for external transpedicular fixation intraoperatively was a distraction on the concave side of 5 mm was held conservative therapy aimed at improving the microcirculation of the spinal cord.

After treatment, the percentage of correction of scoliosis in the thoracic region was 53%, the HPI IV degree. Right rib hump. The top of the scoliosis was located on the D8the vertebra. Angle strain was 48o.

When electromyographic study registered a moderate decline. Holding esthesiometer showed a reduction in temperature and pain sensitivity in 4 dermatomes.

The operation was performed similarly to the first clinical example. Intraoperative study of spinal cord blood flow showed that the volume of capillary blood flow in the zone of maximum bending was 28-29 ml/min g, above bending 42-45 ml/min g, below - 41-43 ml/min, After mounting the device for external transpedicular fixation produced a distraction on the concave side 20 mm

Postoperative period was unremarkable. After removing apparatus, the percentage of correction of the deformity was 79%. There was a positive dynamics of indicators of electromyography and esthesiometer.

The proposed method of surgical treatment of scoliosis can reduce the angle of spinal deformity, prediction and prevention of neurological disorders.

A method of treatment of scoliosis, including the imposition of external device transpedicular the CSO channel is measured capillary blood flow in the spinal cord using a needle intraoperative sensor on top of deformation, cranial and Caudalie from it, then do discotomy and re-measured capillary blood flow, then enter rods-screws in the vertebrae located cranially and Caudalie from dichotomie produce a mounting device for external transpedicular fixation, when the value of capillary blood flow to 20 ml/min 100 g at the top of deformation and the amount of blood flow from 18 to 40 ml/min 100 g of cranial her perform intraoperative distraction on the concave side are not more than 5 mm and spend conservative therapy aimed at improving the microcirculation of the spinal cord, and when the amount of blood flow on top of deformation above 25 ml/min 100 g and the amount of blood flow in the caudal segment of more than 40 ml/min 100 g, provide distraction from 5 to 20 mm.

 

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FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.

EFFECT: higher efficiency of therapy.

5 dwg, 1 ex

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