Method of surgical treatment of dysplastic scoliosis iii and iv in children and adolescents

 

The invention relates to medicine, namely to traumatology and orthopedics. Simultaneously with the establishment of andconnector on the spine produce a subperiosteal resection of the ribs on the convex side of the deformity and subperiosteal dissection of the ribs on the concave side of the deformity, and with rigid forms of dysplastic scoliosis IV degree at the height of deformations produce hemilaminectomy 2-3 arches at the apex of deformity of the spine that allows you to achieve the best possible correction and reduce neurological complications 3 Il.

The invention relates to medicine, namely to traumatology and orthopedics.

Known methods of treatment of dysplastic scoliosis with the use of double-vane andconnector (U.S. Pat. Of the Russian Federation No. 2037318 from 9.06.95, "Application of andconnector for surgical treatment of spinal curvature in children. The methodological. Recommendations. Moscow-Krasnoyarsk, 1985, 32 S.).

The disadvantage of the methods is that they do not allow maximum correction of scoliotic spinal deformity in III and IV degrees dysplastic scoliosis in children and adolescents.

There is a method of surgical treatment of spinal curvature using end the violence.with. The USSR №1547101, from 01.11.89).

The disadvantage of this method is that during the operation is not achieved the maximum possible correction without neurological disorders.

The objective of the invention is to achieve the maximum possible correction of scoliotic deformities and reduced neurological complications.

The problem is solved in that in the method of surgical treatment of dysplastic scoliosis III and IV in children and adolescents with the use of double-vane andconnector simultaneously with the establishment of andconnector on the spine produce a subperiosteal resection of the ribs on the convex side of the deformity and subperiosteal dissection of the ribs on the concave side of the deformity, and with rigid forms of dysplastic scoliosis IV degree produce hemilaminectomy 2-3 bows on the top of the spinal deformity.

A method for the treatment of dysplastic scoliosis is shown schematically in Fig.1-3.

In Fig.1 - scheme of the spine in scoliosis.

In Fig.2 - spondyliosoma patient N. 14, the deformation of the spine 74(IV degree).

In Fig.3 - spondyliosoma the same patient after surgery. Warp 20Correction of 83%.

Fig 1. shows the deformed pozvolyayuschimi 4.

The method is as follows.

Provide rear access to the spine with the exposure of the entire arc of curvature.

Next, make access to the rear surfaces of the ribs, at first convex 2, then concave on 3 sides of the deformation. On the convex 2 side strain to separate the periosteum and subperiosteal resetinput 5-7 ribs, 6-8 cm, participating in formation of the rib hump. On the concave side produce a subperiosteal dissection 3-4 ribs, situated at a height of spinal deformity. This allows for the most possible to mobilize the spine to achieve the greatest correction of scoliotic deformities. To prevent local lesions of the spinal cord during simultaneous deformation of the spine with rigid forms of dysplastic scoliosis IV degree with the purpose of decompression are hemilaminectomy 4 2-3 bows on the top of the spinal deformity.

A subperiosteal resection and dissection of the edges is carried out only in children and adolescents, because regenerating only the child's body can recover ribs.

After you perform installation of andconnector Rodnyansky-Supalova by well-known methods, for which under control is short (4 to 7) levels across the curvature.

The hook attached to the shackle of the vertebra by screwing the rack hook the heel of the hook with the introduction of the rack into the body of the shackle, this position is fixed by a nut that eliminates the offset hook and creates a stable postoperative fixation.

The design of the hooks and the method of deciding under arm eliminates the risk of damage to the membranes of the spinal cord. If the rack hook by screwing into the side of it completely goes, it rests on the nose of the hook.

A pair of hooks are connected to the blocks by pins with an elongated groove and nuts. When this stud with groove strain and vertically align the hooks in blocks.

To the thus created to the mounting blocks fixed to the elastic plate, located on both sides of the spinous processes for the curvature, which are the earrings and the clamps that allow you to move the plates in a vertical plane.

Denotational effect is created by dosing the required amount of force 2-3 hooks with a concave side at the top of the spinal curvature by pulling them through the threaded rack unit with the support plate. Possible additional phased correction in subsequent interventions. If necessary, targeted tightening Oh kyphosis and lumbar lordosis for their normalization. Special pliers skusyvat protruding parts racks hooks and studs.

The proposed method allows to achieve the maximum possible correction of spinal deformity, reduces the risk of neurological disorders, leads to greater denotational effect and better cosmetic results.

According to the method in our clinic was held on 29 operations. All patients were with III degree of scoliosis (from 37up to 56on cobu). Postoperative correction of the main arc deformation ranged from 41 to 63%. However, in the postoperative period, 3 patients showed neurological complications in the form of lower hemiparesis in 1 case we observed damage to the dural SAC with the formation of further liquor fistula and in 2 patients in long-term period were identified fractures plates andconnector.

The proposed method in the clinic was operated 42 patients in the age group of 10 to 16 years, including 39 girls and 3 boys. Among them, 31 patients with III degree of scoliosis (34-58on cobu). Correction of the main arc deformation in the postoperative period have ranged from 53% to 87.5%. 11 patients had IV step is raised from 30% (at stabilizing operations) to 84% (with corrective actions).

Neurological complications in the form of moderate lower hemiparesis was observed in 1 case in a patient with IV degree of scoliosis (84on cobu) and correction of 54%. In the late postoperative period in this patient in the appointment of adequate medical and rehabilitation therapy was observed regression of neurological deficit.

Loss of correction of the deformity in the late postoperative period (3 years) ranged from 6 to 28% while using classic techniques, it reached 46%.

Claims

Method of surgical treatment of dysplastic scoliosis III and IV in children and adolescents using andconnector Rodnyansky-Supalova, characterized in that simultaneously with the establishment of andconnector on the spine produce a subperiosteal resection of the ribs on the convex side of the deformity and subperiosteal dissection of the ribs on the concave side of the deformity, and with rigid forms of dysplastic scoliosis IV degree at the height of deformations produce hemilaminectomy 2-3 bows on the top of the spinal deformity.

 

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