Method for fixing spondylolysis

FIELD: medicine, vertebrology.

SUBSTANCE: at the bottom of spinous process and posterior part of its arch in frontal plane one should form a canal, resect caudal part of spinous process and semi-arch of the above-located vertebra so to form two transplants upon connecting flaps to replace the defect of inter-articular parts of arch after dissecting the obtained osseous fragment and inter-spinous ligament. Then on should introduce a rod into this canal and move it cranially to fix the ends in screws' caputs inserted into the roots of vertebral arches in case of spondylolysis that enables to restore the function of vertebral mobile segment.

EFFECT: higher efficiency of fixation.

10 dwg, 1 ex

 

The invention relates to medicine, namely to traumatology and orthopedics, and can be used with the defeat of the posterior structures of the spine.

There is a method of fixation of the posterior structures of the vertebra in the presence of a defect in his interarticular part by means of wire by holding it over the transverse processes of the transition and capture the base of the spinous process and exposure of bone in the defect area and the contraction of the fragments (Keith H. Bridwell. The Textbook of Spinal Surgery. Second Edition, Vol.2. Lippincott Raven. 1997. P.1202-1206). However, this does not create a rigid fixation, in load conditions persist movement of fragments of vertebrae and restore the isthmus part of the bow does not occur.

Closest to the claimed is the method of fixation isthmus part of the pedicles of the vertebra by means of the hooks are clasped behind the lower part of the bow with the tightening and fixing them to the heads of the screws that held transpedicular, a preliminary introduction to the area of defect free bone graft (John W.Frymoyer. The Adult Spine. Principles and Practice. Second Edition. Vol.2. Lippincott Raven. 1997. P.1894-1897). The disadvantages of the method are the preservation of the mobility in the area of spondylolysis due to the continued motion of the rear part of the arm rotation and extension movements in the spine that does not create optimal conditions for bone fusion in the area of defects.

The objective of the invention is to restore the anatomical integrity of the arch of the affected vertebrae and restore the function of the affected segment of the spine.

When performing the method has a positive therapeutic effect, which consists in restoring the anatomy of the vertebrae, preventing progression of the disease, the elimination of pain and fatigue sensations in the spine. The economic effect is to reduce the length of stay of the patient in the hospital. Social effect: method allows to improve the quality of life of those affected.

The technical result is achieved due to the stable fixing zone of the defect interarticular part of the bow and plastics his graft ligament subperiosteal flap, accelerating bone fracture that leads to the restoration of motor functions of the spinal segment.

The problem is solved due to the fact that at the base of the spinous process and the rear arm in the frontal plane form a channel, the caudal part of the spinous process and palubicki viersprong vertebra resetinput thus, what is obtained after dissection of bone fragments and megastate ligaments in the sagittal plane and partial clipping of the yellow ligament consists of two graft ligament patches, which perform the defect interarticular parts of the bow, formed in the channel conducting metal rod, promote it in the cranial direction and the ends are fixed in the head of the screw is in, entered into the roots of the bows of a vertebra having spondylolis.

The method is as follows. In the position of the patient on his stomach, under General anesthesia provide access to the posterior structures of the vertebra with spondylolysis defect in interarticular part of the bow. To create conditions for the restoration of the anatomic integrity of the interarticular portion of the shackle in the vertebra with spondylosis, according to anatomical landmarks spend transpedicular screws 1 (figa). Remove scar tissue from the area of the defect 2 (figa) in its interarticular parts on both sides, and remove sclerotherapy bone turned to each other surfaces of this part and the adjacent part of the rear surface of paludosus and the bases of the transverse processes on both sides. The caudal part of the spinous process and palubicki above vertebra mark 3 (fega), and then their resetinput thus, what is obtained after dissection of bone fragments and megastate ligaments in the sagittal plane and partial amputation of the yellow ligament formed two transplant 4 (figb) ligament of the flaps 5 (figb). Grafts to the right and left turn and introduce defects interarticular parts of the bow. At the base of the spinous process and the rear part of the pedicles of the vertebra with spondylosis, latero-lateral direction F. reroute channel 6 (figb). Through him teach and model the wire so that its shape and length to give the necessary bends the rod, the diameter of which corresponds to the diameter of the formed channel in the spinous process and produzca. The bent rod 7 (pigv) is conducted through the channel, the end parts are placed in the heads held transpedicular screws. Creates compression in defects interarticular parts of the bows, where the embedded grafts, promotion rod in the cranial direction and fixing it in the heads of the screws by tightening the nuts 8 (pigv). Implemented in this way a stable fixation eliminates mobility in interarticular part of the shackle, and plastic autotransplants ligament patches provides rapid bone Union in this area and the restoration of the anatomical integrity of the vertebra, which ultimately leads to the elimination of pain, functional insolvency of the spine.

An example of clinical application

Patient Century. 15 years old (case history No. 1562/2001) appealed with complaints of pain in the lumbar spine that occur when standing, tilt, long seat and carrying of heavy loads. Clinical and radiographic examination. On radiographs of the lumbar spine (figure 1) revealed bilateral the isthmic spondylolis L3 vertebra. On the basis of clinical and radiological examination diagnosed with bilateral isthmic spondylolis L3 vertebra. Lumbodynia. Functional failure of the lumbar spine.

Conducted conservative treatment was ineffective. The decrease of pain syndrome occurred only when wearing rigid orthopedic belt.

Given this, patients received surgical treatment by the method of fixation of spondylolysis. Under General anesthesia in the prone position on his stomach made access to the rear of the anatomical elements of the L3 vertebra. Revealed bilateral spondylolis isthmic part of paludosus, of which removed the scars, resected sklerozirovana bone. According to anatomical landmarks in the roots of the arms L3 on both sides of the formed channels through which were held transpedicular screws. Caudal part of the spinous process and palubicki L2 vertebra initially left resected so that the formed bone graft in a subperiosteal-ligament flap yellow and megastate ligaments (figure 2). The graft is rotated (figure 3) and introduced into the defect interarticular part of palubicki L3 (figure 4). Such manipulation is made on the opposite side. At the base of the spinous process and the rear part of the arm L3 from left to right by means of a drill formed ka the al (figure 5). Through him, held the rod, which gives the desired bend. The rod is placed in the head transpedicular conducted screws. Then he pushed in the cranial direction and simultaneously fixed in the heads of the screws and nuts (6), which created the compression zone spondylolysis on both sides, which were established grafts, and provided the immobility of the fixed anatomical elements of the L3 vertebra. Sutured the wound healed by first intention. For 3.5-4 months the patient was kept gently. Pain in the lumbar spine was gone. Have a clinical recovery. On radiographs of the spine through 1.5 years after surgery restored anatomical integrity L3 saved (Fig.7). Zone spondylolysis not traced.

The method of fixation of spondylolysis by introducing transpedicular in the vertebra screws, creating compression in the area of spondylolysis and bone plasticity his, characterized in that the base of the spinous process and the rear arm in the frontal plane form a channel, the caudal part of the spinous process and palubicki upper vertebra resetinput thus, what is obtained after dissection of bone fragments and megastate ligaments in the sagittal plane and partial cut yellow ligaments form two transplant tie is cnyh the flaps, which perform defect interarticular parts of the bow, formed in the channel conducting metal rod, promote it in the cranial direction and the ends fixed in the heads of the screws, put in the roots of the bows of a vertebra having spondylolis.



 

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