Method and puncture needle for carrying out paracentetic non-endoscopic laser-mediated intervertebral disk nucleotomy

FIELD: medicine.

SUBSTANCE: method involves making access to pulpous nucleus and evaporating a portion of its substance by means of repeated sequential actions with laser radiation having effective wavelength in effective power dose creating cavity in the pulpous nucleus in changing laser beam direction treatment-by-treatment. Adjacent elongated closed canals are formed from the cavity formed in the pulpous nucleus so that their axes were inclined at an acute angle to each other intersecting practically at the same point. The puncture needle is brought to the pulpous nucleus through fibrous disk ring. Some pulpous nucleus substance portion is evaporated and the puncture needle is returned in reversed way so that its distal end is placed into the center of hernial protrusion aside from the fibrous disk ring and direct vaporization of the hernial protrusion is carried out. The puncture needle for carrying out paracentetic non-endoscopic laser-mediated intervertebral disk nucleotomy is manufactured as tubular rod having longitudinal axis, tail and distal part with distal end curved at an acute angle to the longitudinal axis. Distal end bevel is directed towards distal part curvature and has angular plane displacement for making conductor, light guide easily pass and additionally deflecting laser beam from distal light guide end.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

33 cl, 10 dwg

 

The invention relates to medicine, namely, neurosurgery, and is intended for treatment of degenerative disc disease of the spine, in particular for the treatment of compression forms of lumbar osteochondrosis puncture endoskopicheskim method using a laser beam.

A known method of percutaneous laser discectomy and decompression of the lumbar discs, namely, that to the fibrous ring of an intervertebral disc under fluoroscopic control introduces the endoscope, and then through the working channel of the endoscope is inserted quartz light guide through which the tissues of the disc is supplied laser electromagnetic radiation with certain parameters (Choy DS, Altman P, Trokel SL "Effeciency of disc ablation with lasers of various wavelengths", Clin. laser Med.Surg. 1995, 13 (3), R-156). In the heat generation due to absorption of energy at the end of the fiber and surrounding the tissues evaporation tissues in the Central parts of the disk, representing mainly the pulpous nucleus in the form of a gelatinous substance. Due to this evaporation in the Central regions of disk form a cavity with a volume of several cubic centimeters. A bulge is noticeable partially drawn into the formed cavity, additionally is wrinkling and compression of the collagen tissue of the disc, which reduces the profile hernial protrusion. In the e the CSOs pressure protrusion on the neural elements of the spinal canal is reduced, and the pain and other symptoms decrease or disappear. This method differs little trauma to tissues, compared with open discectomy, a relatively short recovery period, a small percentage of adverse outcomes and recurrence. However, after conducting such operations intervertebral bulge is noticeable reduced, but not completely resolved. In addition, used endoscopes, for example in the form of multi-channel hollow needle with a curved end (patent US 4808157, publ. 28.02.1989), have a relatively large diametrical dimensions, which leads to the increase of the degree of injury of the operation.

When conducting endoskopicheskih operations, for example, under x-ray control, to puncture used hollow puncture needle, the diametrical size of which is less than that of the endoscope as in the case of single-channel and multi-channel execution, for example, coaxial cable TV (patent US 4959063, publ. 25.09.1990).

The known method Aigozel treatment of osteochondrosis by puncture of the intervertebral disc by the hollow needle and dosed on the pulpous nucleus, according to which in the cavity of the needle, the end of which is immersed in the disk, enter a point source of heat at the other end of the guide laser beam, the energy of heat radiation dose change of the radiation power, carry out heat is TV exposure, creating depending on the stage of the disease the required temperature of heating of the nucleus pulposus and its destruction and disposal through the cavity of the needle its decay products (patent RU 2012388, publ. 15.05.1994). Using a laser power of 20 W for 20-35 sec.

There is a method of treatment of an osteochondrosis of a backbone, in which the use of laser radiation with a wavelength of 960-980 nm, with a capacity of 2.5 to 5.0 volts and the total energy of radiation upon evaporation of 360-720 J. (patent RU 2212916, publ. 27.09.2003). First drive the dotted line conductor in the form of metal needles, which, after perforation of the annulus advance to the third quarter of the disk. Then the guidewire is inserted a hollow metal needle. The position of the guidewire and needle control using electro-optical Converter. Then the conductor is removed, and the needle is injected quartz fiber, the other end of which is optically connected to the laser facility "Lason-10-P". Next, carry out energetic influence on the area in the center of the disk and in the immediate vicinity of hernial protrusion. The vaporizing substance spontaneously removed in the gaseous state through the clearance between the fiber and the inner surface of the needle. As a result of exposure under grievin the protrusion form a cavity with a volume of about 2 cm3. The cavity results in the reduction of intradiscal pressure, resulting forces acting on the contour of the disk, directed inwards, resulting in a bulge is noticeable drawn into the formed cavity, and the laser irradiation rear sections of the collagen tissue of the disc shrink and thicken.

A known method of surgical treatment of radicular syndrome with osteochondrosis of the lumbar spine (patent RU 2054956, publ. 27.02.1996). The method includes access to the pulpous nucleus of an intervertebral disc through the channel 4.0 mm, created by the laser radiation power of 50 W and a frequency of 50 Hz, and the subsequent evaporation of the substance of the nucleus pulposus within 2-3 min by means of a deflection of the fiber emitter from the original axis 5-7° in different directions, forming the core of the cavity volume 2.0-2.5 cm, using a laser-based yttrium aluminium garnet with a wavelength of 1060 nm.

To the General disadvantages of the above methods is that the treatment is in many cases still does not lead to complete elimination of hernial protrusion, because the puncture is carried out through the annulus outside the hernial protrusion, because it was believed that the puncture and direct exposure to laser radiation to this area can cause unwanted complications. With this approach in the pulpous nucleus, generally outside hernial protrusion, created the considerable volume of the cavity, who themselves are traumatic enough, which increases the recovery period, and also reduces the elasticity of the intervertebral disc. In addition, a relatively large outer diameter of the used tools is not possible to reach directly to the hernial protrusion without the threat of injury sensitive spine.

These shortcomings deprived known method of treating intervertebral discs, in which the influence of the laser radiation is subjected directly bulge is noticeable, while the alleged previously possible complications are not marked (patent US 6562028, publ. 13.05.2003). In the implementation of this method first hollow straight puncture needle transdural Explorer lead directly to vibriosea ring approximately in the middle of the hernial protrusion without contact with him. The needle enter the light guide through which conduct the laser impact directly on the bulge is noticeable (direct vaporization). As the formation of the fibrous ring evaporated channel, the latter in the direction of the nucleus pulposus using Windows Explorer promote fiber and needle and then evaporated cavity in the area of hernial protrusion directly. The way, in the particular case, is performed with the use of cooling parts of the body around the intervertebral disc. Manipulations made in the field under control, why use x-ray roentgenocontrast, magnetic resonance imaging or computed tomography. However transdural holding the puncture needle may be accompanied by damage to the cauda equina roots and infectious complication. In addition, the fiber during exposure is directly in the spinal canal, which can lead to radiation defeat dural SAC.

As the prototype is set to a known method, percutaneous laser discectomy, according to which uses a laser with a different wavelength (patent US 5084043, publ. 28.01.1992; patent divisional application of US 5201729, publ. 13.04.1993). The method consists in the puncture of an intervertebral disc, the evaporation of the nucleus pulposus and the substance of the disk by the sequential use of hollow steel puncture needle with a curved distal end, an Explorer in the form of elastic pointed spokes. After insertion of the needle guide removing and inserting a fiber laser device. Subsequent tap of products of evaporation can be carried out using aspirazione-irrigation device. With the help of laser energy first create first evaporated cavity, and then perform the second and subsequent evaporation. The second and subsequent viparyayah needle powerchip is jut around the longitudinal axis, increasing the evaporated region. The bending of the needle and its point in the form of an oblique slice to reject the laser beam from the longitudinal axis of the needle, so after consecutive turns of the needle evaporated region has a tapered shape. For turns using a special needle shank. In addition to the above-mentioned drawback, related to the relatively large volume of the vaporizing cavity, to the disadvantage also applies that used to sharpen as conductor and needles cause a relatively large effort required to overcome friction, especially in the bend of the needle, their mutual longitudinal displacement relative to each other, and, as a consequence, the deviation of the laser beam emanating from an end of the fiber, at a greater distance from the longitudinal axis of the need to increase the diametrical size of the needle, which increases the degree of injury.

Solved technical problem - increasing the effectiveness of treatment of osteoarthritis of the spine by reducing injuries tissues of the intervertebral disc and surrounding anatomical structures when conducting needle endoskopicheskoi laser nucleotomy.

We propose a method of conducting needle endoskopicheskoi laser nucleotomy intervertebral disc, including access to the pulpous nucleus and the evaporation of part of the substance of the nucleus pulposus with POM is by repeated sequential effects of the laser radiation with an effective wavelength in the effective energy dose with the changing direction of the laser beam from impact to impact. What's new is that due to the evaporation of part of the nucleus pulposus in it form a contiguous closed elongated channels, the axes of which are at an acute angle to each other and intersect almost at the same point. The proposed method is a gentle, because instead of volume of the cavities, as in the known technical solutions, generates multiple channels is much smaller, it is possible using a laser of lower power and instrument sufficiently small diametral size, which also reduces the trauma and allows access to the pulpous nucleus directly through the bulge is noticeable without the threat of injury sensitive spine.

Before exposure to laser radiation in the pulpous nucleus better to introduce an effective amount of a hypertonic solution, which you can use 10%aqueous solution of sodium chloride. This also reduces the possibility of trauma, in particular from the burn tissue.

Hypertonic solution can be administered in amounts of 0.5 to 2.0 ml.

The impact is better to perform laser radiation with a wavelength of 960-980 nm. Thus the capacity of a single impact can be 2-4 watts and a total energy dose of 540-1200 J.

Elongated channels is better to form a cone extending from the point of intersection of their axes.

L is CSE, when the total amount of elongated channels is not more than 2% of the volume of the intervertebral disk.

The better channels to form part of the nucleus pulposus in the vicinity of a hernial protrusion.

Better when at least part of the manipulation is performed under control selected from the group: fluoro x-ray, magnetic resonance control, computer tomography.

After forming elongated channels bulge is noticeable can be subjected to direct vaporization.

Best when to access the pulpous nucleus of the intervertebral disc the dotted line in the elastic conductor, then in the pulpous nucleus guidewire is inserted a hollow puncture needle, after which the conductor is removed.

In the pulpous nucleus through a hollow puncture needle with a gap can be inserted distal end of the light guide, the proximal end of which is optically connected to the laser source.

For the formation of the first elongated channel can be used straight hollow puncture needle.

For forming elongated channels is better to use a hollow curved needle needle that rotates around its longitudinal axis from impact to impact.

Thus, before rotation of the hollow puncture needle around its longitudinal axis, the distal end of the optical fiber, the better to draw in the cavity of the puncture needle.

Better when the distal end cut at an angle of 20-40° to the longitudinal axis of the distal portion of the shaft.

Better when the distal portion of the rod is bent to the longitudinal axis of the rod at an angle of 5-25°.

Better when the length of the distal portion of the rod does not exceed half the diameter of the intervertebral disk.

Preferably, the cut distal end oriented so that the plane of the cross-section of the distal portion of the rod in the cut distal end of the angular offset between the diametrical axis of the cross section, perpendicular to the plane of bending of the rod, and a projection of the plane of the cut distal con is and is 12-70° .

The needle can be provided with a resilient conductor in the form of needles with a pointed distal end, and the outer diameter of the cross section of the spokes is made smaller than the inner diameter of the cross-section of a hollow core needle, and the point is made wedge-shaped with two faces with an angle 16-50° at the top of the taper. This dihedral tapering not only helps to Orient the guide during the puncture, but precisely orients in the angular direction of the needle itself during its introduction in the pulpous nucleus.

Better when the needle is additionally a wedge-shaped sharpened in the plane perpendicular to the faces, and the angle at the vertex of additional sharpening is 60-130°.

The invention is illustrated by drawings. Figure 1 presents a top view of a bent needle needle, figure 2 is its side view, and figure 3 - cross section of its distal part. Figure 4-5 shows the distal portion of the conductor on the main view and top view, respectively. The invention is also illustrated by drawings, where figure 6-10 schematically explain the basic stages of puncture endoskopicheskoi laser nucleotomy intervertebral disk.

The invention is illustrated on an established and proven methodology polyaniline laser decompression of intervertebral disc (PLD), which is the original the option puncture endoskopicheskoi laser nucleotomy.

For carrying out the operation according to the method PLDD apply a few basic tools.

Curved hollow puncture needle 1 (see Fig.1-3) has a distal end 2, a curved angle α=10° to the longitudinal axis 3, the distal end 4 is sharp cut at an angle of 25° to the longitudinal axis of the distal portion 2, and the cut plane is oriented at an angle β=45°. At the proximal end of the needle 1 has a shank 5. The needle 1 is made of steel, has an external diameter of 1.6 mm, an inner diameter of 1.0 mm, total length 100 mm and the length of the distal portion 12 mm

The conductor 6 in the form of a steel needles with a length of about 300 mm round cross section with a diameter of 0.9 mm is at the distal end 7 tapering in two perpendicular planes with angles γ=90° and δ=25° (see Fig.4-5).

In addition, use: light pipe 8 made of quartz svetovolokna, with an external diameter of 400-500 μm with a length of about 300 mm; steel hollow straight puncture needle 9 with dimensions similar to the needle 1.

The operation according to the method PLDD performed under local anesthesia with intravenous augmentation, because it requires constant contact between doctor and patient to avoid damage to adjacent structures of the spinal canal.

In x-ray operating room the patient is placed on the x-ray table on the left side. Manipulation is performed under the fluoroscope is economic control with the use of electron-optical Converter (EOC).

The intervertebral discs 10 by the dotted line Explorer 6 and needles 1 and 9 as follows:

- puncture disc L4-L5 produce through the intervertebral foramen of the modified access De Sessa and Lavergne (de Seze S. et Levernieux J. L injection directe du nucleus pulposus par voil paravertebrale// Sem. Hop. Paris. 1951. V.27/28. P.1230-1231);

disc L5-S1 dotted line method Erlacher developed for access to the back-side and Central departments of the disk, the puncture is performed between the arms, the more medially articular processes, retreating from the middle line 1-1,5 cm (Erlacher P.R. Klinische und diagnostische Bedeutung der Nukleographie// Z. Orthop. 1950. V.79. No. 2. R-278);

disks L4-L5 and L5-S1 the dotted line through the intervertebral foramen or between the arms and the disc herniation scheme topographic-anatomic relationships at the level of, respectively, L4-L5 and L5-S1 vertebrae (the cake A.A., Talshynskaya P.P., Khvesyuk NI Surgical approaches to the thoracic and lumbar vertebrae. M: Medicine. 1968).

The disk 10 by the dotted line Explorer 6 in through a bulge is noticeable 11 one of the methods above. After perforation of the posterior of the annulus 12, the conductor 6 to promote the third quarter of the disk 10 (see Fig.6).

Explorer 6 until about the middle of the disk 10 is injected straight needle 9, making sure that the needle 3 is positioned parallel to the switching plates of the vertebral bodies. The position of the conductor 6 and the needle 9 is controlled in the sagittal and frontal flat the positions on the screen of the image intensifier. Because the needle 9, is located at an acute angle (35-40°) to the horizontal plane, the image intensifier tube oriented perpendicular to the direction of needle 9.

When the puncture disc 10 and the passage Explorer 6 or needle 9 through the bulge is noticeable 11 is often noted provocative test increase in pain with radiating leg. In this case, the patient specify which leg is pain irradiation. If the pain occurs in the intact limb, it is necessary to make pereformyrovanye, because the tip of the conductor 6 or needle 9 is likely near the contralateral spine, i.e. opposite to the hernial protrusion 11 of the disk 10 (angle position of the needle 9). The position of the needle 9 is considered optimal when the puncture channel passes through the Central part of the hernial protrusion 11.

The conductor 6 is removed, leaving the needle 9 in the optimum position.

Later in the disc 10 through the cavity in the needle 9 is injected hypertonic solution (10%sodium chloride solution) in the amount of 0.5-2.0 ml, depending on the capacity of the disk 10.

Then, in the cavity of the needle 9 to its distal end to enter the light guide 8, the proximal end of which is optically connected to the laser facility "Lason-10-P" (scalpel-coagulator portable laser THAT 9444-001-07504407-99).

Initially, the influence of the laser radiation passes through the needle 9 (see Phi is .7). The exposure time (exposure time) - with 15-20, power radiation with a wavelength of 970 nm to 3 watts, which corresponds to an energy dose of 45-60 J.

After laser exposure light guide 8 is extracted and formed in the cavity 13 add a small amount (0.2-0.5 ml) hypertonic solution.

Then, the needle 9 is again injected Explorer 6, after which the needle 9 is removed. On the screen of the image intensifier specify the position of the conductor 6, after which it about the middle of the disk 10 is injected curved needle 1. The conductor 6 is removed. Needle 1 pull back to the fibrous ring 12 and again hold forth in the pulpous nucleus of the disc 10 is approximately the same distance. When the distal end 4 takes away from the original direction due to bending α. From this position the needle 1 can form a new channel 14. The process of creating a new channel 14 consists of two main stages - the actual formation of the channel 14 and its extension (smfg). 1. The needle 1 enter the light guide 8. Then 5-15 with included laser radiation with a power of about 3 watts, the light guide 8 is held by three quarters drive forward and pulled back, forming the channel 14. Laser radiation is switched off. The needle 1 is turned around its axis 3 by means of a shaft 5 at a certain angle. With this rotation of the needle 1, a new direction of longitudinal movement of the light guide 8, which is used to model the newly formed channel 14. Manipulation rotated at different angles, repeat 5-10 times.

Then to create the next adjacent channel 15 needle 1 pull up to the fibrous ring 12, is turned around the axis 3, for example at an angle of 90°and again bring forward (see Fig.9). All described above is repeated. So form and other new channels.

The total dose of laser energy deposited in the zone of laser activity, depends on the size of hernial protrusion 11 and the height of the intervertebral space. In most cases, the dose of laser energy does not exceed 1200 joules, but the large size of the hernia prolapse, severe pain syndrome, the total dose of laser radiation can reach 1500 j.

If the value of the hernial protrusion 11 is more than 7 mm (8-15 mm), and there are signs of sequestration hernia, the needle 1 is withdrawn from the drive-reverse (retrograde) so that its distal end 4 was in the centre of hernial protrusion 11, outwards from the fibrous ring of the disc (the best option - see figure 10). The size of the hernial protrusion and signs of sekvestirovanija are determined with multi-planar reconstruction in lateral projection CT images (CT-CT). In this position, the needle 1 is held the third stage puncture laser surgery - direct retrograde vaporization of disc 10, i.e. the laser radiation acts directly is directly in the area of hernial protrusion 11 - "right on the hernia. The radiation power is about 3 watts, exposure - 40-160 C. the Effectiveness of direct vaporization increases with the introduction of a herniated disc saline solution.

The analysis of the clinical results of treatment with the aforementioned method PLDD in 386 patients with lumbar osteochondrosis conducted using a 10-point analog scale classification of pain by Macnab, showed that in the first three months after the laser treatment, excellent results were obtained in 163 (42,2%), good in 132 (34,2%), satisfactory in 79 (20,5%) patients. In the postoperative observation period of one year to three years clinical results have improved. Excellent results were obtained in 227 (58%) patients, good in 101 (26,2%), satisfactory in 57 (14.8 per cent). In 17 cases (4.4%) cases were repeated puncture laser surgery, because some patients from this group in the first three months after surgery remained the expressed painful syndrome, other more physical activity and active movement caused worsening vertebral and lumboischialgia syndrome. After the second laser treatment during the observation period more than one year, an excellent result was obtained in 6, good in 5, satisfactory in 6 patients. Successful re-puncture laser interventions allows to improve the statistics of the positive outcomes of operations and therefore, in even greater degree to reduce the number of indications for open discectomies.

In 143 patients after laser surgery in terms of one to three months were performed control computed tomographic (CT) studies (in some cases, magnetic resonance imaging (MRI). As a result, 72 (50,4%) patients there was complete or almost complete involution hernial protrusion.

Analysis of CT scanning in the specified period showed that 22 (15,4%) patients hernia after laser surgery has decreased in size by 50 percent or more. The remaining 49 (34,3%) patients determined by the changing contours of the hernial protrusion. In General, 94 (65,8%) patients there was no compression of the dural SAC and nerve root compression. In the case of changing the contours of hernias (49), N is the density of hernial protrusion in comparison with N-density of the cartilage disk was significant, two, three and more times lower.

Computed tomographic study conducted one year after laser surgery, showed that the number of cases of complete degradation (resorption) hernia protrusions over time increases significantly. The number of observations with complete resorption of herniated disc was 114 (83,7%). In the remote period the number of cases decided not to change conturo the disc herniation, was 13 (3.8 percent), reducing its size by 50% or more 3 (2,7%).

Repeated computed tomography or magnetic resonance imaging confirmed that the disc herniation after puncture polyaniline laser decompression, re-generated.

Methodology PLDD in most cases (84%-87%) in the period from one month to one year after surgery provides full resolution local pathogenetic situation of lumbar degenerative disc disease and the elimination of disco-vascular or disco-radicular conflict.

The above described technique is used only for illustration purposes, the possibility of carrying out the invention and does not limit the scope of legal protection provided in the claims, the expert in the art capable of relatively easy exercise and other ways of carrying out the invention.

1. Method of making a puncture endoskopicheskoi laser nucleotomy intervertebral disc, including access to the pulpous nucleus and the evaporation part of his substance with repeated sequential effects of the laser radiation with an effective wavelength in the effective energy dose with the creation of a cavity in the pulpous nucleus by changing the direction of the laser beam from exposure to exposure, wherein the placer was generated from the in the pulpous nucleus cavity formed adjacent the closed elongated channels so to their axis was at an acute angle to each other and intersect almost at the same point.

2. The method according to claim 1, characterized in that the access to the pulpous nucleus carry a bulge is noticeable.

3. The method according to claim 1, characterized in that prior to exposure to laser radiation in the pulpous nucleus is administered an effective amount of a hypertonic solution.

4. The method according to claim 3, characterized in that as a hypertonic solution using 10%aqueous solution of common salt.

5. The method according to claim 3, wherein the hypertonic solution is injected in the amount of 0.5 to 2.0 ml.

6. The method according to claim 1, characterized in that the influence exercised by laser radiation with a wavelength of 960-980 nm.

7. The method according to claim 6, characterized in that the exposure is 2-4 watts.

8. The method according to claim 6, characterized in that the total energy dose effects is 540-1200 J.

9. The method according to claim 1, wherein the elongated channels form a cone-shaped, extending from the point of intersection of their axes.

10. The method according to claim 1, characterized in that the total amount of elongated channels is not more than 2% of the volume of the intervertebral disk.

11. The method according to claim 1, wherein the elongated channel is formed in part of the nucleus pulposus in the vicinity of a hernial protrusion.

12. The method according to claim 1, characterized in that the PU is Klenow laser nucleotomy are under the control, selected from the group: fluoro x-ray, magnetic resonance control, computer tomography.

13. The method according to any one of claims 1 to 12, characterized in that after forming elongated channels bulge is noticeable is subjected to direct vaporization.

14. The method according to any one of claims 1 to 12, characterized in that to access the pulpous nucleus of the intervertebral disc the dotted line in the elastic conductor, then in the pulpous nucleus guidewire is inserted a hollow puncture needle, after which the conductor is removed.

15. The method according to 14, characterized in that the pulpous nucleus through a hollow puncture needle with a gap introducing the distal end of the light guide, the proximal end of which is optically connected to the laser source.

16. The method according to item 15, characterized in that for forming the first elongated channel using a straight hollow puncture needle.

17. The method according to item 15, characterized in that for forming elongated channels use a hollow curved needle needle that rotates around its longitudinal axis from impact to impact.

18. The method according to 17, characterized in that before the turn of the hollow puncture needle around its longitudinal axis, the distal end of the fiber to be drawn into the cavity of the puncture needle.

19. Puncture needle for endoskopicheskoi laser nucleotomy of mejpozvonkovogo the disk, made in the form of a tubular rod with a straight longitudinal axis, with the shank and curved at an acute angle to the longitudinal axis of the distal part having a distal end that is cut at an acute angle to the distal portion, wherein the cut distal end is oriented away from the direction of bending of the distal portion and has an angular deflection plane to facilitate the passage of the conductor, to facilitate the passage of the light guide and for additional deflection of the laser beam from the distal end of the light guide.

20. The needle according to claim 19, characterized in that the distal end cut at an angle of 20-40° to the longitudinal axis of the distal portion.

21. The needle according to claim 19, characterized in that the distal portion is curved toward the longitudinal axis at an angle of 5-25°.

22. The needle according to claim 19, characterized in that the length of the distal portion does not exceed half the diameter of the intervertebral disk.

23. The needle according to article 22, characterized in that the cut distal end of the angular offset between the diametrical axis of the cross section, perpendicular to the plane of bending of the rod, and a projection of the plane of shear, the distal end is 12-70°.

24. The needle according to any one of p-23, characterized in that it has elastic conductor in the form of needles with a pointed distal end, and the outer diameter of the cross section of the spokes is made smaller than int is Ni the diameter of the rod, and the point is made wedge-shaped in the form of two faces with an angle 16-50° at the top of the taper.

25. The needle according to paragraph 24, wherein the needle is additionally a wedge-shaped sharpened in the plane perpendicular to the faces, and the angle at the vertex of additional sharpening is 60-130°.

26. Method of making a puncture endoskopicheskoi laser nucleotomy intervertebral disc, including the announcement of the hollow puncture needle to the fibrous ring in the middle of the hernial protrusion, the introduction of the needle fiber and the influence of the laser radiation at an effective wavelength in the effective energy dose, changing the direction of the laser beam from exposure to exposure, wherein the puncture needle to spend the pulpous nucleus through the annulus, carry out the evaporation of part of the substance of the nucleus pulposus, then puncture needle display of reverse swing so that its distal end was in the centre of hernial protrusion outwards from the fibrous ring of the disc, and carry out direct vaporization hernial protrusion.

27. The method according to p, characterized in that the evaporation of part of the substance of the nucleus pulposus repeated sequential laser impacts carried out by changing the direction of the laser beam from the exposure to the impact with the formation of cavities in the form of Minich closed elongated channel, the axes of which are at an acute angle to each other and intersect almost at the same point.

28. The method according to p, characterized in that to direct vaporization hernial protrusion it is administered an effective amount of saline.

29. The method according to p, characterized in that the direct vaporization hernial protrusion carried out by laser radiation with a wavelength of 960-980 nm.

30. The method according to clause 29, wherein the laser power is 2-4 W with exposure C. 40-160.

31. The method according to clause 29, wherein the needle laser nucleotomy are under the control selected from the group: fluoro x-ray, magnetic resonance control, computer tomography.

32. The method according to p, characterized in that use a curved needle needle that rotates around its longitudinal axis from impact to impact.

33. The method according to p, characterized in that use hollow puncture needle according to any one of p-25.



 

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1 dwg

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with surgical treatment of lower limbs ischemia at considerable lesion of distal channel and impossibility to conduct direct revascularization of vascular channel of affected limb. One should perform mechanical perforation of bony tissue up to medullary canal in epiphyses of femoral and leg bones being 4-5 cm, correspondingly, higher and lower against a knee joint, and, also, in the lower third of shin, metatarsal bones and phalanges followed by stimulation of bone marrow and tunnelization of muscular tissue of femur and shin by applying perforation foramens upon femur and punctures in additionally performed at lateral and posterior surfaces of shin by performing, moreover, per three tunnels from each foramen and puncture in. Stimulation of bone marrow and muscular tunnelization should be carried out with high-intensity laser radiation of diode laser of 10-15 W power in constant mode, with a light guide of 0.4 cm diameter, at exposure of 3-10 sec and quantity of therapy seances being, at least, two.

EFFECT: higher efficiency of therapy.

2 ex

FIELD: medicine, ORL-surgery.

SUBSTANCE: beforehand one should form a carcass out of two transplants of flat bone of human fetal cranial arch at width up to 1 mm, thickness of 0.1 mm each of them that correspond to the width of osseous part of patient's auditory canal. At first, transplants should be fixed in mutually perpendicular position in two points with laser biological welding (LBW) performed with distal part light guide's edge of semiconductor laser "ATKUS-15" in impulse mode at impulse duration being 450 msec and output power of laser radiation being 8.5 W. Then the transplant should be fixed to osseous walls of auditory canal due to LBW in similar mode in four points. Then one should apply a flap of human fetal dura mater onto osseous transplants that completely cover perforation foramen of tympanic membrane which should be, also, fixed with LBW technique to the rest of tympanic membrane. The innovation suggested enables to exclude transplant's shift and keep sounding through tympanic membrane.

EFFECT: higher efficiency of plasty.

1 ex

FIELD: medicine.

SUBSTANCE: method involves carrying out double-sided transverse nerve vaporization at the places the sacrouterine ligaments fuse with inferior uterine segment. Ablation is additionally applied all along the whole length between the transverse ablations along the inferior uterine segment.

EFFECT: enhanced effectiveness of treatment.

1 dwg

FIELD: medicine, ORL-surgery.

SUBSTANCE: one should apply a cartilaginous transplant out of human fetal nasal septum twisted around with human fetal dura mater towards perforation foramen of nasal septum. Moreover, transplant's sizes should be 5-7 mm higher against the diameter of perforation foramen Human fetal dura mater should be fixed to the edges of perforation foramen due to laser biological welding in 8-10 points from each side due to contact technique in impulse mode. The suggested innovation enables to achieve tight fixation of a transplant to the edges of perforation foramen without applying catgut sutures onto its surface.

EFFECT: higher efficiency of plasty.

1 ex

FIELD: medicine, ORL-surgery.

SUBSTANCE: one should apply a transplant out of human fetal nasal septum into perforation foramen of nasal septum. Moreover, transplant's sizes should be 5 mm higher against the diameter of perforation foramen. Fixation to mucosa of nasal septum should be performed due to laser biological welding in 7-8 points being around perforation foramen due to contact technique. The suggested innovation enables to achieve tight fixation of a transplant to mucosa of nasal septum without separating opposite mucosal leaves and perichondrium.

EFFECT: higher efficiency of plasty.

1 ex

FIELD: medicine, otorhinolaryngological surgery.

SUBSTANCE: one should apply thin layer of "Solcoseryl" gel onto osseous facial walls of frontal and maxillary sinuses at the border with trepanation opening after removing pathological content out of them and before applying a transplant out of flat bone of human fetal cranial arch that exceeds the diameter of trepanation opening by 3-4 mm. Then, one should additionally fix the transplant by affecting with distal edge part of a light guide of semi-conductor laser "ATKUS-15" with contact-type technique at output power of laser radiation being 8 W at constant mode. The method enables to increase fixation density of allobrefobone to osseous walls of sinus along its whole diameter.

EFFECT: higher efficiency of fixation.

1 ex

FIELD: medicine; medical engineering.

SUBSTANCE: method involves exposure to laser radiation by moving scanning laser beam over biological object surface under treatment. Spatial object position is varied concurrently with scanning laser beam radially and circumferentially moving over surface under treatment and changing inclination angle with respect to biological object surface. State of surface under treatment is controlled by recording its temperature, comparing the temperature to maximum permissible level. Radiation power is adjusted. Device has casing, laser, objective and guide. The objective is radially and circumferentially movable and inclination angle variable with respect to objective surface The objective is radially and circumferentially movable. Computer, control unit, power control unit and scanning device are also available.

EFFECT: accelerated surgical intervention procedure; save action of laser radiation beam.

2 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out instrumentally controlled intervention with high intensity laser radiation being supplied to thyroid gland node via light guide brought into thyroid gland node body with a conductor through soft tissues. Dynamic temperature control is carried out 0.2-0.7 cm laterally far from nodal form boundary as the instrumental control in performing laser radiation treatment. 37-40°C being reached, laser radiation treatment is to be stopped. Laser light guide is introduced into the thyroid gland node 2-3 cm far from conductor end.

EFFECT: enhanced effectiveness of non-invasive, organ-saving treatment without narcosis being applied.

2 cl

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: one should perform local anesthesia to make deformed part of curved cartilage be anemic. Mechanical impact upon the cartilage of deformed part of nasal septum should be carried out after its distance heating due to laser radiation. Impact should be performed due to successive smoothing out the parts with a curved manual holder with thickening at its end to be then coincide with distance-contact additional heating due to laser radiation of adjacent cartilaginous parts. Treated part of nasal septum should be heated along the perimeter and kept with Killian's speculum. The innovation broadens technological abilities and simplifies therapy.

EFFECT: higher efficiency of therapy.

3 cl, 1 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: method involves closing passability of intramural portion of uterine tube. Intermittent photocoagulation is carried out of isthmus and intramural portion of uterine tube in subablation mode with a sort of solder alloy being applied to irradiation area, scattered laser radiation in moving laser light guide from isthmus lumen through intramural portion of the uterine tube in the uterus cavity direction making pause for irradiation, creating solid partitions on the traveling path and forming closed sections in cavities of cervix and intramural portion of the uterine tube.

EFFECT: enhanced effectiveness of treatment; retained areas of transit tube and uterus epithelium.

1 dwg

FIELD: medicine, cardiology, surgery.

SUBSTANCE: one should perform myocardial revascularization with laser radiation. Moreover, one should intravenously inject Photosens solution at 1.4-2.0 mg/kg body weight to irradiate boundary areas of myocardial ischemia with laser radiation at wave length being 675 nm, output power 150 mW, fiber's diameter being 0.6 mm, for 3-5 sec at 1-3 light impact/myocardial sq. cm. The innovation enables to decrease side effects.

EFFECT: higher efficiency of therapy.

FIELD: medicine, ORL-surgery.

SUBSTANCE: the present innovation deals with treating the lesions of tympanic membrane. For this purpose one should fix a transplant out of a flat bone of human fetal cranial arch. The transplant mentioned should be of 1 mm width, 0.1 mm thickness and its length being 2 mm higher against the size of perforation foramen. Fixation should be fulfilled due to laser biological welding in two points. One should put a fragment out of fetal dura mater above an osseous transplant being 2 mm higher against perforation foramen. Distal part of light guide's edge of semiconductor laser should be put on the transplant perpendicularly its surface. Welding should be carried out by contact technique in impulse mode at impulse duration being 450 msec and output laser radiation power being 8.5 W in 8 points. The method enables to achieve transplant's tight fixation, exclude its shift and prevent penetration of infection into tympanic membrane and keep sound passage through tympanic membrane.

EFFECT: higher efficiency of plasty.

1 ex

FIELD: medicine, ORL-surgery.

SUBSTANCE: one should apply a thin layer of 10%-Syntomycin emulsion onto the edges of perforation foramen, then one should apply a transplant out of a flat bone of human fetal cranial arch. The transplant mentioned should be of 1 mm width, 0.1 mm thickness and its length being 2 mm higher against the size of perforation foramen. Fixation should be fulfilled due to laser biological welding in two points to the edges of perforation foramen with distal part of light guide's edge in impulse mode. One should put a fragment out of fetal dura mater above an osseous transplant being 2 mm higher against perforation foramen. Distal part of light guide's edge of semiconductor laser should be put on the transplant perpendicularly its surface. Welding should be carried out by contact technique in impulse mode at impulse duration being 600-700 msec in 6-8 points. The method enables to achieve transplant's tight fixation, exclude its shift and excessive coagulation of tympanic membrane in the site of light guide's edge application.

EFFECT: higher efficiency of plasty.

1 ex

FIELD: medicine, ophthalmosurgery.

SUBSTANCE: one should affect patient's cornea with radiation of eximer laser: at first, at bundle's diameter being 8 mm, energy of 175 mJ/sq. cm and Gauss' energy distribution. Then, the edges of ablation area should be treated with circular scanning eximer laser's ray at diameter of 3.5 mm at the same energy up to peripheral area being at the distance of 0.5 mm against the limbus. The method enables to decrease the possibility for postoperative complication as bullous keratopathy in peripheral area.

EFFECT: higher efficiency of therapy.

2 dwg, 3 ex

FIELD: medicine, oncology.

SUBSTANCE: one should perform laser treatment for the surface of intercostals muscles and tissues in subclavicular and axillary areas at the distance of 4-6 mm against the wound, replace light guide's emitter with circular and liner-reciprocating movements, affect with focused laser beam at wave length being 1.06 mcm, at output power of 10-25 W, diameter of laser spot being 5 mm for 2-8 sec depending upon the dose of irradiation and power density. The method enables to decrease the volume of postoperational lymphorrhea and prevent the development of postoperational infectious complications.

EFFECT: higher accuracy and efficiency.

1 dwg, 1 ex, 1 tbl

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