Method for transpedicular fixation of affected vertebral segment

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with fixing affected segment in thoracic, lumbar and sacral vertebral departments. One should apply supporting elements of transpedicular system of bars which should be crossed in frontal plane and connected together with a fixing knot to regulate the angle of bars' crossing depending upon the requirements appeared, moreover, supporting elements should be applied through pedicles of vertebral arches that increases reliability of fixation at achieving osseous ankylosis.

EFFECT: higher efficiency.

2 dwg, 1 ex


The invention relates to medicine, namely to traumatology and orthopedics, and can be used when fixing the damaged spinal segment in the thoracic, lumbar and sacral spine.

Patients with complicated spinal cord injuries heal quickly, locking the affected segment of the spine bone autograft (Vvoice, Conforti, Kookana. Operative Orthopaedics and traumatology. Sofia, 1961. - S-771, 774-776). The main disadvantages of these operations are difficult to achieve intervertebral frets technically difficult and dangerous front-line access, additional tissue trauma associated with the capture of a bone graft, the need for long-term compliance with bed rest after surgery.

Known methods of surgical treatment of patients with spinal cord injuries, involving the application of various metal plates cyto, NIITO couplers of Ramya-Ziviani (Neurosurgical, Vamapaull, B.v.gaidar. Closed injuries of the spine in the thoracic and lumbar localization. Saint-Petersburg. - Mopcap AB, 2000. - Pp.62-64).

There is a method of fixing vertebrae with metal rods, which are located on the posterior surface of the spine and connected by screws conducted transpedicular above and below the area of poraj the deposits (Measurer, Allgower, Rsnyder, Vellinger. Manual of internal fixation. - Ad Marginem, Moscow, 1996. - S-670). The method provides an approximate parallel to the direction of holding adjacent supporting rods in the frontal plane. The support rod connects located transpedicular higher - and lower screws Trench placed on one side of a line drawn through the spinous processes. When you need to perform a laminectomy, the locking system is supplemented by a cross rod connecting the support rod. Transverse rod performs a dual function - protects the spinal cord and its roots in the zone of laminectomy, and is also the stabilizer of the entire locking system.

This method is used as a prototype, because it has common features with claimed: the creation of fusion by stabilizing by using implantable metal, the introduction of locking elements through the legs of the arc of a vertebra.

The disadvantages of the prototype is insufficient strength of fixation of the metal structure with respect to a complex rotation-flexion and rotation is inclined loads and high cost structures installed, limiting the applicability of the prototype in the treatment of patients with disorders of the spine.

The essence of the proposed method lies in the fact that during the stabilization of damaged spinal segment using implantable transpedicular metal as supporting elements use barbells, which perekrashivat in the frontal plane and are connected with the original mount. The result is improved reliability of fixing of a damaged spinal segment, Pets early activation of the patient in the postoperative period. You can use the proposed method in combination with decompression by laminectomy - created content protection of the spinal canal at the level of the decussation, reduced treatment costs by reducing the number of structural elements. When applying the weights to each other, we can model the intersection zone by bending one of the rods. The mount allows you to adjust the angle of the crossing rods depending on the emerging demands from 0 to 170 degrees. As transpedicular input elements use standard metal screws Trench or pedicularia the screws, open the side.

The method is illustrated in the drawings 1, 2. Figure 1 shows a schematic depiction of transpedicular fixation of the proposed method in the frontal plane. Figure 2 - attachment.

Description of the mount. The mount is presented in the form of two hollow cylinders with a diameter of 6.2 mm and a length of 15 mm. On one of the side surfaces of each cylinder has a support area of the trapezoidal shape. In the center of the support point of one of the of cilindrov is a round hole with the screw thread, corresponding to the diameter of the insertion of the screw. In the frame of another cylinder is provided by a longitudinal hole edges, razzenkovannye under the bonnet fixing screw.

The method is as follows. After installing transpedicular screws make the selection of the desired length rods with a diameter of 6 mm Rod is simulated with special plates, taking into account the physiological curves of the spine and specific biomechanical situation. If necessary, the spinous process of the fixed vertebra and speakers anatomical bone formation back complexes vertebrae sparingly resetinput for optimal adaptation of the rods to the bone structures.

Then on the supporting rod is placed cylinders that make up the mount by turning their foothold to each other. The design is mounted on the entered transpedicular screws with nodes so that rod, placed one above the other, overlap in the frontal plane. Then combine holes reference sites cylinders mounted on the cross support rod, overlaying on top of the support platform with a longitudinal hole. Get the stop on the top of foothold in the wall of the second cylinder. Fix foothold cylinders interconnected by means of screws, thus connecting the crossed rod and is our transpedicular screws in a single system.

Clinical example

Patient P., 46 years old, was admitted in the Samara regional clinical hospital. Kalinin 21.11.2000, 12 days after Calatrava with a diagnosis of Closed comminuted unstable, Pereloma-dislocation L2with injury and spinal cord compression, the lower prepares, dysfunction of the pelvic organs.

After the examination and detail of the nature of disorders, the patient was performed surgery decompressive laminectomy L2rear-side decompression of the spinal osteosynthesis L1-L2transpedicular vertebral rod device according to the proposed method. The postoperative period was uneventful.

The wound healed by first intention. The patient was allowed to stand and to walk with crutches in a week after surgery. The function of the pelvic organs were normal. Examined after 3 months. after surgical intervention. No complaints, neurological disorders are not identified. The control x-ray signs of bone ankylosis between the first, second and third lumbar vertebrae, no signs of instability.

Thus, the proposed method is simple in technique, low-impact and can be recommended for application in medical practice.

The way transpedicular f is xali damaged spinal segment, including the creation of fusion by stabilizing by using implantable metal, the introduction of locking elements through the legs of the arc of the vertebra, wherein the support elements are placed on the back surface of the spine, apply rod, crossing them in the frontal plane and connecting the attachment.


Same patents:

FIELD: medicine, in particular, equipment used in traumatology and orthopedics.

SUBSTANCE: apparatus has connection member 5, sealing cap 12, tightening means 13, locking means 21 for fixation, fixation means 35 used for securing of screw head 30 of bone fixation means in cavity 8 of connection member 5. Connection member 5 is positioned coaxially relative to central axis 2 and has upper end 6, lower end 7, cavity 8 arranged coaxially relative to central axis 2 extending through connection member 5 from its upper end 6 to its lower end 7, said cavity converging to its lower end 7 formed as at least one flange 9, and channel 10 extending through connection member 5 transverse to longitudinal axis 2 for receiving of longitudinal holder 11. Sealing cap 12 has front end 20, rear end 19, second cavity 18 open at its front end 20 for locating therein of connection member 5, and second channel 17 extending transverse to central axis 2 and opening toward front end 20 of sealing cap 12. Tightening means 13 may be fixed at rear end 19 of sealing cap 12 for retaining of longitudinal holder 11 located in channel 10 in connection member 5. Locking means 21 are positioned outside connection member 5 and in second cavity 18 of sealing cap 12 so as to mate each other and serve for fixation of sealing cap 12 on connection member 5.

EFFECT: increased efficiency owing to reduced space for implantation which is due to the possibility of introducing surgical instrument having diameter smaller than that of implant for preventing surrounding tissues from injury.

7 cl, 6 dwg

FIELD: medicine; neurosurgery; traumatic surgery.

SUBSTANCE: holder can be used for stabilization of damaged sectors of spinal column. Holder has transpedicular screws, longitudinal and lateral beams, fixing unit with two mutually perpendicular holes for screws and longitudinal beam. Longitudinal beams are made of shape-memory-effect material, which provides flexural rigidity of holder within 10 to 80 H/mm.

EFFECT: reduced risk of post-operational complications; stabilized traumatized segment of spinal column.

5 cl, 1 dwg

FIELD: medical engineering.

SUBSTANCE: device has ball and socket joint casings having cylindrical and supporting parts, transpedicular screws having spherical heads, axial rods and transverse tie rods. Lower unseparable lips are available on external surfaces of supporting parts of ball-and-socket joints. The upper lips are separable and they are mounted on cylindrical parts of the casings. Cylindrical grooves which radii are equal to the axial rod radii are available on opposite surfaces of the upper separable and lower unseparable lips of the ball-and-socket joints. External thread is available in cylindrical parts of the casings with fastening nuts mounted thereon for fixing the separable lips. Locking members controlling angular displacements of spherical heads along transpedicular screw axes are manufactured as fixing screws having ring-shaped cutting edge on contact side to enable one to introduce them into internal threaded openings of the cylindrical parts. The axial rods are manufactured as pivot levers having rod part on one end and bushings on the other end arranged in perpendicular to each other. Locking member for controlling bushings rotation of pivot levers relative to each other is manufactured as radial teeth on plug plane and locking screws for positioning in bushing holes.

EFFECT: rigid fixation of injured vertebral column segment; small-sized fixing members; reduced risk of traumatic complications.

6 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: device has at least one connection member shaped as rod, at least two fixing means each fixable on vertebra body. The means have fork-shaped head parts which two branches determine U-shaped receiving space for the connection member to fit into it. Head is, as a rule, saddle-shaped, has locking screw for screwing-in into receiving space for fixing the connection member between two fork-shaped head branches. The head is guiding member for independent locking piece usable for carrying out fixation on the head after having set connection member into head fork. The locking piece is usually U-shaped, its branches being engageable with fork-shaped head part branches and its bottom part having opening with internal thread engageable with the locking screw. The guiding member available on the head part is formed with arc-shaped flanges available on lateral external surfaces of fork-shaped area. Fixing member has fork head, two branches of which determine receiving space of strictly U-shaped form for receiving connection member. Head is, as a rule, saddle-shaped. It serves as guiding member for independent locking piece usable for carrying out fixation on the head after having set connection member into head fork. The locking piece is usually U-shaped, its branches being engageable with fork-shaped head part branches and its bottom part having opening with internal thread engageable with the blocking screw. The guiding means available on the head part is formed with arc-shaped flanges available on lateral external surfaces of fork-shaped area. Auxiliary member has two end pieces positionable in slots available on implant head part and a means for applying force to the rod for causing lateral or vertical displacement to allow rod to be positionable in the slot.

EFFECT: retained correction degree and final fixation and tightening of screws selected by surgeon during operation.

12 cl, 4 dwg

FIELD: medical engineering.

SUBSTANCE: device has supporting frame and threaded rods mounted thereon to enable their transpedicular introduction into displaced vertebra body to take place with triangular structure being formed which apex is directed towards vertebral body. The supporting frame has screws introduced in transpedicular way into vertebral bodies adjacent to the displaced one, and connective bars building rigid structure by means of crossbars. The device has additional removable reposition frame resting upon the connective bars and joined to the threaded rods by means of transverse beam serving as triangular rigid structure base movable relative to the supporting frame. The screws and threaded rods have two threaded parts separated with spherical head, one of which is used for being introduced into bone tissue, and the other one is used for making connection to the connective bars. The connection is made as detachable floating fixing members having concave spherical surface for receiving rod and screw heads with variable connection angle. The detachable floating fixing members of the threaded rods have slots for receiving fingers connecting the threaded rods to the supporting frame allowing variable connection distances from the connective bars.

EFFECT: enhanced effectiveness of treatment.

2 dwg

FIELD: medical engineering.

SUBSTANCE: device has plates having longitudinal segmentally counterbored slots and fastening members manufactured as bone screws with clamps. The clamps are manufactured as cramps having threaded openings in lower shelf. Locking members are mounted in threaded openings of the clamps. The locking members have threaded heads, hexagonal slot and smooth conic part set in hexagonal bone screw head slots. The bone screws are set in longitudinal segmentally counterbored slots of the plates. Their narrow parts under the heads pass through slits in the lower shelves of the clamps. The plates are connected to each other with cross-bar manufactured as rod ending with hook on one end which upper shelf has threaded hole for receiving locking member having threaded head, hexagonal slot and smooth thrusting part for fixing the cross-bar to a plate, the other free cross-bar end having corrugated part, has cross-bar clamp manufactured as cramps having threaded opening in upper shelf for receiving locking member having threaded head, hexagonal slot and smooth thrusting part supported by corrugated surface of the cross-bar to fix the cross-bar to the second plate. A hole is available in the upright connecting crossbar clamp shelves. The corrugated free crossbar end is movable and fixable in the hole.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; avoided blood deposit under plates.

9 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: device is rectangular and has four or more slits for fixing means to pass through each of them. Two slits have exit to lateral side of plate to enable one to set the plate at required position and fix it without preliminarily removing the instrument for correcting orientation relative to vertebral column. Lateral plate surface runs from edge pointing the same direction with longitudinal plate direction. The latter exactly coincides with the vertebral column direction. The system comprises several vertebral column osteosynthesis plates to keep orientation correction relative to the vertebral column unchanged. Correction is carried out by means of the instrument for correcting orientation.

EFFECT: less number of holes to be drilled for mounting the device.

11 cl, 10 dwg

FIELD: medical engineering.

SUBSTANCE: device has two elastic plates and unit for fastening the plates to vertebral arches by means of two hooks placed under the arches on both sides of spinous process, two pins attached to corresponding hook with threaded connection and thrown over the hook with support given by its thrust journal for fastening arches in corresponding hook. The pins have restricting rest means. Connection strap is manufactured as a whole with elastic plate holders building U-shaped clamp having locking protrusions at pedicle ends turned inward. Plate holders are formed by clamp pedicles and locking protrusions. Elongated slot is available in clamp crossbar. The clamp is put over the pins via the elongated slot of the crossbar thrusting against restricting rest means of pins and connected to the pins by means of two nuts screwed over the corresponding pin from the external clamp side. Catching cells are produced in thrust journal of each hook for making additional fixation of the pins.

EFFECT: increased rigidity; fixation stability; accelerated operation process; reduced risk of traumatic complications.

2 cl, 3 dwg

The invention relates to medicine, in particular of traumatology and orthopedics

The invention relates to medicine, namely to surgical vertebrology, and can be used to correct the kyphotic deformity and fixation of the spine in tuberculous spondylitis in children

FIELD: neurosurgery; traumatology.

SUBSTANCE: device intends for fixing bone or its substitute in cranium at cranioplasty. Device is made of shape memory effect alloy and it has support and top and lower rings. Lower ring is closed. Top ring is made separated. Support connects rings and its length 0,-3,5 mm exceeds minimal distance between rings. Bone or its substitute is fixed reliable in cranium despite of difference in thickness. Bone or its substitute as well as device itself is not able to migrate.

EFFECT: simplified surgical work.

3 cl, 6 dwg

FIELD: medical engineering.

SUBSTANCE: plate for stabilizing sternocoastal complex comprises openings for permitting securing it to costae and is made of a material possessing the shape memory effect, with shape retrieval temperature being from 10 to 37°C, which provides loading on sternum to be from 20 to 100 N.

EFFECT: decreased traumatizing.

1 cl, 2 dwg

FIELD: medical engineering.

SUBSTANCE: device has two supporting rectangular platforms having rounded edges and rectangular plate. Lateral surfaces are rounded each having single hole for fastening the platforms. Each of the supporting platforms have two holes at the ends and are hold in the plate hole with fixing member on one side and with rivet on the other side. Supporting platform having fixing member is removable.

EFFECT: prevented mediastinum organs injuries.

2 dwg

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with metalloosteosynthesis of intra-articular and peri-articular fractures. According to the first variant, the suggested plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Osseous part of teeth, branching fan-shapely, circles metaphysis and has a curvature at the angle of 180°. Submergible parts of teeth are parallel to each other. Teeth are designed to be round in cross-section. Teeth are being in a plane parallel to that of osseous plate. The length of submergible part of teeth knowingly exceeds the diameter of a semilunar fragment of patient's elbow bone. According to the second variant, the plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Osseous part of teeth, branching fan-shapely, circles metaphysis. Submergible parts of teeth are parallel to each other. Teeth are designed to be round in cross-section. The distance between submergible parts of teeth is 1.5-2 times higher against the width of an osseous plate. According to the third variant, the plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Perosseous part of teeth, branching fan-shapely, circles metaphysis, and submergible parts of teeth are being parallel to each other. Teeth are designed to be round in cross-section. The plate has a curvature according to the shape of condylar edge of patient's brachial bone. Osseous part of teeth is supplied with a crosspiece to provide the chance to be fixed up with screws.

EFFECT: higher efficiency of osteosynthesis.

3 cl, 4 dwg

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

FIELD: medicine, traumatology.

SUBSTANCE: the present innovation deals with corporectomy in patients with pathological vertebral fractures. One should introduce an insertion into inter-body defect after pre-manufacturing it out of cement as a groove of 2-3 mm thickness to be placed into defect with its protuberance towards dural sac at 2-3 mm against it; in case of a great inter-body defect one should introduce drainages from the side of safe vertebrae with possibility for their removal. If additional fixation is necessary one should introduce metal rods into vertebrae being adjacent with inter-body defect which partially protrude into defect area that prevents neural structures against thermal and mechanic damage.

EFFECT: higher efficiency of vertebroplasty.

2 cl, 2 ex

FIELD: medical engineering.

SUBSTANCE: device has rod having bendable end and threaded end with nut and sliding union thrusting against cortical plate of fractured bone segment. The rod has sharp tip round part to be introduced into the bone fragments by rotating and four-sided part to be introduced by hammering. Bendable end is produced on the sharp tip round part of the rod. The threaded end is available on the four-sided rod part.

EFFECT: reliable compression of bone fragments; avoided relative rotation and soft tissue decubitus ulcers.

2 dwg

FIELD: medical engineering.

SUBSTANCE: device has supraosseous part and intraosseous part parting at an angle of 90° and having rectangular rectilinear longitudinal segment having protrusion on both ends. The supraosseous part is longitudinal, narrow, 2 mm wide member having transverse protrusions modeled along the frontal boundary of the medial malleolus having holes for receiving fastening members. The intraosseous part protrusions are rounded and sharp along curvature arc.

EFFECT: improved functional results; improved fracture consolidation conditions.

1 dwg

FIELD: surgery, in particular, traumatology and orthopedics.

SUBSTANCE: intraosteal retainer has pin with cavity and two slots at the end of pin, and two wires positioned in pin for further accommodation in slots. Distal ends of two wires are equipped with round loops. Intraosteal retainer is provided with compressing unit comprising spring, supporting plate with wire receiving openings, and nuts. Proximal ends of wires are provided with thread for nuts. Proximal ends of wires are disposed in spring and supporting plate. Cavity in pin is formed opened along the entire length. Through slots of 0.2x1 cm size are provided at pin ends. Wires are 40-50 cm long and have diameter of 0.2-0.3 cm.

EFFECT: increased efficiency by reduced injury during operation owing to moderate dosed compression.

6 dwg

FIELD: medical engineering.

SUBSTANCE: device has wire clamp manufactured from material possessing thermomechanical shape memory properties. The clamp has irregularly curved supraosseous member and straight pedicles fixable in bone and inclined toward each other. The irregularly curved supraosseous member has rectangular back and two Ω-shaped loops arranged on both sides with an area forming central cross-pieces of straight-line back. End cross-pieces of the straight-line back are mated with corresponding pedicles by means of arc-shaped areas embracing bone from both sides relative to the straight-line back. Each of planes formed by corresponding pedicle and mating arc-shaped area is arranged in perpendicular to the straight-line back. Projection of each Ω-shaped loop over the nearest of said planes is arc-shaped, the arc being arranged as arc symmetrically conjugated to an arc of arc-shaped area relative to corresponding end cross-piece.

EFFECT: constant compression of fractured bone fragments; high fixation reliability.

2 cl, 3 dwg, 2 tbl

FIELD: medicine.

SUBSTANCE: method involves making longitudinal incision in tibia projection. Pathologically changed tissues are withdrawn. Two cutaneofascioperiosteal flaps produced by separating longitudinal surgical wound edges from bone are used for filling. Threads are conducted through bone. The cutaneofascioperiosteal flap ends are sutured and drawn close with the frontal thread ends. The rear thread ends are brought to posteroexterior shank surface and fixed on support members. Filling tissues are adapted to bone wound walls by progressively increasing tension in threads conducted through bone.

EFFECT: reliable fixation and controlled tension of filling tissues; reduced risk of suppuration and skin necrosis.

2 cl, 1 tbl