Method of combined plasty of giant post-operational ventral hernias
SUBSTANCE: invention relates to medicine, namely to surgery and can be applied for treatment of giant post-operational ventral hernias. After dissection of aponeurosis of rectus muscles of abdomen, indenting 4-5 cm from hernial ring edge, hernial sac is opened. Intraabdominal stage of operation is performed. By means of two pararectal cuts from both sides dissected are skin, subcutaneous fat to aponeurosis of external oblique and transverse abdominal muscles. Tendon part of external oblique, internal oblique and transverse abdominal muscles is excised. Implants in form of mesh endoprostheses are sewn to external oblique, internal oblique and transverse abdominal muscles and rectus abdominal muscle from both sides. Aponeurosis is sutuired together without tension on medium line with continuous suture "joint-to-joint". Above sutured aponeurosis of rectus abdominal muscles third mesh endoprosthesis is implanted.
EFFECT: improvement of results of giant post-operational ventral hernia treatment and reduction of number of recurrences and complications.
1 ex, 1 dwg
The invention relates to medicine, namely to surgery, and may be applicable for the treatment of giant postoperative ventral hernias.
Surgical treatment of hernias of the anterior abdominal wall and remains one of the most urgent problems of abdominal surgery, the incidence is 3-4%. According to Russian statistics, the share of hernias account for up to 20% of all operations performed in a surgical hospitals . Despite the large number (over 200) the proposed methods of surgical treatment of postoperative ventral hernias remains high frequency of relapses, component 14-50%and re-operation accompanied by rising to 20-64% [4, 6]. The main reasons for the failure of autoplasty are marked degenerative and cicatricial changes in the field of hernia gate and nearby musculoaponeurotic frame, progressive rigidity of the abdominal wall, which significantly affects the formation of connective tissue in the area of surgical intervention and reduces its strength . Thus, from the point of view of surgical tactics, the key issue is the location and method of fixation of the implant .
The known method combined hernioplasty without opening the abdominal cavity, the proposed Devlin in 1993, the Essence of this method consists of placing the Explant is ahead of musculoaponeurotic layer with minimal tension on the edges of the hernial defect. Palpation determine the size of the hernial defect, excised the scar and the subcutaneous fat over grievin bag, departing at 4-5 cm from the edge of the hernia gate, cut through the front wall of the vagina of recti on both sides, the hernia SAC without opening immersed in the abdominal cavity, then sew the medial edge of the cut sheets of the vagina of recti, to the lateral edges of the cut sheets is stitched to the graft .
The advantage of this method plastics is no need to cut all layers of the anterior abdominal wall and the entry into the abdominal cavity, and therefore decreases the likelihood of complications from abdominal cavity.
However, the method has the following disadvantages: a) the risk of complications specific to the subcutaneous location of the implant (seroma, hematoma, infiltrates); b) impossibility of the use of this plastic with postoperative ventral hernias with a defect in the aponeurosis of more than 10 cm in diameter.
Closest to the present invention is a method Ramirez, proposed in 1990, the idea of the method is in the intersection of the tendinous part of the external oblique muscle of the abdomen on both sides, which reduces the width of the hernial defect. Originally mobilize the hernia SAC and the front leaf sheaths of recti to Segalovich is ini on both sides. Then on the edge of the muscular part of m. obliquus abdominis externus its tendinous part of the cross throughout from the costal arch to the iliac bone. The zone plate, it is advisable to limit or using flaps hernial SAC, or by the greater omentum. Gryzenia gate reduces seams, avoiding large tension. This is followed by implantation .
The advantages of this plastics: helps to strengthen the anterior abdominal wall with large and giant postoperative ventral hernias.
The disadvantages of this method are: 1) frequent formation of accumulations of serous fluid due to the intersection of many lymph and blood capillaries in the detachment of subcutaneous fat basis; 2) the broad contact of fatty tissue from the Explant, which may lead to rejection of the implant and further to hernia recurrence.
The objective of the invention is to improve the results of treatment of giant postoperative ventral hernias and to reduce the number of relapses and complications.
The task carried out due to the fact that after the dissection of the aponeurosis of recti, departing at 4-5 cm from the edge of the hernia gate, open hernia SAC, perform intra-abdominal phase of the operation, two adrectal slits on both sides cut through the skin, subcutaneous fat to aponet the oz the external oblique and transverse abdominal muscles, perform clipping of the tendinous part of the external oblique, internal oblique and transverse abdominal muscles; the implants in the form of mesh implants are attached to the tendinous part of the external oblique, internal oblique, transverse abdominal muscles and the rectus abdominis muscle on both sides, the wound is sutured in layers, the aponeurosis is sutured between the tension in the midline continuous seam "at the junction interface on top, then sutured over the aponeurosis of recti implanted third mesh implant, skin wound is sutured closed.
The proposed method is shown schematically in figure 1, where:
A - longitudinal dissection postoperative wound on the white line of the abdomen, abdominal phase of the operation;
B - run adrectal incisions on both sides and trim the tendinous part of the external oblique, internal oblique and transverse abdominal muscles on both sides;
- Sew mesh implants to the tendinous part of the external oblique, internal oblique, transverse abdominal muscles and the rectus abdominis muscle on both sides;
Mr. sewing placed over the sutured aponeurosis of recti implant in the form of a mesh implant.
The invention consists in the following. Two semi-oval sections excised the scar and the excess skin and subcutaneous fat over grievin bag, departing at 4-5 cm from the edge of the hernia gate, RA is scout the aponeurosis of recti. Open hernia SAC, perform intra-abdominal phase of the operation (Fig.1a). Two adrectal slits on both sides cut through the skin, the subcutaneous fat to the aponeurosis of the external oblique and transverse abdominal muscles. Perform clipping of the tendinous part of the external oblique, internal oblique and transverse abdominal muscles (Fig.1b). Implants in the form of mesh implants are attached to the tendinous part of the external oblique, internal oblique, transverse abdominal muscles and the rectus abdominis muscle on both sides (Resv). Install the vacuum drainage Redon in nationalrates space on both sides. Layers are sutured the wound. The aponeurosis is sutured between the tension in the midline continuous seam "at the junction interface". Above sutured aponeurosis of recti implanted third mesh implant (risg). Install the vacuum drainage Redon in nationalrates space. The skin wound is sutured closed.
According to the method of Ramirez (the comparison group) and the proposed method (study group) were operated on 9 patients. In the comparison group 3 patients (33%) patients had seroma formed with a long exudation from the wound within 14 days. When ultrasonography in the subcutaneous tissue was determined by the accumulation of serous fluid in volume from 50 to 90 ml, which required a multiple (3-5 times) punctures. Drain the LM was removed on a 7-9 day. Infiltration into the surgical wound was observed in one (11%) patients. One (11%) patient was noted superficial suppuration of postoperative wounds, mesh implant was not removed. In the study group seroma formed in two (22%) patients with exudation from the wound within 5-6 days. The drainage was removed on a 5-6 day. The suppuration of wounds and infiltration into the surgical wound in this group of patients was not observed.
An example implementation of the method
Patient C., 48 years old, medical history, No. 1345, hospitalized, 03.03.2008 routinely for surgical treatment of giant postoperative ventral hernia. Complaints on admission to the presence of a hernial protrusion of the old postoperative scar, intermittent pain in the hernial protrusion. From the anamnesis it is known that ten years ago the patient underwent median laparotomy for acute calculous cholecystitis. Two years after surgery, noted the emergence of a hernial protrusion of the postoperative scar. About 1.5 years ago there was an episode of infringement hernia, which the patient own right. To doctors did not address. A bulge is noticeable gradually increased in size, episodes infringement was repeated. Comorbidities: hypertension of II degree. The condition ol the receipt of satisfactory. Skin and visible mucous membranes pale pink. The vesicular breathing, is all lung fields, no wheezing. AD - 135/90 mm Hg Pulse - 76 minutes Language clean, damp. The abdomen is soft, not swollen, not tense, asymmetric due to the hernial protrusion, participates in the act of breathing, painless on palpation in all departments. Symptoms of peritoneal irritation no. Intestinal noises normal sonority. Stool and urination are normal. Locally: on the anterior abdominal wall from the xiphoid process to the umbilicus there is an old, postoperative scar. In the upper third of the scar is determined by the bulge is noticeable, size 22 x 15 cm, painless, soft-elastic consistency, pravima into the abdominal cavity. The symptom "cough push" positive. 06.03.2008, Made elective: gryzhesechenie of the proposed method. Operations: by palpation determined the size of the hernial defect 22×15 cm, two semi-oval sections excised the scar, the excess skin and subcutaneous fat over grievin bag, departing at 4-5 cm from the edge of the hernia gate, cut through the aponeurosis of recti. Open hernia SAC, perform intra-abdominal phase of the operation (Fig.1a). Two adrectal slits on both sides cut through the skin, the subcutaneous fat to the aponeurosis of the external oblique and transverse muscles is Iwata. Perform clipping of the tendinous part of the external oblique, internal oblique and transverse abdominal muscles (Fig.1b). Implants in the form of mesh implants are attached to the tendinous part of the external oblique, internal oblique, transverse abdominal muscles and the rectus abdominis muscle on both sides (Resv). Install the vacuum drainage Redon in nationalrates space on both sides. Layers are sutured the wound. The aponeurosis is sutured between the tension in the midline continuous seam "at the junction interface". Above sutured aponeurosis of recti implanted mesh implant, size 30×30 cm (risg). Install the vacuum drainage Redon in nationalrates space. The skin wound is sutured tightly, treated with iodine solution, apply a sterile dressing.
The postoperative period was uneventful. The wound healed by first intention, the sutures were removed on the 8th day. The patient was examined by one month, signs of inflammation of postoperative scar and no recurrence of the hernia is not marked.
The proposed method allows to:
to reduce the number of complications in the early postoperative period (gray, suppurations, infiltrates), due to the limited area of contact between the mesh endoprosthesis with fat;
- run plicatio of recti, to restore and strengthen the ü white line of the abdomen due to dissection of the tendon part of the external oblique, the internal oblique and transverse abdominal muscles;
- allows to approximate the rectus muscles of the abdomen without tension and more extensive mobilization of subcutaneous fat flap.
Sources of information
1. IVAN Borodin, Scarabei E.V., Akulich VP Surgery incisional hernias of the abdomen. - Mn.: Belarus, 1986. - 159 S.
2. Eview NR. Stretch hernioplasty. - M.: Malpractice-M, 2002. - P.146.
3. Ermolov A.S., Epirev AV and other Features of the postoperative period when the various technologies of plastics hernias of the abdominal wall // New technologies in surgery of hernias: proc. Dokl. scientific and practical use. conference. - Saratov, 2006. - P.6-9.
4. Toskin CD, Zebrowski CENTURIES Hernia of the abdominal wall. - M.: Medicine, 1990. - 272 S.
5. Devlin H.B. Managament of abdominal hernias. - London: Butterworths, 2000. - 430 R.
6. Langer, S., Kley, S., Neufang T. et al. Problem of recurrent incisional hernia after mesh repair of the abdominal wall // Chirurg. - 2001. - Vol.72, No. 8. - P.927-933.
7. Ramirez O.M., Ruas e, Dellon L. 'Components separation' method for closure of abdominal wall defects: an anatomic and clinical study // Plastic and Reconstructive Surgery. - 1990. - Vol.86. No. 3. - H.519-526.
The method of combined plastics giant postoperative ventral hernias, including the intersection of the tendinous part of the external oblique muscle of the abdomen on both sides, characterized in that after the dissection of the aponeurosis of recti, departing at 4-5 cm from the edge of the hernia gate, open hernia SAC, perform intra-abdominal phase of the operation, two parar stalnye slits on both sides cut through the skin, the subcutaneous fat to the aponeurosis of the external oblique and transverse abdominal muscles, perform clipping of the tendinous part of the external oblique, internal oblique and transverse abdominal muscles, the implants in the form of mesh implants are attached to the tendinous part of the external oblique, internal oblique, transverse abdominal muscles and the rectus abdominis muscle on both sides, the wound is sutured in layers, the aponeurosis is sutured between the tension in the midline continuous seam "at the junction interface on top, then sutured over the aponeurosis of recti implanted third mesh implant, dermal wound tightly sutured.
SUBSTANCE: apparatus is fixed on bone structures with contact heating. The apparatus comprises a plate with upper grippers, arms and a flange. The upper grippers represent two open rings pulled apart in their tops; there is a notch formed between their bases in a plate to bring a posterior C1 pedicle under the posterior tubercle. The plate arms are turned backwards and extend in legs directed downwards. The hooks bent towards each other are located on the ends of the legs. The flange starts from the bottom of the plate, is opposed to the notch and has a segment bent forward, and then a segment bent backwards and downwards to the convergence of the hooks. The flange length is 2/3 of the leg length. The method involves the anterior decompression of the spinal cord by a transpharyngeal approach with the removal of a compression substrate and the anterior spinal fusion of C1-C2 vertebras with the insertion of a porous memory implant, as well as the posterior atlas-axial spinal fusion with the application of the stabilisation memory apparatus. The posterior decompression of the spinal cord involves the creation of a groove in a base of the spinous process of C2 vertebra. The aforementioned apparatus is cooled to -5°C with a coolant, the upper ring grippers and leg hooks are unbend; the flange is bend backwards. The apparatus is transferred to a wound and fixed; therefor, the upper ring grippers are brought behind the atlas pedicle, and the hooks are brought under the spinous process of C2 vertebra. The flange is inserted into the groove. By contact heating, the apparatus is fixed on bone structures. The combination of the anterior porous implant spinal fusion by the transpharyngeal approach and the posterior atlas-axial fixation with using the apparatus described above enables the treatment of complicated acute and chronic fracture dislocations of C1-C2 vertebras. First of all, the anterior decompression is performed to the extraction of a bone fragment negatively affecting the spinal cord, the dislocation reposition and anterior spinal fusion; the posterior spinal fusion of C1-C2 vertebras with using the declared apparatus is performed secondarily.
EFFECT: more reliable and durable stabilisation, possibility to avoid the external stabilisation.
2 cl, 9 dwg, 1 ex
SUBSTANCE: invention refers to medicine, namely to vertebrology. The approach to an involved vertebral segment is ensured by formation of at least three punctures with longitudinal axes of at least two of them directed on the involved segment. A thoracoport is fixed in each puncture. The resection of the involved vertebral fragments is enabled by a drilling machine with its shaft transmitting rotation to a milling head and having a length not less a thorax thickness and provided with a fixed protective casing with its external diametre being less than a drift diametre of the thoracoport. A video camera with a light source is delivered to the operative area through the second puncture directed to the involved segment. Through the third puncture, an instrument used to slide out the internal organs blocking the operative area is introduced. After the removal of bone material, a valley formed in a vertebra is filled with bone cement or ground bone material mixed with bone cement. That is ensured by a syringe with a needle of an external diametre being less than a diametre of the thoracoport, and an internal diametre threefold exceeding the greatest fraction of the bone material. The fractured bone material is removed through the first puncture, after the shaft of the drilling machine is removed. The fractured bone material is removed through the additional fourth puncture. The punctures are formed in the intercostal space. For the vertebral resection, the drilling machine of shaft speed min. 4000 rpm is used.
EFFECT: higher efficiency.
5 cl, 1 ex, 6 dwg
SUBSTANCE: spinal prosthesis contains first element of spinal prosthesis fastened to first spinal structure, and second element of spinal prosthesis, fastened to second spinal structure. First and second elements of spinal prosthesis are movably joined with each other by means of fastening device which has untight position, allowing spatial movement of first and second elements of spinal prosthesis relative to each other with obtaining desired orientation, and tight position, in which first and second elements of spinal prosthesis are fixed with relation to each other in desired orientation. First element of spinal prosthesis contains monolithic body which includes flexible knot located between first and second connecting elements. Hogging of flexible knot allows to move first connecting element relative to second connecting element. First connecting element has at least one connecting point for connection with first spinal structure. Second connecting element is movably connected with second element of spinal prosthesis by means of said fastening device.
EFFECT: invention has possibility of on-site regulation, for instance lordosis angle in prosthesis.
9 cl, 4 dwg
SUBSTANCE: body of C2-C3 disk is approached. Through a base of C2 vertebra, pins are introduced into a fragment of dens. Screws with a through axial channel are inserted on the pins to be removed thereafter. After approach to the C2-C3 body, an apparatus under cl.2 with its pointed flange of a base body is introduced into the C2 vertebral body from the C2-C3 disk. The opposite end of the base body together with an attached pair of oblong bodies is displaced downwards with raising and displacing anteriad the C2 vertebral body. At displacing downwards and keeping the pointed flange and the C2 vertebra in contact, the lower part of the pointed flange is shifted inside of the C3 vertebra until the axes of longitudinal through apertures of the oblong bodies are in the plane with the axis of dens and the fragment. The required direction is fixed to introduce a pair of pins through the apparatus under cl.2 into dens further. The apparatus for introducing the pins to tread the screws with the through axial aperture therethrough, herewith fixing C2 vertebral dens fracture comprises a base body supplied with at least a pair of the oblong bodies attachable to the base body. The oblong body is provided with the longitudinal through aperture formed for said pint, and a pointed end. Axes of the longitudinal through apertures from the pointed ends are at an acute angle to each other. The base body has a pointed flange concerning a plane passing through the axes of the longitudinal through apertures of the oblong bodies, and symmetrised between the pair of the oblong bodies.
EFFECT: inventions provide precise one-stage introduction of two spokes in dens, reduced surgery time and complexity.
5 cl, 1 ex, 19 dwg
SUBSTANCE: fastening elements are connected to each other with transversal bars provided with two couplings which have screwed holes for locking elements. Coupling are located near spinous processes. Transversal bars are connected via couplings with longitudinal bars and distraction is carried out. Longitudinal bars are fixed by means of locking elements in couplings. Fixation of fastening elements is weakened and reclination is performed by converging central rods, introduced into central screwed holes of heads of fastening elements. Transpedicularly screwed into adjacent vertebra locking elements are finally fixed, central rods are removed. Intraosteal reposition-fixing device for spine contains fastening elements with heads which have side slots, located at acute angle to axis of fastening elements and whose bases are made in form of hollows and projections, external thread, central screwed holes and edge cuts, longitudinal bars, fixing nuts with wide bases, central rods, introduced into central screwed holes of heads of fastening elements. In device additionally included are transversal bars with installed on them two couplings, which have holes for locking screws. Transversal bars are located in side slots of heads of fastening elements and are fixed with nuts, longitudinal bars being installed in couplings of transversal bar and rigidly fixed with locking screws.
EFFECT: increase of reposition and reclination possibilities of system with distribution of even loading on screws and on the whole system in general.
2 cl, 5 dwg, 1 ex
SUBSTANCE: invention concerns medicine, namely traumatology, orthopaedics and can be used for treatment of spinal osteomyelitis. That is ensured by antibacterial, immunocorrective, detoxication therapy, and surgical sanation and resection of the inflammation centre, and autogenous bone grafting of the cavity, and stabilisation with a plate of the system AESCULAP "MACS". It is combined with regional lymphotropic therapy according to the schedule dry Lydasa 64 st. units, 2% lidocaine 2 ml, lincomycin 2 ml. The mixture is introduced every 48 hours in number of 5 injections in the preoperative period and 7 injections in the postoperative period.
EFFECT: such method of spinal stabilisation in combination with the developed schedule of regional lymphotropic therapies provides higher stability in injured spinal locomotive segment and prevention of inflammatory complications before surgical sanation of the centre.
SUBSTANCE: invention relates to medicine, namely to vertebrology. Transpedicular screws are installed from one side of fracture into the body of intact vertebra at definite angle within from 10° to 30° relative to horizontal plane. From the other side of fracture transpedicular metal construction screws are installed into vertebra with I-II degree compression at angle within from 5° to 10° relative to sagittal plane.
EFFECT: method ensures more full-fledged reposition of vertebrae bodies, which increases affected segment function.
SUBSTANCE: corrector contains rod, installed in supporting fastening elements - hooks, elements of fastening of supporting fastening elements, additional supporting element in form of screw. Rod ends are made with longitudinal facets. Hook and screw head have bodies. Bodies have internal surface with facets installed on rod with possibility of interaction with rod facets, and threaded upper opening, by which body is fixed on rod. 2/3 of cylindrical screw rod length are made with section.
EFFECT: invention ensures increase of corrector reliability and stability.
SUBSTANCE: group of inventions relates to medicine. Element (10) of connection for spine fixation system intended for connecting of at least two implanted connective nodes, is formed by rod containing flexible part (11) extending at least on one of its ends by means of rigid part (12). Flexible part (11) contains cable (13) surrounded at least partially, by polymer envelope (14). Cable contains at least one elastic strand, coaxial with said envelope (14). Spine fixation system contains at least two implanted connective nodes, joined by means of at least one said element (10). Inventions ensure centering in order to adapt to natural lordosis of spine lumbar part, low invasiveness, at the same time ensuring required functional characteristics of dynamic connection element (flexibility, wear resistance), quick mounting on elements of cable anchorage, fixed on vertebrae.
EFFECT: invention also ensures possibility to undergo extension and/or compression after its mounting on elements of cable anchorage.
19 cl, 5 dwg
SUBSTANCE: invention relates to medicine, namely to neurosurgery and traumatology. Repositional holder contains bars with fastening elements in form of bone thread rods, connected between themselves with crossbeam with hooks, equipped with threaded locking devices for fixation on bars. Holder also has locking screws for fixation of bone thread rods on bars and nuts. Bone thread rod has head with external thread for nut, through slot for bar and internal thread for said locking screw. Central part of bar is made smooth. On peripheral parts of bar supporting thread with small pitch is made for providing sliding of fastening elements while carrying out distraction of vertebra with fracture and for holding fastening elements from their crawling to periphery during final fixation of system.
EFFECT: invention ensures improvement of treatment results due to more effective stabilisation of system, ensuring optimal reclination of traumatised vertebra.
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
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 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.
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.
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 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.
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: 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, 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
FIELD: medicine; traumatic surgery; orthopedic devices.
SUBSTANCE: device for applying lengthening or stretching force to patient's body has aid for fastening first and second components to bones or to adjacent bones. Mentioned components are connected by increasing-length connecting aid. Device also has magnet connected with connecting aid and drive unit disposed outside patient's body for generating moving or changing electromagnetic field which results in rotation of magnet and elongation of connecting aid. Connecting aid has screw and nut. Magnet is connected with screw and nut by means of transmission box to generate relative rotation for elongating the device. Endoprosthesis replacement device to be elongated has first and second components that are connected by increasing-length unit. The first component has fraction of extremity joint. The second component has aid for fastening to resected long bone, magnet connected with connecting unit, and aid adjusted for disposition outside patient's body for generation of moving electromagnetic field which results in rotation of magnet and elongation of connecting unit. Magnet is connected with connecting unit by means of reduction gear. Device for correcting curvature of the spine has first and second shafts for elongation. Any shaft has its end to be connected with aid for fastening to corresponding vertebra. Connecting unit is adjusted in such a way that ends provided with fastening means were relatively movable. Mentioned connecting unit is connected with drive mechanism, which has rotated magnet, reduction gear, and drive aid for disposition outside patient's body. Generated moving or changing electric/magnetic field induces rotation of magnet and motion of fastening aid, disposed onto one shaft, relatively fastening aid, disposed at the other shaft.
EFFECT: elongation of bones or implants without surgical operation.
15 cl, 5 dwg