RU2254080C2 - Damper method and device for treating vertebral column diseases - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: method involves introducing a pair of fastening members into each vertebra. Controllable elastic force is applied to the pairs of fastening members as unit- or bilateral load in particular cases. It enables one to support forces in continuous way in loading and relaxing vertebral muscles. Device has movable supporting beams connected to each other in specific way with threaded rods each manufactured from plates attached to each other. Two plates are outer and one of them is intermediate. Each plate has two members for fixing vertebra manufactured as screw rods. The plates are connected on one side with elastic member having spring and clamp mounted on threaded rod, one rod end being freely arranged on the plate and the other one being fixed in the plate with single-axle hinge; on the other side with elastic member having spring having hooks and threaded rod, one rod end being fixed in the plate with nuts and the other one is connected to opening in the plate.

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

5 cl, 10 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology, and in particular to methods of treating diseases of the spine using compressive and tensile mechanisms of external fixation located along the spine.

There is a method of posterior differentiated spring fixation of the spine, which consists in the formation of elastic fixation in the area of unstable damage to the spine, in which elastic fixation is formed behind the spine, taking into account the type of instability, the nature of the damage to the vertebrae and the method of front fixation (RF Application 95121456, Publ. 10.02.1998).

A known method of dosed local distraction of the spine, which consists in removing the damaged vertebra (disk) after preliminary distraction of the vertebra located above and below the damaged vertebra (disk), in which local distraction is metered and atraumatic for the vertebrae (RF Application 95121455, Publ. 02.10.1998 )

There is a method of anterior local damper fixation of the spine, which consists in fixing the affected part of the spine after removing the body of the damaged vertebra by installing instead of the last fixing element, in which the damper fixing of the vertebrae is formed by means of an elastic fixing element with a pre-calculated value of elasticity between adjacent vertebrae in which grooves are previously formed for installing the locking element (RF Application 95121453, Publ. 10.02.1998).

However, the known method involves the removal of a damaged vertebra and the creation of local damper fixation of the spine in the area of its removal and installation of the fixing element. Its use is not intended for the treatment of scoliosis under the influence of loads applied and supported in curved areas of the spine.

Known rear spring retainer of the spine A.V. Kedrova, which consists of two parallel metering springs with upper hooks and two brackets for fixing for a stable vertebra through hooks and screws with a bolt and lock nut, and the spring effect is achieved due to the axial action of two parallel springs on the level of at least one vertebral motor segment (RF Patent 2103937, Publ. 10.02.1998).

However, the known latch is intended for internal use.

Known auxiliary (additional) equipment for the correction of a damaged vertebra, containing at least two gripping elements for adhesion of one or both sides of at least two corresponding vertebrae, at the same time, the coupling of parallel longitudinal structures in the form of a support frame through the appropriate sliders and a movable base of the aforementioned the gripping elements and further includes elements for adjusting and connecting the gripping elements to their mutual position or a combination of three orthogonal boards (Patent US 5,797,910, publ. 25.08.1998).

However, the known auxiliary equipment does not provide for the creation of additional damping force when exposed to a portion of the spine during the entire period of its use in treating a patient.

A device for external fixation of the spine, containing a pair of fixing screws (left and right), which are located separately on the set of vertebral bodies for screwing into them, connected by nuts, like which are connected to the upper part of the fixing screws so that they partially protrude beyond the wound and a fixing device securing the connection of the nuts, or in such a way that the distance between them is adjustable outside the wound (Patent JP 09187465, Publ. 22.07.97).

However, the design of the known device does not provide for the creation of a damper load on the spinal column during the treatment of its pathologies.

A device for external transpedicular fixation of the spine, a method for its use and a surgical clamp containing three support blocks, each of which is made of connected plates, on each of which at least two vertebral fixation elements are fixed, two support blocks are extreme, and one of of them is intermediate, each of them is interconnected with the possibility of moving by means of screeds, when performing the method, transdermal introduction of the elements of their fixation into the vertebral bodies is carried out and subsequent distraction efforts, laminectomy and discotomy of the cranial and caudal spinal discs located at the top of the deformity, and the introduction of autografts into the cavity of each disc (Application WO 01/56488, Publ. 09.08.01; Patent - analogue of the Russian Federation No. 2220676, Publ. 10.01.2004 g ., Bull. No. 1).

However, the design of the known device does not provide for the creation of additional supporting damper forces in the process of eliminating scoliotic deformation.

An object of the present invention is to provide a method and apparatus for treating diseases of the spinal column by supporting a damping load and with minimal trauma.

The problem is solved in that in the method of damper treatment of diseases of the spine, including mechanical fixation of the vertebrae, transosseous fixation of the spine is carried out by introducing into each vertebra a pair of fixation elements that are rigidly fixed to the plates, while in a plane perpendicular to the midline of the spine and in the plane perpendicular to the plane of fixation, create controlled elastic forces on pairs of elements of fixation of the spine; for this, a damper apparatus is used to treat a disease of the spine, containing supporting blocks interconnected by threaded rods with the possibility of movement, each of which is made of plates fixed to each other, two of which are extreme and one intermediate, with two elements of vertebral fixation made on each plate fixed in in the form of a rod - screw, on one side of the plate are connected by an elastic element in the form of a spring with a clamp mounted on a threaded rod, one end of which is freely placed in the plate, and the other is fixed in the plate after stvom uniaxial hinge and on the other hand - the elastic element in the form of a spring with hooks and a threaded rod, one end of which is fixed in the nut plate and a second end connected to one end of the elastic member, the second end of the latter is connected to the hole plate.

In an embodiment of the method, in the treatment of spinal injuries in a plane perpendicular to the plane of fixation, create the same elastic effort on both sides.

It is advisable to eliminate spondylolisthesis of the spine in a plane perpendicular to the plane of fixation to create an elastic force on one side.

Patented method of damper treatment of diseases of the spine and the damper apparatus for its implementation is explained by a detailed description, experimental and clinical examples, and illustrated by diagrams and radiographs, in which

Figure 1 depicts a damper with elastic elements located along the spine to eliminate C-shaped scoliosis;

Figure 2 depicts an elastic element in the form of a spring, working between the blocks in tension;

Figure 3 depicts an elastic element in the form of a spring with hooks, working between the blocks in compression;

Figure 4 depicts a damper with elastic elements located along the spine to eliminate S-shaped scoliosis;

Figure 5 depicts a damper apparatus for the treatment of spondylomesthesis, the elastic element in which is located between the supporting blocks;

6 illustrates a deformed spine of an animal (frontal projection) prior to application of a damper force;

7 illustrates an elastic element located along the spine of a damper apparatus (frontal projection);

Fig. 8 illustrates a damper apparatus (sagittal projection) in the deformation correction mode, in which the elastic element is made in the form of a spring;

Fig.9 is a copy of the R-gram of patient I. before the treatment of S-shaped scoliosis of the 4th degree;

Figure 10 is a copy of the R-gram of patient I. in the process of treating S-shaped scoliosis of the 4th degree using a damper apparatus;

11 is a copy of the R-gram of patient I. after correction of S-shaped scoliosis of the 4th degree.

The damper apparatus includes a block 1 and 2 (Figure 1). Each of the blocks is made of interconnected plates 3, 4, 5 and 6, 7, 8, equipped with holes and grooves. The plates 3, 4, 5 are located in parallel and are fixed relative to each other by rods and pairs of nuts. The plates 6,7, 8 are arranged and fixed in a similar manner. On each of the plates 3, 4, 5, 6, 7, 8, a pair of screw rods are fixed by means of clamps and nuts.

Blocks 1 and 2 of the damper apparatus are interconnected. On one side of the plate 5, one end of the threaded rod 9 is freely located in the hole. On the rod 9 there is an elastic element made in the form of a spring 10 (Figure 2), which is fixed by a clamp 11 (Figure 1), made in the form of a nut. The second end of this rod is fixed by means of a uniaxial hinge 12 with the plate 6. On the other hand, the end of the threaded rod 13 is fixed to the hole of the plate 5 by a pair of nuts 14 (not shown) and 15. The second end of the rod 13 is connected to one of the ends of the elastic element 16. The second the end of the latter is connected to the hole of the plate 6. The elastic element 16 is made in the form of a spring, equipped with hooks 17 and 18 (Figure 3).

One of the plates of the support block 1 (FIG. 1) is provided with a fastening element 19, in which the end of the elastic element made in the form of an elastic rod 20 is fixed. The second end of this elastic element is located in the hole of the guide element 21, which is fixed in the hole of the plate 8 of the support block 2.

Damper apparatus for the treatment of S-shaped kyphoscoliotic deformation consists of three supporting blocks 1, 2, 22 (Figure 4). The third support block is made of interconnected plates 23, 24, 25. The end plate 25 of the support block 22 is movably connected to the plate 3 of the support block 1. On one side of the plate 3, one end of the threaded rod 26 is located in the hole. On the rod 26 is located an elastic element made in the form of a spring 27, which is fixed by a clamp 28 made in the form of a nut. The second end of this rod 26 is fixed by means of a uniaxial hinge (not shown) with the plate 3. On the other hand, the end of the threaded rod 29 is fixed to the hole of the plate 3 by a pair of nuts 30 (not shown) and 31. The second end of the rod 29 is connected to one end of the elastic element 32. The second end of the latter is connected to the hole of the plate 25. The elastic element 32 is made in the form of a spring, equipped with hooks 17 and 18 (Figure 3).

One of the plates 8 of the support block 2 (Figure 4) is provided with a fastening element 19, in which the end of the elastic element is made, made in the form of an elastic rod 20, which is passed through the guide element 21. The second end of the elastic rod 20 is located in the hole of the guide element 33, which is fixed in the hole of the plate 23 of the support block 22.

The method and apparatus are used as follows.

A pair of rods - screws are introduced into each of the vertebrae located above and below the top of the scoliotic deformation. The free ends of the rods - screws are attached to the plates 3, 4, 5, 6, 7, 8 (Figure 1). The plates 3, 4, 5 are fixed to each other by threaded ties, forming a block 1. Similarly, the plates 6, 7, 8 are fixed, forming a block 2.

On one side of the plate 5, one end of the threaded rod 9 is freely installed in the hole. An elastic element 10 is placed on the rod 9. The elastic element 10 is made for this in the form of a spring, which is fixed with a clip 11 made in the form of a nut. The second end of the rod 9 is fixed by means of a uniaxial hinge 12 with the plate 6. On the other hand, the end of the threaded rod 13 is fixed in the hole of the plate 5 by a pair of nuts 14 (not shown) and 15. The second end of the rod 13 is connected to one of the ends of the elastic element 16, which perform in the form of a spring and supply it with hooks 17 and 18 (Figure 3).

One of the plates of the support block 1 (Figure 1), for example 5, is provided with a fastening element 19, in which the end of the elastic element 20, made in the form of an elastic rod, is fixed. The second end of this elastic element 20 is located in the hole of the guide element 21, which is fixed in the hole of one of the plates of the support block 2, for example 8.

After assembling the damper apparatus on the third or fourth day, and until the C-shaped deformity of the spine is completely corrected, the nut 11 is screwed up, which leads to compression of the spring 10. On the other hand, the nut 15 is untwisted and the nut 14 is screwed up, creating a tensile force. In this case, the elastic elements 10 and 16 allow for a controlled elastic load on the pairs of vertebral fixation elements.

An elastic element 20 is provided in the damper apparatus. It can be made in the form of one or two elastic rods. One ends of the elastic rods are rigidly fixed in the fastening element 19, which is fixed on the plate 5 of the support block 1. The second ends of the elastic elements 20 are freely located in the hole of the guide element 21. The latter is fixed on the plate 8 of the support block 2. The elastic element 20, parallel to the axis of the spine , absorbs and redistributes the mechanical forces created by the elastic elements 10 and 16 of the damper apparatus.

Damper apparatus for the treatment of S-shaped kyphoscoliotic deformation consists of three supporting blocks 1, 2, 22 (Figure 4). The third support block is composed of interconnected plates 23, 24, 25. The end plate 25 of the support block 22 is connected with the possibility of moving with the plate 3 of the support block 1. On one side of the plate 3, one end of the threaded rod 26 is placed in the hole. On the rod 26 is installed an elastic element made in the form of a spring 27. The latter is fixed with a clip 28 in the form of a nut. The second end of the rod 26 is fixed by means of a uniaxial hinge (not shown) with the plate 3. On the other hand, the end of the threaded rod 29 is fixed in the hole of the plate 3 by a pair of nuts 30 (not shown) and 31. The second end of the rod 29 is connected to one of the ends of the elastic element 32, the ends of which are in the form of hooks 17 and 18. The second of them is connected to the hole of the plate 25.

On one of the plates 8 of the support block 2, a fastening element 19 is fixed, in which the ends of the elastic elements 20, made in the form of elastic rods, are fixed. In this case, the elastic rods 20 are freely inserted into the guide element 21, which is fixed on the plate 5 of the support block 1. The second ends of the elastic rods 20 are located in the hole of the guide element 33, which is fixed on the plate 23 of the support block 22.

After assembling the damper apparatus on the third or fourth day and until the S-shaped deformation of the spine is completely corrected (Fig. 4), the nuts 11 and 28 are screwed at the same time, which leads to compression of the springs 10 and 27, respectively. On the other hand, untwist nut 15 and nut 30 (not shown in the diagram) and screw nuts 14 (not shown in the diagram) and 31, create a tensile force. In this case, the elastic elements 10 and 16 allow angular movement of the support block 1 relative to 2 from one spatial position to another. This not only moves the vertebrae, but also supports and corrects the elastic efforts in the process of moving the vertebrae.

To eliminate kyphosis in the damper apparatus to correct the S-shaped deformation of the spine, an elastic element 20 is made in the form of one or two elastic rods. Some ends of the elastic rods are rigidly fixed in the fastening element 19, which is fixed on the plate 5 of the support block 1. The second ends of the elastic rods 20 are freely located in the hole of the guide element 21. The latter is fixed on the plate 8 of the support block 2. The elastic element 20, parallel to the axis of the spine , absorbs and redistributes mechanical forces and muscle forces that counteract mechanical forces.

Example 1. An example of the experimental use of the method of damper treatment of diseases of the spine and the damper apparatus for its implementation.

The history of the experimental animal No. 160 (dog No. 1342).

Pre-simulated scoliotic deformation (3rd degree) of the lumbar spine (Fig.6).

Two spokes are passed through the spinous processes of the 12 thoracic vertebra and one spoke through the body of the first lumbar vertebra, and one spoke through the body, and two knitting needles through the spinous process of the fifth lumbar vertebra. Three spokes were drawn through the wings of the pelvis. Spent and stretched knitting needles fix the support blocks to the plates. Then the supporting blocks of the damper apparatus are assembled, fixing them to the spokes drawn through the spinous processes and vertebral bodies.

The blocks of the damper apparatus are interconnected (Figs. 7, 8). On one side of one block an elastic element is arranged in the form of a spring, which is fixed by a clip made in the form of a nut. One end of the rod is freely located in the hole of the plate. The second end of this rod is fixed by means of a uniaxial hinge with a plate. On the other side of the plate is fixed the end of a threaded rod connected to one of the ends of the elastic element in the form of a spring equipped with hooks.

One of the plates of the support block is provided with a fastening element, in which the end of the elastic element, made in the form of an elastic rod, is fixed. The second end of this elastic element is located in the hole of the guide element, which is fixed in the hole of the plate of the support block.

By screwing a nut at the end of a threaded rod connected to a spring equipped with hooks, a damper force is created that allows the support blocks and corresponding vertebrae to be moved. An elastic rod parallel to the axis of the spine creates additional elastic forces along the spine.

Example 2. An example of the implementation of the proposed method using a damper.

Patient I., medical history No. 2843, 13 years old, was treated from 08.08.01 to 03.03.2002 with a diagnosis of dysplastic "S" -shaped thoracolumbar scoliosis of the III-IV degree (Fig. 9). Right costal hump.

Upon receipt of a complaint about spinal deformity in the thoracic and lumbar regions. Considers herself ill since 1999. Treated conservatively, without effect. She was hospitalized in the department of neurosurgery for examination and surgical treatment in a planned manner.

The clinical picture of the disease at admission is represented by curvature of the spine in the thoracic and lumbar regions. Asymmetry of the triangles of the waist and shoulders. There is no gross pathology in the neurological status.

On spondylograms of the thoracic and lumbar spine, an “S” -shaped scoliosis of the thoracic and lumbar spine with the apex of deformation in the thoracic spine at D9-10 at an angle of 50 ° and the arc is contrasted with the apex at L1-2, at an angle of 47 °.

08.21.01, under endotracheal anesthesia, the first stage of surgical treatment was performed - subperiosteal resection of 6, 7, 8, 9, 10, 11 ribs on the right in the area up to 10 cm. Postoperative period - without complications.

September 21, 01, the II stage of surgical treatment was completed - a closed imposition of the damper fixation apparatus of the spine (Figure 10). In the postoperative period, deformation correction was performed using a damper apparatus.

November 23, 01 - the III stage of surgical treatment was performed - thoracotomy in the VIIth intercostal space on the right, anterior wedging fusion of D7-8, D8-9, D9-10, D10-11 segments with titanium nickelide implants. Healing by first intention.

December 25, 2001 - the IV stage of surgical treatment was performed - right-sided extraperitoneal access, anterior proppant fusion L2-3, L3-4, L4-5 with titanium nickelide implants. The postoperative period - without features.

Given the data of computed tomography and the period of fixation of the spine with a damper apparatus on 02/26/02, the apparatus was dismantled. The corset is made of polyvic.

On control radiographs, S-shaped scoliosis with an arch of curvature at the apex of D8, an angle of 11 °, an arc of anti-curvature in the lumbar region with an apex at L1 and an angle of 5 ° is determined. Correction of deformation in the thoracic region - 78%, in the lumbar - 90% (Figure 11).

The proposed method and damper apparatus can reduce the time required for correction of spinal deformity by 1.5-2 times. The use of spring elements allows you to constantly maintain efforts by loading or relaxing the muscles of the spine. The design of the elastic elements allows you to create various spatial models of the damper apparatus, adequate to human biomechanics.

The proposed method and apparatus can achieve cosmetic results due to hypercorrection of the deformed spine, which prevents relapses and complications in the treatment process.

In addition, the damper is easy to manufacture, assemble and disassemble. It is used in the neurosurgery department of the RTC "WTO".

Claims (5)

1. A method of damper treatment of diseases of the spine, including mechanical fixation of the vertebrae, characterized in that transosseous fixation of the spine is carried out by introducing into each vertebra a pair of fixation elements that are rigidly fixed to the plates, while in a plane perpendicular to the midline of the spine, and in the plane, perpendicular to the plane of fixation, create controlled elastic forces on the pairs of elements of the fixation of the vertebra. 2. The method according to claim 1, characterized in that the plates are connected into blocks, between which from two sides create a controlled elastic load, in addition, in the plane of the midline of the spine create an elastic damper load. 3. The method according to claim 1 or 2, characterized in that in the plane perpendicular to the plane of fixation, create the same elastic effort on both sides. 4. The method according to any one of claims 1 to 3, characterized in that in the plane perpendicular to the plane of fixation, create an elastic force on one side. 5. A damper apparatus for the treatment of diseases of the spine, comprising supporting blocks interconnected by threaded rods with the possibility of movement, each of which is made of plates fixed to each other, two of which are extreme and one intermediate, with two fixed to each of the plates a vertebral fixation element made in the form of a screw rod, characterized in that on one side of the plate the elastic element is connected in the form of a spring with a clip mounted on a threaded rod, one end of which is free the bottom is placed in the plate, and the second is fixed in the plate by means of a uniaxial hinge, and on the other hand, by an elastic element in the form of a spring with hooks and a threaded rod, one end of which is fixed in the plate with nuts, and the second end is connected to one of the ends of the elastic element, the second the end of the latter is connected to the hole of the plate.

Images