RU2418567C1 - Method of surgical treatment of atlantoaxial instability in dwarf dog breeds - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: method relates to field of veterinary medicine and can be used for stabilisation of vertebral column. Method of surgical treatment of atlantoaxial instability in dwarf dog breeds lies in the following: autotransplant is obtained from spongy tissue of wing of ilium. After that, dorsal access to dorsal arch of the first cervical vertebra and spinous process of the second cervical vertebra is perfermed. Obtained autotransplant is implanted onto dorsal arch of the first cervical vertebra, fixed with three wire cerclages, cranial part of the second cervical vertebra is skeletonised. In spinous process of the second cervical vertebra three holes are formed, the first and the second cervical vertebrae are matched to each other. Fixation of the first and second cervical vertebrae is performed with ends of wire sutures, which fix the first autotransplant and dorsal arch of atlant to each other, by passing them through holes formed in spinous process of odontoid vertebra. The second autotransplant is formed from spongy tissue of wing of ilium opposite to the wing of earlier obtained transplant, and is placed in form of a bridge between the first and the second cervical vertebrae. ^ EFFECT: method makes it possible to increase strength of bone structure, fixing the first cervical vertebra with respect to the second cervical vertebra.

Description

The invention relates to the field of veterinary medicine and can be used to stabilize the spinal column at the level of CI-CII (first-second cervical vertebrae) in dogs with atlantoaxial instability.

There is a method of ventral stabilization of the spinal column at the level of the first or second cervical vertebrae using mini-plates and cortical screws (X. Shebits, V. Brass. "Surgical surgery of dogs and cats" / Transl. With it. V. Pulinets, M. Stepkin . - M.: Aquarium LTD LLC, 2001, p.333-334). The method consists in performing a reposition of the first and second cervical vertebrae and their subsequent fixation with a plate, with six holes, fixed by two screws in the atlas of the atlas and four screws on the ventral surface of the second cervical vertebra. The disadvantage of this method is that with ventral fixation of the vertebral column, tensile forces existing between the dorsal arch of the first cervical vertebra (atlas) and the spinous process of the second cervical vertebra (epistrophy) are preserved, which leads to craniocaudal displacement of the dorsal arch of the atlas relative to the spinous process of an epistrophy.

In addition to the above method of stabilization of the spinal column at the level of the first and second cervical vertebrae, the literature also describes a method of dorsal stabilization using cerclage wire (H. Shebits, V. Brass. "Surgical surgery of dogs and cats" / Transl. With it. V. Pulinets, M. Stepkin. - M .: LLC Aquarium LTD 2001, p.333). The method consists in holding a double wire under the arch of the first cervical vertebra and fixing the ends of the wire to the spinous process of the second cervical vertebra. The disadvantage of the prototype is the eruption of the Atlant’s arch with a wire suture, a broken wire, which leads to a relapse of instability of the first or second cervical vertebrae.

The closest technical solution is an improved method of dorsal stabilization of the spinal column, described by the doctor of veterinary sciences S.A. Yagnikov. It was in this method that the goal was achieved of preventing the destruction (cutting) of the dorsal arch of the first cervical vertebra (atlas). To achieve this goal, a spongy autograft of the iliac wing was implanted on the atlas arch. The space between the atlas arch (first cervical vertebra) and the spinous process of the epistrophy (second cervical vertebra) was filled with collapse granules stimulating osteogenesis (S. Yagnikov, “Strategy for the surgical treatment of atlantoaxial instability in dwarf dogs” / Russian Veterinary Journal, No. 1/2008 , p. 9-13). The disadvantage of this method is the formation of fuzzy bone marrow between the first and second cervical vertebrae in the distant postoperative period or its complete absence from the control radiographs.

The technical result of this invention is to increase the strength of the bone structure, fixing the first cervical vertebra (atlas) relative to the second cervical vertebra (epistrophy) in a given position.

The essence of the invention lies in the fact that in the method of surgical treatment of atlantoaxial instability in dwarf breeds of dogs, comprising obtaining an autograft from the spongy tissue of the iliac wing, performing dorsal access to the dorsal arch of the first cervical vertebra and the spinous process of the second cervical vertebra, implanting the obtained autotransplant the first cervical vertebra and fixation of the last by three wire cerclages, skeletonization of the cranial part of the second cervical ring formation in the spinous process of the second cervical vertebra of three holes, reponition of the first and second cervical vertebrae with each other, followed by fixation by the ends of the wire sutures that fix the first autograft and dorsal arch of the atlas between each other, by passing through the holes formed in the spinous process of the epistrophy the second autograft from the spongy tissue of the iliac wing, opposite to the wing of the previously obtained graft, which is placed in the form of a bridge between the first and second eye cervical vertebrae.

This method meets all the important previously defined requirements, namely: prevention of destruction (cutting) of the dorsal arch of the atlas, stable fixation of the vertebrae until the bone fusion of the arch of the atlas and the spinous process of the epistrophy, fusion of the arch of the atlas with the spinous process of the epistrophy to obtain a "biological" bone fixative. To form a strong bone callus between the atlas and the epistrophy, a spongy autobone of the ilium wing was implanted in the form of a bridge between the atlas arch and the spinous process of the epistrophy, placing bone “chips” under the wire sutures. It is the spongy bone (autograft) that has the maximum potential for osteoinduction, osteoconduction and osteogenesis.

Example 1

The invention is illustrated on a dwarf dog (Yorkshire Terrier) at the age of 2 years. The owners of the animal turned to the clinic complaining of impaired coordination of movement, constantly bent neck and the "squeal" of the animal when trying to pick it up. Clinical examination of the animal revealed an acute pain symptom, ventroflexion and tetraparesis. Based on an X-ray study of the cervical spine in a lateral projection on the radiograph, the spondylolisthesis of the first cervical vertebra (atlas) of the relative second cervical vertebra (epistrophy) was revealed in the animal.

The first step in the surgical intervention was to obtain two bone autografts from the iliac wings. The animal underwent linear skin incisions about 2 cm long in the area of the right and left iliac wing. Selected wings of the ilium were skeletonized by removing fragments of soft tissues from their surface. An osteotomy of the right and left wing was performed. The obtained autograft was placed on a napkin moistened with 0.9% saline. The postoperative wound was sutured in layers, monofilament thread 4-0.

The second stage of surgical intervention consisted in performing dorsal access to the arch of the atlas (first cervical vertebra) and the spinous process of the epistrophy (second cervical vertebra), opening the dura mater of the cranial and caudal dorsal arch of the atlas. The first bone autograft from the iliac wing was placed from the dorsal surface onto the dorsal arch of the atlas and fixed with three wire cerclages from a wire 0.6 mm in diameter at three levels. Three holes were formed in the spinous process of the epistrophy at different levels in height and length with a Kirschner spoke 1 mm in diameter. The cranial surface of the spinous process of the epistrophy was skeletonized from soft tissues. A second bone autograft from the spongy autobone of the ilium wing was implanted in the form of a bridge between the atlas arch and the spinous process of the epistrophy. The first cervical vertebra was repaired relative to the second cervical vertebra, achieving a good comparison, and the vertebrae were fixed with three wire sutures held through holes in the spinous process of the epistrophy. Soft tissue was sutured in layers, intermittent seams, monofilament thread 4-0. Immobilization of the head and cervical spine in relation to each other and the chest was provided with a plastic corset made of turbocast for 30 days.

The animal was returned home on the second day after the operation. Control radiography of the cervical spine in the lateral projection was performed on the 30th day after the operation. On the radiograph, there was a lack of displacement of the vertebrae, fracture of the wire sutures and the formation of the contours of a pronounced bone callus. The animal was removed a bone corset. After removing the corset, the owners were advised to restrict the dog in movement for one month.

Claims (1)

A method of surgical treatment of atlantoaxial instability in dwarf dog breeds, which consists in obtaining an autograft from the spongy tissue of the iliac wing, performing dorsal access to the dorsal arch of the first cervical vertebra and the spinous process of the second cervical vertebra, implanting the obtained autograft to the dorsal arch fix the latter with three wire cerclages, skeletonize the cranial part of the second cervical vertebra, form a second in the spinous process there are three holes in the cervical vertebra, the first and second cervical vertebrae are repaired with each other, followed by fixation by the ends of the wire sutures that fix the first autograft and the dorsal arch of the atlas between each other, by passing through the holes formed in the spinous process of the epistrophy, characterized in that the second autograft is formed from cancellous tissue of the iliac wing, opposite to the wing of the previously obtained graft, which is placed in the form of a bridge between the first and second cervical vertebrae.