RU2428947C1 - Method of fixation of unstable spine injuries - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention can be used during stabilising operations on lumbar spine, in which all support complexes - anterior, middle and posterior are destroyed as a result of trauma or tumour affection of vertebrae. Anterior access to affected vertebral-motor segment is performed. From the front, through bodies of vertebrae into arches of vertebrae adjacent to affected ones, introduced are four or more bone screws, whose length corresponds to diameter of vertebrae bodies with account of length of vertebra arch roots. After that, to screws vertically fixed are two plates, which have holes for screw introduction. ^ EFFECT: method ensures reliable stabilisation of vertebral-motor segment from one surgical access. ^ 2 dwg

Description

The invention relates to medicine, namely to neurosurgery and traumatology, and can be used for stabilizing operations on the lumbar spine, in which all supporting complexes (front, middle and back) are destroyed due to trauma or tumor damage to the vertebrae.

There is a method of fixing unstable spinal injuries (Georg Gradl, Combined Stabilization of Thoracolumbar Spine Fractures. / Eur J Trauma 2006; 32: 249-252.), In which two stages of surgical intervention are performed to stabilize the damaged vertebral-motor segment - from the anterior and from rear access. In this case, the anterior sections of the affected vertebra are prosthetized from the front access by performing anterior corporodesis. And from the rear access fixation of the spinal motor segment by the transpedicular system is performed.

The disadvantage of this method is the need to perform two-stage surgical treatment from the anterior and posterior approaches, since the method does not allow stabilization of the anterior and posterior supporting complexes of the affected vertebra simultaneously.

Closest to the totality of signs to the claimed method is a method of fixing unstable injuries of the spine, (U. Hurms, G. Tabasso, Instrumented Spinal Surgery / Principles and Technique. - Stuttgart, New York: Theme, 1999. - p. 76-78), adopted as a prototype. The method is as follows. In the position of the patient on the right side, a soft tissue incision is made in the left iliac region parallel to the edge of the costal arch. Dissect the muscles of the abdominal wall to the peritoneum. The peritoneum is taken away. Skeletonize the anterolateral surface of the vertebrae. Verify a broken vertebra. Using nippers and bone spoons, up to 2/3 of the body of the affected vertebra is removed with the formation of a groove for the transplant or endoprosthesis of the vertebral body with the removal of the posterior fragments of the body that compress the dural sac. After reklination, a graft is inserted into the formed groove tightly.

One screw of the rod structure is inserted into the lateral surface of the bodies adjacent to the affected vertebrae, the screws are jointed with the rod and fixed with clamping nuts. Produce hemostasis control. Active drainage is introduced into the retroperitoneal space. The wound is sutured in layers. Apply a bandage.

In the course of the operation, X-ray control is performed.

The second stage of surgical treatment is performed in the position of the patient on the abdomen. From a linear incision of soft tissues along the spinous processes, access is made to the posterior parts of the lumbar vertebrae. The insertion points of the transpedicular screws are determined. Alternately, screws are inserted into the roots of the arms. The screws are jointed with rods and fixed with clamping nuts. In the course of the operation, X-ray control is performed.

Produce hemostasis control. The wound is sutured in layers leaving active drains in the wound cavity. Apply a bandage.

The disadvantages of the prototype:

- The need to perform two surgical approaches, which is traumatic, becomes significant loss of blood, increases the time of surgical intervention and, accordingly, the time of anesthetic management, which negatively affects the patient's condition in the postoperative period, since a significant degree of tissue damage leads to long periods of wound healing.

- The need for implantation in the body of two foreign bodies - two metal structures.

The invention is aimed at creating a method for fixing unstable injuries of the spine, which provides reliable stabilization of the affected vertebral-motor segment from one surgical approach due to the simultaneous fixation of three supporting vertebral complexes.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of fixing unstable injuries of the spine, including front access to the affected vertebral-motor segment, performing anterior corporodesis and introducing into the vertebrae adjacent to the affected four or more bone screws, the feature is that that in front through the vertebral bodies, screws are inserted into the roots of the vertebral arches, the length of which corresponds to the diameter of the vertebral bodies, taking into account the length of the roots of the vertebral arches, and the point and the insertion direction for each screw is determined in advance, then the screws parallel to each other are fixed two vertical plates having holes for introducing screws.

The introduction of screws through the body into the roots of the vertebral arches and the fixation of plates to them can reliably strengthen the front, middle and rear supporting vertebral complexes, eliminating additional fixation of the spine from the posterior surgical approach, shortens the time of surgery, reduces blood loss, significantly reduces the invasiveness of the method.

The invention is illustrated by drawings, where figure 1 presents a diagram of the implementation of the method, figure 2 is the same top view, section.

The figures show: bone screw 1, plate 2, vertebral body 3, arch root 4 of the vertebra, graft 5, fixing nut 6. Plates 2 are made of metal (titanium alloy) with longitudinal holes for introducing screws (for example, a plate (Spine plates ) Monarch systems manufactured by the English company DePuy AcroMed). The plates have a length of 25 to 85 cm, depending on the height of the vertebrae and the number of affected vertebrae. The bone screw 1 is made of metal (titanium alloy), (for example, the Monarch system screws (Pedicle Bolt) manufactured by the English company DePuy AcroMed) and have a length of 45-50 cm, depending on the diameter of the vertebral body, taking into account the root length temples of the vertebra.

The method is as follows. Perform front access to the anterior structures of the lumbar spine. In the patient’s position on the back, a skin incision is made, starting 5 cm upwards from the symphysis, leading upward and outward in an arcuate manner to the costal arch in the mid-clavicular line. Dissected: superficial fascia, aponeurosis of the external oblique muscle and in the upper section of the muscle itself, as well as the internal oblique and transverse muscles. Penetrate through the transverse fascia and exfoliate the peritoneum, pulling it along with the ureter medially. Install a conservator. After exposure of the lumbar muscle, the lumbar vertebrae and their relationship with the main vessels and venous plexus are visualized. The sympathetic trunk along with the dissected longitudinal ligament is displaced laterally, exposing the vertebrae. If it is necessary to work on the upper lumbar vertebrae, the access is extended upward and the XII rib is resected. The main vessels are isolated and mobilized throughout the affected, above- and underlying affected vertebral body. Skeletonize the front surface of the affected vertebra and adjacent vertebrae. Using nippers and bone spoons, the destroyed parts of the body of the affected vertebra are removed with the removal of the posterior parts of the body and the formation of a groove for laying the transplant or endoprosthesis of the vertebral body. After reklination, a graft or endoprosthesis filled with bone crumb is inserted tightly into the formed groove after reklination.

Using computer navigation, using, for example, the navigation system of the company STRYKER, determine the point and direction of entry for each bone screw from the front surface of the body to the root of the arch of the vertebra. Four or more screws are inserted into the found points located on the cortical layer of the anterior surface of the vertebral bodies adjacent to the affected vertebra through the vertebral bodies into the roots of the vertebral arches, the length of which is selected depending on the diameter of the vertebral body taking into account the length of the vertebral arch. Then, two plates having holes for introducing screws are put vertically parallel to each other on the screws. The length of the plates is selected depending on the height of the vertebrae and the number of affected vertebrae. Screw the fixing plate nuts onto the screws. Produce hemostasis control. Active drainage is introduced into the retroperitoneal space. Perform a layered suture of the wound. Apply a bandage.

The use of the claimed invention provides reliable stabilization of the affected vertebral-motor segment from one surgical approach, makes it possible to stabilize simultaneously the front, middle and rear supporting structures of the affected vertebra.

Claims (1)

A method for fixing unstable spinal injuries, including front access to the affected vertebral-motor segment, performing anterior corporodesis and introducing four or more bone screws into the vertebrae adjacent to the affected one, characterized in that screws are inserted in front of the vertebral bodies into the roots of the vertebral arches, the length of which corresponds to the diameter of the vertebral bodies, taking into account the length of the roots of the vertebral arches, and the point and direction of entry for each screw is determined previously, then vertically rotate to the screws parallel to each other cial two fixed plates having holes for introducing screws.

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