RU2434599C1 - Method of treating idiopathic scoliosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics, in particular to vertebrology. Submersible fixator is used, transpedicular screws are implanted on concave side of spine deformity. After that they are implanted into pedicles of 3-4 vertebrae, located on the top of deformity and connected with short rods. The top of deformity is subjected to impact of mechanical pressure by means of instrument until degree of spine deformity decreases. After that, derotation is performed by installation of rods on concave surface, and replacement of short rod with a long one from the side of deformity top.

EFFECT: method makes it possible to prevent postoperative complications.

3 ex, 10 dwg, 3 cl

Description

The invention relates to medicine, namely to orthopedics, in particular, is intended for the surgical treatment of diseases of the spine by means of metal construction.

A known method of treating idiopathic scoliosis, in which they influence the growth areas of the spine at the top of the scoliotic arch, the effect is produced using a pulsed magnetic field by magnetic induction of 1.48 T, the duration of the procedure is 10 minutes, a course of 15 procedures (Pat. 2275943 RF. Publ. May 10, 2006).

However, the known method allows to suppress the functional activity of the germinal zones, to eliminate trauma, to maintain the physiological mobility of the spinal column due to the magnetic field and is not intended for surgical treatment of the spinal column.

A known method for the surgical treatment of scoliosis, in which a laminectomy and opening of the spinal canal are performed, capillary blood flow is measured in the spinal cord with a needle intraoperative sensor at the apex of the deformity, cranially and caudally from it, discoctomy is performed, and capillary blood flow is re-measured, while screw rods are inserted in the vertebrae located cranially and caudally from the discootomy, then an external transpedicular fixation device is installed and with a capillary blood flow of up to 20 m / min 100 g at the top of the deformity and with a blood flow from 18 to 40 ml / min 100 g cranially from it, they perform intraoperative distraction on the concave side of not more than 5 mm and conservative therapy is carried out aimed at improving the microcirculation of the spinal cord, and with a blood flow of a strain peak above 25 ml / min 100 g and a blood flow in the caudal segment of more than 40 ml / min 100 g carry out distraction from 5 to 20 mm (Pat. No. 2201129 of the Russian Federation. Publ. September 10, 2002).

However, the known method allows to prevent neurological complications and is not intended for use in the treatment of the spine using bone fixatives.

A known method for the treatment of scoliosis, including the installation of electrodes epidurally connected to an electrical appliance, supplying electrical potentials, taking readings from devices, installing a distractor followed by correction of spinal deformity and monitoring the allowable correction, in which electrodes are installed on both sides of the vertex of the spinal deformity between the installation sites of the distractor hooks and near them, the impedance of the blood vessels of the spinal cord is recorded until correction of spinal deformity, to ontrol of correction of spinal deformity is performed to reduce impedance to a critical level (Pat. No. 20088835 of the Russian Federation. Publ. March 15, 1994).

However, the known method is intended for the prevention of surgical neurological complications by controlling spinal circulation, while hooks rather than rods are used to fix the spinal column.

A known method of correction of C-shaped deformity of the spine, in which a multi-directional dosed correction of all elements of scoliosis is performed (Pat.2341218 RU. Publ. 20.12.08).

However, the presented method allows you to gradually correct scoliosis with an external transpedicular fixation device and does not allow you to save the achieved correction after removal. In addition, the presented method does not exclude the development of recurrence of deformation with the progression of scoliosis.

A known method for the surgical treatment of juvenile progressive scoliosis by stage distraction of posterior fusion with autologous bone, in which epiphysiopondylodesis is carried out along the convex side of spinal deformity, in addition, the first stage of distraction can be performed immediately after epiphysiopondylodesis during a simultaneous two-stage intervention, and the subsequent stages of further distraction deformations of the spine, while instruments are used as a corrective device th Cotrel-Dubousset in a special pediatric layout (Application No. 98117990/14 of the Russian Federation. Published. 06/27/2000).

However, in the known method, the vertebrae are not staggered.

A known method for correcting scoliotic deformity according to Kaneda, including the introduction of screws into each vertebra, fixing the screws with each other, performing slow rotation, laying in the intervertebral spaces of crushed fragments of the ribs, fixing the rods (Mikhailovsky M.V., Fomichev N.G. Surgery of spinal deformities . - Novosibirsk: Sib. Univ. Publishing House, 2002. - S.295-301).

However, when performing the known method, a large number of consumables are used, hypoplastic vertebrae are injured, and surgical intervention is quite long in time.

The objective of the present invention is to prevent injury to hypoplastic vertebrae and neurological complications, reducing consumables, reducing the time of surgery.

The problem is solved in that in a method for the treatment of idiopathic scoliosis, including the use of an immersion fixator, the vertebrae are fixed with transpedicular screws that connect the rods, the pedicle screws are initially implanted on the concave side of the spinal deformity, then they are implanted in the legs of 3-4 vertebrae located on the top of the deformity , and connect with short rods, after which they are subjected to mechanical stress using a tool to the top of the deformation to reduce the degree of deformation tion of the spine, then produce derotation, ustanovlivaya rods on the concave surface, and replaced with a short rod from a long deformation vertices.

When scoliotic deformation accompanied by marked rotation and hypoplasia of the legs of the arches, it is advisable to implant the transpedicular screws along the convex and concave sides of only four cranial and four caudal vertebrae of the scoliosis zone, traction to reduce the strain, and then connect the transpedicular screws with short rods, which then connect transverse connectors and rods.

In an embodiment of the method with scoliotic deformation not exceeding 60-65 °, transpedicular screws are implanted into the legs of all vertebrae on the concave side, and three transpedicular screws are implanted on the convex side in a row, then 2-3 vertebrae are passed, the next three transpedicular screws are implanted in a row, then three vertebrae are missed again.

The present invention is illustrated by a detailed description, a clinical example and illustrative material, on which:

Figure 1 - stages of surgical intervention with scoliotic deformation of more than 100 ° without pronounced rotation and hypoplasia of the legs of the vertebral arches;

Figure 2 - stages of surgical intervention with scoliotic deformation of more than 100 ° with pronounced rotation and hypoplasia of the legs of the vertebral arches;

Figure 3 - stages of surgical intervention with scoliotic deformity not exceeding 60-65 °;

Figure 4 - radiograph of the lumbar spine of the patient V.A. before surgery with scoliotic deformity of more than 100 ° without pronounced rotation and hypoplasia of the legs of the vertebral arches;

Figure 5 - radiograph of the lumbar spine of the patient V.A. after operation;

6 is a radiograph of the thoracolumbar spine of patient F., idiopathic scoliosis, strain 116 °, before treatment;

Fig.7 - the final stage of the operation in patient F.;

Fig. 8 is a radiograph of the thoracolumbar spine of patient F. after treatment;

Figure 9 - x-ray of the thoracolumbar spine of patient A. before treatment of scoliotic deformity not more than 60-65 °;

Figure 10 - x-ray of the thoracolumbar spine of patient A. after treatment of scoliotic deformity not more than 60-65 °.

The method is as follows.

In the proposed method, the task is solved in that the choice of the scheme for holding screws is differentiated and depends on the degree of scoliosis, the severity of rotation of the vertebral bodies at the top of the deformation and hypoplasia of the legs of the vertebral arches.

When performing surgical intervention, the patient is given general anesthesia, usually with profopol. The patient is placed on the operating table face down with silicone cushions under the chest. This styling helps prevent bleeding. The average pressure is kept at 90/60 mm Hg. Art.

A midline incision is performed, depending on the degree of scoliotic curvature. Then, according to the generally accepted method, access to the vertebrae. According to the method of Lenke put labels for the implantation of internal transpedicular screws. Each vertebra has its own label. Do an x-ray control to confirm the implantation sites of transpedicular screws.

In those cases when the magnitude of scoliotic deformation exceeds 100 °, but rotation and hypoplasia of the legs of the vertebral arches are not expressed, which allows transpedicular fixation without complications (Figure 1). In this case, transpedicular screws (hereinafter referred to as screws) are first implanted along the concave portion of the curvature. All possible screws are placed, which are initially implanted on the concave side of the spinal deformity, then they are implanted in the legs of 3-4 vertebrae located at the top of the deformation, and connected with short rods. Then, with the help of a tool, the top of the deformation is subjected to mechanical pressure until the degree of deformation of the spine is reduced, then derotation is performed. After that, from the concave side, a long rod is finally fixed. Then remove the short rod, replace it with a long rod from the side of the deformation apex for final fixation. After correction and derotation, the rods and screws are fastened. The surgical wound is sutured as standard. The patient is recommended to sit down in two days, and on the third day they are allowed to get up.

When scoliotic deformation of more than 100 °, accompanied by pronounced rotation and hypoplasia of the legs of the arches, transpedicular screws are implanted in the cranial and caudal parts of the curvature (at least four screws are implanted in the lumbar region, and at least three on each side in the thoracic region) (Figure 2) . The rods are mounted first on the concave side, then on the convex side, followed by correction of spinal deformity on the operating table. After that, the rods are fixed between themselves by at least two connectors and additional rods.

In an embodiment of the method with scoliotic deformation of 60-65 ° from the concave side, all possible transpedicular screws are implanted. On the convex side, at least three screws are placed caudally. Then two vertebrae are missed. Two or three screws are implanted in the apical part, another two or three vertebrae are missed, and two or three screws are implanted in the cranial section. The rod is fixed first from the convex side, and then from the concave (Figure 3). The surgical wound is sutured as standard. The patient is recommended to sit down in two days, and on the third day they are allowed to get up.

Clinical examples.

Example 1

Patient V.A. diagnosed with idiopathic scoliosis. Scoliotic deformation of more than 100 ° without pronounced rotation and hypoplasia of the legs of the vertebral arches (Figure 4).

When performing surgical intervention, the patient was given general anesthesia with profopol. He was laid on the operating table face down on silicone pillows. This styling helps prevent bleeding. The average pressure was kept at 90/60 mm Hg. Art.

A midline incision was performed, taking into account the magnitude and extent of scoliotic curvature. Then, according to the generally accepted method, access to the vertebrae was made. According to the Linke method, labels were established for the implantation of internal transpedicular screws. They made an X-ray control to confirm the implantation sites of the screws.

Transpedicular screws were first implanted on the concave side of scoliosis (Figure 5). Then they were implanted in the legs of 3-4 vertebrae located at the apex of deformation along the convex side, and connected with short rods. Then, with the help of a tool, by means of pressure on the screws, the degree of spinal deformity was reduced. They made a derotation by setting the rods on a concave surface, then installed a long rod on the convex side instead of the short one. After correction and derotation, rods and transpedicular screws were fixed.

The surgical wound was sutured as standard. The patient was recommended to sit down two days later, and on the third day they were allowed to get up.

Example 2

Patient F. was diagnosed with idiopathic scoliosis. Scoliotic deformation of more than 116 ° is accompanied by severe rotation and hypoplasia of the legs of the vertebral arches (Fig.6).

When performing surgical intervention, the patient was given general anesthesia with profopol. He was placed on the operating table face down on silicone pillows located under the chest. This styling prevented bleeding. The average pressure was kept at 90/60 mm Hg. Art.

A midline incision was performed, taking into account the degree of scoliotic curvature. Then, according to the generally accepted method, access to the vertebrae was made. According to the Linke method, labels were established for the implantation of internal transpedicular screws. They made an X-ray control to confirm the implantation sites of the screws.

Transpedicular screws were implanted on the convex and concave sides in only four cranial and four caudal vertebrae of the scoliosis zone (Figs. 7, 8). Traction was carried out until the strain was reduced, and after it transpedicular screws were connected with short rods, which were then connected by transverse connectors and additional rods.

The surgical wound was sutured as standard. The patient was recommended to sit down two days later, and on the third day they were allowed to get up.

Example 3

Patient A. was diagnosed with idiopathic scoliosis. Scoliotic deformation 60-65 ° (Fig.9).

When performing surgical intervention, the patient was given general anesthesia with profopol. He was laid on the operating table face down on silicone pillows. This styling prevented bleeding. The average pressure was kept at 90/60 mm Hg. Art.

A midline incision was made along the scoliotic curvature. Then, according to the generally accepted method, access to the vertebrae was made. According to the Linke method, labels were established for the implantation of internal transpedicular screws. They made an X-ray control to confirm the implantation sites of the screws.

The transpedicular screws were implanted into the legs of all vertebrae on the concave side, and four transpedicular screws were implanted in the caudal curvature on the convex side in a row. Then 2 vertebrae were missed. The following two screws were implanted in the apical part. Through two vertebrae, three more screws were implanted in the cranial part of the curvature with the passage of one vertebra. After that, the rod was fixed first from the convex side, and then from the concave side (Figure 10).

The surgical wound was sutured as standard. The patient was recommended to sit down two days later, and on the third day they were allowed to get up.

The proposed method allows to reduce the time of surgical intervention, to reduce the number of parts of submersible metal structures, which leads to a reduction in treatment costs.

In addition, the proposed method allows to reduce the risk of damage to the spinal cord and nerves, thereby avoiding neurological complications.

The proposed method is used in the neurosurgery department of FGU "RRC" WTO "them. Acad. G.A. Ilizarova and Baku medical institutions.

Claims (3)

1. A method of treating idiopathic scoliosis, including the use of an immersion fixture, fixing the vertebrae with transpedicular screws that connect the rods, characterized in that the pedicle screws are initially implanted on the concave side of the spinal deformity, then they are implanted in the legs of 3-4 vertebrae located at the top of the deformity and connected with short rods, after which they are subjected to mechanical stress using a tool to the top of the deformation to reduce the degree of deformation of the spine, then make a derotation, setting the rods on a concave surface, and replace the short rod with a long one from the side of the deformation apex. 2. The method according to claim 1, characterized in that the transpedicular screws are implanted on the convex and concave side in only four cranial and four caudal vertebrae of the scoliosis zone, traction is performed until the deformation is reduced, and after it the transpedicular screws are connected with short rods that connect transversely located connectors and rods. 3. The method according to claim 1, characterized in that the transpedicular screws are implanted into the legs of all the vertebrae on the concave side, and three transpedicular screws are placed on the convex side in a row, then 2-3 vertebrae are passed through, the next three transpedicular screws are screwed in a row, then passed again three vertebrae.

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