RU2615900C1 - Device for c1-c2 vertebrae front stabilization - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for C1-C2 vertebrae front stabilization comprises an attachable metal plate including the first base, the second base, the first side generatrix and the second side generatrix. The first base is larger than the second base. The device also includes an abutment surface and an outer surface located opposite the abutment surface. The abutment surface includes the first fragment adjacent to the first base and the second fragment adjacent to the second base. The device also includes the first opening and the second opening located in the first fragment area, along the first base. The device also includes at least the third opening and the fourth opening located in the second fragment area, along the second base. The first fastener is mounted in the first opening. The second fastener is mounted in the second opening. The third fastener is mounted in the third opening. The fourth fastener is mounted in the fourth opening. The first fragment is completely congruent with the front surface of C1 vertebra. The second fragment is completely congruent with the front surface of the C2 vertebra body.

EFFECT: invention can significantly reduce surgery invasiveness, eliminate cervical spine motor activity restriction compared to traditional rear occipitospondylodesis, optimize the surgical approach, and provide earlier rehabilitation, which is important for debilitated and complicated patients, and can provide earlier recovery of patients capability.

10 cl, 2 ex, 42 dwg

Description

The invention relates to medicine, namely to neurosurgery, and can be used in surgical treatment of various diseases of the area of the atlanto-axial articulation: injuries C1-C2 segment of the spine, anomalies of the development of the cranio-vertebral articulation (basilar impression and invagination of the dentoid process of the C2 vertebra).

The invention is intended for operations performed from the anterior (transoral) access during fixation of the first and second cervical vertebrae and is an alternative to their posterior fixation in order to refuse the second operation from the posterior access.

The present invention can be used both with independent front fixation of C1-C2 vertebrae, and in combination with stabilization by various devices during surgery from the rear access.

A device for the frontal stabilization of C1-C2 vertebrae is known, comprising a patch metal plate including a first base, a second base, a first lateral generatrix and a second lateral generatrix, the first base being larger than the second base, also including an adjacent surface and an outer surface located on the opposite side from an adjacent surface, while the adjacent surface includes a first fragment adjacent to the first base and a second fragment adjacent to the second base, also including at least a first hole and a second hole located in the zone of the first fragment along the first base, also including at least a third hole and a fourth hole located in the zone of the second fragment, along the second base, while in the first a first fastener is installed in the hole, a second fastener is installed in the second hole, a third fastener is installed in the third hole, and a fourth fastener is installed in the fourth hole [Xia N., Yin Q., Ai R, Ma X., Wang J., Wu Z., Zhang K., Liu J., Xu J. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J. 2014 Aug; 23 (8): 1648-55].

The above device is selected as a prototype of the proposed device. The disadvantage of the prototype is the low reliability of stabilization of the C1-C2 segment, associated with an incomplete contact area of the adjacent surface of the patch metal plate and the outer surface of the front half ring C1 and the body C2 of the vertebrae, as well as with insufficient degree of fixation of the fasteners.

The technical result of the proposed device is to increase the reliability of stabilization C1-C2 segment of the cervical spine.

The specified technical result is achieved in that the device for the frontal stabilization of C1-C2 vertebrae containing an overhead metal plate including a first base, a second base, a first lateral generatrix and a second lateral generatrix, the first base being larger than the second base, also including an adjacent surface and an outer surface located on the opposite side from the adjacent surface, while the adjacent surface includes a first fragment adjacent to the first base, and the second a fragment adjacent to the second base, also including at least a first hole and a second hole located in the region of the first fragment along the first base, also including at least a third hole and a fourth hole located in the region of the second fragment, along the second base, while the first fastening element is installed in the first hole, the second fastening element is installed in the second hole, the third fastening element is installed in the third hole, the fourth are installed in the fourth hole the first fastener, the first fragment is absolutely congruent to the front surface of the anterior semiring C1 of the vertebra, and the second fragment is absolutely congruent to the front surface of the body of the C2 vertebra.

There is an option in which the profile of the outer surface of the overlay metal plate repeats the profile of its adjacent surface.

There is also an option in which the profile of the outer surface of the overlay metal plate does not repeat the profile of its adjacent surface.

There is also an option in which a first locking element arranged to interact with the first fixing element, a second locking element located to interact with the second fixing element, a third locking element arranged to interact with the third fixing element, and the fourth locking element are introduced into the device an element arranged to interact with a fourth fastening element.

There is also an option in which an installation threaded hole is made in the patch metal plate.

There is also an embodiment in which the first fastening element, the second fastening element, the third fastening element and the fourth fastening element include caps with spherical surfaces, and the first locking element, the second locking element, the third locking element and the fourth locking element include mounting elements with locks, cams and fixing parts, and mounting elements with clamps are interfaced with a laid on metal plate, and the fixing parts are arranged to interact with -symmetric surfaces.

There is also an option in which the first side surface and the second side surface of the overlay metal plate are made in the form of planes.

There is also an option in which the first side surface and the second side surface of the patch metal plate are made in the form of rotated concave U-shaped elements.

There is also an option in which the first side surface and the second side surface of the patch metal plate are made in the form of concave C-shaped elements.

There is also an option in which the angles between the longitudinal axes of the first hole, second hole, third hole and fourth hole are not equal to each other.

In FIG. 1 shows a front view of a device for anterior stabilization of C1-C2 vertebrae.

In FIG. 2 is a side view of FIG. one.

In FIG. 3 is a front view of a device for anterior stabilization of C1-C2 vertebrae with retaining elements.

In FIG. 4 shows a variant of the interaction of the locking element and the fastening element.

In FIG. 5 is an isometric view of the interaction of the locking member and the fastener.

In FIG. 6 is a front view of a device for anterior stabilization of C1-C2 vertebrae with U-shaped concave lateral elements.

In FIG. 7 is a front view of a device for anterior stabilization of C1-C2 vertebrae with C-shaped lateral elements.

In FIG. 8 is an additional front view of a device for anterior stabilization of C1-C2 vertebrae with U-shaped lateral elements.

In FIG. 9 is a side view of a device for anterior stabilization of C1-C2 vertebrae with U-shaped lateral elements.

In FIG. 10 shows section AA in FIG. 8 devices for anterior stabilization of C1-C2 vertebrae with U-shaped lateral elements.

In FIG. 11 is an isometric view of an overlay metal plate with concave U-shaped elements including fasteners.

In FIG. 12 is an additional front view of a device for anterior stabilization of C1-C2 vertebrae with C-shaped lateral elements, including retaining elements.

In FIG. 13 is a side view of FIG. 12 devices for anterior stabilization of C1-C2 vertebrae with C-shaped lateral elements, including retaining elements.

In FIG. 14 is a plan view of FIG. 12 devices for anterior stabilization of C1-C2 vertebrae with C-shaped lateral elements, including retaining elements.

In FIG. 15 is an isometric view of an overlay metal plate with concave C-shaped elements, including locking elements and fasteners.

In FIG. 16 is an image of a mathematical model of a false metal plate with concave U-shaped elements mounted on the front sections of the C1-C2 vertebrae in the frontal projection.

In FIG. 17 is an isometric image of a mathematical model of a false metal plate with concave U-shaped elements mounted on the anterior sections C1-C2 of the vertebrae in oblique projection.

In FIG. 18 is a section BB of FIG. 16 images of a mathematical model of a false metal plate with concave U-shaped elements mounted on the anterior vertebrae C1-C2.

In FIG. 19 is an image of a mathematical model of a false metal plate with concave C-shaped elements, including retaining elements and fasteners, mounted on the front sections of the vertebrae C1-C2 in the frontal projection.

In FIG. 20 is an isometric image of a mathematical model of an overhead metal plate with concave C-shaped elements, including retaining elements and fasteners, mounted on the anterior sections C1-C2 of the vertebrae in an oblique projection.

In FIG. 21 is a section bb of FIG. 19 images of a mathematical model of a false metal plate with concave C-shaped elements, including retaining elements and fasteners, mounted on the anterior vertebrae C1-C2.

In FIG. 22 presents MRI (magnetic resonance imaging) in the sagittal projection of patient G. before surgery.

In FIG. 23 shows CT (spiral computed tomogram) in the sagittal projection of patient G. before surgery.

In FIG. 24 presents SKT in the frontal projection of patient G. before surgery.

In FIG. 25 shows a stereolithographic model of bone structures of patient G. with a mounted overhead metal plate.

In FIG. 26 presents a radiograph in a lateral projection of patient G. after surgery.

In FIG. 27 presents a radiograph in the frontal projection of patient G. after surgery.

In FIG. 28 presents the SKT in the sagittal projection of patient G. after surgery.

In FIG. 29 presents SKT in the frontal projection of patient G. after surgery.

In FIG. 30 presents SKT in axial projection of patient G. after surgery.

In FIG. 31 presents the range of motion in the cervical spine of patient G. after surgery.

In FIG. 32 presents the SKT in the sagittal projection of patient M. before surgery.

In FIG. 33 presents MRI in the sagittal projection of patient M. before surgery.

In FIG. 34 presents MRI in the frontal projection of patient M. before surgery.

In FIG. 35 is an external view of a false metal plate made for patient M.

In FIG. 36 is an inside view of a patch metal plate made for patient M.

In FIG. Figure 37 shows a stereolithographic model of the bone structures of patient M. with a mounted false metal plate.

In FIG. 38 presents MRI in the sagittal projection of patient M. after surgery.

In FIG. 39 presents MRI in the frontal projection of patient M. after surgery.

In FIG. 40 presents SKT in the frontal projection of patient M. after surgery.

In FIG. 41 presents SKT in 3D reconstruction of patient M. after surgery.

In FIG. 42 shows the range of motion in the cervical spine of patient M. after surgery.

A device for the frontal stabilization of C1-C2 vertebrae (Fig. 1, Fig. 2) contains an overhead metal plate 1, including a first base 2, a second base 3, a first side generatrix 4 and a second side generatrix 5. The material of the overlay metal plate 1 can be titanium an alloy, for example Ti6AL4V. The first base 2 is larger than the second base 3. The size of the first base 2 may be in the range of 35-45 mm. The size of the second base 3 may be in the range of 15-20 mm. The height of the overhead metal plate 1 may be in the range of 25-30 mm. The overlay metal plate 1 includes an adjacent surface 6 and an outer surface 7 located on the opposite side of the adjacent surface 6. The adjacent surface 6 includes a first fragment 8 adjacent to the first base 2, and a second fragment 9 adjacent to the second base 3. The overlay metal plate 1 also includes at least a first hole 10 and a second hole 11 located in the region of the first fragment 8 along the first base 2. The patch metal plate 1 also includes at least th least third port 12 and fourth port 13 disposed in the second fragment area 9, along the second base 3. The diameters of the first holes 10, second holes 11, the third hole 12 and the fourth hole 13 may be in the range of 3-7 mm. The first fastener 14 is installed in the first hole 10, the second fastener 15 is installed in the second hole 11, the third fastener 16 is installed in the third hole 12, and the fourth fastener 17 is installed in the fourth hole 13. The fasteners 14, 15, 16 and 17 can be made in the form of self-tapping screws and made of a titanium alloy, for example Ti6AL4V.

The outer diameter of the thread of the self-tapping screws can be in the range of 2-6 mm, the thread height can be in the range of 0.5-1.2 mm. As the main distinguishing feature from the prototype, the first fragment 8 is absolutely congruent to the front surface of the vertebra C1, and the second fragment 9 is absolutely congruent to the front surface of the vertebral body C2. This is performed as follows.

For the manufacture of an overhead metal plate 1, computed tomography is required for the patient to be strictly in a horizontal position (Gentry angle of 0 °) in 3D mode. Computed tomography of the patient is processed in a computer program to generate a mathematical model of the patch plate, which is compared with the mathematical model of the spine of a particular patient. Then, if necessary, the direction of insertion of the fasteners 14, 15, 16, 17 and their sizes are adjusted, as well as the dimensions of the surface-mounted metal plate 1 itself are adjusted. Then, an absolutely congruent individual surface-mounted metal plate is manufactured using high-precision milling or using powder technologies . The patch metal plate 1 takes into account all the anatomical features of the anterior C1-C2 vertebrae and their relationship with each other and is absolutely congruent to the anterior surface of the C1-C2 vertebral segment in a particular patient. The next step is the formation of a full-scale 3D model of the craniovertebral segment from photopolymerizing solutions (polymethylmethacrylate) on a stereolithograph, which is an exact copy of the bone structures of a particular patient. To determine the degree of congruence of the overhead metal plate 1 in a particular patient, it is superimposed on the stereolithographic model of the craniovertebral segment. If necessary, in order to achieve absolute congruence of the laid on metal plate 1 and the anterior sections C1-C2 of the vertebrae, additional processing of the laid on metal plate 1 is performed. The laid on metal plate 1 is fixed using two fasteners 14, 15 inserted into the lateral masses C1 of the vertebra, and two fasteners 16, 17 inserted into the vertebral body C2. To exclude self-deployment of the fastening elements 14, 15, 16, 17, locking elements 18, 19, 20, 21 are used.

There is an option in which the profile of the outer surface 7 repeats the profile of the adjacent surface 6. The thickness of the patch metal plate 1 in this case can be in the range of 1.5-3 mm. There is also an option in which the profile of the outer surface 7 does not repeat the profile of the adjacent surface 6. This happens when a sample is formed on the adjacent surface 6 taking into account the anatomical features of the bone structures C1-C2 of the vertebrae of a particular patient. The thickness of the overhead metal plate 1 in this case should exceed the height of its selection. In addition, the profile of the outer surface 7 must be adapted for adjacent soft tissues and have a smaller area of contact.

There is also an option in which a first locking element 18 (FIG. 3) is inserted into the device, arranged to interact with the first fixing element 14, a second locking element 19, arranged to interact with the second fixing element 15, and a third locking element 20 located with the possibility of interaction with the third fastening element 16, the fourth locking element 21 located with the possibility of interaction with the fourth fastening element 17. All locking elements can be made of ty a tannic alloy, for example Ti6AL4V.

There is also an option in which a mounting threaded hole 22 is made in the overlaid metal plate 1. The thread size of this hole can be in the range from M2 to M5.

There is also an option in which the first fastener 14 (FIG. 4, FIG. 5), the second fastener 15, the third fastener 16 and the fourth fastener 17 include caps 23 with spherical surfaces 24. The height of the caps 23 can be in the range of 1 -2.5 mm. The radii of the spherical surfaces 24 may be in the range of 4-10 mm. The first locking element 18, the second locking element 19, the third locking element 20 and the fourth locking element 21 include mounting elements 25 with latches 26. The mounting elements 25 can be made in the form of cylinders with diameters of 1.5-3 mm The latches 26 can be made in the form of flaring at the ends of the cylindrical mounting elements 25. The locking elements 18, 19, 20, 21 include the cams 27 with the locking parts 28. The mounting elements 25 with the latches 26 are associated with a laid on metal plate 1, and the fixing parts 28 of the cams 27 are arranged to interact with the spherical surfaces 24 of the fasteners 14, 15, 16 and 17. The fixing parts 28 of the cams 27 in the zones of interaction with the fasteners 14, 15, 16 and 17 can have spherical and pointed shapes.

There is also an option in which the first side surface 4 and the second side surface 5 are made in the form of planes.

There is also an option in which the first side surface 4 (Fig. 6) and the second side surface 5 are made in the form of rotated concave U-shaped elements 29.

There is also an option in which the first side surface 4 (Fig. 7) and the second side surface 5 are made in the form of concave C-shaped elements 30.

There is also a variant in which the angles between the longitudinal axes of the first hole 10, the second hole 11, the third hole 12 and the fourth hole 13 are not equal to each other. These differences can be in the range from 0 ° to 25 °, this is determined by the features of the anatomical structure of C1-C2 vertebrae of a particular patient.

A device for anterior stabilization of C1-C2 vertebrae is set as follows.

At the beginning of the operation, anterior (transoral) access to the anterior surface of the C1 and C2 vertebrae is performed: a rotary expander is installed, soft tissues of the oropharynx are dissected, the anterior half ring of the C1 vertebra, the lower part of the dentoid process and the body of the C2 vertebra are skeletonized. If necessary, trepan the anterior half-ring C1 of the vertebra. The tooth-like process of the vertebra C2 is trepanning, which can be displaced posteriorly and which compresses the upper parts of the spinal cord. In this case, decompression of the spinal cord is achieved. However, the removal of the anterior half ring of the C1 vertebra, the dentate process of the C2 vertebra inevitably leads to instability in the region of the C1-C2 segment of the spine, which may be the initial one in case of injury to the C1-C2 segment of the spine. To eliminate the instability of the segment C1-C2 of the spine, an individual overhead metal plate is installed. The upper part of the laid on metal plate 1 is fixed with fasteners 14, 15, which are inserted into the lateral masses C1 of the vertebra, and the lower part of the laid on metal plate 1 is fixed with fasteners 16, 17 to the body C2 of the vertebra. To prevent migration (self-deployment) of the fastening elements 14, 15, 16, 17, the cams 27 of the locking elements 18, 19, 20, 21 are mounted on their hats 23 by rotation. Next, the soft tissues of the oropharynx are sutured.

Given the absolute congruence of the adjacent part 7 of the laid on metal plate 1, the maximum contact area of the laid on metal plate 1 with adjacent bone structures C1 and C2 of the vertebra is achieved, thereby improving the stability of stabilization of C1-C2 segment of the cervical spine.

Clinical examples of the use of the invention.

Clinical example 1. Patient G., 53 years old. I.B. No. 2159/12.

Clinical diagnosis: complicated transdental fracture of C2 vertebra of type III. Upper right-sided monoparesis.

He entered the Institute of Neurosurgery of Riga on 04/25/2012 with complaints of pain in the cervical-occipital region, weakness in the right hand. From the anamnesis it is known that in September 2011, as a result of a car accident, he received a transdental fracture of a C2 vertebra, uncomplicated fractures of Th3 and Th6 vertebrae. He was treated conservatively at the place of residence. For surgical treatment, he entered the Institute of Neurosurgery. Academician N.N. Burdenko.

Examination revealed an upper right-sided monoparesis. Strength in the right hand is reduced to 3-4 points. The head is fixed in a rigid orthopedic head holder.

On MRI in the sagittal projection (Fig. 22) and on the CT scan in the sagittal projection (Fig. 23) and in the frontal projection (Fig. 24) - transdental fracture of C2 vertebra of type III, with compression of the spinal cord at this level.

Considering the topographic and anatomical features of the vertebral C2 fracture, anterior compression of the spinal cord by the posteriorly displaced dentate process of the C2 vertebra, aggravation of instability in the C1-C2 segment of the spine after removal of the displaced toothy process of the C2 vertebra, it was decided to conduct anterior stabilization of the C1-C2 segment with an individual mounted metal plate, using computer mathematical modeling (Fig. 16, Fig. 17, Fig. 18) and a stereolithographic model (Fig. 25).

05/03/2012, the operation was performed: transoral removal of the displaced dentoid process, decompression of the spinal cord at the level of C1-C2. Anterior fusion C1-C2 with an individual plate made using computer mathematical modeling and a stereolithographic model.

Operation description. Superimposed tracheostomy. Endotracheal narcosis. An external lumbar drainage is installed. A rotary expander is installed. The soft palate is dissected paramedially. The posterior wall of the oropharynx is dissected linearly along the midline. The skeletonization of the anterior half ring C1, the body C2 of the vertebrae, and also the lower section of the slope was performed. Using a high-speed drill, the anterior half-ring C1 of the vertebra is trepaned. The tooth-like process of the vertebral vertebra C2, posteriorly displaced posteriorly, is trephined. A damaged (earlier in an injury) transverse ligament C2 of the vertebra was found. A distinct pulsation of the underlying dura mater appeared. No apparent intraoperative cerebrospinal fluid. Hemostasis. An overhead metal plate of an individual design is installed. The upper part of the plate is fixed using guided self-tapping screws that are inserted into the lateral masses C1 of the vertebra, and the lower part of the plate is fixed to the front surface of the body C2 of the vertebra with the help of self-tapping screws inserted into the body of the vertebra C2. Hemostasis. Layered closure of the posterior wall of the oropharynx and soft palate. At the end of the operation, the lumbar drainage is removed.

On radiographs (Fig. 26, Fig. 27) and SKT (Fig. 28, Fig. 29, Fig. 30) after surgery: the fractured tooth process of C2 was removed, decompression of the spinal cord at this level was achieved. The front stabilizing system (patch metal plate) is correctly positioned.

In the postoperative period, pain in the cervical-occipital region completely regressed. Increased strength in the right hand to 5 points. Movement in the cervical spine with virtually no restrictions (Fig. 31). The patient was discharged on the 20th day after the operation.

Clinical example 2. Patient M., 38 years old. I.B. No. 5802/14.

Clinical diagnosis: Chiari syndrome, platibasia, invaginated dentate process C2 of the vertebra, roughly compressing the stem structures.

Received at the Institute of Neurosurgery. Academician N.N. Burdenko 10/21/2014 with complaints of burning in the face, choking when swallowing solid and liquid food, numbness of the hands (hands) and legs (hips), buttocks, dizziness and unsteadiness of the gait.

During the examination revealed dysfunctions of V, IX nn from 2 sides, mild cerebellar symptoms, impaired sensitivity by the type of hyperpathy in the hands and hips, decreased strength in the left hand to 4 points.

On SKT in the sagittal projection (Fig. 32) and MRI in the sagittal projection (Fig. 33) and frontal projection (Fig. 34): basilar impression, invagination of the dentoid process of the C2 vertebra, coarse compression of the medulla oblongata, Chiari type 1 syndrome (omission of the tonsils) are determined cerebellum 15 mm below Chamberlain's line, which is marked by a red dashed line).

Considering the pronounced anterior compression of the spinal cord by the posteriorly tooth-shaped process of the vertebral C2 vertebra, the possible development of instability in the C1-C2 segment of the spine after removal of the tooth-like process of the C2 vertebra, it was decided to carry out the front stabilization of the C1-C2 segment with an individual false metal plate (Fig. 35 is an external view, Fig 36 is an inside view) made using computer mathematical modeling (Fig. 19, Fig. 20, Fig. 21) and a stereolithographic model (Fig. 37).

On October 28, 2014, the operation was performed: transoral removal of the invaginated tooth process of the C2 vertebra, decompression of the medulla oblongata, anterior spinal fusion C1-C2 using an individual plate made using computer mathematical modeling and a stereolithographic model.

Operation description. Superimposed tracheostomy. An external lumbar drainage is installed. A rotary expander is installed. Linear paramedian section of the soft palate. A linear midline incision of the posterior wall of the oropharynx. The front half-ring C1, the lower parts of the dentoid process and the body of the C2 vertebra are skeletonized in stages. The anterior semiring C1 of the vertebra is resected. The enlarged and invaginated dentate process of the C2 vertebra is resected in stages. After removal of the dentoid process of the C2 vertebra, the appearance of a clear pulsation of the underlying dura mater is noted. The dura mater is not damaged, liquorrhea is not marked. An individual overhead metal plate made using computer mathematical modeling and a stereolithographic model is installed. The upper part of the plate is fixed using guided self-tapping screws that are inserted into the lateral masses C1 of the vertebra, and the lower part of the plate is fixed to the front surface of the body C2 of the vertebra with self-tapping screws inserted into the body of the vertebra C2. The heads of the self-tapping screws are fixed with locking elements. Layer-by-layer suturing of soft tissues of the posterior wall of the oropharynx, sutures were laid on the soft palate. External lumbar drainage removed.

In the postoperative period, a complete regression of neurological symptoms was noted: sensitivity in the arms and legs was restored, strength in the arm was restored, and the gait was normalized.

On the control MRI in the sagittal projection (Fig. 38) and in the frontal projection (Fig. 39) and CT in the frontal projection (Fig. 40) and in the 3D reconstruction mode (Fig. 41): complete decompression of the spinal cord; the cerebellar tonsils are relocated (elevated), located at the lower edge of the large occipital foramen (red dashed line - Chamberlain's line). The location of the individual overhead metal plate is correct.

Movement in the cervical spine with virtually no restrictions (Fig. 42). The patient was discharged on the 16th day after the operation.

Technical Results

The fact that the first fragment 8 is absolutely congruent to the front surface C1 of the vertebra, and the second fragment 9 is absolutely congruent to the front surface of the body C2 of the vertebra, increases the stability of the stabilization of C1-C2 segment of the cervical spine.

The fact that the profile of the outer surface 7 repeats the profile of the adjacent surface 6, increases the reliability of stabilization C1-C2 of the vertebrae due to the optimization of the thickness of the overlay metal plate. The fact that the profile of the outer surface 7 does not repeat the profile of the adjacent surface 6 increases the reliability of matching soft tissues of the oropharynx.

The fact that the first locking element 18, arranged to interact with the first fastening element 14, the second locking element 19, located to interact with the second fastening element 15, the third locking element 20, located to interact with the third fastening element 16, is inserted , the fourth locking element 21, located with the possibility of interaction with the fourth fastening element 17, increases the degree of fixation of the fastening elements 14, 15, 16 and 17 and increases the reliability of the stab ation C1-C2 vertebrae by increasing the reliability of fixation of the metal plate itself bill.

The fact that the mounting threaded hole 22 is made in the laid on metal plate 1 allows the position of the vertebrae to be adjusted relative to C1-C2 of the vertebrae during installation of the laid on metal plate 1, which ensures an optimal path for introducing fasteners 14, 15, 16, 17, which leads to an increase reliability of stabilization of C1-C2 vertebrae.

That the first fastener 14, the second fastener 15, the third fastener 16 and the fourth fastener 17 include caps 23 with spherical surfaces 24, and the first locking element 18, the second locking element 19, the third locking element 20 and the fourth locking element 21 include mounting elements 25 with latches 26, cams 27 and locking parts 28 located with the possibility of interaction with spherical surfaces 24, increases the degree of fixation of fasteners 14, 15, 16 and 17 and increases the reliability of the stab ation C1-C2 vertebrae by increasing the reliability of fixation of the metal plate itself bill.

The fact that the first lateral surface 4 and the second lateral surface 5 are made in the form of planes, provides maximum strength of the false metal plate 1, which increases the reliability of stabilization C1-C2 of the vertebrae.

Given that the first side surface 4 and the second side surface 5 are made in the form of concave rotated U-shaped elements 29, and also taking into account that the first fragment 8 is absolutely congruent to the front surface of the vertebra C1, and the second fragment 9 is absolutely congruent to the front surface of the vertebral body C2 improves the ability to connect the soft tissues of the oropharynx after installing and fixing the first metal plate 1 on the front surface C1 of the vertebra and on the front surface of the body C2 of the vertebra, which ultimately reduces t the likelihood of divergence of sutures imposed on the soft tissues of the oropharynx.

Considering that the first side surface 4 and the second side surface 5 are made in the form of concave C-shaped elements 30, and also considering that the first fragment 8 is absolutely congruent to the front surface C1 of the vertebra, and the second fragment 9 is absolutely congruent to the front surface of the body C2 of the vertebra, the free area of the laid-on metal plate 1 increases to accommodate the locking elements (18, 19, 20, 21) in it without reducing its strength, which leads to an increase in the reliability of stabilization of C1-C2 vertebrae.

The fact that the angles between the longitudinal axes of the first hole 10, the second hole 11, the third hole 12 and the fourth hole 13 are not equal to each other, allows you to optimize the angular position of the fasteners 14, 15, 16, 17 relative to C1 and C2 of the vertebrae, which increases the reliability of fixation overhead metal plate, which leads to increased reliability of stabilization of C1-C2 vertebrae.

The present invention in the treatment of various diseases of the craniovertebral joint, accompanied by instability of the C1-C2 segment of the spine, can significantly reduce the invasiveness of the operation, eliminate the limitation of motor activity of the cervical spine in comparison with traditional posterior occipitondondylosis, optimize surgical tactics, as well as conduct earlier rehabilitation, which important in severe and debilitated patients and may provide earlier recovery of labor obnosti patients.

Claims (10)

1. A device for the frontal stabilization of C1-C2 vertebrae containing an overhead metal plate (1) including a first base (2), a second base (3), a first side generatrix (4) and a second side generatrix (5), the first base ( 2) larger than the second base (3), which also includes the adjacent surface (6) and the outer surface (7) located on the opposite side from the adjacent surface (6), while the adjacent surface (6) includes the first fragment (8) adjacent to the first base (2), and the second fragment (9) adjacent to the second base (3), also including at least the first hole (10) and the second hole (11) located in the area of the first fragment (8), along the first base (2), also including at least the third the hole (12) and the fourth hole (13) located in the region of the second fragment (9), along the second base (3), while the first fastener (14) is installed in the first hole (10), and the second hole (11) is installed the second fastener (15), in the third hole (12) a third fastener (16) is installed, in the fourth hole (13) A fourth fastener (17) is installed, characterized in that the first fragment (8) is absolutely congruent to the front surface of the vertebra C1, and the second fragment (9) is absolutely congruent to the front surface of the vertebral body C2. 2. The device according to claim 1, characterized in that the profile of the outer surface (7) repeats the profile of the adjacent surface (6). 3. The device according to claim 1, characterized in that the profile of the outer surface (7) does not repeat the profile of the adjacent surface (6). 4. The device according to p. 1, characterized in that it introduced the first locking element (18) located with the possibility of interaction with the first fastening element (14), the second locking element (19) located with the possibility of interaction with the second fastening element ( 15), a third locking element (20) located with the possibility of interaction with the third fastening element (16), as well as a fourth locking element (21) located with the possibility of interaction with the fourth fastening element (17). 5. The device according to claim 1, characterized in that an installation threaded hole (22) is made in the overlaid metal plate (1). 6. The device according to claim 4, characterized in that the first fastener (14), the second fastener (15), the third fastener (16) and the fourth fastener (17) include caps (23) with spherical surfaces (24) and the first locking element (18), the second locking element (19), the third locking element (20) and the fourth locking element (21) include mounting elements (25) with locks (26), cams (27) and locking parts (28 ), and the mounting elements (25) with clamps (26) are interfaced with the laid on metal plate (1), and the fixing hours and (28) are arranged to cooperate with the spherical surfaces (24). 7. The device according to claim 1, characterized in that the first side surface (4) and the second side surface (5) are made in the form of planes. 8. The device according to claim 1, characterized in that the first side surface (4) and the second side surface (5) are made in the form of rotated, concave Π-shaped elements (29). 9. The device according to claim 1, characterized in that the first side surface (4) and the second side surface (5) are made in the form of concave C-shaped elements (30). 10. The device according to claim 1, characterized in that the angles between the longitudinal axes of the first hole (10), the second hole (11), the third hole (12) and the fourth hole (13) are not equal to each other.

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