RU55570U1 - DEVICE FOR FIXING VESSELS AND FABRICS DURING SPINE OPERATIONS - Google Patents

Abstract

A device for fixing vessels and tissues is proposed, the difference of which is the fixation in the form of a flat nail with notches, mounted on a concave surface below the bend of the limiter with the possibility of free movement along it. The proposed device does not require the installation and removal of the use of additional general surgical expanders and tuffers.

Description

The utility model relates to medical instruments and can be used in traumatology, orthopedics and neurosurgery and is intended to protect vessels and tissues from damage during operations on the spine with front access.

1. It is well known to use needles to limit the surgical field during operations on the anterior spine (USSR Author's Certificate N1215678, Cl. A 61 B 17/02, publ. 1986).

The use of needles provides only the abduction of blood vessels and tissues locally, but does not prevent instrumentation from damage during surgery.

Local pressure throughout the operation on the vessels leads to impaired blood flow and creates conditions for thromboembolic complications. Using needles is not possible in overweight patients. In addition, for the introduction of needles, wide operative approaches are needed involving several assistants, which is associated with significant blood loss and the possibility of developing postoperative complications.

A known method of fixing vessels and tissues during operations on the spine and a device for fixing vessels and tissues during operations on the spine (RF Patent N2146110, Cl. A 61 B 17/00, 17/02, publ. 2000 (prototype)). In this case, the fixation of blood vessels and tissues during operations on the spine is created by surrounding the surgical field with individual stoppers in the form of plates.

The specified device is structurally closest to the offer and is a plate made with a transverse bend, has needles and a through hole on the bent part. Hole

made under the appropriate tool. The tool has the form of a rod with an end groove for pushing against the edge of the through hole. When creating a fence, the lateral bending limiters are placed as free as possible from the needles outside the space of the surgical field. As a result, an overview of the surgical field is achieved.

A device for fixing vessels and tissues during spinal surgery is adopted as a prototype.

The disadvantage of this device is the need to attract additional assistants when installing and removing devices that protect vessels and tissues with tupers and retractors. It is technically difficult to install a device with needles in the vertebral bodies, since it is necessary to constantly remove blood vessels and tissues with additional tools and tuffers when inserting needles, and then remove them. Using a tool with an end groove can injure blood vessels and tissues at the time of insertion of the device. Therefore, you need to do more access. During the operation, due to the conical shape of the needles, the latter are poorly fixed in the bone and can migrate and damage vessels and tissues.

The technical problem solved by the utility model is a device for fixing vessels and tissues during operations on the spine, which, when installed and removed, does not require the use of additional general surgical expanders and tuffers.

The proposed device (Figs. 1-3) has a bayonet shape, a handle (1) and a working surface (2) in the form of a semicircle with a diameter of 3.8-4.2 cm. Moreover, on the inner surface of the circle there is a fixing element in the form of a flat nail with a notch (3) freely moving along the working surface of the device (see figure 1).

The tool is made of medical tool steel.

Anterior extraperitoneal access to the segments L4-L5, L5-S1 is carried out by a cut in the left iliac region, retreating 2-3 cm inward from the upper anterior spine of the ilium. The incision length is 5-6 cm. The aponeurosis of the external oblique muscle is dissected in layers, then the muscles of the anterior abdominal wall, followed by a thin layer of retroperitoneal tissue. Next, the transverse fascia is dissected and a section of the intervertebral disc at the border with the large lumbar muscle is exposed. This zone is free from trunk and segmental vessels. Next, the left part of the fibrous ring is stupidly exposed medially. The first protective device is introduced and simultaneously removes the vessels, the peritoneum in the direction of obliquely medially upward. After the device stops, a fixing nail is inserted into the vertebral body L4 into the vertebral body with a few light short strokes 2 cm to the nail limiter. After this, the second device is likewise introduced in a strictly downward direction with the simultaneous abduction of the peritoneum, fiber, blood vessels, sympathetic trunk and m.psoas. Then, the proposed device abuts against the naked body of the L4 vertebra and a fixing nail of 2 cm is inserted into the body of the vertebra. The educated circle of the hemispheres of the two proposed devices can reliably protect the peritoneum, its contents, vessels and nerves. Formed safe operating field on the bodies and discs of the vertebrae is about 4 cm in diameter, which allows you to freely manipulate in that space.

To remove the device, nails are previously removed. Then devices are safely removed.

Case Study

Patient B.N.E. 45 years was operated on for osteochondrosis of the lumbar spine with radicular syndrome, disc herniation

L4-L5. Type 1 dislocation syndrome. The progress of the operation. Anterior extraperitoneal access to the L4-L5 segment is through an incision in the left iliac region, backing 2-3 cm inward from the superior anterior iliac spine. The incision length is 5-6 cm. The aponeurosis of the external oblique muscle is dissected in layers, then the muscles of the anterior abdominal wall, followed by a thin layer of retroperitoneal tissue. The transverse fascia is dissected and a section of the intervertebral disc at the border with the large lumbar muscle is exposed. This zone is free from trunk and segmental vessels. Next, the left part of the fibrous ring is stupidly exposed medially. Protective devices are introduced into the bodies of the upper and lower vertebrae. The first protective device diverts vessels and soft tissues up and to the right, then is fixed with the help of a fixing element in the body of the L4 vertebra. The second protective device is inserted so that the intervertebral disc is between the first and lower device. In this case, the second device leads the vessels medially and downward. Then the locking element of the second device is inserted. In cases where the vein is mobilized with technical difficulties, an anterior longitudinal ligament is dissected to the bone tissue and medial mobilization of the vein is performed along with it. The educated circle of the hemispheres of the two proposed devices can reliably protect the peritoneum and blood vessels. The formed safe operating space is about 4 cm in diameter. L4-L5 discectomy was performed. Then, with a crown mill 3 cm in diameter, hemispheres of the vertebral bodies L4-L5 are removed to 2/3 of the anteroposterior size. Then, a milling cutter with a diameter of 2 cm removed the posterior third of the vertebrae of the vertebral bodies. The spinal canal has been opened, from which fragments of the hernia of the L4-L5 disc have been extracted. Then the fragments comprising 2/3 of the vertebra are inserted into the formed bed in an upright position and a proppant bone autograft is inserted between them. In control received

reliable interbody fusion. The fixing nails of the devices are removed and then the devices themselves are safely removed. Layer-by-layer sutures on the wound leaving tubular drainage in retroperitoneal space. Aseptic dressing. Postoperative intestinal paresis resolved on the second day. The patient is activated, taking into account the minimally invasive access, on the second day after the operation in a removable hard corset. The postoperative period was uneventful. The wound healed by primary intention. During the observation of the patient for 1.5 years, recurrence of radicular syndrome was not observed. A good bone block came between the bodies of L4-L5.

The proposed device was used during 27 surgical interventions with ventral access. Cases of damage to blood vessels, nerves, peritoneum and its contents were not observed. Thus, the proposed device allows you to reliably protect blood vessels, nerves, peritoneum and its contents during insertion of the device during surgery and its removal after completion of surgery, minimally invasive surgery, reduce the duration of the operation, minimize possible intra- and postoperative complications

Claims (1)

A device for fixing vessels and tissues during operations on the spine, including a limiter in the form of a concave plate with a transverse bend and equipped with a latch on the concave side, characterized in that the latch is made in the form of a flat nail with notches, mounted on a concave surface below the bend of the limiter with the possibility of free moving along it.