MD1084Z - Method of treatment of scoliosis in children - Google Patents

Method of treatment of scoliosis in children

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Publication number
MD1084Z
MD1084Z MDS20160057A MDS20160057A MD1084Z MD 1084 Z MD1084 Z MD 1084Z MD S20160057 A MDS20160057 A MD S20160057A MD S20160057 A MDS20160057 A MD S20160057A MD 1084 Z MD1084 Z MD 1084Z
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Moldova
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articular
points
line passing
vertebra
transverse
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MDS20160057A
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Romanian (ro)
Russian (ru)
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Николай ШАВГА
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Николай ШАВГА
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Priority to MDS20160057A priority Critical patent/MD1084Z/en
Publication of MD1084Y publication Critical patent/MD1084Y/en
Publication of MD1084Z publication Critical patent/MD1084Z/en

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Abstract

Изобретение относится к области медицины, в частности к травматологии и ортопедии и может быть использовано для миниинвазивного лечения сколиоза у детей.Сущность изобретения заключается в том, что определяют проекцию изгиба деформации позвоночника, проводят общую анестезию, определяют точки для введения транспедикулярных шурупов. В поясничной области точки расположены в самой выпуклой части латеральных суставных отростков, а именно на пересечении линии, проходящей через середину основания суставного отростка с линией, проходящей вдоль бокового края суставного отростка, медиальнее места соединения поперечных и суставных отростков. В грудной области точки находятся на пересечении линии, проходящей по центру суставного отростка с линией, проходящей по верхнему краю поперечного отростка, после чего в упомянутые точки трансдермально вводят направляющие спицы во фронтальной плоскости под углом 45° в направление головы, которые проходят через ножку, корень дуги позвонка, закрывающую пластину позвонка, через диск с пульпозным ядром, затем через закрывающую пластину верхнего позвонка и спонгиозную ткань с выведением конца спиц на 1…2 см на фронтальную поверхность тела позвонка, затем вводят по ходу спиц транспедикулярные шурупы, выполненные с продольным сквозным каналом или без канала.The invention relates to medicine, in particular to traumatology and orthopedics, and can be used for minimally invasive treatment of scoliosis in children. The invention consists in determining the projection of the bend of the spinal deformity, conducting general anesthesia, determining the points for the introduction of transpedicular screws. In the lumbar region, the points are located in the most convex part of the lateral articular processes, namely at the intersection of the line passing through the middle of the base of the articular process with the line running along the lateral edge of the articular process, medial to the junction of the transverse and articular processes. In the thoracic region, the points are at the intersection of the line passing through the center of the articular process with the line running along the upper edge of the transverse process, after which guide needles are transdermally introduced into the mentioned points in the frontal plane at an angle of 45 ° in the direction of the head, which passes through the leg, the root arches of the vertebra, covering the plate of the vertebra, through the disk with the pulpous nucleus, then through the covering plate of the upper vertebra and the spongy tissue with the end of the spokes leading 1 ... 2 cm to the front surface of the body along Wonka, then introduced in the course of spokes transpedicular screws are formed with a longitudinal through bore or without a channel.

Description

Invenţia se referă la medicină, în special la traumatologie şi ortopedie şi poate fi utilizată pentru tratamentul miniinvaziv al scoliozei la copii. The invention relates to medicine, in particular to traumatology and orthopedics and can be used for the minimally invasive treatment of scoliosis in children.

Este cunoscută metoda de tratament al scoliozei la copii, care include incizia ţesuturilor moi de-a lungul apofizelor spinoase până la arcul vertebrelor pe partea convexă a deformării. La vârf, mai jos şi mai sus de arcul deformării coloanei vertebrale se scheletează apofizele transversale ale vertebrelor neutre, apoi un capăt al unei benzi elastice se fixează de apofiza transversală a vertebrei neutre superioare din partea convexă a deformării, se trece banda elastică de-a lungul apofizelor transversale din partea convexă a deformării până la vârful deformării, după care printre apofizele spinoase pe partea concavă, pe partea menţionată se trece de-a lungul apofizelor spinoase ale vârfului deformării, apoi printr-o porţiune din apofizele spinoase ale părţii convexe a deformării, după care banda se întinde şi se fixează cu capătul de apofiza transversală a vertebrei neutre inferioare [1]. The method of treatment of scoliosis in children is known, which includes incision of soft tissues along the spinous processes to the vertebral arch on the convex side of the deformity. At the apex, below and above the arch of the spinal deformity, the transverse processes of the neutral vertebrae are skeletonized, then one end of an elastic band is fixed to the transverse process of the upper neutral vertebra on the convex side of the deformity, the elastic band is passed along the transverse processes of the convex side of the deformity to the apex of the deformity, then through the spinous processes on the concave side, on the said side it is passed along the spinous processes of the apex of the deformity, then through a portion of the spinous processes of the convex side of the deformity, after which the band is stretched and fixed with the end to the transverse process of the lower neutral vertebra [1].

Este cunoscută, de asemenea, metoda de tratament al scoliozei, care constă în aceea că se efectuează incizia pielii deasupra apofizelor spinoase ale vertebrelor, care fac parte din arcul deformării din partea concavă, proximal până la vertebra superioară de hotar a deformării, iar distal până la vertebra inferioară de hotar a deformării. Apoi incizia se prelungeşte de-a lungul crestei sacrale mediale până la orificiul dorsal al sacrumului. Se scheletează regiunile de sprijin ale vertebrelor. Se instalează un distractor metalic. Se instalează un capăt de sprijin superior sub apofiza articulară a vertebrei superioare de hotar din partea concavă a deformării coloanei vertebrale. Capătul de sprijin inferior al distractorului se instalează în primul sau al doilea orificiu dorsal al sacrumului, apoi în orificiile capetelor instalate se introduce tija distractorului. Se suturează plăgile pe straturi şi se imobilizează coloana vertebrală cu ghips [2]. The method of treatment of scoliosis is also known, which consists in performing an incision of the skin above the spinous processes of the vertebrae, which are part of the arch of the deformity on the concave side, proximally to the upper vertebra bordering the deformity, and distally to the lower vertebra bordering the deformity. Then the incision is extended along the medial sacral ridge to the dorsal foramen of the sacrum. The supporting regions of the vertebrae are skeletonized. A metal distractor is installed. An upper supporting end is installed under the articular apophysis of the upper vertebra bordering the concave side of the spinal deformity. The lower supporting end of the distractor is installed in the first or second dorsal foramen of the sacrum, then the distractor rod is inserted into the holes of the installed ends. The wounds are sutured in layers and the spine is immobilized with plaster [2].

Dezavantajele metodelor cunoscute constau în aceea că sunt traumatizante, ceea ce poate duce la apariţia complicaţiilor postoperatorii, totodată durata de spitalizare este îndelungată. The disadvantages of known methods are that they are traumatic, which can lead to postoperative complications, and the duration of hospitalization is long.

Problema pe care o rezolvă invenţia constă în elaborarea unei metode miniinvazive de tratament eficient al scoliozei, scopul fiind blocarea zonelor de creştere, fără efectuarea discectomiei, fără imobilizare îndelungată cu reducerea semnificativă a duratei de spitalizare. The problem that the invention solves consists in developing a minimally invasive method for the effective treatment of scoliosis, the aim being to block growth zones, without performing discectomy, without prolonged immobilization, with a significant reduction in the duration of hospitalization.

Esenţa invenţiei constă în aceea că se determină proiecţia curburii deformaţiei coloanei vertebrale, se efectuează anestezie generală, se determină punctele pentru introducerea unor şuruburi transpediculare. În regiunea lombară punctele sunt situate în partea cea mai proeminentă a apofizelor articulare laterale, şi anume la intersecţia liniei care trece prin mijlocul bazei apofizei articulare cu linia care trece de-a lungul marginii laterale a apofizei articulare, mai medial de locul de unire a apofizelor transversale şi articulare. În regiunea toracică punctele se află la intersecţia liniei care trece prin mijlocul apofizei articulare cu linia care trece pe marginea superioară a apofizei transversale, după aceasta în punctele menţionate transdermal se introduc broşe de ghidare în plan frontal sub un unghi de 45° în direcţie cefalică, care trec prin pedicul, rădăcina arcului vertebrei, placa de închidere a vertebrei, prin discul cu nucleul pulpos, apoi prin placa de închidere a vertebrei superioare şi ţesutul spongios cu exteriorizarea vârfului broşelor la 1…2 cm pe suprafaţa frontală a corpului vertebrei, apoi se introduc pe traiectul broşelor şuruburile transpediculare, executate cu un canal longitudinal străpuns sau fără canal. The essence of the invention is that the projection of the curvature of the spinal column deformation is determined, general anesthesia is performed, the points for the introduction of transpedicular screws are determined. In the lumbar region, the points are located in the most prominent part of the lateral articular apophyses, namely at the intersection of the line passing through the middle of the base of the articular apophyses with the line passing along the lateral edge of the articular apophyses, more medial to the place of union of the transverse and articular apophyses. In the thoracic region, the points are located at the intersection of the line passing through the middle of the articular apophysis with the line passing along the upper edge of the transverse apophysis. After this, guide pins are inserted transdermally into the mentioned points in the frontal plane at an angle of 45° in the cephalic direction, passing through the pedicle, the root of the vertebral arch, the vertebral endplate, through the disc with the nucleus pulposus, then through the upper vertebral endplate and the spongy tissue with the tip of the pins protruding 1…2 cm on the front surface of the vertebral body. Then, transpedicular screws are inserted along the path of the pins, made with a pierced longitudinal channel or without a channel.

Rezultatul invenţiei constă în aceea că metoda elaborată este miniinvazivă, durata intervenţiei chirurgicale este redusă, cu complicaţii intraoperatorii şi postoperatorii minime, ceea ce reduce perioada de spitalizare. Metoda propusă permite fixarea efectivă şi stabilă a carcasei cutiei toracice în gradele iniţiale ale scoliozei, ce previne progresarea deformaţiei scoliotice şi dezvoltarea complicaţiilor cardiorespiratorii. The result of the invention is that the developed method is minimally invasive, the duration of the surgical intervention is reduced, with minimal intraoperative and postoperative complications, which reduces the period of hospitalization. The proposed method allows for effective and stable fixation of the rib cage in the initial stages of scoliosis, which prevents the progression of scoliotic deformation and the development of cardiorespiratory complications.

Avantajele metodei constau în aceea că: The advantages of the method are that:

- este o metodă miniinvazivă, prin blocarea centrelor de creştere; - it is a minimally invasive method, by blocking the growth centers;

- nu se efectuează discectomia prin abord transabdominal sau transtoracic printr-o intervenţie traumatizantă; - discectomy is not performed through a transabdominal or transthoracic approach through a traumatic intervention;

- fără imobilizare îndelungată; - without prolonged immobilization;

- se reduce durata de spitalizare. - the duration of hospitalization is reduced.

Scolioza este una dintre cele mai dificile probleme ale ortopediei moderne. Această boală se caracterizează printr-un complex de schimbări tipice funcţionale, morfologice şi radiologice ale coloanei vertebrale, cavităţii toracice, pelvisului, precum şi a poziţiei organelor interne. În conformitate cu datele din literatura de specialitate prevalenţa scoliozei în rândul copiilor este de 5…9%. Scoliosis is one of the most difficult problems of modern orthopedics. This disease is characterized by a complex of typical functional, morphological and radiological changes in the spine, thoracic cavity, pelvis, as well as the position of internal organs. According to the data from the literature, the prevalence of scoliosis among children is 5…9%.

Datele unor cercetători sugerează că media de viaţă a pacienţilor netrataţi cu scolioză severă este de 35…40 ani. Data from some researchers suggest that the average life expectancy of untreated patients with severe scoliosis is 35…40 years.

Scolioza este boala creşterii. Curbura scoliotică a coloanei vertebrale se dezvoltă ca urmare a unor dereglări ale elementelor de creştere ale vertebrelor. Odată cu finalizarea creşterii scheletului încetează progresarea scoliozei. Tipic pentru scolioză este deformarea vertebrelor şi a discurilor (deformarea corpurilor vertebrelor, deformare de arcuri şi apofize, torsiune), inclusiv o deplasare a nucleului pulpos în partea convexă a arcului curburii, care este un fenomen secundar. Scoliosis is a disease of growth. Scoliotic curvature of the spine develops as a result of disorders of the growth elements of the vertebrae. With the completion of skeletal growth, the progression of scoliosis stops. Typical for scoliosis is the deformation of the vertebrae and discs (deformation of the vertebral bodies, deformation of the arches and apophyses, torsion), including a displacement of the nucleus pulposus to the convex part of the arch of curvature, which is a secondary phenomenon.

Studierea roengenologică a materialelor morfologice şi dinamice în procesul de formare şi progresare a scoliozei structurale de diversă etiologie a convins cercetătorii că, indiferent de etiologia scoliozei, modificările structurale ale vertebrelor sunt identice. Diferenţa se observă numai în gradul de deformare a coloanei vertebrale, dar nu şi în natura ei. Şi mai mult decât atât, succesiunea modificărilor morfologice ale vertebrelor în procesul de progresare sunt identice pentru diferite forme etiologice de scolioză structurală. Roentgenological study of morphological and dynamic materials in the process of formation and progression of structural scoliosis of various etiologies has convinced researchers that, regardless of the etiology of scoliosis, structural changes in the vertebrae are identical. The difference is observed only in the degree of deformation of the spine, but not in its nature. Moreover, the sequence of morphological changes in the vertebrae in the process of progression are identical for different etiological forms of structural scoliosis.

Cele menţionate servesc ca temei pentru studierea etapelor de formare a curburii scoliotice a coloanei vertebrale, indiferent de formele etiologice; acest lucru ia în considerare numai faptul că adevărata scolioză structurală se formează exclusiv în perioada de creştere scheletică. The above serve as a basis for studying the stages of formation of scoliotic curvature of the spine, regardless of the etiological forms; this only takes into account the fact that true structural scoliosis is formed exclusively during the period of skeletal growth.

Cea mai mare progresare a scoliozei are loc în perioada de creştere intensivă a scheletului, ceea ce corespunde vârstei de 10…15 ani. The greatest progression of scoliosis occurs during the period of intensive skeletal growth, which corresponds to the age of 10…15 years.

De aceea, în practica mondială la moment este în general acceptat faptul că tratamentul chirurgical al scoliozei infantile şi juvenile este necesar de a începe la vârsta de 8…12 ani, în timp ce operaţia ar trebui să includă intervenţia de disectomie pe partea convexă a coloanei vertebrale la vârful curburii, şi anume (îndepărtarea nucleului pulpos şi a plăcilor de închidere) şi corecţia dorsală fără efectuarea spondilodezei posterioare. Scopul este de a bloca creşterea discului pe partea convexă pentru stoparea progresării deformaţiei. Corecţia finală a deformării şi spondilodeza posterioară se realizează la sfârşitul creşterii coloanei vertebrale. Therefore, in world practice at the moment it is generally accepted that surgical treatment of infantile and juvenile scoliosis should begin at the age of 8…12 years, while the operation should include discectomy intervention on the convex side of the spine at the apex of the curvature, namely (removal of the nucleus pulposus and the closing plates) and dorsal correction without performing posterior spondylodesis. The goal is to block the growth of the disc on the convex side to stop the progression of the deformity. The final correction of the deformity and posterior spondylodesis is performed at the end of the growth of the spine.

Metoda (epifiziodeza): percutan se introduc şuruburile prin pediculul vertebrei, disc, nucleul pulpos (în scolioză este pe porţiunea convexă a discului), prin plăcile de închidere ale vertebrelor adiacente cu introducerea în stratul spongios. Method (epiphysiodesis): the screws are inserted percutaneously through the vertebral pedicle, disc, nucleus pulposus (in scoliosis it is on the convex portion of the disc), through the endplates of the adjacent vertebrae with insertion into the spongy layer.

Tehnica intervenţiei chirurgicale. Pacientul se investighează clinic şi paraclinic, şi anume roengenologic se determină proiecţia curburii deformaţiei coloanei vertebrale, se efectuează anestezie generală, se determină punctele pentru introducerea unor şuruburi transpediculare. În regiunea lombară punctele sunt situate în partea cea mai proeminentă a apofizelor articulare laterale, şi anume la intersecţia liniei care trece prin mijlocul bazei apofizei articulare cu linia care trece de-a lungul marginii laterale a apofizei articulare, mai medial de locul de unire a apofizelor transversale şi articulare. În regiunea toracică punctele se află la intersecţia liniei care trece prin mijlocul apofizei articulare cu linia care trece pe marginea superioară a apofizei transversale, după aceasta în punctele menţionate transdermal se introduc broşe de ghidare în plan frontal sub un unghi de 45° în direcţie cefalică, care trec prin pedicul, rădăcina arcului vertebrei, placa de închidere a vertebrei, prin discul cu nucleul pulpos, apoi prin placa de închidere a vertebrei superioare şi ţesutul spongios cu exteriorizarea vârfului broşelor la 1…2 cm pe suprafaţa frontală a corpului vertebrei, apoi se introduc pe traiectul broşelor şuruburile transpediculare, executate cu un canal longitudinal străpuns sau fără canal. Surgical technique. The patient is investigated clinically and paraclinically, namely roentgenologically the projection of the curvature of the spinal deformity is determined, general anesthesia is performed, the points for the introduction of transpedicular screws are determined. In the lumbar region the points are located in the most prominent part of the lateral articular apophyses, namely at the intersection of the line passing through the middle of the base of the articular apophysis with the line passing along the lateral edge of the articular apophysis, more medial to the place of union of the transverse and articular apophyses. In the thoracic region, the points are located at the intersection of the line passing through the middle of the articular apophysis with the line passing along the upper edge of the transverse apophysis. After this, guide pins are inserted transdermally into the mentioned points in the frontal plane at an angle of 45° in the cephalic direction, passing through the pedicle, the root of the vertebral arch, the vertebral endplate, through the disc with the nucleus pulposus, then through the upper vertebral endplate and the spongy tissue with the tip of the pins protruding 1…2 cm on the front surface of the vertebral body. Then, transpedicular screws are inserted along the path of the pins, made with a pierced longitudinal channel or without a channel.

Intervenţii chirurgicale conform invenţiei revendicate au fost efectuate la 4 pacienţi. Surgical interventions according to the claimed invention were performed on 4 patients.

Exemplu Example

Pacienta N., 10 ani, a fost internată cu acuze la dureri şi oboseală periodică în regiunea toracică a coloanei vertebrale. Prima dată acuzele au apărut 8 luni în urmă. Apoi durerile au devenit mai frecvente şi asociate cu senzaţia de oboseală în regiunea toracică a coloanei vertebrale care se accentuau în poziţia ortostatică îndelungată şi la eforturi fizice. Patient N., 10 years old, was admitted with complaints of periodic pain and fatigue in the thoracic spine. The complaints first appeared 8 months ago. Then the pain became more frequent and associated with a feeling of fatigue in the thoracic spine, which was aggravated by prolonged standing and physical exertion.

La examinare se observă o asimetrie uşoară a triunghiurilor taliei, umărul drept puţin mai înalt şi omoplatul drept mai înalt cu 2 cm şi mai proeminent, unghiul inferior al scapulei drepte se află mai lateral de linia mediană cu 2 cm. Linia apofizelor spinoase în regiunea toracică este deviată spre dreapta. Tratamentul a fost efectuat după metoda revendicată. Perioada postoperatorie a decurs fără complicaţii. Pacienta a fost externată din spital peste 3 zile, nu s-a folosit imobilizarea pentru coloana vertebrală. Acuze nu prezintă, durerile şi oboseala au dispărut. Asimetria triunghiurilor taliei şi umerilor s-a micşorat. On examination, a slight asymmetry of the waist triangles is observed, the right shoulder is slightly higher and the right shoulder blade is 2 cm higher and more prominent, the lower angle of the right scapula is 2 cm laterally from the midline. The line of the spinous processes in the thoracic region is deviated to the right. The treatment was performed according to the claimed method. The postoperative period was without complications. The patient was discharged from the hospital after 3 days, no spinal immobilization was used. She has no complaints, pain and fatigue have disappeared. The asymmetry of the waist and shoulder triangles has decreased.

1. SU1748803 A1 1992.07.23 1. SU1748803 A1 1992.07.23

2. SU 1685418 A1 1991.10.23 2. SU 1685418 A1 1991.10.23

Claims (1)

Metodă de tratament al scoliozei la copii, care constă în aceea că se determină proiecţia curburii deformaţiei coloanei vertebrale, se efectuează anestezie generală, se determină punctele pentru introducerea unor şuruburi transpediculare; în regiunea lombară punctele sunt situate în partea cea mai proeminentă a apofizelor articulare laterale, şi anume la intersecţia liniei care trece prin mijlocul bazei apofizei articulare cu linia care trece de-a lungul marginii laterale a apofizei articulare, mai medial de locul de unire a apofizelor transversale şi articulare, iar în regiunea toracică punctele se află la intersecţia liniei care trece prin mijlocul apofizei articulare cu linia care trece pe marginea superioară a apofizei transversale, după aceasta în punctele menţionate transdermal se introduc broşe de ghidare în plan frontal sub un unghi de 45° în direcţie cefalică, care trec prin pedicul, rădăcina arcului vertebrei, placa de închidere a vertebrei, prin discul cu nucleul pulpos, apoi prin placa de închidere a vertebrei superioare şi ţesutul spongios cu exteriorizarea vârfului broşelor la 1…2 cm pe suprafaţa frontală a corpului vertebrei, apoi se introduc pe traiectul broşelor şuruburile transpediculare, executate cu un canal longitudinal străpuns sau fără canal.A method of treating scoliosis in children, which consists of determining the projection of the curvature of the spinal column deformation, performing general anesthesia, and determining the points for the introduction of transpedicular screws; in the lumbar region the points are located in the most prominent part of the lateral articular apophyses, namely at the intersection of the line passing through the middle of the base of the articular apophysis with the line passing along the lateral edge of the articular apophysis, more medial to the place of union of the transverse and articular apophyses, and in the thoracic region the points are located at the intersection of the line passing through the middle of the articular apophysis with the line passing along the upper edge of the transverse apophysis, after this, in the mentioned points transdermally guide pins are inserted in the frontal plane at an angle of 45° in the cephalic direction, which pass through the pedicle, the root of the vertebral arch, the closing plate of the vertebra, through the disc with the nucleus pulposus, then through the closing plate of the upper vertebra and the spongy tissue with the tip of the pins externalizing 1…2 cm on the front surface of the vertebral body, then transpedicular screws are inserted along the path of the pins, made with a pierced longitudinal channel or without a channel.
MDS20160057A 2016-04-19 2016-04-19 Method of treatment of scoliosis in children MD1084Z (en)

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MD1825B2 (en) * 1998-05-29 2002-01-31 Univ Nicolae Testemitanu Device for surgical treatment of scoliosis
MD806Y (en) * 2013-10-24 2014-08-31 Universitatea De Stat De Medicină Şi Farmacie "Nicolae Testemiţanu" Din Republica Moldova Method for treating progressive thoracic scoliosis

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