MD806Z - Method of treatment of progressive chest scoliosis in children - Google Patents
Method of treatment of progressive chest scoliosis in children Download PDFInfo
- Publication number
- MD806Z MD806Z MDS20130176A MDS20130176A MD806Z MD 806 Z MD806 Z MD 806Z MD S20130176 A MDS20130176 A MD S20130176A MD S20130176 A MDS20130176 A MD S20130176A MD 806 Z MD806 Z MD 806Z
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- Moldova
- Prior art keywords
- scoliotic curvature
- ribs
- scoliotic
- curvature
- children
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- 238000000034 method Methods 0.000 title claims abstract description 13
- 206010039722 scoliosis Diseases 0.000 title claims abstract description 9
- 230000000750 progressive effect Effects 0.000 title claims abstract description 4
- 230000006641 stabilisation Effects 0.000 claims abstract description 10
- 238000011105 stabilization Methods 0.000 claims abstract description 10
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 9
- 210000000845 cartilage Anatomy 0.000 claims abstract description 5
- 210000001562 sternum Anatomy 0.000 claims abstract description 5
- 230000002146 bilateral effect Effects 0.000 claims abstract description 4
- 238000002695 general anesthesia Methods 0.000 claims abstract description 4
- 206010011985 Decubitus ulcer Diseases 0.000 claims description 3
- QTCANKDTWWSCMR-UHFFFAOYSA-N costic aldehyde Natural products C1CCC(=C)C2CC(C(=C)C=O)CCC21C QTCANKDTWWSCMR-UHFFFAOYSA-N 0.000 abstract description 4
- ISTFUJWTQAMRGA-UHFFFAOYSA-N iso-beta-costal Natural products C1C(C(=C)C=O)CCC2(C)CCCC(C)=C21 ISTFUJWTQAMRGA-UHFFFAOYSA-N 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 3
- 230000000399 orthopedic effect Effects 0.000 abstract description 2
- 210000000038 chest Anatomy 0.000 description 5
- 206010023509 Kyphosis Diseases 0.000 description 3
- 230000002802 cardiorespiratory effect Effects 0.000 description 3
- 230000036407 pain Effects 0.000 description 3
- 230000004064 dysfunction Effects 0.000 description 2
- 238000002271 resection Methods 0.000 description 2
- 238000011477 surgical intervention Methods 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 206010058314 Dysplasia Diseases 0.000 description 1
- PPTYJKAXVCCBDU-UHFFFAOYSA-N Rohypnol Chemical compound N=1CC(=O)N(C)C2=CC=C([N+]([O-])=O)C=C2C=1C1=CC=CC=C1F PPTYJKAXVCCBDU-UHFFFAOYSA-N 0.000 description 1
- 206010058907 Spinal deformity Diseases 0.000 description 1
- 208000014306 Trophic disease Diseases 0.000 description 1
- 206010052428 Wound Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 208000037873 arthrodesis Diseases 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- 239000012634 fragment Substances 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 238000012423 maintenance Methods 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 210000000944 nerve tissue Anatomy 0.000 description 1
- 230000002746 orthostatic effect Effects 0.000 description 1
- 230000000737 periodic effect Effects 0.000 description 1
- 239000011505 plaster Substances 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000000069 prophylactic effect Effects 0.000 description 1
- 210000001991 scapula Anatomy 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 230000001960 triggered effect Effects 0.000 description 1
- 210000000689 upper leg Anatomy 0.000 description 1
- 231100000216 vascular lesion Toxicity 0.000 description 1
Landscapes
- Orthopedics, Nursing, And Contraception (AREA)
Abstract
Description
Invenţia se referă la medicină, şi anume la traumatologie şi ortopedie, şi poate fi utilizată în tratamentul scoliozei toracice progresive la copii. The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of progressive thoracic scoliosis in children.
Este cunoscută metoda de tratament chirurgical al scoliozei, care include corecţia şi stabilizarea curburii toracale primare, rezecţia ghibozităţii costale reziduale, după care cutia toracică se imobilizează într-un corset mare ghipsat şi se fixează de coapsa din partea convexităţii curburii scoliotice. Pacientul stă imobilizat în spital timp de 4 luni, apoi urmează un tratament ambulator încă 4…6 luni [1]. The method of surgical treatment of scoliosis is known, which includes correction and stabilization of the primary thoracic curvature, resection of residual rib kyphosis, after which the rib cage is immobilized in a large plaster corset and fixed to the thigh from the side of the convexity of the scoliotic curvature. The patient is immobilized in the hospital for 4 months, then follows outpatient treatment for another 4...6 months [1].
În calitate de cea mai apropiată soluţie este cunoscută metoda de tratament al scoliozei toracice în ghibozitatea costală de mică adâncime, care constă în aceea că se delimitează subperiostal coastele pe 10...15 cm, care se rup, iar capătul ventral al lor se deplasează anterior capetelor dorsale ale aceloraşi coaste, apoi capătul ventral al coastelor se trage deplasându-l spre fragmentul vertebral şi plasându-l pe suprafaţa lui anterioară, prin aceasta se obţine corecţia ghibozităţii costale, astfel prin dublicaturi de coaste se formează un canal unde se introduc ligaturile şi se fixează corecţia obţinută [2]. As the closest solution, the method of treating thoracic scoliosis in shallow rib kyphosis is known, which consists in delimiting the ribs subperiosteally for 10...15 cm, which are broken, and their ventral end is moved anterior to the dorsal ends of the same ribs, then the ventral end of the ribs is pulled, moving it towards the vertebral fragment and placing it on its anterior surface, thereby obtaining the correction of the rib kyphosis, thus by duplicating the ribs, a channel is formed where the ligatures are introduced and the obtained correction is fixed [2].
Dezavantajul metodelor menţionate constă în volumul mare de lucru în cadrul intervenţiilor chirurgicale şi rezultate nesătisfăcătoare. Pentru a izola coastele pe o lungime de 14 cm este necesară o incizie mai extinsă, ceea ce cauzează traumatizarea ţesuturilor, terminaţiilor nervoase, apar leziuni vasculare ale regiunilor costale, ulterior se declanşează afecţiuni trofice şi progresează deformaţia. Coastele sunt, de asemenea, un element de stabilizare a carcasei cutiei totacice, iar rezecţia şi deplasarea acestora lipsesc scheletul de acest factor de stabilizare. De aceea în gradele iniţiale de scolioză neajunsul este tactica de aşteptare din partea medicilor şi pacienţilor. Pentru o mare parte dintre pacienţi tratamentul chirurgical se efectuează prea târziu, când deformarea coloanei vertebrale ajunge la un grad sever. Riscul intervenţiei chirurgicale în asemenea cazuri este mare, iar eficienţa este comparativ mai mică decât în cazul corecţiei curburilor mai mici. The disadvantage of the mentioned methods is the large volume of work during surgical interventions and unsatisfactory results. To isolate the ribs over a length of 14 cm, a more extensive incision is required, which causes traumatization of tissues, nerve endings, vascular lesions of the costal regions appear, subsequently trophic disorders are triggered and the deformation progresses. The ribs are also an element of stabilization of the thoracic cage, and their resection and displacement deprive the skeleton of this stabilization factor. Therefore, in the initial degrees of scoliosis, the disadvantage is the waiting tactic on the part of doctors and patients. For a large part of patients, surgical treatment is performed too late, when the deformation of the spine reaches a severe degree. The risk of surgical intervention in such cases is high, and the efficiency is comparatively lower than in the case of correction of smaller curvatures.
Problema pe care o rezolvă invenţia dată constă în prevenirea sau micşorarea progresării deformaţiei segmentului toracal al coloanei vertebrale prin stabilizarea precoce a articulaţiilor costo-sternale şi restabilirea poziţiei coastelor în zona axilară. The problem solved by this invention consists in preventing or reducing the progression of the deformation of the thoracic segment of the spine by early stabilization of the costo-sternal joints and restoring the position of the ribs in the axillary area.
Conform invenţiei, metoda revendicată include efectuarea anesteziei generale, după care pacientul se poziţionează în decubit lateral, pe partea convexă a curburii scoliotice cu ajutorul unor role şi fixatoare prin mişcări de rotare şi apăsare se efectuează derotarea vertebrelor incluse în curbura scoliotică, apoi se efectuează stabilizarea bilaterală prin introducerea a câte o broşă în plan orizontal prin coastele 4…7, la o distanţă de 3…4 cm de cartilajul coastelor prin spaţiul osteomedular, prin articulaţiile costo-sternale în stern, apoi prin aceleaşi coaste, între linia axilară anterioară şi medie, bilateral, se introduc în plan vertical încrucişat câte două broşe din partea concavă a curburii scoliotice, apoi din partea convexă a curburii scoliotice. According to the invention, the claimed method includes performing general anesthesia, after which the patient is positioned in lateral decubitus, on the convex side of the scoliotic curvature with the help of rollers and fixators, through rotation and pressing movements, the vertebrae included in the scoliotic curvature are derotated, then bilateral stabilization is performed by introducing one pin in a horizontal plane through ribs 4...7, at a distance of 3...4 cm from the rib cartilage through the osteomedullary space, through the costo-sternal joints in the sternum, then through the same ribs, between the anterior and median axillary lines, bilaterally, two pins are introduced in a vertical plane crossed from the concave side of the scoliotic curvature, then from the convex side of the scoliotic curvature.
Rezultatul tehnic obţinut se bazează pe două momente principale: depistarea precoce a deformaţiei coloanei vertebrale şi utilizarea tehnologiilor minim invazive, care exclud traumatizarea ţesuturilor, fiind acceptabile pentru pacienţi. Datorită siguranţei stabilizării precoce a carcasei cutiei toracice prin efectuarea metodei minim invazive revendicate, se obţine menţinerea foarte efectivă a carcasei şi coloanei vertebrale cu evitarea deviaţiilor axiale şi rotative, ceea ce previne complicaţiile asociate cu progresarea deformaţiei şi asigură creşterea fiziologică adecvată a copilului, fără apariţia disfuncţiilor cardiorespiratorii, la fel se previne progresarea precoce a scoliozei la copii şi la adolescenţi. The technical result obtained is based on two main points: early detection of spinal deformity and the use of minimally invasive technologies, which exclude tissue trauma, being acceptable for patients. Due to the safety of early stabilization of the rib cage by performing the claimed minimally invasive method, very effective maintenance of the carcass and spine is achieved with avoidance of axial and rotational deviations, which prevents complications associated with the progression of the deformity and ensures adequate physiological growth of the child, without the appearance of cardiorespiratory dysfunctions, as well as preventing early progression of scoliosis in children and adolescents.
Avantajul metodei revendicate constă în utilizarea intervenţiei minim invazive, care exclude traumatizarea ţesuturilor pe o suprafaţă mare şi cauzează un disconfort minor, acceptabil de pacienţi la o vârstă fragedă. Stabilizarea precoce a coastelor oferă un suport sigur carcasei cutiei toracice şi „elementului principal de sprijin” - coloanei vertebrale - de la deviaţiile axiale şi rotative, asigură creşterea fiziologică adecvată a trunchiului copilului, fără apariţia disfuncţiilor cardiorespiratorii. The advantage of the claimed method is the use of minimally invasive intervention, which excludes traumatization of tissues over a large surface and causes minor discomfort, acceptable to patients at an early age. Early stabilization of the ribs provides reliable support for the rib cage and the "main supporting element" - the spine - from axial and rotational deviations, ensures adequate physiological growth of the child's trunk, without the occurrence of cardiorespiratory dysfunctions.
Metoda se realizează în felul următor. După efectuarea anesteziei generale, pacientul se poziţionează în decubit lateral. Pe partea convexă a curburii scoliotice cu ajutorul unor role şi fixatoare prin mişcări de rotare şi apăsare se efectuează derotarea vertebrelor incluse în curbura scoliotică, apoi se efectuează stabilizarea bilaterală prin introducerea a câte o broşă în plan orizontal prin coastele 4…7, la o distanţă de 3…4 cm de cartilajul coastelor prin spaţiul osteomedular, prin articulaţiile costo-sternale în stern, apoi prin aceleaşi coaste, între linia axilară anterioară şi medie, bilateral, se introduc în plan vertical încrucişat câte două broşe din partea concavă a curburii scoliotice, apoi din partea convexă a curburii scoliotice. În caz de displazie a cartilajului costal şi lipsa contactului cu sternul se efectuează artrodeza şi fixarea cu plăci metalice. The method is performed as follows. After general anesthesia, the patient is positioned in lateral decubitus. On the convex side of the scoliotic curvature, using rollers and fixators, the vertebrae included in the scoliotic curvature are derotated by rotating and pressing movements, then bilateral stabilization is performed by inserting one pin in a horizontal plane through ribs 4…7, at a distance of 3…4 cm from the rib cartilage through the osteomedullary space, through the costo-sternal joints into the sternum, then through the same ribs, between the anterior and median axillary lines, bilaterally, two pins are inserted in a vertical plane crossed from the concave side of the scoliotic curvature, then from the convex side of the scoliotic curvature. In case of dysplasia of the costal cartilage and lack of contact with the sternum, arthrodesis and fixation with metal plates are performed.
Exemplu Example
Pacienta I., 15 ani, a fost internată cu acuze la oboseală periodică şi dureri în regiunea toracică a coloanei vertebrale. Prima dată acuzele au apărut cu 6 luni în urmă. Apoi durerile au devenit mai frecvente, asociindu-se cu senzaţia de oboseală în regiunea toracică a coloanei vertebrale care se accentuau în poziţia ortostatică îndelungată, la eforturi fizice. Patient I., 15 years old, was admitted with complaints of periodic fatigue and pain in the thoracic spine. The complaints first appeared 6 months ago. Then the pain became more frequent, associated with the feeling of fatigue in the thoracic spine, which was aggravated by prolonged orthostatic position, during physical exertion.
La examinare se observă o asimetrie uşoară a triunghiurilor taliei, umărul drept puţin mai înalt şi omoplatul drept mai înalt cu 1,5 cm şi mai proeminent, unghiul inferior al scapulei drepte se află mai lateral de linia mediană cu 1,5 cm. Linia proceselor spinoase în regiunea toracică este deviată spre dreapta. Se observă o ghibozitate costală din dreapta cu înălţimea până la 2 cm. On examination, a slight asymmetry of the waist triangles is observed, the right shoulder is slightly higher and the right shoulder blade is 1.5 cm higher and more prominent, the lower angle of the right scapula is located 1.5 cm laterally from the midline. The line of the spinous processes in the thoracic region is deviated to the right. A right costal hump is observed with a height of up to 2 cm.
Tratamentul a fost efectuat conform metodei revendicate. Perioada postoperatorie a decurs fără complicaţii. Plăgile s-au vindecat per primum. Postoperator a fost efectuată o cură de antibioticoterapie profilactică. Pacienta s-a externat din spital peste 6 zile, frecventează şcoala fără a folosi imobilizarea pentru coloana vertebrală. Acuze nu prezintă, durerile şi oboseala au dispărut. Asimetria triunghiurilor taliei şi umerilor s-a diminuat vădit. The treatment was performed according to the claimed method. The postoperative period was without complications. The wounds healed per primum. A course of prophylactic antibiotic therapy was performed postoperatively. The patient was discharged from the hospital after 6 days, she attends school without using spinal immobilization. She has no complaints, pain and fatigue have disappeared. The asymmetry of the waist and shoulder triangles has clearly decreased.
Metoda propusă este minim invazivă şi permite fixarea eficientă şi stabilă a carcasei cutiei toracice în gradele iniţiale ale scoliozei, astfel se previne progresarea deformaţiei scoliotice şi dezvoltarea complicaţiilor cardiorespiratorii. The proposed method is minimally invasive and allows for efficient and stable fixation of the rib cage in the initial stages of scoliosis, thus preventing the progression of scoliotic deformity and the development of cardiorespiratory complications.
1. Цивьян Я. Л. Оперативное лечение горбов. Москва. Медицина, 1973, р. 177-178 1. Цивян Я. L. Operative treatment of humps. Moscow. Medicine, 1973, р. 177-178
2. Куслик М. И. Многотомное руководство по хирургии. Москва, 1963, т. 4, р. 431 2. Kuslik M. И. Многотомное руководство по хиругии. Moscow, 1963, p. 4, p. 431
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20130176A MD806Z (en) | 2013-10-24 | 2013-10-24 | Method of treatment of progressive chest scoliosis in children |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20130176A MD806Z (en) | 2013-10-24 | 2013-10-24 | Method of treatment of progressive chest scoliosis in children |
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| Publication Number | Publication Date |
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| MD806Y MD806Y (en) | 2014-08-31 |
| MD806Z true MD806Z (en) | 2015-03-31 |
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| Application Number | Title | Priority Date | Filing Date |
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| MDS20130176A MD806Z (en) | 2013-10-24 | 2013-10-24 | Method of treatment of progressive chest scoliosis in children |
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| Country | Link |
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Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD1084Z (en) * | 2016-04-19 | 2017-05-31 | Николай ШАВГА | Method of treatment of scoliosis in children |
Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1192803A1 (en) * | 1984-06-29 | 1985-11-23 | Ki Nii Ortopedii | Method of treatment of serious forms of scoliosis |
| SU1367972A1 (en) * | 1986-05-29 | 1988-01-23 | Евпаторийский Филиал Центрального Научно-Исследовательского Института Курортологии И Физиотерапии | Method of treatment of children ill with scoliosis |
| SU1426601A1 (en) * | 1984-08-21 | 1988-09-30 | Новосибирский научно-исследовательский институт травматологии и ортопедии | Method of treatment of progressing scoliosis of the spine |
| SU1676605A1 (en) * | 1987-07-16 | 1991-09-15 | Научно-производственное объединение "Сибцветметавтоматика" | Method for treatment of scoliosis and spinal corrector for carrying the method into effect |
| MD1825C2 (en) * | 1998-05-29 | 2002-07-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Device for surgical treatment of scoliosis |
-
2013
- 2013-10-24 MD MDS20130176A patent/MD806Z/en not_active IP Right Cessation
Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1192803A1 (en) * | 1984-06-29 | 1985-11-23 | Ki Nii Ortopedii | Method of treatment of serious forms of scoliosis |
| SU1426601A1 (en) * | 1984-08-21 | 1988-09-30 | Новосибирский научно-исследовательский институт травматологии и ортопедии | Method of treatment of progressing scoliosis of the spine |
| SU1367972A1 (en) * | 1986-05-29 | 1988-01-23 | Евпаторийский Филиал Центрального Научно-Исследовательского Института Курортологии И Физиотерапии | Method of treatment of children ill with scoliosis |
| SU1676605A1 (en) * | 1987-07-16 | 1991-09-15 | Научно-производственное объединение "Сибцветметавтоматика" | Method for treatment of scoliosis and spinal corrector for carrying the method into effect |
| MD1825C2 (en) * | 1998-05-29 | 2002-07-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Device for surgical treatment of scoliosis |
Non-Patent Citations (2)
| Title |
|---|
| Куслик М. И. Многотомное руководство по хирургии. Москва, 1963, т. 4, р. 431 * |
| Цивьян Я. Л. Оперативное лечение горбов. Москва. Медицина, 1973, р. 177-178 * |
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| Publication number | Publication date |
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| MD806Y (en) | 2014-08-31 |
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| KA4A | Patent for invention lapsed due to non-payment of fees (with right of restoration) |