RU167514U1 - Device for the treatment of osteomyelitis of the spine - Google Patents

Device for the treatment of osteomyelitis of the spine Download PDF

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Publication number
RU167514U1
RU167514U1 RU2016113092U RU2016113092U RU167514U1 RU 167514 U1 RU167514 U1 RU 167514U1 RU 2016113092 U RU2016113092 U RU 2016113092U RU 2016113092 U RU2016113092 U RU 2016113092U RU 167514 U1 RU167514 U1 RU 167514U1
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Prior art keywords
implant
spine
treatment
osteomyelitis
channel
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RU2016113092U
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Russian (ru)
Inventor
Александр Юрьевич Базаров
Константин Сергеевич Сергеев
Владимир Михайлович Осинцев
Леонид Борисович Козлов
Original Assignee
федеральное государственное бюджетное образовательное учреждение высшего образования "Тюменский государственный медицинский университет" Министерства здравоохранения Российской Федерации (ФГБОУ ВО Тюменский ГМУ Минздрава России)
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/0058Suction-irrigation systems

Abstract

The utility model relates to medicine, namely to traumatology, orthopedics, neurosurgery and phthisiology, is intended for the treatment of purulent-inflammatory lesions of the spine. In the device for the treatment of osteomyelitis of the spine, consisting of a cylindrical porous implant with a through channel, a polyvinyl chloride tube with a diameter of 5-6 mm is additionally mounted inside the through channel of the implant, at the distal end of which there are oval holes 2-4 mm in size, and the proximal end of the tube is connected to vacuum system. The proposed device significantly reduces the risk of developing postoperative purulent-inflammatory complications in the area of fusion.

Description

The utility model relates to medicine, namely to traumatology, orthopedics, neurosurgery and phthisiology, is intended for the treatment of purulent-inflammatory lesions of the spine.

Osteomyelitis of the spine is recorded in 2-7% of all cases of inflammatory bone lesions. Diagnosis of this disease is difficult and not timely, which is the reason for the development of frequent complications. The frequency of formation of abscesses in spondylitis of various parts of the spine is 50-67% [Boussel L1, Marchand B, Blineau N. Imaging of osteoarticular tuberculosis, J Radiol. 2002 Sep; 83 (9 Pt 1): 1025-34; Perrotti PP, Corrales JL, Popescu BM Pyogenic vertebral osteomyelitis. Medicina (B Aires). 2009; 69 (5): 513-8 ;. Euba gl,

Figure 00000001
, Nolla JM, Murillo O,
Figure 00000002
,
Figure 00000003
, Ariza J. Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum. 2008 Aug; 38 (l): 28-40. Epub 2007 Dec 11].

To prevent the development of purulent-inflammatory complications in the postoperative period, it is advisable to use an implant to drain residual cavities in the area of vertebral body resection.

The well-known "implant for the treatment of hematogenous osteomyelitis of the spine" [RU Patent No. 129793 of 07/10/2013]. This device was not used in the inflammatory process in the spinal canal, since the polymethyl methacrylate implant blocks the passive outflow of fluid from the epidural space.

The well-known "Combined implant for anterior fusion" [RU Patent No. 2133595 from 07.27.1999]. The implant is not intended for the treatment of osteomyelitis due to the presence of a through undrained canal. At the boundary of the porous implant - pin, conditions are created for the formation of biofilms of bacteria resistant to antimicrobial agents. The design of this implant does not allow for the rehabilitation of the focus of inflammation.

As a prototype of the selected device for spinal fusion "[Patent RU No. 61125 from 02.27.2007]. The proposed device does not allow drainage of paravertebral and epidural abscesses.

The task of developing this device is to ensure effective rehabilitation of the purulent-inflammatory focus in terms of preventing the development of inflammatory processes in the postoperative period.

The technical result is simple, not requiring large material costs and is based on the use of a perforated polyvinyl chloride tube installed inside a cylindrical implant.

The technical result is achieved by the fact that in the device for the treatment of osteomyelitis of the spine, consisting of a cylindrical porous implant with a through channel, an additional 5–6 mm PVC pipe is installed inside the through channel of the implant, at the distal end of which there are oval holes 2–4 mm in size, and the proximal end of the tube is connected to a vacuum system.

The proposed utility model is illustrated by graphic material. The figure 1 shows the details of the device, where 1 is a porous implant of cylindrical shape; 2 - a through channel in a porous implant; 3-polyvinyl chloride tube; 4 - oval holes at the distal end of the PVC pipe, 5 - connection to the vacuum system, made at the distal end of the PVC pipe.

The proposed device is used as follows: after the rehabilitation stage of the operation, a porous implant of the required size is inserted into the bone defect formed during the operation. Previously, in the central part of the porous implant, a through channel with a diameter of 5-6 mm is formed. A smaller diameter PVC pipe is inserted inside the channel, at the distal end of which, located inside the implant, oval holes are made, and at the proximal end, a connection to the vacuum system. A polyvinyl chloride tube is removed through a contra-hole and fixed to the skin with a ligature. In the postoperative period, through the installed tube, vacuum drainage of the focus of inflammation is performed.

An example of the practical use of the device.

Patient Α., 50 years old, medical record inpatient No. 17592. He was hospitalized on August 26, 2014 at the Tyumen State Children's Health Clinical Hospital No. 2, with complaints of neck pain, weakness in the hands, fever, difficulty swallowing for 5 days. The general condition is serious. The skin and mucous membranes are pale. Nutrition lowered. HELL 140/90 mm Hg, pulse 100 beats / min. The abdomen is soft, painless. Catheter urination.

On palpation of the spinous processes C III- C VII and axial load on the cervical spine, soreness. The range of motion is sharply reduced. Tetraparesis is determined, muscle strength in the limbs on the right up to three points, in the left limbs up to four points. Pathological stop signs on both sides. Dysfunction of the pelvic organs as a type of urinary retention

According to CT and MRI, signs of spondylitis, epiduritis at the level of C V -C VII with the formation of a paravertebral abscess.

Diagnosis: “Acute hematogenous osteomyelitis of C V -C VII vertebrae, discitis, secondary epiduritis, paravertebral abscess. Tetraparesis. Dysfunction of the pelvic organs as a type of urinary retention

Given the serious condition of the patient, the presence of an inflammatory process in the cervical spine, increasing neurological symptoms, there were absolute indications for surgical treatment: resection of the lesion, drainage of paravertebral and epidural abscesses, vacuum drainage of the lesion. Consent of the patient to the operation is obtained. The patient was examined by an anesthetist. Surgery was performed under endotracheal anesthesia: In the patient’s position on the back with a roller between the shoulder blades after processing the surgical field, an incision up to 7 cm long along the inner edge of the sternocleidomastoid muscle on the right. In parallel with the skin incision, the subcutaneous muscle of the neck was dissected. The front surface of the cervical vertebrae is exposed along the inner edge of the sternocleidomus, stratifying the interfascial spaces bluntly. Inflammatory infiltration at the level of the lower cervical vertebrae is noted. When the paravertebral tissues were stratified, an abscess was drained up to 35 ml of liquid creamy pus with a greenish tint. The revision of the paravertebral space was performed, the streaks were opened on the opposite side. An installed needle-tag in the intervertebral disc C VI-VII performed x-ray control. A cervical distractor is installed. With the help of chisels, bone spoons, conchotomes and bites, subtotal resection of the body of the C VI vertebra was performed. Under the posterior longitudinal ligament inflammatory granulation, a small amount of liquid pus was released as the vertebral body was resected (about 1 ml). The wound is abundantly washed with antiseptics. Using a brain spatula, patency of the epidural space was checked. The epidural space is passable within the adjacent vertebrae.

A porous titanium nickelide implant of the required size has been formed. Considering the presence of an acute purulent process in the spine, a hole with a diameter of 5 mm was preliminarily formed in the porous implant; the latter had a polyvinyl chloride tube installed, at the distal end of which located inside the implant oval holes were made, and at the proximal end there was a connection to the vacuum system.

The implant is installed in the interbody C V -C VII during distraction of the cervical spine on top of the implant, the plate is laid and fixed with four screws, while the tube is brought out into the plate hole, without fixing the drainage at the level of the implant. The tube is brought out through a contraperture and is fixed to the skin with two sutures.

X-ray - control. Implant standing is correct. Hemostasis during the operation. Wound closure: continuous suture by m. Platisma, nodal sutures on the skin. Aseptic dressings. Blood loss up to 300 ml. The drainage tube is connected to a vacuum with a maximum vacuum of 0.1 MPa. The duration of vacuum drainage is 7 days.

A histological examination of the removed material confirmed the diagnosis of acute osteomyelitis of the spine.

In the postoperative period, the pain disappeared, the body temperature returned to normal, and the general condition of the patient improved. Postoperative wound healing by first intention, sutures were removed on day 12.

Tetraparesis regressed to mild monoparesis in the right upper limb, was discharged under the supervision of a surgeon and a neurologist in the community.

Arbitrary urination recovered 2 months after discharge.

Long-term results were tracked for 1 year and 3 months. On control CTs, the formation of a cat-metal block was noted, the position of the implants was satisfactory, no resorption zones were noted, edema of bone structures, fluid formations in the area of surgical intervention was also not noted.

The advantages of the proposed utility model in comparison with the prototype are presented in the table.

The proposed utility model has been tested in the clinic of traumatology, orthopedics and HPV Tyumen State Medical University in the treatment of patients with hematogenous spinal osteomyelitis. Conducted 16 operations. High efficiency of using the proposed device was noted, the risk of developing postoperative purulent-inflammatory complications in the fusion zone was significantly reduced.

Figure 00000004

Claims (1)

  1. A device for the treatment of spinal osteomyelitis, consisting of a cylindrical porous implant with a through channel, characterized in that a 5-6 mm diameter PVC tube is mounted inside the through channel, oval holes 2-4 mm in size are made at its distal end, and the proximal end of the tube is connected with a vacuum system.
RU2016113092U 2016-04-05 2016-04-05 Device for the treatment of osteomyelitis of the spine RU167514U1 (en)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2026085C1 (en) * 1991-11-11 1995-01-09 Институт травматологии и ортопедии Восточно-Сибирского филиала СО АМН РФ Device for curing post-operational and purulent cavities
RU2247548C2 (en) * 1999-04-02 2005-03-10 Кей Си Ай ЛАЙСЕНСИНГ, Инк. Vacuum system for closing wounds by applying means introduced for healing the wound
RU2410124C2 (en) * 2006-03-14 2011-01-27 КейСиАй Лайсензинг Инк. Device for treatment by lower pressure supply, containing main pipe with primary flow canal and occlusion-preventing element
US8939933B2 (en) * 2006-03-14 2015-01-27 Kci Licensing, Inc. Manifolds, systems, and methods for administering reduced pressure to a subcutaneous tissue site

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2026085C1 (en) * 1991-11-11 1995-01-09 Институт травматологии и ортопедии Восточно-Сибирского филиала СО АМН РФ Device for curing post-operational and purulent cavities
RU2247548C2 (en) * 1999-04-02 2005-03-10 Кей Си Ай ЛАЙСЕНСИНГ, Инк. Vacuum system for closing wounds by applying means introduced for healing the wound
RU2410124C2 (en) * 2006-03-14 2011-01-27 КейСиАй Лайсензинг Инк. Device for treatment by lower pressure supply, containing main pipe with primary flow canal and occlusion-preventing element
US8939933B2 (en) * 2006-03-14 2015-01-27 Kci Licensing, Inc. Manifolds, systems, and methods for administering reduced pressure to a subcutaneous tissue site

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Effective date: 20170406

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Effective date: 20180410