RU2069536C1 - Method for performing decompression cranium trephination - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves putting on Ilizarov apparatus over the head after performing operation field treatment. Cranial vault bone area of needed size and form is resected. The resected area is placed into the canal formed in this way and fixed. It is to be moved into the maternal bed after alleviating acute phenomena. EFFECT: enhanced effectiveness of the operation. 2 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics.

 A known method of decompressive trepanation of the skull, including resection of a section of the bones of the cranial vault, retaining communication with the soft tissues, and after completing manipulations in the cranial cavity, laying the resected fragment into the mother’s bed (1).

 A known method of replacing a defect in the bones of the skull, including the formation of a bone graft congruent in shape, which in the process of replacing the defect is centered by the spokes between the edges of the defect (2).

 However, the known method for replacing a defect in the bones of the skull is quite lengthy due to the need to maintain a certain rate of movement of the bone fragment to form a distraction regenerate. In addition, the re-operation to replace the defect is always associated with a certain risk to the patient’s life and when using the known method, there is the possibility of complications associated with additional head injury.

 The objective of the present invention is the ability to accelerate the healing and rehabilitation of patients due to the one-stage conduct of resuscitation (decompressive trepanation of the skull) and recovery operations (plate).

 The problem is solved in that in the method of decompressive trepanation of the skull, including resection of a section of the bones of the cranial vault followed by autologous bone replacement, the bone fragment is moved to the canal near the edge of the defect, traction spokes are passed through the bone fragment and the edges of the defect, the fragment is dosed to the mother bed, and then fixed to the fusion of the edges.

 A comparative analysis of the proposed method with the prototype and well-known technical solutions in this field allows us to judge its compliance with the criteria of "novelty" and "inventive step".

 In the future, the method of decompressive trepanation of the skull is illustrated by specific examples, R-grams and patterns.

 In FIG. 1 shows the condition of the skull after decompression trepanation of the skull according to the invention; in FIG. 2 state of the skull after replacement of the defect with a displaced bone fragment.

 The method is as follows.

 After processing the surgical field with a 5% solution of iodine and alcohol, an apparatus (Illizarova) is placed on the head. An incision is made on the scalp in the projection of the proposed decompressive trepanation. Then, a section of the bones of the cranial vault is resected of the required size and shape. At the same time, if possible, the nutritional connections of the resected bone fragment with adjacent tissues are maintained due to the soft-tissue leg. At one of the edges of the defect of the bones of the cranial vault, a channel is formed in the soft tissues, the walls of which can only be soft tissues or soft tissues and bones of the skull. A resected bone fragment is placed in this canal and fixed there with the help of traction spokes drawn through it and the edges of the defect. After the abatement of acute phenomena in the brain, the metered movement of the resected bone fragment of the cranial vault into the maternal bed begins. Upon reaching the initial position, the bone fragment is fixed until it merges with the edges of the mother bed and the apparatus is removed.

 An example of the method.

 Medical history N 164.

 Operation: Applying the Ilizarov apparatus on the head, resection of the bones of the cranial vault, fixation of the resected fragment under the soft tissues of the head at the posterior edge of the defect.

 10 days after the operation, the metered movement of the bone fragment into the maternal bed with a pace of 1.5 mm per day was started, which was carried out for 35 days (taking into account subsequent compression at the junction of the anterior edges of the defect and fragment). The fixation period was 31 days.

 A good result was obtained: the defect was largely replaced, and the fusion of the edges of the defect and the fragment over a large extent was achieved. There is no resorption of the fragment.

 Medical history N 242.

 Operation: application of the Ilizarov apparatus on the head, resection of the site of the bones of the cranial vault, fixation of the resected fragment under the soft tissues of the head at the posterior edge of the skull defect. 7 days after the operation, a metered movement of the bone fragment into the mother’s bed was started at a rate of 1.5 mm per day, carried out for 17 days. Then, for 56 days, the fragment was fixed and the animals were observed after removal of the apparatus for 91 days. Fusion of the displaced bone fragment with the posterior edge of the defect is achieved, and not along the entire length with the right and left edges. The structure of the fragment is close to the structure of the surrounding bone.

 The proposed method of decompressive trepanation of the skull reduces the time of treatment and rehabilitation, prevents repeated surgery to replace post-trepanation defects of the skull, reduces the percentage of primary and persistent disability due to the replacement of the defect with autobone.

Claims (1)

 The method of decompressive craniotomy, including the formation of a bone graft, moving it under adjacent to the edge of the defect tissue of the cranial vault with subsequent reverse movement to the mother’s bed, characterized in that the bone graft is formed on a leg of soft tissue, traction knitting needles are passed through the bone fragment and the edges of the defect , dose the fragment into the mother’s bed and fix it to the fusion of the edges.

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