RU2324447C1 - Method of percutaneous vertebroplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method can be used in percutaneous vertebroplasty of osteoporotic vertebras. The 1/2-1/4 of cavity volume low viscosity bone cement is injected into vertebra, followed by the osteogenous substance, till the cavity is filled. Then, 0.5-1.0 ml of high viscosity bone cement is injected to seal the cavity.

EFFECT: reliability of fixation is increased due to bone block between vertebras and recurrent vertebral displacement is avoided.

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Description

The invention relates to medicine, namely to traumatology and neurosurgery, and is intended for surgical treatment of patients with osteoporotic vertebral fractures.

Uncomplicated vertebral fractures associated with osteoporosis are common and are of great social importance. Such damage is more common in older age groups with concomitant diseases. Conventional methods for the surgical treatment of uncomplicated vertebral fractures are unacceptable because of their morbidity, somatic status of the victims, and pronounced osteoporosis of adjacent bone structures.

A known method of intraoperative use of osteogenic gel, for example, a valve (Germanov V.G. The use of a valve in stabilizing operations on the cervical spine. Diss. Candidate of Medical Sciences, 1999, 147 pages). The method allows to create conditions for bone formation. However, this fixation of the spine requires wide surgical access, additional fixation of the spine, which leads to its invasiveness.

A known method of percutaneous vertebroplasty by introducing polymerizable cement into the vertebral body through a needle (Galibert P., Deramond N., Rosat P., Le Gars D. Prelimenari note on the of vertebral angioma by percutaneous acrilic vertebroplasty. Neurochirurgie 1987, 33, p. 166 -168).

The method allows reliable fixation of the spine, however, given the foreign nature of the material, its excessive stiffness, the development of osteoporosis around the cement and the secondary displacement of the vertebrae are possible.

OBJECT OF THE INVENTION is to increase the reliability of stabilization of a damaged vertebra.

The STATED PROBLEM is solved by the method consisting in percutaneous puncture of the damaged vertebral body with a needle and introducing into the fracture zone sequentially first 1 / 4-1 / 2 of the cavity volume of bone cement of low viscosity, after polymerization of which osteogenic substance is introduced, then 0.5-1.0 ml High viscosity bone cement as a cork.

As the cement of low and high viscosity, the same medical surgical bone cement Simplex P of the HAUMEDIKA firm is used. Its low or high viscosity depends on the time elapsed after mixing the components. The polymerization of cement is accompanied by heat (exothermic reaction), it cools down to a safe level (≈40 °) in no more than 3 minutes (experimentally determined using a thermocouple inserted through a needle).

The claimed method differs from the known one in that low-viscosity bone cement is sequentially injected into the vertebral body, after 3-5 minutes an osteogenic substance, for example bone crumb or a valve, and then a dose of high-viscosity bone cement is injected to form a cork.

The technical result of the method is that the introduced cement plays a stabilizing role, and bone crumb or a valve performs an osteogenic function.

In practice, the method is as follows. The patient is placed on the operating table in a position on the stomach. Under x-ray control with an image intensifier tube (electron-optical converter) determine the level of pathology. Under local anesthesia (0.5% solution of marcaine - 30 ml), a needle with a diameter of 3 mm is held with mandrin into the body of the damaged vertebra. Introduce 1.0-2.0 ml of Omnipack to clarify the topography of the vascular bed of the vertebra. Then slowly under X-ray control, 1 / 2-1 / 4 of the cavity is injected with bone cement of low viscosity, the needle position is changed to properly fill the cavity. Three to five minutes after the curing of the cement and lowering its temperature, a suspension of bone chips or a valve is introduced through the lumen of the needle. After this stage, the position of the needle is again corrected in order to inject 0.5-1.0 ml of bone cement of increased viscosity to form a cork. Apply an aseptic dressing. 2 hours after the operation, the patient is activated - they allow walking within the ward, the next day he can be discharged for outpatient treatment.

EXAMPLE of clinical observations.

Patient I.A.P., 67 years old, and.b. 4486. Was admitted to the hospital on the day of the injury. Injury from a fall from a height of 0.5 m. Upon receipt, severe pain in the lumbar and lower thoracic spine. Position forced, sharp muscle tension of the extensors of the body. Palpation of the spinous processes and paravertebral points is sharply painful at the level of Th12-L1 vertebrae. There are no motor disorders, sensitive disorders, pathological signs. There are no dysfunctions of the pelvic organs. On radiographs: against the background of diffuse osteoporosis, the wedge-shaped deformation of the vertebral body L1 at 1/2 of its height. Concomitant diseases: coronary cardiosclerosis, bronchial asthma for 20 years. To stop attacks of bronchial asthma, it uses a spray with hormonal drugs. After further examination of the general condition of the patient on the 7th day after the injury, an operation was performed under local anesthesia.

Percutaneously with a puncture needle through the leg L1 of the vertebra, 2.0 ml of low viscosity bone cement was introduced into its cavity. After 3 minutes (after curing and cooling of the cement), bone crumb was introduced until the cavity was filled, then, after the needle was moved to the edge of the leg, 1.0 ml of high viscosity cement was introduced to form a cork. The patient operation was well tolerated. I got out of bed on my own 2 hours after the operation. She characterized her feelings as "the spine became painless and stable." After 8 months with x-ray control, integration of bone crumbs into the bone tissue of the vertebral body is noted. During x-ray scintigraphy, Tc 99 hyperfixation is not determined, which indicates the completion of osteoreparation.

Claims (1)

The method of percutaneous vertebroplasty of the vertebral body after a fracture by introducing bone cement through a puncture needle under the control of an electron-optical transducer, characterized in that 1 / 4-1 / 2 of the cavity volume is injected with low viscosity bone cement, osteogenic substance is administered after three to five minutes until filling cavity, then injected with 0.5-1.0 ml of bone cement of high viscosity as a tube.