RU2328245C2 - Mehod of cervical vertebral osteosynthesis for small domestic animals - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: method includes transosseous pin installation through ventral and dorsal vertebral structures and their following reposition using external fixing device; and each pin is installed at least through two anatomically indicated parts of one or adjacent cervical vertebras.

EFFECT: increased fixing stability and possibility to regulate position of vertebras within reposition.

5 cl, 7 dwg

Description

The invention relates to the field of veterinary surgery and can be used to restore the integrity and anatomical relationships of the segments of the cervical spine in small pets with damage and diseases.

A known method of treating injuries of the cervical spine of dogs, providing for the stabilization of the first and second cervical vertebrae by screw fixation of the ventral articular surfaces and pin fixation of the vertebral bodies (Denny Hemish R., Butterwof Stephen J. Orthopedics of dogs and cats. / Transl. From English M. Dorosh and L. Eveleva. - M .: Aquarium BUK LLC, 2004, p. 246-247).

However, this method is traumatic and does not provide the possibility of closed reposition of fragments of damaged cervical vertebrae.

There is a method of treating fractures of the cervical spine in small domestic animals with an external fixation apparatus, which provides for the osteosynthesis of the damaged spine with fixation by the needles of the occipital tuber and the spinous process of one of the cervical vertebrae outside the damage zone (Kirsanov K.P., Dyuryagina O. V., Menshikova I.A., Timofeev V.N. Treatment of fractures of the cervical spine in small pets with external fixation apparatus // Veterinary clinic. - 2003. - No. 12 (19). - P.25-26).

However, with this fixation method, the reposition of the cervical vertebrae or their fragments is carried out only as a result of axial displacement, which limits the possibility of their directed movement directly in the damage zone and, therefore, their exact comparison.

In addition, when performing the known method due to the limited contact area between the fixing elements and the bone, the eruption of the latter is not excluded, which requires its re-conducting.

The objective of the invention is to develop a method for osteosynthesis of the cervical spine in small pets, providing increased stability of fixation and controllability of the position of the cervical vertebrae during their closed reposition.

This problem is solved by the fact that in the method of osteosynthesis of the cervical spine in small domestic animals, including transosseous needles through the ventral and dorsal structures of the vertebrae and their subsequent reposition using an external fixation device, each of the spokes is carried out through at least two anatomically designated parts of one or adjacent cervical vertebrae.

To fix the posterior structures of the first and second cervical vertebrae, it is advisable that the fixing spoke is passed through the atlas wing and the spinous process of the second cervical vertebra.

To fix the posterior structures of the third or seventh cervical vertebrae, it is advisable that the fixing needle is passed through the spinous process of one and the articular processes of the same and adjacent cervical vertebrae.

To fix the front structures of the second to sixth cervical vertebrae, it is advisable that the retaining spoke is passed through both transverse processes of the cervical vertebra.

To fix the anterior structures of the third or seventh cervical vertebrae, it is advisable that the retaining needle is passed through the bodies and both transverse processes of the cervical vertebra.

The present invention is illustrated by the description, an example of its practical use and illustrative material, which shows:

figure 1 - diagram of the fixation of the cervical vertebra by holding a spoke through the wing of the atlas and the spinous process of the second cervical vertebra;

figure 2 - diagram of the fixation of the cervical vertebra by holding the knitting needle through the spinous process of one and the articular processes of the same and adjacent cervical vertebrae;

figure 3 - diagram of the fixation of the cervical vertebra by holding a spoke through both transverse processes;

4 is a diagram of the fixation of the cervical vertebra by holding the spokes through the caudal part of the body and both transverse processes;

5 is a radiograph of the cervical spine of the dog before treatment for subluxation of the occipital-atlas joint;

6 (a, b) - radiographs of the dog’s cervical spine during stable fixation using the apparatus after closed reduction of the subluxation of the occipital-atlant joint: a - direct projection, b - lateral projection;

7 is a radiograph of the cervical spine of the dog after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, closed osteosynthesis of the damaged cervical spine is performed. During its implementation, the fixing spokes are carried through the front and / or rear structures of the vertebrae lying above and below the damaged one. Moreover, each of the spokes is carried out through at least two anatomically designated parts of one or adjacent cervical vertebrae. Depending on the damage zone, the following options can be used:

- the locking needle is passed through the wing of the atlas and the spinous process of the second cervical vertebra (figure 1);

- the fixing needle is passed through the spinous process of one and the articular processes of the same and adjacent cervical vertebrae (figure 2);

- the locking needle is passed through both transverse processes of the cervical vertebra (figure 3);

- the locking needle is passed through the caudal part of the body and both transverse processes of the cervical vertebra (Fig. 4).

In a tense state, the spokes are mounted on external supports installed in the projection of the corresponding vertebrae, made in the form of arcs, which are connected with each other with the help of threaded rods and hinged nodes with the possibility of multi-plane movement.

Further, taking into account the data of x-ray, by shifting the supports of the apparatus with the spokes fixed on them relative to each other, a closed reposition of the vertebrae and / or their fragments is carried out until they are accurately compared and the anatomical relationships of the segments of the cervical spine are restored. Upon completion of the reposition, the systems of the apparatus are stabilized. The operation is completed by performing control radiography.

In the postoperative period, until clinically reliable signs of fusion of the damaged segment are obtained, stable fixation of the cervical spine is performed using the apparatus.

After dismantling the apparatus, which is performed in the reverse order, additional immobilization of the cervical spine is not required.

The practical implementation of the method is illustrated by the following clinical observation.

Dog, age 4 years. Was admitted to the animal clinic of the RTC "WTO" after a road injury. Diagnosis: subluxation of the occipital-atlant joint (figure 5).

To stabilize the subluxation, closed osteosynthesis of the cervical spine was performed using an external fixation device.

During the operation, after anesthesia and treatment of the surgical field, initially, three fixing knitting needles were passed through the occipital and frontal bones of the skull. Following this, the fixing knitting needles passed through the wing of the atlas and the spinous process of the second cervical vertebra. When carrying these knitting needles, each of them was mounted on the ventral surface of the atlas wing at an angle of 40-45 ° to the frontal plane, 10.0 mm from its edge, and then passed through the atlas and the spinous process of the second cervical vertebra. Cross-spoke was carried out in the spinous process of the axial vertebra.

Then, the retaining needle was passed through the caudal part of the body and both transverse processes of the fourth cervical vertebra. In addition, by conducting crossed needles through the spinous and articular processes, the posterior structures of the fourth cervical vertebra were fixed.

The free ends of the spokes were fixed on the external supports of the apparatus, which were connected to each other by means of threaded rods and hinge assemblies. Following this displacement of the support with the spokes securing the skull fixed to it, relative to the intermediate support, a closed reduction of the subluxation of the occipital-atlant joint was performed. The apparatus system stabilized (Fig.6).

In the postoperative period, for 25 days, stable fixation of the cervical spine was carried out, after which the apparatus was dismantled. Throughout the indicated period, signs of teething of spokes from fixed bone structures were not noted.

At the time of removal of the apparatus, the condition of the animal is satisfactory. Radiological: complete restoration of the anatomical relationship in the occipital-atlant joint (Fig.7). Clinically: movements in the cervical spine in full, the animal freely turns its head.

The proposed method allows for complete stable fixation and controllability of the position of the cervical vertebrae during their closed reposition.

The proposed method is used in the experimental clinical department of the RRC "WTO" them. Acad. G.A. Ilizarova.

Claims (5)

1. The method of osteosynthesis of the cervical spine in small domestic animals, including transosseous needles through the ventral and dorsal structures of the vertebrae and their subsequent reposition using an external fixation device, characterized in that each of the fixing spokes is carried out through at least two anatomically designated parts of one or adjacent cervical vertebrae. 2. The method according to claim 1, characterized in that the retaining spoke is passed through the caudal part of the body and both transverse processes of the cervical vertebra. 3. The method according to claim 1, characterized in that the retaining spoke is passed through the spinous process of one and the articular processes of the same and adjacent cervical vertebrae. 4. The method according to claim 1, characterized in that the retaining pin is passed through both transverse processes of the cervical vertebra. 5. The method according to claim 1, characterized in that the retaining spoke is passed through the wing of the atlas and the spinous process of the second cervical vertebra.

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