RU2421175C1 - Device for treating fractures of spine and method of repositioning bone fragments of damaged vertebra bodies with application of said device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to field of medicine, in particular to spinal surgery. Device includes injection needle, guide for injection needle passing, made in form of metal tube, injection needle for gripping bone fragments, guiding bush for passing injection needle for gripping bone fragments and goniometre. On one end of tube funnel-shaped widening is made, on the other end of metal tube along opposite lateral surface generatrices made are two oval slots, one of which is located at the distance to 1 cm from straight tube end, the other being located in such a way as to provide output of passed through it injection needle for gripping bone fragments into the first slot, at angles from 10 to 45 degrees with respect to the axis. Width of slots equals diameter of injection needle for gripping bone fragments. On lateral surface of tube, from the side of funnel-shaped widening, graduation of deepening magnitude is marked. Injection needle has mandrin. Goniometre has arch and is fixed on tube under funnel-shaped widening. On goniometre arch graduation is marked. Guiding bush for injection needle for gripping bone fragments is placed on arch with possibility of movement and fixation. Method includes transpediculare passage of needle under broken closing plate of vertebra body and introduction of binding substance through it. By direction, calculated by pre-operation tomograms, transpedicularly introduced is said device for treatment of spine fractures, with installed inside mandarin. Mandrin is removed. Lines of fracture and cavity in body of broken vertebra, via needle, are filled with fibrin glue Tissucol Kit with Thrombin 4 IU. Needle is removed with other needle, passed through lateral slots of guide, at angle, determined by tomograms and set by means of goniometre, glue Tissucol Kit with Thrombin 4 IU is introduced. By means of needle fragments, present in spinal canal are gripped and by translational-rotational movements are introduced into space filled with glue Tissucol Kit with Thrombin 4 IU. After X-ray control device is removed. In case of necessity, similar manipulation is performed through opposite root of broken vertebra arch.

EFFECT: inventions provide possibility to perform reposition and reclination of bone fragments, to eliminate stenosis of spinal canal and realise stabilisation of spinally motor segments of thoracolumbar part of spine in case of its traumas, without damage to content of bone marrone canal in case of compression-comminuted, or "explosion" fractures with injury of posterior parts of vertebra body, which form anterior wall of spinal canal.

2 cl, 2 dwg

Description

The invention relates to medicine, in particular to spinal surgery. More specifically, it relates to the treatment of compression-comminuted, or “explosive”, fractures with damage to the posterior vertebral body, forming the front wall of the spinal canal. As a rule, with "explosive" fractures of the vertebral bodies, free fragments of bone tissue are displaced into the lumen of the spinal canal, causing its stenosis, thereby squeezing the spinal cord and its roots. In addition, the severity of stenosis can increase with repeated axial load (compression) on the damaged vertebra. With such fractures, the body of the damaged vertebra is a conglomerate of fragments with the presence of cartilaginous interposites belonging to adjacent discs.

Currently existing surgical procedures on the posterior structures of the spine (for example, decompressive laminectomy with removal of bone fragments) do not always lead to the desired results, fraught with trauma to the spinal cord and its roots and, as a result, the emergence, or amplification, of neurological deficit. Surgical interventions on the front structures of the spine are more time-consuming, traumatic, require the removal of the damaged vertebral body and the use of expensive metal structures to replace it, and can also lead to various serious complications [1].

Currently, there are methods of vertebroplasty with polymeric materials to strengthen the vertebral bodies [2], but with damage to the posterior vertebral body structures, polymer may leak into the spinal canal, with damage to its structures (thermal factor, compression by hardened cement), which does not allow eliminating the resulting a problem. The introduction of polymers into the vertebral body is carried out using a puncture needle along the axial channel, which does not allow restoration of the posterior wall of the spinal canal.

Closest to the claimed invention is a device that is a trocar - a surgical instrument in the form of a thin metal tube with a trihedral needle inside for piercing bones during a stabilizing operation on the spine [3]. But such a trocar ensures that the needle is held only in the axial direction and does not allow the needle to be brought out to the area surrounding the free end of the tube.

At present, it is possible to reposition bone fragments of damaged vertebral bodies both by conservative methods (for example, reclamation using a special tool) and surgical ones. None of them allows you to restore the structure of the posterior wall of the spinal canal.

The closest to the claimed method, in its technical solution, is transpedicular vertebroplasty for fractures of the vertebral bodies during osteoporosis [4], where a needle with a pump is inserted through the skin access, through the vertebra leg, under a broken contact plate, with which it is inserted bone cement, the polymerization time of which is 5-7 minutes However, this does not exclude the possibility of penetration of bone cement into the spinal canal, which will require an emergency operation - its removal. The method allows to strengthen the body of the compressed vertebra, but does not make it possible to restore its back wall. However, there is no possibility of moving bone fragments protruding into the spinal canal.

The aim of the invention is to provide a device for reposition of bone fragments of the posterior vertebral bodies forming the front wall of the spinal canal, and a method that allows using this device to reposition and recline bone fragments, eliminate stenosis of the spinal canal and stabilize the vertebral-motor segments of the lumbar spine the spine in case of damage, without damaging the contents of the spinal canal.

The essence of the claimed invention consists in the combination of essential features sufficient to achieve the desired technical solution, allowing reposition and reklination of bone fragments acting on the anterior structures of the spinal cord, without damaging the contents of the spinal canal. This technical solution allows you to eliminate stenosis and stabilize the vertebral motor segments by gluing bone fragments.

This essence lies in the fact that the device for the treatment of spinal fractures includes an injection needle, a guide for the injection needle, made in the form of a metal tube, with a funnel-shaped expansion made at one end of the tube. The device has an injection needle for capturing bone fragments, a guide sleeve for holding an injection needle for capturing bone fragments and goniometers. At the other end of the metal tube, two oval grooves are made along the opposite generatrices of the lateral surface, one of which is located at a distance of 1 cm from the straight end of the tube, and the other so as to allow the injection needle passed through it to capture bone fragments into the first groove , at angles of 10 to 45 degrees relative to the axis. The width of the grooves is equal to the diameter of the injection needle to capture bone fragments. On the side surface of the tube, from the side of the funnel-shaped expansion, a graduation of the magnitude of the recess is applied. The injection needle has a mandrin. The goniometer has an arc and is mounted on the tube under the funnel-shaped extension; graduation is applied on the arc of the goniometer. The guide sleeve for the injection needle to capture bone fragments is placed on the arc with the ability to move and fix.

Performing a groove at a distance of 1 cm from the straight end of the tube provides the necessary strength of the tube during the manipulations performed by the injection needle during surgery.

The injection needle through the oval grooves of the tube at angles of 10 to 45 degrees relative to the axis provides the necessary access to the area surrounding the straight end of the tube (depending on the width of the bone fragment and the degree of protrusion) without damaging the contents of the spinal canal.

The width of the grooves, equal to the diameter of the injection needle, allows the injection needle to pass through these grooves.

The protractor mounted on the guide tube, having a guide sleeve for holding the injection needle, placed, with the possibility of movement and fixation, on the arc with graduation, allows you to enter the needle at the required angle relative to the axis.

Graduation on the surface of the tube allows you to control the magnitude of the deepening of the instrument, which eliminates additional trauma to the affected vertebra.

The essence of the method for the treatment of spinal fractures includes the transpedicular holding of a needle under a broken back plate of the vertebral body and the introduction of a binder through it. In the direction calculated by preoperative tomograms, a device for the treatment of spinal fractures according to claim 1 with a mandrel installed inside is introduced transpedicularly. The mandrin is removed, the fracture lines and cavities in the body of the broken vertebra, through the needle, are filled with fibrin glue Tissucol Kit with Thrombin 4 ME, the needle is removed. Another needle, drawn through the lateral grooves of the guide, at an angle determined by the tomograms and set using the goniometer, is injected with Tissukol Kit glue with Thrombin 500 ME. The needle is captured by fragments located in the spinal canal, and translationally rotate into a space filled with glue Tissukol Kit with Thrombin 4 ME. After x-ray control, the device is removed. If necessary, the same manipulation is carried out through the opposite root of the arch of the broken vertebra.

The use of an injection needle with a mandrin as a needle ensures the formation of a channel in the body of the damaged vertebra and the introduction of a binder in one procedure, without additional introduction of the instrument. Mandren prevents the penetration of bone substance into the needle, provides a free channel for the introduction of a binder.

The use of this device provides access to the affected vertebra without damaging the contents of the spinal canal.

Filling with the first needle the fracture line and the cavity in the body of the broken vertebra with fibrin glue Tissucol Kit with 4 ME thrombin having a polymerization rate of 40-60 sec, prepares the fracture line and cavity in the body of the broken vertebra for the implantation of bone fragments located in the spinal canal.

The introduction of Tissucol Kit glue with Thrombin 500 ME, with a polymerization rate of up to 10 sec, onto the bone and cartilage fragments protruding into the spinal canal, with a second needle passing through the lateral grooves of the guide, ensures fast bonding of these fragments [5]. When the needle is moved along with the guide deep into the body of the broken vertebra, the glued fragments are immersed in the space previously filled with the adhesive composition for slow hardening. This ensures the restoration of the anatomical integrity of the spinal canal and reliable strengthening of the body of the broken vertebra. Even when particles of fibrin glue having a jelly-like consistency get into the spinal canal, they do not squeeze the spinal cord and its roots, quickly dissolve (within 10-14 days) and contribute to early tissue regeneration in the area of damage. In the presence of a rupture of the dura mater, fibrin glue reliably sticks it together [5].

The reposition of bone fragments acting on the anterior structures of the spinal cord and its roots, by gluing them together and introducing the “explosive” vertebra into the spongy material of the body without damaging the contents of the spinal canal, allows the vertebral body structure to be restored and significantly reduces the invasiveness of surgical intervention, prevents development neurological complications.

The device and method are illustrated by the following drawings. Figure 1 shows a General view of the device with a local section of the guide sleeve of the protractor and the straight end of the guide tube; figure 2 shows a device guided into the body of the vertebra, when implementing the method.

A device for treating spinal fractures consists of a guide 1, in the form of a thin metal tube 2, for introducing an injection needle 3. A funnel-shaped extension 4 is made at one end of the tube 2. At the opposite end of the tube 2, oval grooves 5 and 5 are placed along opposite generatrices of the side surface. 6. On the outer surface of the tube 2, from the side of the funnel-shaped expansion 4, a graduation is applied 7. An angle meter 8 is fixed on the tube 2 of the guide 1, on which an guide 9 is placed with an angular graduation (not shown) I have a sleeve 10, with the ability to move and fix.

The device, when implementing the method, is used as follows.

Under general anesthesia in the patient’s supine position, a standard approach is taken to the legs of the damaged vertebra. After the guide passes, with the injection needle with the mandrel installed inside, through one of the roots of the arches of the affected vertebra and its introduction into the body, the mandrin is removed. All manipulation is carried out under x-ray control. A gluing agent, Tissucol Kit fibrin glue with Thrombin 4 MB, containing a component for slow hardening, is introduced through a needle. The needle is removed. Another needle is inserted through the lateral grooves at an angle of 10 to 45 degrees to the axis, depending on the size of the fragments protruding into the front sections of the spinal canal, so that there is a possibility of their capture. Tissucol with Thrombin 500 ME is injected through the needle for fast bonding of bone fragments. The guide with the injection needle is rotationally deepened into the body of the damaged vertebra, capturing fragments, to the required depth, calculated from preoperative tomograms. After x-ray control, the device is removed. If necessary, the same manipulation is carried out on the other side of the damaged vertebra. Impose a transpedicular system.

Information sources

1. Tsivyan Ya. L. Spinal Surgery, M. 1966.

2. Pedachenko EG, Kushchaev S.V. Puncture vertebroplasty. Kiev, 2005, p. 64-68.

3. Yangson P.M. Medical Encyclopedic Dictionary, M .: ACT Astrel, 2005, p.1135.

4. Gauthier S.S., Aganesov A.G., Meskhi K.T. Transpedicular vertebroplasty for vertebral fractures. Traumatology and Orthopedics of Russia, 2008. - No. 3. - S.78-79.

5. Jonillat C., Tete B., Frering V. et al. Evaluation of the effectiveness of two fibrin glues in digestive surgery: An experimental study in pigs. Lion Chir. 1990; 86: 481-485.

Claims (2)

1. A device for treating spinal fractures, including an injection needle, an injection needle guide made in the form of a metal tube, and a funnel-shaped extension is made at one end of the tube, characterized in that it has an injection needle to capture bone fragments, a guide sleeve for conducting an injection needle for capturing bone fragments and a goniometer, at the other end of the metal tube there are two oval grooves along the opposite side surface forming one of which is located at a distance of up to 1 cm from the straight end of the tube, and the other so as to ensure the exit of an injection needle through it to capture bone fragments into the first groove, at angles of 10 to 45 ° relative to the axis, while the width of the grooves is equal to the diameter of the injection needles to capture bone fragments, and on the side surface of the tube, from the side of the funnel-shaped expansion, a graduation of the depth is applied, the injection needle has a mandrin, the goniometer has an arc and is mounted on the tube under the funnel-shaped extension, on the arc Graduation is applied to the protractor, and the guide sleeve under the injection needle for capturing bone fragments is placed on the arc with the possibility of movement and fixation. 2. A method of treating spinal fractures, including transpedicularly holding a needle under a broken back plate of the vertebral body and introducing a binder through it, characterized in that, in the direction calculated by the preoperative tomograms, a device for treating spinal fractures according to claim 1, with the installed inside the mandrin, the mandrin is removed, the fracture lines and cavities in the body of the broken vertebra, through the needle, are filled with fibrin glue Tissucol Kit with Thrombin 4 ME, the needle is removed, with another needle drawn through the lateral grooves of the guide at an angle determined by the tomograms and set using the goniometer, Tissukol Kit glue with Thrombin 500 ME is introduced, fragments located in the spinal canal are captured with a needle and inserted into the space filled with Tissukol Kit glue with thrombin 4 ME, after the X-ray control, the device is removed, if necessary, the same manipulation is also carried out through the opposite root of the arc of the broken vertebra.

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