RU2423943C1 - Method of correcting juvenile spine kyphosis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to orthopedics, and can be used for treatment of juvenile spine kyphosis in children. Operation is performed from dorsal access to spinal column. Metal construction rods are modeled in accordance with physiological sagttal profile of spine. As support elements, installed on caudal part of kyphosis, reducing transpedicular screws are used. Movement of caudal part of kyphosis in ventro-dorsal direction to metal construction rods is performed by successive tightening of fixing nuts on separated threaded part of reducing transpedicular screws.

EFFECT: method ensures full correction of large degrees of deformation.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used for the surgical treatment of juvenile kyphosis of the spine in children.

A known method for the correction of juvenile kyphosis in children, consisting in disepiphysectomy and mobilization of the spine at the level of deformation in combination with corporodesis of a bone autograft (rib) from anterolateral thoracotomy access and correction of juvenile kyphosis with multi-support metal construction from dorsal access (Mikhailovsky M.V. Surgery of spinal deformities. - Novosibirsk, 2002. - Pages 422-424). In the described method, the metal structure rods are modeled by the bends of the spine obtained after mobilization of the spine by wide skeletonization of the posterior support complex and multilevel diskepiphysectomy, and fix them with transpedicular screws.

This method has several disadvantages. During the operation, a complete correction of the existing pathological kyphosis of the spinal column is not carried out, since metal construction rods modeled on the bends of the spine after mobilization are used, which, as a rule, does not fully achieve the anatomically correct position of the spine. Performing two approaches increases the duration, severity of the operation and the amount of blood loss.

The technical result achieved by the invention is to achieve complete correction of juvenile kyphosis of the spine and to ensure stability of the achieved result in the process of growth and development of the child, as well as to reduce the morbidity and duration of surgery.

The essence of the invention is to achieve the claimed technical result in a method for correcting juvenile kyphosis of the spine in children, including dorsal access to the spinal column and installing a multi-support metal structure in the kyphosis region, according to which the metal structure rods are modeled according to the physiological sagittal profile of the spine as supporting elements mounted on the caudal part kyphosis, use reducing transpedicular screws, while moving the caudal part of the ki Phase in the ventro-dorsal direction to the metal structure rods is carried out by sequentially tightening the fixing nuts along the separated threaded part of the reduction pedicle screws.

The possibility of achieving a technical result is due to the fact that in the claimed method of correction of juvenile kyphosis, the value by which the deformation will be corrected is set initially by modeling (bending) the metal structure rods according to the normal physiological sagittal profile of the spine. The movement of the caudal part of kyphosis in the ventro-dorsal direction to the metal structure rods is ensured by obtaining large mechanical forces developed during the sequential tightening of the fixing nuts along the separated threaded part of the reduction pedicle screws.

Figure 1 and 2 presents a diagram of the method.

The method is carried out, for example, as follows.

An incision is made in the skin and subcutaneous fat along the line of the spinous processes at the level of kyphosis. Then, the thoracolumbar fascia surrounding the spinous processes is dissected, the posterior spinal column, including the spinous processes, vertebral arches, transverse processes and arched joints, are skeletonized at the level of kyphosis.

Then form sites at the points of insertion of the transpedicular screws and mark these points by installing x-ray marks in the roots of the arcs. A control x-ray is taken to assess the correct location and direction of the Rg tags. After removing marks in the vertebral bodies of the upper thoracic region, which make up the cranial 1 part of kyphosis, screws 2 are introduced transpedicularly (Fig. 1).

Reduction screws 4, which have a separable elongated threaded part 5, are introduced into the vertebrae of the lower thoracic region and the thoracolumbar junction of the spine — the caudal part 3 of kyphosis.

Further on the supporting elements - transpedicular screws 2 are installed on both sides of the rods 6, modeled on the physiological sagittal bends of the spinal column. While the rods 6 are fixed with nuts 7 to the supporting elements 2 installed in the cranial part 1 of kyphosis.

Correction of spinal deformity is achieved by moving the caudal part 3 of kyphosis in the ventro-dorsal direction to the metal structure rods 6 by sequentially tightening the fixing nuts 8 of the reduction screws 4 (Fig. 1).

After the implementation of inter-segment contraction, the rods 6 are finally fixed to the supporting elements 2 and 4 with nuts 7 and 8, the separated threaded parts 5 of the reducing screws 4 are removed (Fig. 2). Carry out hemostasis and drainage of the wound by a graduate of the Redon type. The wound is sutured in layers, an aseptic dressing is applied.

The method is illustrated by the following clinical example.

Patient X., 15 years old. The diagnosis is juvenile kyphosis.

The angle of kyphotic deformation is 86 degrees, the angle of left-sided scoliotic deformation is 20 degrees. Surgery was performed from one surgical approach.

In the patient’s position on the abdomen, a skin incision was made along the spinous processes at the level of ThIII-LII. Subcutaneous fat, thoracolumbar fascia surrounding the spinous processes is sequentially dissected. Skeletonization of the spinous processes, arches, arches and transverse processes was performed.

Installed transpedicular screws on the cranial part of kyphosis in the bodies of the third, fourth, fifth and sixth thoracic vertebrae on both sides. Next, reduction transpedicular screws were installed on the cranial part of kyphosis: in the bodies of the tenth, eleventh, twelfth thoracic and first lumbar vertebrae on both sides. The rods of circular cross section, preliminarily modeled by physiological sagittal bends of the spine, are laid on both sides of the support elements and are fixed in them with fixing internal nuts. Then, the deformation was corrected by displacing the caudal part of kyphosis in the ventrodorsal direction by sequentially tightening the fixing nuts along the threads of the reduction screws installed in the bodies of the tenth, eleventh, twelfth thoracic and first lumbar vertebrae, in the direction of the supporting elements.

The support elements are brought together along the rods in the longitudinal direction due to intersegmentary contraction and are finally fixed with internal nuts. Hemostasis. Through a separate puncture of the paravertebral tissues, drainage was established according to Redon. The wound is sutured in layers tightly. Aseptic dressing. The volume of blood loss is 500.00 ml. Blood transfusion was not performed. The operation time is 2.5 hours.

The angle of kyphotic deformation after surgery was 40 degrees, and the scoliotic deformation was 2 degrees.

According to the claimed method, operations were performed in 5 patients aged 13 to 17 years. All patients had kyphotic spinal deformity. The angle of kyphosis before surgery ranged from 64 to 88 degrees (average 76.2 degrees). After the operation, the kyphosis angle is from 34 to 42 degrees (average 38.6 degrees).

The control group consisted of 3 patients who underwent surgery according to standard methods. The angle of kyphosis before surgery was 68 degrees, 72 degrees and 84 degrees, respectively. After surgery in these patients, the angle of kyphosis was corrected to 52 degrees, 58 and 62 degrees, respectively.

The follow-up period for patients of both groups after surgery was from 6 months to 2 years. In the control group, the progression of kyphotic deformation in all patients was noted at 4, 12 and 8 degrees, respectively. In the main group after surgery for the entire observation period, spinal deformity did not progress in any observation.

The method provides a full correction of large degrees of deformation, allows you to perform an operation from only one, dorsal access, reduces trauma, the duration of the operation and blood loss during surgery, prevents further progression of the deformation.

Claims (1)

A method for the correction of juvenile kyphosis of the spine in children, including dorsal access to the spinal column and installation of a multi-support metal structure in the kyphosis region, characterized in that transpedicular reduction screws are inserted into the vertebral bodies of the upper thoracic part, which make up the cranial part of the kyphosis, and into the vertebrae of the lower thoracic and thoracolumbar vertebra constituting the caudal part of kyphosis, reduction screws are inserted with a separated elongated threaded part, the transpedicular screws are installed The rods modeled on the physiological sagittal bends of the spinal column are fixed and fixed on both sides; they move the caudal part of kyphosis to the rods by sequentially tightening the nuts of the reduction screws towards the supporting elements.

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