RU2432134C1 - Method of treating scoliosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to spinal surgery, and can be applied in surgical correction of spinal bending associating scoliosis, mainly in children. A corrector is fixed to transverse processes. A first band of the corrector is delivered along the transverse processes on a convex side of the bending from a superior neutral to inferior neutral vertebra, and fixed. Through an incision above a spinous process of a deformation apex, ends of a second band are delivered behind the transverse process of a concave side of an apical vertebra through gaps between the spinous processed of the adjacent vertebrae, and delivered on the convex side. Then the second band is pulled and fixed to the band of the convex side of the bending.

EFFECT: improved corrective effect.

1 ex

Description

The invention relates to medicine, namely to surgery of the spine, and can be used for surgical correction of curvature of the spine in scoliosis, mainly in children.

There is a method of treating impaired posture and scoliosis by manually traction effects on the spine and therapeutic exercises, in which longitudinal vertical traction is carried out by hand with the trunk shifted to the right and left until the axis of the spine is straightened and the resulting treatment pose is statically held. Then, without weakening the traction, the displaced vertebrae are repaired by manual therapy and pressure on the vertebrae in the center of deformation and derotation. After restoring the correct axis of the spine, the passive static effect is replaced by the active static retention of the resulting treatment posture by the muscle effort of the patient lying, sitting and standing (RF patent for the invention No. 2367403, class A61H 7/00. Publ. September 20, 2009).

The disadvantages of this method include the possibility of obtaining neurological complications of various kinds.

There is also a method of treating scoliosis by cutting soft tissues along the spinous processes to the vertebral arches on the convex side of the curvature at the apex above and below the arch of curvature of the spine, skeletal transverse processes of the neutral vertebrae, bringing them in and fixing the corrector, correction of curvature (RF patent for the invention No. 949881 , CL A61B 17/56. Publish. 12/27/1996).

The disadvantage of this method is the inability to correct the rotational component of spinal deformity.

Closest to the proposed in its technical essence is a method of treating scoliosis by cutting soft tissues along the spinous processes to the arches of the vertebrae on the convex side of the curvature at the apex above and below the curvature of the spine, skeletonizing the transverse processes of the neutral vertebrae, bringing them in and fixing the corrector, correcting the curvature . One end of the corrector in the form of an elastic tape is fixed to the transverse process of the upper neutral vertebra from the convex side, the tape is drawn along the transverse processes on the convex side to the apex of deformation, then between the spinous processes to the concave side, on the concave side, along the spinous processes of the vertebrae to the deformation top , then - in the interval between the spinous processes on the convex side, the tape is pulled and the other end of the tape is fixed to the transverse process of the lower neutral vertebra (RF patent No. 1748803, cl. A61B 17/56. Published on July 23, 1992).

But this method does not allow to obtain the maximum corrective effect of all components of scoliotic deformation. This is due to the fact that part of the effort that develops when the tape is tensioned is lost in the section of the tape passing through the concave side of the curvature.

The task to which the invention is directed is to increase the corrective effect of all components of scoliotic deformation.

The technical result is to increase the effectiveness of treatment.

The problem is solved in that in the method of treating scoliosis by cutting soft tissues along the spinous processes to the vertebral arches on the convex side of the curvature at the apex, above and below the arch of the curvature of the spine, skeletonization of the transverse processes of the neutral vertebrae, bringing them in and fixing the corrector, correcting the curvature, in which one end of the corrector in the form of an elastic tape is fixed to the transverse process of the upper neutral vertebra, hold the tape along the transverse processes on the convex side, fix nother end of the tape to the transverse process of the lower vertebra neutral administered second tape. The ends of the second tape lead beyond the transverse process of the concave side of the apical vertebra through the gaps between the spinous processes of adjacent vertebrae and bring them to the convex side. Then the second tape is pulled and fixed to the tape on the convex side of the curvature.

The introduction of the second tape and the insertion of its ends beyond the transverse process of the concave side of the apical vertebra through the gaps between the spinous processes of adjacent vertebrae, the withdrawal of both ends to the convex side, the tension of the second tape and its fixation to the tape of the convex side of the curvature leads to the correction of the rotational component of the deformation of the spinal column.

The method is as follows.

Under general anesthesia in the patient’s position on the abdomen, two small incisions (2-3 cm) of soft tissues are made along the spinous processes to the vertebral arches on the convex side of the curvature above and below the arch of the curvature of the spine, skeletonization of the transverse processes of the neutral vertebrae, bringing them to and fixing the corrector, in which one end of the corrector in the form of an elastic dacron tape is fixed to the transverse process of the upper neutral vertebra. With the help of a clamp or a forceps, the tape is held under the paravertebral muscles along the transverse processes on the convex side and after tensioning, its end is fixed on the transverse process of the lower neutral vertebra. The third, slightly arched, section (4-5 cm long) is made over the spinous processes of the deformation apex. A second tape is introduced, the ends of which, between the spinous processes and the interspinous ligaments, are led beyond the transverse process of the concave side of the apical vertebra of the adjacent vertebrae and brought out on the convex side one vertebra above and one vertebra below the vertebra, and in the stretched state they are fixed to the tape of the convex side curvature. Because Since the ribbons are non-radiopaque, the ends of the convex and concave sides of the curvature and the tapes of the concave side of the curvature at the level of the vertebral vertebra are marked with vascular clips for x-ray control. At the end of the operation, the wounds are sutured in layers.

Example.

Patient S., 4 years old, was admitted to the department of pediatric orthopedics with a diagnosis of "Dysplastic unstable right-sided thoracolumbar progressive scoliosis of the III degree." On radiographs noted: the angle of scoliotic deformity standing - 48 degrees; lying - 35 degrees; angle of kyphotic deformation - 32 degrees; rotational component - 28 degrees. Neutral vertebrae superior Th III; lower LII; vertex of deformity Th VIII vertebra. After the examination, the operation was performed according to the method described in this application: correction of spinal deformity by lavsan endocorrectors.

Under general anesthesia in the patient’s position on the abdomen, a soft tissue incision was made 2 cm long along the spinous processes of the Th II - Th III vertebrae to the vertebral arches on the convex side of the curvature above the curvature of the spine, and the transverse process of the Th III neutral vertebra was skeletonized. One end of the mylar ribbon was fixed to the transverse process of the Th III vertebra. A second soft tissue incision was made 2 cm long along the spinous processes of the L II – L III vertebrae to the vertebral arches on the convex side of the curvature below the arch of curvature of the spine. Skeletonization of the transverse process of the neutral L II vertebra was performed. Using the forceps, a tape was drawn under the paravertebral muscles along the transverse processes from the Th III vertebra to the L II vertebra on the convex side and after tension, its end was fixed on the transverse process of the L II vertebra. A third, slightly arched, section 4 cm long was made above the spinous processes of the Th VIII - Th IX vertebrae.

The second tape was inserted behind the transverse process of the Th VIII vertebra of the concave side of the curvature. The ends of the tape through the gaps between the spinous processes of the Th VII – Th VIII and Th VIII – Th IX vertebrae and the interspinous ligaments were brought out to the convex side and, in tension, were fixed to the tape on the convex side of the curvature. The ends of the tapes of the convex and concave sides of the curvature were marked with vascular clips for x-ray control. At the end of the operation, the wounds were sutured in layers.

On the control x-ray of the spine, made in 2 projections, it was noted: the angle of lateral curvature of the spine was 20 degrees (correction of 15 degrees - 43%). Kyphotic deformation decreased by 12 degrees (20 degrees - 38%), rotational deformation component - 18 degrees (decreased by 10 degrees - 36%).

Claims (1)

A method for treating scoliosis by cutting soft tissues along the spinous processes to the vertebral arches on the convex side of the curvature at the apex above and below the spinal curvature arch, skeletalization of the transverse processes of the neutral vertebrae, bringing to them and fixing the corrector, curvature correction, in which one end of the corrector is in the form of an elastic tapes are fixed to the transverse process of the upper neutral vertebra, hold the tape along the transverse processes on the convex side, fix the other end of the tape to the transverse process the lower neutral vertebra, characterized in that through the incision above the spinous process of the deformation vertex, a second tape is introduced, the ends of which are led beyond the transverse process of the concave side of the vertebral vertebra through the gaps between the spinous processes of adjacent vertebrae and are brought out to the convex side, then this tape is pulled and fixed to the tape convex side curvature.