RU2433797C1 - Method of treating comminuted fracture of vertebra body with compression of dural sac - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to neurosurgery, traumatology, orthopedics and can be used in treatment of spine injury, accompanied by compression of dural sac with fragment of vertebra body, displaced into lumen of spine canal. Four transpedicular screws are introduced into bodies of vertebrae above and below the place of comminuted fracture. After that into fragment of injured vertebra, which displaced into lumen of spine canal, additional transpedicular screw with length, corresponding to length between pedicle and cortical layer of vertebra body fragment. After that, fixation of introduced transpedicular screws with connecting bars id carried out. Additional screw is fixed to one of bars. ^ EFFECT: method ensures fragment reposition without taking into account state of ligament apparatus and presence of special equipment. ^ 1 ex, 2 dwg

Description

The invention relates to medicine, namely to neurosurgery, traumatology, orthopedics, and can be used in the treatment of spinal injury, accompanied by compression of the dural sac by a fragment of the vertebral body, displaced into the lumen of the spinal canal.

There is a method of treating comminuted fracture of the vertebral body with compression of the dural sac (Usikov VD Guidelines for transpedicular osteosynthesis of the spine. - St. Petersburg: "Hippocrates", 2006. - S.93-107), which carry out transpedicular fixation of the spine 4-6 - screw construction with the introduction of transpedicular screws into the vertebral bodies above and below the site of the comminuted fracture and performing a laminectomy at the level of damage. The disadvantage of this method is that for its implementation it is necessary to carry out a laminectomy, which often violates stability in the damaged vertebral-motor segment, and therefore in the future there is a need for anterior corporodesis, as well as the fact that it is not possible in all cases to achieve the reduction of the fragment.

A known method of treating comminuted fracture of the vertebral body with compression of the dural sac (Makarevich SV Spondylodez universal fixator of the thoracic and lumbar spine. - Minsk: Unipaks, 2001. - P.30), adopted as a prototype. 4-6 transpedicular screws are inserted into the vertebral bodies above and below the site of a comminuted fracture of the spine. Connecting rods are installed, after which intraoperative multiplanar reposition is carried out with gradual hyperextension and segmental distraction by manipulations on a multifunctional operating table with additional correction using removable repair rods.

In this case, the reduction of the bone fragment displaced into the spinal canal and repositional decompression of the dural sac occur as a result of distraction and tension of the intact posterior longitudinal ligament, the so-called ligamentotaxis.

The disadvantages of the prototype:

- mandatory preservation of the ligamentous apparatus of the damaged vertebral-motor segment of the spine, which is rarely observed;

- the complexity of the proposed reduction of the bone fragment of the vertebral body with compression of the dural sac during surgery, the need for a special operating table.

The invention is directed to a method for the treatment of comminuted fracture of the vertebral body with compression of the dural sac, which allows the reduction of the fragment without taking into account the condition of the ligamentous apparatus and the availability of special equipment.

The specified technical result in the implementation of the invention is achieved by the fact that in the method of treating a comminuted fracture of the vertebral body with compression of the dural sac, which includes installing a structure for transpedicular fixation of the spine with the introduction of four transpedicular screws into the vertebral bodies above and below the site of the comminuted fracture, the feature is that an additional transpedicular screw is introduced into the fragment of the damaged vertebra, which has shifted into the lumen of the spinal canal, standing between the leg and the cortical layer of a fragment of the vertebral body, then fixation of the introduced transpedicular screws with connecting rods is performed.

The invention is illustrated by drawings, in which Fig. 1 shows the introduction of a shorter size screw into a fragment of a damaged vertebra after installing transpedicular screws above and below the comminuted fracture, and Fig. 2 shows the fragment fragmentation during fixation of transpedicular screws by connecting rods.

The method is as follows. When assembling the structure for transpedicular fixation of the spine, two main transpedicular screws are inserted into the body of the intact vertebra above the site of the comminuted fracture and two main transpedicular screws are inserted into the body of the intact vertebra below the site of the comminuted fracture. An additional fifth transpedicular screw of a shorter size is introduced into the fragment of the damaged vertebral body. The length of this screw corresponds to the distance between the leg and the cortical layer of a fragment of the vertebral body, determined by survey radiographs of the spine or by computer or magnetic resonance imaging. Then, the introduced main transpedicular screws are fixed by connecting rods, an additional fifth screw is fixed to one of the rods. In this case, the displaced fragment, which causes compression of the dural sac, is pushed forward from the lumen of the spinal canal, the vertebral fragment is reduced and the compression of the dural sac is eliminated.

The claimed method for the treatment of comminuted fracture of the vertebral body with compression of the dural sac was developed at the Federal State Institution “Russian Research Neurosurgical Institute named after prof. A.L. Polenova of the Russian Medical Technologies ”and passed clinical trials in the treatment of 10 patients with spinal cord injury. In all cases, it was possible to put a fragment of the vertebra into place and eliminate the compression of the dural sac.

We give a clinical example - an extract from medical records.

Example No. 1. Patient A., 48 years old, medical history No. 10572, was admitted to the hospital on 07/11/09 with a diagnosis of closed complicated compression-comminuted fracture of the body and right arch of the L1 vertebra with displacement of fragments and stenosis of the spinal canal, lower monoparesis on the right, closed uncomplicated compression fracture of the L4 vertebral body, kidney injury. Upon receipt, a spiral computed tomography was performed with the measurement of the diameter of the vertebral canal at the level of the broken vertebral body L1 and the distance between the leg and the cortical layer of the vertebral body fragment to determine the length of the fifth short pedicle transpedicular screw.

07/20/09, an operation was performed: bisegmental transpedicular fixation of the spine by the Medtronic construction with the introduction of four main transpedicular screws 55 mm long above and below the site of the comminuted fracture, as well as an additional fifth transpedicular screw 30 mm long into the bone fragment displaced into the spinal canal by fracture level L1 of the vertebra and causing compression of the dural sac. The design on five transpedicular screws was assembled, and the displaced fragment, which causes compression of the dural sac, is adjusted using an additional screw by pushing it out of the lumen of the spinal canal forward. The operation went without complications, the wound healed by first intention.

During the control spiral computed tomography, the metal structure is satisfactory, the fragment is 70% inserted into the vertebral body, there is no compression of the dural sac at the level of damage. The diameter of the spinal canal at the level of damage before surgery was 7.2 mm, after the operation on the proposed method for the treatment of comminuted fracture of the vertebral body with compression of the dural sac, it was 13.9 mm. In the postoperative period, a complete regression of neurological disorders with restoration of muscle strength of the right lower limb was noted. Discharged home in satisfactory condition.

Thus, the treatment of comminuted fracture of the vertebral body with compression of the dural sac according to the proposed method was successful, the comminuted fracture was corrected, compression of the dural sac was eliminated and recovery of motor disorders was noted.

Claims (1)

A method of treating a comminuted fracture of the vertebral body with compression of the dural sac, including the installation of a structure for transpedicular fixation of the spine with the introduction of four transpedicular screws in the vertebral body above and below the comminuted fracture, characterized in that an additional fragment is introduced into the fragment of the damaged vertebra that has shifted into the lumen of the spinal canal transpedicular screw with a length corresponding to the distance between the leg and the cortical layer of a fragment of the vertebral body, then the inserted x transpedicular screws connecting rods.

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