RU2436534C1 - Method of reposition and fixation of spine in case of comminuted fractures - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to traumatology. Preliminarily, taking into account results of computer-tomographic examination prepared is tap with stop, the latter being installed at a distance from thread edge of tap, which equals the distance from arch root to anterior cortical plate of injured vertebra. Transpedicular screws are introduced into adjacent to injured one vertebra through their roots of arches. After that, through Roy-Camille point prepared tap is introduced into injured vertebra to cortical plate of its ventral fragment. Compression of ventral fragment of injured vertebra is performed by rotation of tap around its longitudinal axis. Through contralateral Roy-Camille point into injured vertebra introduced is transpedicular screw which is used to fix its ventral fragment. Tap with stop is removed. Into formed by tap canal transpedicular screw is introduced. Assemblage of transpedicular system is completed by connection of all transpedicular screws with modeled fixing bars. ^ EFFECT: invention contributes to increase of method efficiency with increase of reposition possibilities of internal transpedicular system, reduction of rehabilitation terms and risk of developing postoperative complications. ^ 1 ex, 4 dwg

Description

The invention relates to medicine, namely to traumatology, and can be used in the treatment of fractures of the thoracic and lumbar spine in the presence of significant displacements of fragments of the body of the damaged vertebrae.

Known methods of reposition and fixation for traumatic injuries of the thoracic and lumbar spine, including the internal fixation of adjacent to the injured vertebrae by the device for osteosynthesis of the spine with the introduction of screws into the vertebral bodies through the roots of the arches [Damage to the spine and spinal cord. Ed. N.E. Polishchuk, N.A. Korzha, V.Ya. Fishchenko, Kiev: "BOOK plus", 2001, part 11].

Also known is the “Method of spinal canal reformation in comminuted fractures” [RU patent No. 2285488], including internal fixation of spinal osteosynthesis adjacent to damaged vertebrae with screws inserted into vertebral bodies through the roots of arcs. After preliminary dissection of the supraspinatus and interspinous ligaments of the damaged vertebral segment, intraoperative longitudinal distraction of the damaged spine is carried out with a controlled local kyphosis of 10-15 °.

However, the above methods do not allow to achieve the anatomical integrity of the damaged vertebra.

The closest analogue to the claimed invention is the "Method of reposition of the spine in comminuted fractures and fractures" [RU patent for the invention No. 2223705]. In this method, the internal fixation of adjacent vertebrates from the damaged vertebrae is carried out using a device for transosseous osteosynthesis with the introduction of screws through their roots of the arches. Carry out simultaneous distraction. Then, screws are inserted into the fragmented vertebra to the anterior cortical plate through the roots of the arches.

However, in this method does not completely eliminate diastasis between fragments of the body of the damaged vertebra. As a result, the formation of an overgrown fracture or a false joint can occur, which can lead to a loss of correction of vertebral deformation after bone resorption around transpedicular screws.

The task of the invention is to increase the efficiency of the method while increasing the repositioning capabilities of the internal transpedicular system, shortening the rehabilitation time and reducing the risk of postoperative complications.

The essence of the claimed invention is characterized by the fact that in the method of reposition and fixation of the spine during comminuted fractures, a tap with a limiter is preliminarily prepared taking into account the results of a CT scan, setting the tap at a distance from the threaded end of the tap equal to the distance from the arc root to the anterior cortical plate of the damaged vertebra, then access to the posterior spine, insertion of transpedicular screws into adjacent from damaged by the stitches through their roots of the arches, then the prepared tap is introduced through the Roy-Camille point into the damaged vertebra to the cortical plate of its ventral fragment, dynamic compression of the ventral fragment of the damaged vertebra is performed by turning the tap around its longitudinal axis, through the contralateral Roy-Camilla point is introduced into the damaged vertebra the transpedicular screw, fixing it with its ventral fragment, remove the tap with the stopper, insert the transpedicular screw into the channel formed by the tap, complete installation of the transpedicular system by connecting all transpedicular screws with simulated fixing rods.

The technical result of the claimed invention consists in solving the problem posed earlier. The set of signs of the implementation of the claimed in this application method provides a reduction in the duration of the rehabilitation period by reducing the risk of postoperative complications. The possibility of performing dynamic compression of the ventral fragment of the damaged vertebra during reposition allows the diastasis between the fragments to be completely eliminated, which, in turn, reduces the risk of developing post-traumatic osteonecrosis - Kümmel's disease - and the occurrence of overgrown fractures and false joints.

The invention is illustrated using Fig.1-4, which depict: Fig.1 is a schematic representation of the introduction of a tap into a damaged vertebra; figure 2 is a schematic representation of a damaged vertebra after dynamic compression of its ventral fragment; figure 3 is a schematic illustration of the introduction of a transpedicular screw through the contralateral Roy Camille point; figure 4 is a schematic illustration of the introduction of the transpedicular screw after removal of the tap with the limiter. In figure 1-4, positions 1-4 are indicated:

1 - tap;

2 - limiter;

3 - transpedicular screw inserted through the Roy-Camille point;

4 - transpedicular screw inserted after removal of the tap with the stopper.

The method of reposition and fixation of the spine in comminuted fractures is as follows.

Preliminarily, taking into account the results of a CT scan, a tap 1 with a stopper 2 is prepared. The tap is installed at a distance from the threaded end of the tap 1 equal to the distance from the root of the arch to the anterior cortical plate of the damaged vertebra.

The patient is placed on the operating table in a position on the abdomen with rollers under the chest and pelvis. After processing the surgical field, they access the posterior spine by cutting soft tissues over the spinous processes of the damaged and adjacent vertebrae. Skeletonization of the spinous processes and vertebral arches is performed. Under the x-ray control, transpedicular screws are inserted into the vertebrae adjacent to the damaged vertebra through the roots of the arches. Then, a tap 1 with a limiter 2 is inserted into the damaged vertebra through the Roy-Camille point to the cortical plate of its ventral fragment into a channel 1 preliminarily formed with the help of an awl guide. In this case, the angles of inclination in the horizontal plane are observed: for the lower thoracic spine - 5-10 °, lumbar - 15 °. Dynamic compression of the ventral fragment of the damaged vertebra is carried out by turning the tap 1 around its longitudinal axis, thereby eliminating diastasis between fragments of the body of the damaged vertebra. Through the contralateral Roy-Camille point, a transpedicular screw 3 is inserted into the damaged vertebra through the channel formed with the help of a guide awl and a second tap, fixing it with its ventral fragment. The tap 1 with the stopper 2 is removed and a transpedicular screw 4 is inserted into the channel formed by it. The installation of the transpedicular system is completed by connecting all transpedicular screws with simulated fixing rods.

Example

Patient R., 55 years old, was treated at a traumatology clinic with a diagnosis of “Closed uncomplicated trauma of the lumbar spine. Compression-comminuted fracture of the L1 vertebral body. Vertebrogenic pain syndrome. " The patient complained of pain in the lumbar spine, aggravated by turns of the body. The patient underwent a CT scan, which showed: Compression-comminuted fracture of the L1 vertebra with a fracture line passing through the upper and lower cortical plates with the presence of a large ventral fragment of the body of the damaged vertebra, diastasis between fragments of the damaged vertebra was 4 mm.

After preparing the patient, the operation was performed according to the method claimed in this application: correction of pathological deformation and fixation using the transpedicular system in the segment Th 2 - L1 - L2. After the operation, control computed tomographic and radiological studies were performed, which showed: the metal structure is stable, there is no pathological kyphotic deformation, the spinal canal is intact, there is no diastasis between the fragments of the body of the damaged L1 vertebra. After 6 months, the patient began to work.

Claims (1)

The method of reposition and fixation of the spine in comminuted fractures, characterized in that, preliminarily, taking into account the results of a CT scan, a tap with a stopper is prepared, setting the tap at a distance from the threaded end of the tap equal to the distance from the arc root to the anterior cortical plate of the damaged vertebra, then access to the posterior spine, the introduction of transpedicular screws into adjacent vertebral from the damaged vertebra through their roots of the arches, after prepared tap through the Roy-Camille point into the injured vertebra to the cortical plate of its ventral fragment; dynamic compression of the ventral fragment of the damaged vertebra by dynamic rotation of the tap around its longitudinal axis; through the contralateral Roy-Camille point, a transpedicular screw is inserted into the damaged vertebra, fixing it with its ventral fragment, remove the tap with the limiter, insert the transpedicular screw into the channel formed by the tap, complete the installation of the transpedicular system by connecting all transpedicular screws with simulated locking rods.

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