RU2509535C1 - Vertebroplasty technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is referred to medicine, namely neurosurgery and traumatology. Pre-operative helical computed tomography is performed. Maximum d_max-a and minimum d_min-a diameters above an injured vertebra and maximum d_max-b and minimum d_min-b diameters below the injured vertebra are measured in an axial plane. An average diameter d_av, equal to the total value divided by 4 is calculated. Maximum h_max-a and minimum h_min-a height of the vertebra above the injured vertebra and maximum h_max-b and minimum h_min-b height of the vertebra below the injured vertebra are measured in a sagittal plane. An average height h_av, equal to the total value divided by 4 is calculated B. Heights of anterior h₁ and posterior h₂ segments of the injured vertebra are measured in a sagittal plane. The required amount V of cement to be introduced is calculated by formula: $$V=\pi \times \frac{d_{av}^2}{4}\left(h_{av}-h_1-\frac{h_2-h_1}{2}\right).$$

Needles are inserted transpedicularly into the injured vertebral body under guidance of the electronic image converter. Cement is introduced in the amount equal to the injured vertebral body volume calculated before the surgery.

EFFECT: invention provides more effective manipulation ensured by introducing the required and adequate amount of bone cement into the vertebral body.

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Description

The invention relates to medicine, namely to neurosurgery and traumatology, and can be used for percutaneous vertebroplasty in patients with fracture of vertebral bodies as a result of trauma, osteoporosis and a tumor process.

It is known that vertebroplasty (puncture cementoplasty) is a minimally invasive method for ensuring stabilization and consolidation of damaged vertebrae using bone cements. The method is effective, but when using bone cement in large doses, complications can occur in the form of leakage outside the vertebral body, including into the cavity of the spinal canal, which leads to compression of the spinal cord and spinal nerves. At the same time, the effectiveness of vertebroplasty is determined by a sufficient amount of cement injected into the affected, wedge-shaped deformed vertebra.

There is a known method of vertebroplasty (Pedachenko E.G., Kushchaev S.V. . The disadvantage of this method is the lack of accuracy in determining the volume of required cement and high radiation exposure.

There is a known method of vertebroplasty (Manukovsky V.A. Vertebroplasty in the treatment of pathology of the spine (clinical and experimental research): Abstract of thesis. ... Dr. med. Sciences. - St. Petersburg., 2009. - 45 p.). After installing the needles, bone cement is injected transpedicularly. The amount of cement introduced is determined by the table with averaged data on the required volume of cement, depending on the level and degree of damage to the vertebra. The disadvantage of this method is its inaccuracy, the possibility of insufficient or excessive volume of injection of bone cement, since the anatomical structure of the vertebrae has a gender and age difference, and the degree of damage to the vertebra is largely determined by the nature of the pathological process.

, Closest to the claimed method is vertebroplasty (RF patent No. 2432910, published November 10, 2011), adopted as a prototype. In preoperative planning, the height and base area of the fragments of the damaged vertebra are recorded, the volume of each fragment is determined by the formula: $$V=\left(S_{\mathrm{one}}+S_2+\sqrt{S_{\mathrm{one}}\times S_2}\right)\times H/3$$

,

where V is the volume of the fragment of the damaged vertebral body, S ₁ is the area of the side of the fragment of the damaged body of the vertebra, which is facing ventrally, S ₂ is the area of the side of the fragment of the damaged body of the vertebra, which is facing dorsally, N is the height of the fragment of the damaged body of the vertebra. Under the control of the electron-optical transducer, puncture needles are brought to the middle of each fragment of the damaged vertebral body through the bases of the legs of the vertebral body and bone cement is introduced through bilateral access in an amount equal to the volume of each fragment.

However, the prototype is not effective enough, because:

- the calculation of the volume of injected cement is carried out on a deformed, different from normal, vertebra and obviously changed fragment,

- can be introduced during the operation of insufficient or excessive amount of bone cement, since the volume of the cement is considered equal to the volume of each of the fragments, while the deformation does not necessarily occur on _^half part vertebra and fragment

- the use is limited only by osteoporosis of the spine, as well as general contraindications for vertebroplasty for comminuted fractures of the vertebral body due to the impossibility of retaining bone cement with a high risk of its leakage outside the body of the damaged vertebra.

The invention is directed to the creation of a vertebroplasty method that improves the efficiency of manipulation regardless of the pathology that leads to damage to the vertebra by introducing the necessary and sufficient volume of bone cement into the vertebral body.

.The specified technical result in the implementation of the invention is achieved by the fact that in the method of vertebroplasty, including the transpedicular installation of needles into the body of a damaged vertebra under the control of an electron-optical transducer and the introduction of cement volume calculated before surgery, the feature is that spiral computed tomography is performed before surgery axial plane measure the largest d _max-in and the smallest d _min-in diameters of the vertebra above, as well as the largest d _max-n and the smallest d _min-n diameters of the vertebra lower not damaged, calculate the average diameter d _cp , equal to the sum of the obtained indicators divided by 4, in the sagittal plane measure the largest h _max-in and the smallest h _min-in height of the vertebra above, as well as the largest h _max-n and the smallest h _min-n the height of the vertebra below the damaged, calculate the average height h _cp equal to the sum of the obtained indicators divided by 4, in the sagittal plane measure the height of the front h ₁ and rear h ₂ departments of the damaged vertebra, calculate the required amount of injected cement V according to the formula: $$V=\pi \times \frac{d_{cp}^2}{\mathrm{four}}\left(h_{cp}-h_{\mathrm{one}}-\frac{h_2-h_{\mathrm{one}}}{2}\right)$$

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The method is as follows. A preoperative calculation of the required amount of injected cement is carried out by calculating the deficit of the body volume of the affected vertebra.

The amount of cement injected is calculated as the missing volume of a vertebral defect based on radiation examination data. To do this, determine the volume of the injured vertebra before damage on the basis of calculating the average volumes of the upper and lower vertebrae, then calculate the available volume of the injured vertebra. The difference in these volumes is the required amount of input cement. Perform spiral computed tomography. In the axial plane measure the largest d _max-in and the smallest d _{min-in the} diameters of the vertebra above (figure 1), as well as the largest d _max-n and the smallest d _min-n diameters of the vertebra below (figure 2) damaged in cm, calculate the average diameter d _cp equal to the sum of the obtained parameters divided by 4 in cm. In the sagittal plane (Fig. 3), the largest h _max-in and the smallest h _min-in vertebra height are higher, as well as the largest h _max-n and the smallest h _min-n height of the vertebra below the damaged in cm, calculate the average height h _cp equal to the sum of the obtained indicators divided by 4 in cm. In the sagittal plane, the height of the anterior h ₁ and posterior h ₂ departments of the damaged vertebra is measured in cm. A preoperative calculation of the required amount of injected cement V is carried out by calculating the deficit of the body volume of the affected vertebra according to the formula:

. $$V=\pi \times \frac{d_{cp}^2}{\mathrm{four}}\left(h_{cp}-h_{\mathrm{one}}-\frac{h_2-h_{\mathrm{one}}}{2}\right)$$

.

A patient with a fracture of the vertebral body is laid during surgery on the cervical spine on the back with hands fixed along the body, on the chest and lumbar on the stomach or side. After laying the patient, preoperative marking is carried out taking into account the presence of distinctive signs and anatomical features of the spinal column at the level of the lesion. Under local anesthesia, a long needle (10-15 cm) with a mandrel with a tapered end at an angle of 45 °, a diameter of 8-13G, puncture the vertebral body with transpedicular access from one or both sides (according to indications, depending on the nature of the damage), while the needle must be within the "oval" of the arc root. X-ray control is carried out using an electron-optical transducer of x-ray mobile surgical devices. The needle is immersed in the vertebral body to the level of the anterior third. Prior to the introduction of a composite mixture into the vertebra, venospondylography with omnipack (3-5 ml) is performed. Bone cement and solvent are mixed in a special vertebroplasty kit system, tantalum dust and / or barium sulfate are added to give bone cement X-ray contrast, then the mixture is pumped into the damaged vertebra in the volume calculated before surgery. After the introduction of cement, the needle is removed, and 20 minutes after the onset of polymerization, the patient is transported to the ward.

The claimed method of vertebroplasty was developed and passed clinical trials in the treatment of 17 patients with injuries and diseases of the spine, which underwent puncture vertebroplasty.

We give an example - an extract from the medical history.

Patient E., 57 years old, East. illness 14789, was treated at the Komi Republican Hospital from 10/14/10 to 01/01/10 with a diagnosis of compression fracture of the body of the Th ₁₂ vertebra. Fell at home from the stepladder 2 days before admission, pain appeared in the thoracolumbar region. Upon admission, he complained of pain in the thoracolumbar spine, aggravated after exercise and at night. Somatic status and neurological examination of the pathology did not reveal. There is a sharp pain on palpation of the lumbar region and limitation of range of motion. Spiral computed tomography of the lower thoracic and lumbar spine revealed a compression fracture of the Th ₁₂ vertebral body with its wedge-shaped deformation. According to the claimed method, computed tomography was performed, in the axial plane the largest and smallest diameters of the vertebra were measured above (d _max-in = 3.18 cm, d _min-in = 2.44 cm) and below (d _max-n = 3.7 cm , d _min-n = 2.82 cm) of the damaged, calculated d _cp = ( _dmax-in + d _min-in + d _max-n + d _min-n ): 4 = (3.18 + 2.44 + 3 , 7 + 2.82): 4 = 3.04 cm. In the sagittal plane, the highest and smallest vertebral heights were measured above (h _max-in = 2.47 cm, h _min-in = 2.03 cm) and below (h _max-n = 2.7 cm, h _min-n = 2.42 cm) damaged, calculated h _cp = (h _max-in + h _min-in + h _max-n + h _min-n ): 4 = ( 2.47 + 2.03 + 2.7 + 2.42):. 4 = 2.4 cm measured front height h ₁ = 1.64 cm, and rear in the sagittal plane tdelov damaged vertebra h ₂ = 2.47 cm swipe preoperative calculation of the required amount of cement injected by the formula.:

$$\begin{array}{c}V=\pi \times \frac{d_{cp}^2}{\mathrm{four}}\left(h_{cp}-h_{\mathrm{one}}-\frac{h_2-h_{\mathrm{one}}}{2}\right)=\\ =3.14\times {\left(3.04\right)}^2:\mathrm{four}\times \left[\mathrm{2,4}-\mathrm{1,64}-\left(2.47-\mathrm{1,64}\right):2\right]=2.6\mathrm{from}{m}^3\end{array}$$

The calculation showed that for the propping effect it is necessary to introduce 2.6 cm ^{3 of} bone cement. On October 27, 10, puncture vertebroplasty of the body of the Th ₁₂ vertebra was made with the introduction of the estimated volume of bone cement. No complications were observed during the operation; a good clinical and radiological effect was obtained. The postoperative period was uneventful. Discharged in satisfactory condition, pain in the thoracolumbar spine does not bother.

Claims (1)

The method of vertebroplasty, including the transpedicular insertion of needles into the body of a damaged vertebra under the control of an electron-optical transducer and the introduction of cement volume calculated before surgery, characterized in that before the operation they perform spiral computed tomography, the largest d _max and the smallest d _min are measured in the axial plane _{in the} diameters of the vertebra above, and also the largest d _max-n and the smallest d _min-n diameters of the vertebra below the damaged one, calculate the average diameter d _cp equal to the sum of the obtained indicators divided by 4 , in the sagittal plane measure the highest h _max-in and the smallest h _min-in height of the vertebra above, as well as the largest h _max-n and the smallest h _min-n height of the vertebra below the damaged, calculate the average height h _cp equal to the sum of the obtained indicators divided 4, in the sagittal plane measure the height of the front h ₁ and rear h ₂ departments of the damaged vertebra, calculate the required amount of injected cement V according to the formula: $$V=\pi \times \frac{d_{cp}^2}{\mathrm{four}}\left(h_{cp}-h_{\mathrm{one}}-\frac{h_2-h_{\mathrm{one}}}{2}\right)$$

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