RU2615863C2 - Vertebral body endoprosthesis for low invasive (thoracoscopic) spondylosyndesis, instrument for endoprosthesis implantation with locking device, and method for claimed endoprosthesis installation with claimed tools and locking device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: vertebral body prosthesis for low invasive spondylosyndesis is made in the form of a hollow cylinder. Surfaces that are not in contact with the bone slot walls, have a smooth surface without holes for osseointegration. The front and posterolateral surfaces that are in contact with the bone slot walls, have circumferential rows of holes intended for autobone material osseointegration in the endoprosthesis cavity into a damaged vertebral bone after slot formation therein. The entire circumference of the cylinder has separating grooves for cylinder cutting, spaced at a distance and at an angle relative to each other, passing through the rows of holes on its front and posterolateral surfaces and conventionally dividing the endoprosthesis into sections. The anterolateral surface has a longitudinal series of holes intended for locking device mounting. A tool for implantation of the said vertebral body hollow prosthesis with a prosthesis fixing device is designed as an impactor key consisting of outer and inner parts. The outer part is designed for direct introduction of the endoprosthesis, it is T-shaped and consists of a rod represented by a tube connected to the handle and froming an assembly. The handle has a through hole that extends and equal to inner hole of the rod. The impactor key interior comprises a rod and a removable T-handle. The removable T-handle consists of a handle and a base with a polygonal hole in a suitable form to insert the rod. The rod may be formed as a polyhedron or have a polyhedron portion at the unthreaded end, where the handle is put on, and has a hole with an internal thread at the other end in the center, designed for screwing a locking device consisting of a bolt and a nut. The bolt is installed from the inside of the endoprosthesis through one hole of the row of holes on the anterolateral surface, and the nut fixes it on the outside. The installation method of the said endoprosthesis by means of the said tool with a locking device includes low invasive ventral or thoracoscopic access, bone groove formation by resection of the bone tissue of the damaged vertebra, endoprosthesis installation from the interior to one of the holes located on the anterolateral surface of the locking device in the form of a fixing bolt, which is attached to the endoprosthesis by the nut from the outside, and endoprothesis filling with bone autotransplants or osteoinductive material, lowering in the chest cavity, and then deployment and retention, so that the anterolateral surface with the lockinging device was directed towards the surgical wound. Next, the implantation tool in the form of an impactor key is fixed to the remaining end of the bolt rod fix, for this, the impactor key interior is introduced via low minimally invasive ventral or thoracoscopic access and fixed to the protruding part of the bolt rod fixed to the endoprosthesis, twirling the impactor key interior with a threaded hole located at one end of the rod, using the T-shaped handle at the other end. Next, the outer T-shaped portion is imposed over the impactor key interior, after T-handle removal from the impactor key interior. The endoprothesis is introduced in the formed bone groove of the damaged vertebra by tapping on the impactor key outer T-shaped part with rod abutting directly against the endoprosthesis surface around the locking device nut. After endoprothesis introduction in the damaged vertebra body, the impactor key is dismantled by removing the outer part and unscrewing the interior rod from the fixing bolt rod. After impactor key removal, the nut is unscrewed.

EFFECT: invention provides minimally invasive implantation of the vertebral body prosthesis with low surgical access and large surgical wound depth for thoracic and lumbar spine bodies reconstruction after total or subtotal removal thereof in case of traumatic, inflammatory and neoplastic spine lesions, improved results of surgical treatment, reduced implantation time and reduced blood loss due to hard temporary locking device fixation to the deivery tool and implant, and more accurate and fast introduction in the bone groove prepared for implantation, simplified design, allowing to form an prosthesis of required size with faces having an angle corresponding to the angle of the end plates of adjacent vertebrae, allowing endoprosthesis filling with autobone material in sufficient quantities to form a fusion, and helping to reduce the risk of endoprosthesis migration, implementation of the possibility to fix the prosthesis to the tool directly in the surgical wound, preventing the late endoprosthesis migration due to creation of optimal conditions for high-grade biopolymer-bone block formation.

7 cl, 12 dwg

Description

The group of inventions relates to medicine, namely to traumatology, neurosurgery, spinal surgery, and can be used for minimally invasive, including thoracoscopic bisegmental stabilization during anterolateral spinal fusion surgery in the surgical treatment of fractures and pathological processes of the thoracic and lumbar vertebrae.

The most important problems in prosthetics of vertebral bodies are: technical difficulties in installing endoprostheses when using thoracoscopic and minimally invasive ventral approaches, as well as late migration of endoprostheses due to insufficiently pronounced fusion.

To perform bisegmental ventral spinal fusion, it is known to use autografts, usually from the iliac crest, which requires additional surgery to collect them, a long time for the formation and installation of autografts. There is a danger of its displacement or lysis with the loss of the achieved correction of the spinal column. Retention and implantation of an autograft is performed using surgical clamps (Billroth, Mikulich, etc.), which is associated with technical difficulties.

It is known to use monolithic implants made of various materials (titanium, its alloys, etc.). The monolithicity of such structures does not imply the formation of a bone-metal block. The integration of the implant is carried out due to the surrounding scar tissue. There is a possibility of non-union and migration of implants.

The use of mesh metal endoprostheses of vertebral bodies is known (Patent US 5702451 A, published December 30, 1997 (Space holder, in particular for a vertebra or an intervertebral disk), and Patent US 20120029638 A1, published February 2, 2012 (Vertebral body replacement device configured to deliver a therapeutic substance) (www.uspto.gov/)).

The disadvantage of these patents is that with a bisegmental installation from traditional thoracotomic and extraperitoneal accesses, technical difficulties arise due to the lack of rigid implant retention at the time of its implantation between adjacent vertebral bodies, which leads to an extension of the installation phase and, as a result, an increase in epidural blood loss vessels and spongy tissue of the resected vertebra, as well as an increased risk of postoperative complications such as lung atelectasis, pneumonia, neurological distress oystva et al. Hold autortansplantata and implementation using reticulated metallic implants also be accomplished using conventional surgical clips Billroth type. What makes it impossible to use such implants in minimally invasive thoracoscopic operations. All metal (titanium) implants in an MRI study of the spine in the postoperative period change the MRI picture of the condition of the spinal cord at an damaged level due to the appearance of unwanted artifacts, making it difficult to assess the state of the nervous tissue and assess the degree of formation of fusion.

The patent US 20120016478 A1, published January 19, 2012 (Intervertebral implant with multi-piece end cap), and the patent US 20110218631 A1, published September 8, 2011 (Adjustable intervertebral implant) (www.uspto.gov/), disclosing bisegmental installation of telescopic endoprostheses with a mechanism for expanding the supporting parts of the implant for thoracoscopic and minimally invasive spinal fusion. The telescopic implants are held and inserted using a key holder, with the subsequent rotation of the coupling, the required height is established. The main problem of telescopic implants is the inability to fill the implant with bone-replacing material in sufficient volume for the formation of fusion. High modulus of elasticity of titanium contributes to the resorption of bone tissue in the late period. The absence of criteria by which it is possible to determine the height of the extension and the pressure force of the supporting pads on the locking plates of neighboring vertebrae in the future leads either to increased bone resorption or to the implant migration with insufficient compression force.

The high efficiency of using various implants made of synthetic biostable polymers (polyetheretherketone, ultra high molecular weight high density polyethylene) and biodegradable polymers (polyhydroxyalkanoates, hydroxyapatite) has been proven in experimental and clinical surgery. Properties such as high strength, wear resistance, lack of toxicity, biological inertness and low X-ray contrast make these materials more and more popular in implantology. Low X-ray contrast of polyhydroxybutyrate, polyetheretherketone (PEEK OPTIMA®) and ultra high molecular weight high density polyethylene (Chirulen ^® 1020) allow X-ray evaluation of bone marrow formation on magnetic resonance and computed tomograms in dynamics.

Known biodegradable plate and screws Inion S-2 ™ System, http://www.inion.com/Proaucts/spine/Inion_S2_folder/en_GB/Inion_S-2_system/, designed for front fixation of the lumbar and thoracic vertebrae. The plate and screws consist of biodegradable copolymers, which include L-lactic and D-lactic acids. Bioresorption of the material occurs within two to four years. However, the role of the plate and screws lies solely in fixing the spinal segment.

In those cases, if for some reason there was no osteosubstitution between the vertebral bodies with full interbody fusion, and the biodegradable plate, due to natural lysis, ceased to fulfill the stabilizing function, the probability of mechanical and functional instability of the vertebral-motor segment is not excluded.

Known implants for replacing the bodies of the thoracic and lumbar vertebrae from the material polyether etherketone - PEEK OPTIMA®: Novel CP (Alphatec Spine's company www.alphatecspine.com/); HAWKEYE ™ Vertebral Body Replacement (VBR) Implant Device (ChoiceSpine www.choicespine.net/); NIKO® (Globus Medical Inc), as well as US20100185292 A1, published July 22, 2010. Holes for osseointegration are located only on the lateral surface, which prevents the formation of fusion around the implant. The number of holes for bone germination is minimal, which also reduces the likelihood of spinal fusion. Significant wall thickness of the implants reduces the volume of its internal cavity necessary for placement of bone-substituting material, which generally affects the quality of fusion. The method of implantation of the endoprosthesis does not allow to reduce the wall thickness, since there is a thread in the endoprosthesis wall designed for the locking key. Implants are not intended for thoracoscopic installation.

Disclosure of the invention.

Objectives of the claimed invention.

Ensuring low-traumatic (including thoracoscopic) implantation of the endoprosthesis of the vertebral body under conditions of small surgical access and a large depth of the surgical wound for reconstruction of the bodies of the thoracic and lumbar vertebrae after total or subtotal removal of them with traumatic, inflammatory and tumor lesions of the spine.

Improving the results of surgical treatment: reducing the time of implantation and reducing blood loss due to the rigid temporary fixation of the fixing device to the delivery tool and the implant and its more accurate and quick insertion into the bone groove prepared for implantation.

To develop an endoprosthesis of the vertebral body and a fixing device with such properties as biocompatibility, low radiopacity, osteoinduction, osteoconduction, etc.

To develop an endoprosthesis of the vertebral body, having a simple structure, which allows forming an endoprosthesis of the required size with ends having an angle corresponding to the angle of the closure plates of adjacent vertebrae, allowing filling the endoprosthesis with autologous material in a sufficient volume for the formation of fusion and reducing the risk of endoprosthesis migration.

To develop a universal fixation device and instrument, allowing implantation of any mesh endoprostheses of the bodies of the thoracic and lumbar vertebrae, including the claimed one, from the anterolateral accesses and allowing the endoprosthesis to be fixed to the instrument directly in the surgical wound itself.

To prevent late migration of the endoprosthesis by creating optimal conditions for the formation of a full biopolymer-bone block.

A constructive solution to the problems lies in the fact that the claimed endoprosthesis of the vertebral body is a cylinder, hollow inside, with approximate dimensions: length 70 mm, external diameter 24 mm, internal diameter 20 mm, wall thickness 2 mm, made, for example, of polyetheretherketone ( PEEK OPTIMA®) or ultra high molecular weight high density polyethylene (Chirulen ^® 1020).

On its surfaces, it has an orderly arranged circular through holes (3 mm) (1.5), which subsequently provide for the osseointegration of the bone autograft (6) located inside the endoprosthesis (1) into the surrounding bone tissue of the injured (affected) vertebra (4).

The maximum number of holes (1.5) staggered are on the front (1.1) (Fig. 1 (front view)) and the rear lateral (1.2) (Fig. 1 (left view)) surfaces of the endoprosthesis (1) (Fig. 1 )

The anterolateral surface of the endoprosthesis (1.3) (Fig. 1 (right view)) contains 7 holes (2.1) with a diameter of 5 mm, located in the midline.

The back surface of the endoprosthesis is solid (1.4) (Fig. 1 (rear view)).

This location of the holes is explained by the largest contact area between the endoprosthesis (1) and the bone tissue (4.1) of the damaged vertebra (4) after installing the endoprosthesis (1) in the bone groove (4.2) (Fig. 2), since the walls of the bone groove (4.2) are the anterior and posterolateral internal surfaces of the distant vertebra, and the posterior surface of the vertebra (the anterior surface of the spinal canal) is completely removed to decompress the spinal canal. The posterior surface of the endoprosthesis (1.4) does not contain holes, since there is no need for bone tissue to grow in the direction of the spinal canal (5) (Fig. 2).

Thus, the most durable surfaces of the endoprosthesis (1) are those of its surface where spinal fusion cannot and should not be formed. The maximum location of holes on the anterior (1.1) and posterolateral (1.2) surfaces of the endoprosthesis (1) creates conditions for bone integration of the autograft (6) located inside the endoprosthesis (1) with the bone tissue of the destroyed vertebra surrounding it (4). In this case, the primary stabilizing characteristics of the endoprosthesis (1) are not lost due to the preserved integrity of its posterior surface (1.4). Along the longitudinal axis of the endoprosthesis (1) on the anterolateral (1.3) surface there is an x-ray positive area with seven 5-mm holes (2) for the locking device (Fig. 1 (right view)).

An X-ray positive area (2) facilitates the control of the correct angle of inclination of the endoprosthesis (1) in the sagittal and frontal planes during its installation. Due to the manufacturability of the polymer material, the correspondence between the sizes of the endoprosthesis (1) and the bone groove (4.1) is determined intraoperatively. To facilitate the formation of the endoprosthesis (1) of the required size, circularly located grooves (3) passing along the lines of the existing openings (Fig. 1) are indicated on it with a depth of 0.5 mm.

Furrows (1) pass at an angle of 0 ° and 4 ° and / or 0 ° and 6 ° at a distance of 10 mm from each other and strictly in the center of the holes (1.5) for osseointegration. With the obligatory presence in the central part of the furrow of 0 degrees (Fig. 1).

Endoprosthesis trimming (1) according to the existing furrows provides the formation of the ends at an angle corresponding to the angle of the connecting plates of adjacent vertebrae. The ends of the endoprosthesis (1) have sharp edges due to the semicircles formed after trimming the endoprosthesis (1) (Fig. 1). The presence of sharp edges of the ends as a result of their introduction into adjacent vertebrae reduces the risk of its migration.

Implantation of the endoprosthesis in the bone bed is carried out with a special tool with a key-impactor (7), using a universal fixing device (Fig. 3).

It should be noted that the claimed key-impactor and the claimed fixing device can be used to install any mesh endoprostheses.

The endoprosthesis (1) is fixed to the impactor key (7) using a fixing device in the form of a bolt and nut, the bolt (8) is installed from the endoprosthesis cavity (1) through the holes for the fixing device (2.1), and from the outside of the endoprosthesis to the bolt tighten the nut (9), thereby securing the bolt to the endoprosthesis (Fig. 6, Fig 10).

For the manufacture of a fixing device in the form of a bolt with a nut, a biostable polymer, for example, polyetheretherketone, or ultra-high molecular weight polyethylene, or biodegradable polymers, for example polyhydroxybutyrate, (hydroxyapatite) is used, which is more preferable, since it possesses properties such as osteoconduction and osteoinduction osteogenesis processes.

The bolt has the following approximate dimensions: length 15 mm; diameter 4 mm; cap diameter 8 mm; hat thickness 3 mm.

The nut has the following approximate dimensions: outer diameter 16 mm, thickness 5 mm, inner (threaded) diameter 4 mm.

The use of a fixing device allows you to increase the internal diameter of the endoprosthesis, and hence the volume of its cavity by reducing (maintaining a minimum) the thickness of its walls. A larger volume of the endoprosthesis cavity allows filling it with a large amount of autologous material, which, along with optimally located holes on the surface of the endoprosthesis, contributes to the formation of a reliable fusion. The biodegradable cap of the bolt of polyhydroxybutyrate, being a tissue-engineering matrix, located in the cavity of the endoprosthesis and having close contact with autologous tissue, undergoes osteoreparative processes over time. The location of the end face of the fixing device above the surface of the endoprosthesis allows it to be fixed to the implantation tool directly in the surgical wound itself, thereby expanding the possibility of its use in thoracoscopic approaches.

A tool for minimally invasive implantation of the claimed endoprosthesis key-impactor consists of 2 parts, external and internal (Fig. 3).

The inner part of the impactor key consists of a rod (10) and a removable T-shaped handle (11).

The removable T-shaped handle (11) consists of a handle (11.1) and a base (11.2). Moreover, the base of the handle (11.2) has a multifaceted hole inside a suitable shape for inserting the rod (10) (Fig. 3).

The rod has at one end in the center a hole with an internal thread (12), intended for the fixing device (8), (9) (Fig. 3). Moreover, the rod can be made in the form of a polyhedron, three-, four-, five-, etc. (in Fig. 3 it is presented in the form of an octahedron) or at the end without thread, have a part in the form of a polyhedron, on which a handle (11) is put on, the base (11.2) of which has the same polyhedral hole inside (Fig. 3).

The approximate dimensions of the inside of the universal impactor key are: rod length 350 mm, rod diameter 14 mm, inner diameter of the hole with a thread at the end of the rod 4 mm, handle diameter 12 mm, handle length 100 mm, base diameter 16 mm.

The outer part of the impactor key (13) has a T-shape and consists of a handle (13.1) and a rod (13.2) (Fig. 3).

The rod (13.2) is presented in the form of a tube and is connected to the handle (13.1) as a whole, the handle (13.1) has a through hole extending and equal to the inner hole of the rod (13.2) (Fig. 3, 10).

The outer part of the impactor key (13) is intended for the direct introduction of the endoprosthesis (1) (Fig. 3, 9, 10).

During implantation of an endoprosthesis (1), due to the use of the outer part of the impactor key (13), mechanical action is not carried out on its fixing device, consisting of a fixing bolt (8) and nut (9), but on the anterolateral wall of the endoprosthesis (1.3). This saves the thread of the fixing bolt (8), necessary for twisting the inside of the impactor key, namely the rod (10), at the final stage of installation and allows you to tightly insert the endoprosthesis (1) into the bone bed, between the end parts of the endoprosthesis (1) and the bodies adjacent vertebrae (Fig. 3, 4).

Description of drawings

FIG. 1 is a schematic representation of an endoprosthesis in projections viewed from the front, right, left, back, bottom, top, and horizontal section AA shown in the right view;

FIG. 2 is a schematic representation of an injured vertebra with an installed endoprosthesis;

FIG. 3 is a schematic illustration of an impactor key assembly with a fixed endoprosthesis using a fixing device in the form of a bolt and nut in M 1: 2;

FIG. 4 is a schematic illustration of an enlarged portion of an impactor key assembly with a fixed endoprosthesis using a fixing device in the form of a bolt and nut;

FIG. 5 is a section along the line BB in M 1: 1;

FIG. 6 is a schematic illustration of an endoprosthesis illustrating the installation of a locking device into it;

FIG. 7 is a schematic representation of the lowering of the endoprosthesis into the chest cavity;

FIG. 8 is a schematic representation of an endoprosthesis in the chest, deployed by the anterolateral surface with a locking device in the direction of the surgical wound;

FIG. 9 is a schematic representation of an endoprosthesis in the chest with a fixed impactor key fixed on it and assembled;

FIG. 10 is a schematic illustration of the installation of an endoprosthesis into the body of a damaged vertebra using a fixing device and an impactor key;

FIG. 11 is a schematic illustration of an injured vertebra with an installed endoprosthesis and additionally fixed to the ventral plate;

FIG. 12 is a schematic representation of an injured vertebra with an installed endoprosthesis and a cut off bolt shaft.

Description of structural elements

1 - endoprosthesis;

1.1 - the front surface of the endoprosthesis;

1.2 - the posterolateral surface of the endoprosthesis;

1.3 - anterolateral surface of the endoprosthesis;

1.4 - the back surface of the endoprosthesis;

1.5 - holes for osseointegration;

1.6 - semicircles;

2 - x-ray positive area with five holes for the fixing device;

2.1 - holes for the locking device;

3 - furrows;

4 - damaged vertebra;

4.1 - bone groove;

5 - spinal canal,

6 - bone autograft;

7 - key-impactor;

8 - a fixing bolt;

8.1 - a bolt head;

8.2 - a bolt core;

9 - a nut;

10 - the core of the inner part of the key impactor;

11 - removable T-shaped handle of the inner part of the key impactor;

11.1 - the handle of the T-shaped handle of the inner part of the impactor key;

11.2 - the base of the T-shaped handle of the inner part of the impactor key;

12 - hole with a female thread at the end of the rod of the inner part of the impactor key,

13 - the outer part of the key impactor;

13.1 - the handle of the outer part of the impactor key;

13.2 - the rod of the outer part of the impactor key;

14 - ligature;

15 - operational wound of thoracoscopic access;

16 - chest cavity;

17 - ventral plate.

The implementation of the implantation of the claimed endoprosthesis using the claimed tool and a fixing device in the vertebral body.

Carry out minimally invasive ventral or thoracoscopic access.

A bone groove is formed in the damaged vertebra by partial resection of part of the bone tissue.

Next, an endoprosthesis is prepared. Determine the distance between the locking plates of the adjacent vertebrae. On radiographs determine the angles of the end plates of adjacent vertebrae. According to the data obtained, the distance between the vertebral bodies and the corners of the locking plates perform the selection and trimming of the endoprosthesis according to the grooves on its circumferences.

From the inner part of the endoprosthesis (1) into one of the 5 holes (2.1) (Fig. 1, 6) located on the anterolateral surface (1.3) (Fig. 1, 6), a part of the fixing device is inserted in the form of a fixing bolt (8 ) (Fig. 6), which is fixed to the endoprosthesis (1) from the outside with a nut (9) (Fig. 6). As a result, the head of the bolt (8.1) is located inside the endoprosthesis (1), and its shaft (8.2) with a screwed nut (9) protrudes on the outside of the endoprosthesis (1) (Fig. 6); subsequently, the impactor key is screwed onto the remaining end of the shaft. (Fig. 3, 4).

Next, the endoprosthesis (1) is filled with bone autografts (6) or osteoinductive material. The assembled endoprosthesis (1) through thoracoscopic access using the ligature (14) and any surgical clamp is lowered into one of the chest cavity (16) with one of its ends (Fig. 7), where it is deployed by pulling the ligature and holding so that its anterolateral surface with the fixing device was turned towards the surgical wound (15) (Fig. 8). Then, through a minimally invasive ventral or thoracoscopic access, the inside of the impactor key is introduced, consisting of a rod (10) with a fixed handle (11), which is fixed with a hole with an internal thread (12) at the end of the rod (10) to the protruding part of the bolt rod (8.2 )

After that, the T-handle (11) of the inner part of the impactor key is removed from the rod (10) (Fig. 10) and the final assembly of the impactor key is made by inserting and fixing its outer part (13) over the inside (Fig. 9) .

An impactor key with an endoprosthesis (1) is installed above the bone groove (4.1) of the damaged vertebra (4) in a strictly perpendicular direction (Fig. 10).

The implant (1) is inserted into the damaged vertebra (4) by tapping the external T-shaped part of the impactor key (13) with a hammer, namely, the handle (13.1), abutting the edge of the shaft (13.2) directly into the anterolateral surface of the endoprosthesis (1) around the nut (9) of the locking device (Fig. 10).

After implantation of the endoprosthesis (1) into the body of the damaged vertebra (4), the impactor key is removed by removing the outer part (13) and unscrewing the core (10) of the inner part from the shaft (8.2) of the fixing bolt (8).

After dismantling the impactor key, unscrew the nut and the protruding end of the bolt rod (8.2) is removed with an electric knife.

When using a fixing device made of biodegradable material, this is not necessary.

In particular cases of using the claimed invention, the protruding end of the bolt rod (8.2) is not removed, but is used for fixation to the ventral plate with an anti-migration purpose (Fig. 11).

Thus, using the claimed solution, the following technical result is achieved:

- providing less traumatic (including thoracoscopic) implantation of the endoprosthesis of the vertebral body under conditions of small surgical access and a large depth of the surgical wound for reconstruction of the bodies of the thoracic and lumbar vertebrae after total or subtotal removal of them in case of traumatic, inflammatory and tumor lesions of the spine;

- improving the results of surgical treatment; reduction of implantation time and reduction of blood loss due to the rigid temporary fixation of the fixing device to the delivery tool and the implant and its more accurate and quick implementation into the bone groove prepared for implantation;

- to simplify the design, allowing the formation of the endoprosthesis of the required size with the ends having an angle corresponding to the angle of the closure plates of the adjacent vertebrae, allowing the endoprosthesis to be filled with autologous material in a sufficient volume to form a fusion and to reduce the risk of endoprosthesis migration;

- the implementation of the ability to fix the endoprosthesis to the instrument directly in the surgical wound;

- prevention of late migration of the endoprosthesis by creating optimal conditions for the formation of a full biopolymer-bone block.

Claims (7)

1. Endoprosthesis of the vertebral body for minimally invasive spinal fusion, made in the form of a hollow inside the cylinder, characterized in that surfaces that are not in contact with the walls of the bone groove have a flat surface without holes for osseointegration, on the front and posterolateral surfaces in contact with the walls of the bone groove, the circle has rows of holes designed for osseointegration of the autologous material located in the endoprosthesis cavity into the bone tissue of the damaged vertebra after the formation of a groove in it, a cylinder and around its circumference there are dividing grooves for cutting the cylinder, located at a distance and relative to each other at angles, passing through the rows of holes on its front and posterolateral surfaces and conditionally dividing the endoprosthesis into sections, and on the anterolateral surface has a longitudinal row of holes for installation fixing device. 2. The endoprosthesis according to claim 1 is characterized in that the rows of holes located circumferentially on the front and posterolateral surfaces of the endoprosthesis are offset relative to each other so that the holes in adjacent rows are staggered. 3. A tool for implantation of a hollow endoprosthesis of the vertebral body with an endoprosthesis fixing device in the form of a key-impactor, consisting of the outer and inner parts, characterized in that the outer part is for direct implant implantation, has a T-shape and consists of a rod in the form of a tube connected to the handle as a whole, the handle has a through hole extending equal to the inner hole of the rod, the inside of the impactor key contains the rod and a removable T-shaped handle, removable T-o a different handle consists of a handle and a base having a multifaceted hole inside a suitable form for inserting the rod, the rod can be made in the form of a polyhedron or at the end without a thread can have a part in the form of a polyhedron, on which the handle is worn and has a hole at the other end with an inner a thread designed to screw in a fixing device consisting of a bolt and a nut, the bolt being installed from the inside of the endoprosthesis through an opening from a series of holes on the anterolateral surface, and ha ka fixes it on the outside. 4. The method of installing the claimed endoprosthesis according to claim 1 using a tool with a fixing device according to claim 3 includes minimally invasive ventral or thoracoscopic access, formation of a bone groove by resection of a part of the bone tissue of the damaged vertebra, installation from the inside of the endoprosthesis into one of the openings located on anterolateral surface, parts of the fixing device in the form of a fixing bolt, which is fixed to the endoprosthesis from the outside with a nut, and filling the endoprosthesis with bone autografts or osteoin with ductile material, lowering into the chest cavity, and then unfolding and holding so that its anterolateral surface with the locking device is facing the side of the wound, then the implantation tool is fixed to the remaining end of the bolt shaft in the form of an impactor key, for this, through a minimally invasive ventral or thoracoscopic access introduces the inner part of the impactor key and fixes it to the protruding part of the bolt shaft mounted on the endoprosthesis by screwing a hole with a thread located on one end of the rod, the inner part of the impactor key using a fixed T-shaped handle on the other end, then on top of the inner part of the impactor key, put on the outer T-shaped part, after removing the T-handle from the inside of the impactor key, the implant is inserted into the formed bone groove of the damaged vertebra is carried out by tapping with a hammer on the outer T-shaped part of the impactor key, abutting the edge of the rod directly on the surface of the endoprosthesis around the nut of the fixing device, after the endoprosthesis is inserted into the body of the damaged vertebra, the impactor key is removed by removing the outer part and unscrewing the core of the inner part from the rod of the fixing bolt, after removing the impactor key, the nut is unscrewed. 5. The method according to p. 4 is characterized in that the protruding end of the bolt rod is removed. 6. The method according to claim 4 is characterized in that an endoprosthesis and a fixing device are made of biodegradable material, and therefore, when the endoprosthesis is installed, the protruding end of the bolt shaft is not removed. 7. The method according to claim 4 is characterized in that upon completion of the installation of the endoprosthesis, the endoprosthesis is fixed to the ventral plate with the protruding end of the bolt shaft for anti-migration purposes.

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