RU2645246C1 - Method of surgical treatment in myeloceles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to neurosurgery and may be applicable to spinal hernias surgical treatment. Before the hernial sac dissection, it is covered with an elastic ring, which sectional diameter is at least two-thirds of the hernial sac height, a horseshoe-shaped line of the future incision is planned and along its outer edge, at least four strands are attached with sutures to the wall of the hernial sac, each filament is laid on the ring upper surface, on its outer surface, rings along its lower surface are routed from below, introducing into its thickness and passing from the inside to the outer side, performing the hernial sac dissection along the intended line and tighten the free ends of the threads, at that stretching the hernial sac walls at the surface of the ring, after which performing the allocation of roots and plastic surgery of the hernia gates.

EFFECT: method allows to simplify the course of the surgery.

1 cl, 2 dwg

Description

The invention relates to medicine, namely to neurosurgery, and can be used in surgical treatment of patients with spinal hernias.

A known method of surgical treatment for spinal hernias (application No. 2002114383, IPC АВВ 17/00), which consists in dissecting the hernial sac, isolating the roots of the spinal cord from it, excising the walls of the hernial sac and plastic hernial gates.

The disadvantage of this method is that after removal of cerebrospinal fluid from the hernial sac, it contracts, decreases, its anatomy changes significantly and this significantly complicates the orientation in the cavity of the opened hernial sac and the subsequent stages of the operation.

There is also a method of treating spinal hernias (Fundamentals of Pediatric Neurosurgery. Edited by A. A. Arendt and S. I. Nereseyants. Moscow: “Medicine”, 1968. pp. 276-279), taken as a prototype, consisting of puncture a hernial sac with a hollow needle, in removing fluid from it, dissecting the hernial sac, fixing its edges, isolating the roots of the spinal cord from it, followed by excision of the walls of the hernial sac and plastic hernia gate. At the same time, the walls of the dissected hernial sac at the stage of extraction of the roots of the spinal cord from it are fixed with surgical clamps superimposed on its edges.

The disadvantage of this method is the need for the surgeon to hold the clamps holding the edges of the dissected hernial sac at the stage of isolation of the roots of the spinal cord, which reduces the quality of treatment and significantly complicates the operation.

The objective of the claimed invention is to improve the quality of surgical treatment of spinal hernia and simplify the course of the operation.

The problem is solved in that according to the method of surgical treatment for spinal hernias, including dissection of the hernial sac, fixation of its edges, isolation of the roots of the spinal cord and plastic of the hernial collar, before dissection of the hernial sac it is surrounded by an elastic ring, the cross-sectional diameter of which is at least two thirds of the height of the hernial sac, a horseshoe-shaped line of the future incision is outlined and at least four threads are attached with interrupted sutures to the wall of the hernial sac along its outer edge, which gave e laid on the upper outer surface of the ring and carried through its thickness from the inside to the outside, produce the dissection of the hernia sac of the intended line and pull the free ends of filaments, stretching with the walls of the hernial sac on the surface of the ring and then perform selection of roots and plastic hernial ring. A gauze or polypropylene ring is used as the elastic ring.

The claimed method allows to improve the quality of treatment due to the fact that it prevents uncontrolled deformation of the hernial sac at the moment of dissection and at subsequent stages of the operation. Reliable retention of the walls of the hernial sac after removal of cerebrospinal fluid from it creates favorable conditions for the subsequent stages of the operation.

The walls of the dissected hernial sac are firmly held by the threads attached to it and stretch on the surface of the elastic ring, which greatly facilitates orientation in the cavity of the hernial sac and creates the conditions for high-quality, low-traumatic separation of the roots of the spinal cord from the adhesions with the inner walls of the hernial sac. In this case, the threads fixed along the edge of the incision and drawn through the thickness of the ring allow you to finely control the degree of stretching of the walls of the hernial sac due to the friction force acting on the threads in the thickness of the elastic ring.

The invention is illustrated by drawings, which depict:

FIG. 1 - hernial sac with threads attached to it and an elastic ring laid along its edge.

FIG. 2 - the passage of threads fixed to the hernial sac through an elastic ring.

The method is as follows: before dissection of the hernial sac 1 (Fig. 1), it is surrounded by an elastic ring 2, the cross-sectional diameter of which is at least two-thirds of the height of the hernial sac, a horseshoe-shaped line 3 of the future incision is outlined and attached with interrupted sutures to the wall a hernial sac of at least four threads 4. Each thread is laid on the upper surface of the ring 2 (Fig. 2), on its outer surface, held from the bottom of the ring along its lower surface, inserted into its thickness and carried out from the inside us to the outside. Dissection of the hernial sac along the outlined line 3 (Fig. 1) is carried out and the free ends of the threads 4 are pulled, stretching the walls of the hernial sac on the ring surface, after which the roots and plastic hernial glands are extracted. A gauze or polypropylene ring is used as the elastic ring.

Clinical example

Patient V., 5 days old, was born with spinal hernia (meningoradiculocele) of the lumbar region. The size of the hernial sac was 5 × 5 × 6 cm. The hernial sac was hermetic, no liquorrhea was noted from it. In the operating room, a dense gauze ring was laid along the edge of the hernial sac, the thickness of which was 2/3 of the height of the dome of the hernial sac relative to its base. Then a horseshoe-shaped incision line was drawn (drawn with a felt-tip pen) in the area of the dome of the hernial sac. On the outer edge of the incision line, six long sutures were attached to the hernial sac by stitching with interrupted sutures, which were laid on the upper surface of the ring, on its outer surface, were drawn from the bottom of the ring along its lower surface, inserted into its thickness and drawn from the inside to the outside with a surgical needle. Then the hernial sac was dissected along the intended line in the area of its dome and by pulling the free ends of the threads previously fixed to the hernial sac and guided through the gauze ring, the walls of the hernial sac were stretched and laid on the inner and upper part of the gauze ring. Then, the roots of the spinal cord were extracted from the fusion with the inner walls of the hernial sac (meningoradiculolysis) and the plastic of the hernial portal with local tissues. At the same time, reliable fixation of the walls of the hernial sac on the gauze ring facilitated these surgical procedures. Then, the sutures from the walls of the hernial sac and the gauze ring were removed, the excess tissue of the hernial sac was excised and the wound was sutured according to the standard procedure.

Claims (2)

1. A method of surgical treatment for spinal hernias, including dissection of the hernial sac, fixation of its edges, isolation of the roots of the spinal cord and plastic hernia gate, characterized in that before dissection of the hernial sac it is surrounded by an elastic ring, the cross-sectional diameter of which is at least two-thirds of the height hernial sac, outline a horseshoe-shaped line of the future incision and at its outer edge attach at least four threads to the wall of the hernial sac with interrupted sutures, each thread is laid on the top the surface of the ring, on its outer surface, is carried out from below the ring along its lower surface, inserted into its thickness and carried out from the inside to the outside, the hernia sac is cut along the intended line and the free ends of the threads are pulled, while stretching the walls of the hernia sac on the ring surface , then carry out the allocation of roots and plastic hernial gates. 2. A method of surgical treatment for spinal hernias according to claim 1, characterized in that a gauze or polypropylene ring is used as the elastic ring.

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