A METHOD FOR SURGICAL VENTRAL DYNAMIC CORRECTION OF SPINAL DEFORMITIES IN ADULT PATIENTS AND CHILDREN AND A DEVICE FOR IMPLEMENTING A METHOD FOR SURGICAL VENTRAL DYNAMIC CORRECTION OF SPINAL DEFORMITIES IN ADULT PATIENTS AND CHILDREN Russian patent published in 2023 - IPC A61B17/00 A61B17/70 

FIELD: medicine.

SUBSTANCE: inventions group relates to medicine, in particular to orthopedics and traumatology, and may be used for surgical ventral dynamic correction of spinal deformities in adult patients and children. The design consists of plates and fixing screws with placement of a flexible cord in the heads of the screws, which is led along the vertebrae and fixed in the heads of fixing screws with locking screws. Monoaxial fixation screws with an open tunnel head with internal thread are used, in which the head of the fixation screw is one piece with the cylindrical part and the external screw surface. Rectangular or square shaped plates are placed on the convex side of the deformity on the surface of each vertebra selected to suit the shape of the vertebra so that the edges of the plate do not extend beyond the vertebra surface. On one diagonal of the plate there are spikes on the end sections facing the vertebrae, and on the other diagonal there are two through holes for fixation screws. The upper and lower closure plates, the anterior edge of the body and the anterior edge of the vertebral canal of each vertebra are identified. A thread is cut in each vertebra and two fixation screws are screwed through the holes in the plate via a guide into the vertebra passing through both cortical layers so that they cross over in the vertebral body along the longitudinal axis and the ends of the screws extend outward from the vertebra. Flexible cords are inserted in the screw heads. One flexible cord runs along one side of the plates and the other runs along the opposite side of the plates. From the seventh thoracic vertebra and above, one flexible cord and one fixation screw are used. The spine is corrected by tensioning the flexible cords along the vertebrae and the degree of tension is controlled. After achieving proper correction results and correcting the spinal deformity, the flexible cords are fixed via alternative tightening with locking screws in the open heads of the fixation screws. The spatial visualisation of the affected spine is determined by multislice spiral computed tomography prior to surgical treatment. The surrounding soft tissue, vascular and nerve structures are evaluated using MRI. Vertebral levels are set for anteroposterior and lateral access after anaesthesia using intraoperative fluoroscopy with the patient in the lateral position with the convex side of the spinal deformity facing upwards. Palpation of the 12th rib is performed under EOC control. A thoracolumbar skin and subcutaneous fat incision and visualization of the lumbar aspect of the affected spine are performed with the incision extended in the direction of the external oblique abdominal muscle by 3-5 cm anteriorly with dissection of the parietal pleura along the entire length of the planned fixation over the vertebral bodies and discs. The lungs are taken off to the side. The anterolateral part of the vertebral bodies is skeletonised. The segmental vessels are identified. Coagulation and dissection preserving the collateral circulation between the segmental arteries in the intervertebral foramen are performed. For retroperitoneal access, the incision is extended caudally towards the muscle fibres of the external oblique abdominal muscles mobilising peritoneal from the quadriceps lumbar and iliac muscles and identifying and anteromedially mobilising the ureter in the posterior peritoneum. For retroperitoneal access, the incision is extended caudally towards the muscle fibres of the external oblique abdominal muscles mobilising peritoneal from the quadriceps lumbar and iliac muscles and identifying and anteromedially mobilising the ureter in the posterior peritoneum. The peritoneum is separated from the posterior and lateral abdominal wall and diaphragm, the internal oblique and transverse muscles are crosses, and the diaphragm is dissected to within 1 cm of its attachment excluding denervation of the descending diaphragmatic nerve. The lumbar muscle is withdrawn posteriorly exposing the segmental vessels located at the midpoint between the lumbar intervals, which are ligated to visualize and provide access for the lateral edge of the lumbar vertebral bodies and discs. Perform fluoroscopy of the spine in the anteroposterior and lateral projections after final fixation of the retaining screws in the fixation screws heads in order to confirm that the patient's spinal deformity has been corrected. Trim the ends of the flexible cord, leaving at least 2 cm at both ends. Place a pleural drain fitting over the diaphragm suture. The pleural cavity is irrigated with physiological solution, the lungs are inflated, and the wound is sutured layer by layer. The ends of the fixation screws are blunted to avoid damaging the organ and/or tissue. The process device contains square or rectangular shaped plates for attachment to vertebrae. The shape of the plate is selected to suit the vertebra so that the edges of the plate do not extend beyond the vertebra and the surface facing the vertebra matches the vertebra surface. On one diagonal of each plate there are spikes on the end sections for insertion into the vertebrae, and on the other side there are two through holes for open-headed screws with screw threads, in which either one flexible cord running along one side of the plates or two flexible cords, one running along one side of the plates and the other running along the opposite side of the plates are placed secured with locking screws.

EFFECT: invention provides for increasing the spinal deformities correction efficiency by reducing the surgery duration, blood loss and recovery period.

4 cl, 12 dwg