FIELD: medicine; traumatology; orthopaedics.
SUBSTANCE: invention can be used for surgical mobilization of the main arc of scoliotic deformity of the thoracic spine during ventral dynamic correction. Before performing surgical treatment, spatial visualization of the affected spine is carried out and the condition of the surrounding soft tissues, vascular and nervous structures is assessed. After performing anaesthesia using intraoperative fluoroscopy with the patient positioned on his side with the convex side of the spinal deformity upward, vertebral levels are established to determine access in the anteroposterior and lateral positions. Next, the 12th rib is palpated under image intensifier control. A thoracotomy incision of the skin and subcutaneous fat is performed with visualization of the thoracic region of the affected spine of the patient, extending the incision in the direction of the external oblique abdominal muscle by 3-5 cm in front with dissection of the parietal pleura along the entire length of the planned fixation, skeletonizing the anterolateral part of the vertebral bodies, identifying segmental vessels are coagulated and dissected while maintaining collateral circulation between the segmental arteries in the intervertebral foramen. After access to the lateral surfaces of the vertebral bodies of the deformed thoracic spine and intervertebral discs, the spinal motion segments are mobilized by dissecting the fibrous ring of the disc for 1-1.5 cm on each disc of the deformed thoracic spine using a scalpel, followed by partial removal of the nucleus pulposus on the convex side of the spinal deformity. Plates are placed on the surface of each vertebra, each of which has a rectangular or square shape, which is selected taking into account the shape of the vertebra, so that the edges of the plate do not extend beyond the surface of the vertebra. Moreover, the plate has spikes along one diagonal at the end sections directed towards the vertebrae, and along the other diagonal there are two through holes at the end sections located on opposite sides of the plate for fixing screws. The superior and inferior endplates, the anterior margin of the body, and the anterior margin of the spinal canal of each vertebra are identified. A thread is cut in each vertebra with a tap and two fixing screws with blunt ends, passing through both cortical layers, are screwed into the vertebra through the through holes in the plate through the guide. The screws are screwed in so that they intersect in the vertebral body along the longitudinal axis, and the ends of the screws extend outside the vertebra. Mono-axial fixing screws with an open head of the tuning fork type with an internal thread are used, in which the fixing type head is integral with the cylindrical part and with the outer screw surface. Flexible cords are inserted into the screw heads, with one flexible cord running along one side of the plates and another flexible cord running along the opposite side of the plates. From the seventh thoracic vertebra and above, one flexible cord and one fixing screw are used, then the spine is corrected by tensioning the flexible cords along the vertebrae. After achieving the appropriate correction and eliminating the spinal deformity, the flexible cords are fixed by tightening them alternately with locking screws in the open heads of the fixing screws, and after the final fixation of the locking screws in the heads of the fixing screws, fluorovisualization of the spine is performed in the anteroposterior and lateral projections to confirm the elimination of the patient’s spinal deformity. The ends of the flexible cord are cut, leaving at least 2 cm at both ends, and pleural drainage is installed during thoracotomy. The pleural cavity is irrigated with saline solution, the lungs are inflated under visual control, aero- and haemostasis are performed, and the wound is sutured in layers. In this case, the cord is made of polyethylene terephthalate, and the blades with spikes, monoaxial fixing screws and locking screws are made of titanium alloy.
EFFECT: method ensures restoration of frontal and sagittal balance and mobility of spinal motion segments due to the peculiarities of its implementation.
3 cl, 4 dwg, 3 ex
