FIELD: medicine; traumatology; orthopedics.
SUBSTANCE: invention can be used for surgical mobilization of the main arch of scoliotic deformity of the thoracolumbar spine during ventral dynamic correction. Before performing the surgical treatment, a spatial imaging of the involved thoracolumbar spine is determined, state of surrounding soft tissues, vascular and nerve structures is assessed. After performing the anesthesia with the use of intraoperative fluoroscopy with the patient lying on his/her side vertebral levels are set with the convex side of the spinal deformation upwards to determine the approach in the anteroposterior and lateral positions. 12th rib is palpated. Thoracolumbar incision of skin and subcutaneous fat is performed with imaging of patient's thoracolumbar spine with an extension of the incision in the direction of the external oblique muscle of abdomen by 3–5 cm from the front with dissection of the parietal pleura along the entire length of the planned fixation. Anterolateral part of the vertebral bodies is skeletonised. Segmental vessels are identified. Coagulation and dissection with preservation of collateral circulation between segmental arteries in intervertebral foramen, with extension of access caudally in direction of muscle fibers of external oblique muscle of abdomen with mobilization of peritoneum from square muscle of lower back and iliac muscle, by separating the peritoneum from the posterior and lateral abdominal wall and diaphragm, followed by transection of the internal oblique and transverse muscles using electrocoagulation. Diaphragm is dissected at distance of 0.8–1 cm from its attachment point. After the lateral surfaces of the vertebral bodies of the deformed lumbar spine and the intervertebral discs are approached, the spinal motion segments are mobilized performing on each disc of a deformed lumbar spine using a scalpel of dissection of a fibrous ring of disc for 1–1.5 cm with subsequent partial removal of the nucleus pulposus on the convex side of the spinal deformity. On the surface of each vertebra, plates are installed, each of which has a rectangular or square shape, which is selected so that the edges of the plate do not extend beyond the surface of the vertebra. Plate has spines on one diagonal on the end sections directed towards the vertebrae, and on the other diagonal there are two through holes on the end sections for fixing screws. Identifying the upper and lower end plates, the front edge of the body and the front edge of the spinal canal of each vertebra, thread is cut in each vertebra, and two fixing screws with blunt ends passing through both cortical layers are screwed in through the through holes in the plate through the guide into the vertebra. Screws are screwed in so that they intersect in the vertebral body along the longitudinal axis, and the ends of the screws protrude outside the vertebra. Monoaxial fixing screws with an open head of a tuning fork with an internal thread are used. Flexible cords are inserted into screw heads. One cord passes along one side of the plates, and the other flexible cord passes along the opposite side of the plates. One flexible cord and one fixing screw are used from the seventh thoracic vertebra and higher. Spinal correction is performed by stretching flexible cords along vertebrae and fixing them with locking screws in open heads of fixing screws. Spinal fluorimaging is performed in anteroposterior and lateral projections. Ends of flexible cord are cut, leaving 2–2.5 cm on both ends. Pleural drainage is installed, a pleural cavity is irrigated with normal saline, the lungs are inflated, and aero- and hemostasis is performed. Wound is closed in layers. Flexible cord is made from polyethylene terephthalate, and the studded plates, monoaxial fixing screws and locking screws are made from titanium alloy.
EFFECT: method provides reliable anatomical restoration of frontal and sagittal balance, mobility of spinal motion segments, achieving maximum cosmetic effect, possibility of treating patients with rigid deformations, as well as early rehabilitation and improved quality of life due to adequate derotation of the scoliotic arch of the deformed spine.
3 cl, 4 dwg, 3 ex
