FIELD: medicine.
SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for surgical correction of the main arch of scoliotic deformation of the thoracic spine. With the patient lying on his/her side, the convex side of the spinal deformity is upwards, the vertebral levels are set to determine the approach in the anteroposterior and lateral positions. Under the image intensifier, 12th rib is palpated, a thoracotomic incision of the skin and subcutaneous fat is performed with visualization of the patient's thoracic spine with the incision extended 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 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. After access to lateral surfaces of vertebral bodies of the deformed thoracic spine and intervertebral discs, mobilization of spinal motion segments is performed by dissecting a fibrous ring of the disc on each disc of the deformed thoracic spine for 1-1.5 cm followed by removal of the nucleus pulposus on the convex side of the spinal deformation, a polymer interbody cage is installed in the formed defects of the intervertebral discs, which is made from polyaryletherketone selected from the group of polyetherketone, or polyetheretherketone, or polyetherketoneketone, or polyetheretherketoneketone, or polyetherketoneetherketoneketone. On the surface of each vertebra, plates are installed, each of which has a rectangular or square shape, so that the edges of the plate do not extend beyond the surface of the vertebra. Plate has spikes 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 located on opposite sides of the plate for fixing screws. Upper and lower end plates, an anterior edge of the body and an anterior edge of the spinal canal of each vertebra are identified. Thread is cut in each vertebra, and two fixing screws with blunt ends passing through both cortical layers are screwed through through holes in the plate through the guide into the vertebra so that they cross 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 flexible cord passes along one lateral side of the plates, and the other flexible cord passes along the opposite lateral 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. After adequate correction and elimination of spinal deformation, flexible cords are fixed by tightening them in turn with locking screws in open heads of fixing screws. After the final fixation of the retaining screws in the heads of the fixing screws, the spine is imaged in anteroposterior and lateral projections to confirm elimination of the patient’s spinal deformity. Ends of flexible cord are cut off, leaving 2.0-2.4 cm on both ends, pleural drainage is installed in thoracotomy, pleural cavity is irrigated with normal saline, lungs are inflated under visual control, aero- and haemostasis is performed. Wound is closed in layers. Flexible cord is made from polyethylene terephthalate, and the 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, adequate derotation of the scoliotic arch of the deformed spine, achieving the maximum cosmetic effect and possibility of treating the patients with rigid deformities, and early social rehabilitation of the patient with simultaneous improvement of the quality of life due to the fixation features.
3 cl, 4 dwg, 5 ex
