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 lumbar spine with ventral dynamic correction. With the patient lying on his side, the convex side of the spinal deformity is upwards, vertebral levels are set to determine the approach in the anterior-posterior and lateral positions. 12th rib is palpated. Thoracolumbar incision of skin and subcutaneous fat is performed with visualization of lumbar spine of patient with extension of incision in direction of external oblique muscle of abdomen by 3-5 cm from front with dissection of parietal pleura along whole length of planned fixation. Anterolateral part of the vertebral bodies is skeletonised. Segmental vessels are identified. Coagulation and dissection with preservation of collateral blood circulation between segmental arteries in intervertebral foramen, with expansion of access caudally in direction of muscle fibres of external oblique muscle of abdomen with mobilization of peritoneum from square lumbar and iliac muscles, separation of the peritoneum from the posterior and lateral abdominal wall and the 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. To lateral surfaces of vertebral bodies of deformed lumbar spine and intervertebral discs. Spinal motion segments are mobilized by making a deformed lumbar spine on each disc for 1-1.5 cm, followed by removal of a nucleus pulposus on the convex side of the spinal deformity. Plates are placed on the surface of each vertebra 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. Thread is cut with a tap in each vertebra, and two fixing screws with blunt ends passing through both cortical layers are screwed through the through holes in the plate so that they cross in the vertebral body along the longitudinal axis, and the screw ends protrude outside the vertebra. Monoaxial fixing screws with an open head of a tuning fork with an internal thread are used, in which the fixing type head is an integral part with a cylindrical part and with an external screw surface. Flexible cord is introduced into screw heads starting from a plate of the upper lumbar spine and extending along one lateral side of the plates to the plate of the lower lumbar spine. Spinal correction is performed by stretching the flexible cord along the vertebrae starting from the upper vertebra plate in turn. After achieving correction and elimination of spinal deformation, flexible cord is fixed by tightening it in turn with locking screws in open heads of fixing screws of lumbar spine. Same flexible cord is continued to be inserted starting from the lower lumbar spine plate and continued along the opposite lateral side to the upper lumbar spine plate. Spine is corrected by stretching the flexible cord along the vertebrae, starting from the plate of the lower vertebra, alternately from the opposite sides of the plates. After achieving correction and elimination of spinal deformation, flexible cord is fixed by tightening it in turn with locking screws in open heads of fixing screws in upper part of lumbar spine. After final fixation of locking screws in heads of fixing screws, ends of flexible cord are cut, leaving 2.0-2.4 cm on both ends. Pleural drainage is installed. Pleural cavity is irrigated with normal saline, the lungs are inflated, the wound is closed in layers.
EFFECT: method provides correction of the main arch of scoliotic deformation of the spine with ventral dynamic correction, anatomical restoration of frontal and sagittal balance with mobility of spinal motion segments, performing adequate derotation of the scoliotic arch of the deformed spine due to the peculiarities of fixation and passing of the cord.
3 cl, 4 dwg, 3 ex
