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 ventral dynamic correction. After performing the anaesthesia with the patient lying on his 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. 12th rib is palpated. Thoracotomic incision of the skin and subcutaneous fat is performed to visualize 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 of the planned fixation. Anterolateral part of the vertebral bodies is skeletonised. Coagulation and dissection with preservation of collateral circulation between segmental arteries in intervertebral foramen. Spinal motion segments are mobilized by performing a deformed thoracic spine on each disc using a scalpel to dissect a fibrous ring of 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. 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 with a tap in each vertebra, and two fixing screws with blunt ends passing through both cortical layers are screwed 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 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 inserted into the screw heads, starting from the upper thoracic vertebra plate, and continued along one lateral side of the plates to the lower thoracic vertebra plate, wherein the spinal cord is corrected by stretching the flexible cord along the vertebrae, starting from the upper vertebra plate in turn, wherein degree of tension is controlled, and after correction and elimination of spinal deformity is achieved, flexible cord is fixed by tightening it in turn with locking screws in open heads of fixing screws of thoracic spine. Then the same flexible cord is introduced starting from the plate of the lower thoracic spine, and is continued along the opposite lateral side to the plate of the upper thoracic spine. 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. Degree of tension is controlled and after achieving the correction and elimination of the spinal deformation, the flexible cord is fixed by tightening it alternately with locking screws in the open heads of the fixing screws in the upper part of the thoracic spine, and 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 the elimination of the patient's spinal deformation. Ends of flexible cord are cut, leaving 2.0-2.4 cm at both ends. Pleural drainage is installed. Pleural cavity is irrigated with normal saline. Lungs are inflated, aero- and haemostasis is performed, 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 by fixing and passing the cord.
3 cl, 4 dwg, 3 ex
