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 thoracolumbar spine with ventral dynamic correction. With the patient lying on the side with the convex side of the spinal deformation upwards, 12th rib is palpated, a thoracolumbar incision of the skin and subcutaneous fat is performed with visualization of the thoracolumbar portion of the involved 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. 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 muscle of loin 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. Spinal motion segments are mobilized by performing on each disc of a deformed lumbar spine using a scalpel to dissect a fibrous ring of disc for 1-1.5 cm, followed by partial removal of a pulp nucleus on the convex side of 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 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 inserted into the screw heads starting from the upper thoracolumbar vertebra plate and extending along one lateral side of the plates to the lower thoracolumbar vertebra plate. Spinal correction is performed by stretching the flexible cord along the vertebrae starting from the upper vertebra plate in turn. After the correction is achieved, the flexible cord is fixed by tightening it in turn with locking screws in the open heads of the fixing screws of the thoracolumbar spine. Same flexible cord is continued to be inserted starting from the plate of the lower thoracolumbar spine and continuing along the opposite lateral side to the plate of the upper thoracolumbar spine. Spinal correction is performed by stretching the flexible cord along the vertebrae, starting from the plate of the lower vertebra, alternately from the opposite side 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 thoracolumbar spine. After final fixation, the ends of the flexible cord are cut, leaving 2-2.5 cm on both ends. Pleural drainage is installed, the pleural cavity is irrigated with normal saline, the 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, adequate derotation of the scoliotic arch of the deformed spine ensured by the peculiarities of the cord fixation and insertion.
3 cl, 4 dwg, 3 ex
