FIELD: medicine.
SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for a method of surgical correction of the main arch of scoliotic deformity of the lumbar spine using a polymer cage with ventral dynamic stabilization. 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. Twelfth 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, and the segmental vessels are identified. Coagulation and dissection with preservation of collateral 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 peritoneum from posterior and lateral abdominal wall and diaphragm with subsequent transection of 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 by performing a deformed lumbar spine on each disc and dissection of fibrous ring of disc for 1–1.5 cm with subsequent removal of pulpous nucleus on convex side of spinal deformity. Polymer interbody cage is installed in formed defects of intervertebral discs, 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, which is selected 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 with a tap and two fixing screws passing through both cortical layers are screwed into the vertebra through the through holes in the plate, wherein the screws are screwed 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, in which the fixing type head is an integral part with a cylindrical part and with an external screw surface. 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. Spinal correction is performed by stretching flexible cords. After correction and elimination of spinal deformity are achieved, flexible cords are fixed and tightened in turn with locking screws. Ends of flexible cord are cut, leaving 2–2.4 cm on both ends. Pleural drainage is installed during thoracotomy, the pleural cavity is irrigated with normal saline, the lungs are inflated under visual control, 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, 5 ex
