RU2576800C1 - Method of correcting positions of displaced articular processes of cervical vertebras in bilateral dislocations - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to spinal surgery and can be used for correction of positions of displaced articular processes of cervical vertebras in bilateral dislocation. Method comprises using a device for correcting shift position of articular processes of cervical vertebrae, comprising a composite body of a head and a cylindrical base, upper and lower support platform having spiky projections on end surfaces, upper bearing pad is upper end head, lower bearing pad is integral with a vertically mounted, and from centre threaded rod having four longitudinal grooves and a bore at its free end on side of supporting platform, coaxial grooves are plotted longitudinal notches on rod set nozzle having a centered bottom through hole fitted with protrusion at longitudinal grooves of rod, and knurled, pine projection, on a vertical threaded rod, inside cup, mounted nut having a radial through-holes, a vertical rod mounted with a nozzle and nut is located in a stepped cylindrical cavity, on outer surface of bottom substrate and inner surface of nozzle is threaded, providing a compound of cylindrical base and cup is flush on outer surface of cup and cylindrical base from bottom nozzle, at a height greater than height of nut, a longitudinal cut surface half diameter holds window in upper part of cylindrical base is made of T-shaped protrusion protruding side parts of which are guides for grooves mating mold arranged in lower portion of head having a top of T-shaped projection, identical projection of cylindrical base stem and base of composite body coupled threaded rod having smooth ends, diameter of which is less than diameter of middle of threaded portion of rod end of rod is equipped with a blind hole cap screws, placed in a grommet having a thread on outer side surface and a slot at end of rod to sleeve is installed in through hole of composite body, perpendicular to its longitudinal axis, on basis of composite body formed blind holes for mounting holder tool. Device is placed in resultant “niche”, head of composite body is output to position corresponding to degree of displacement dislocated vertebrae, with a socket wrench installed in hole at end of threaded rod, wherein inclination of head of patient is carried forward by an angle of at least 10°, distraction of lesion produced by rotating nut on a vertical threaded rod, integrally formed with bottom support platform from radial slots in nut, device holding tool for holding, mounted in holes in side surfaces of body, carried reposition, for which rotation of threaded rod mechanical key in opposite direction output displaced vertebra to its physiological position.

EFFECT: method enables to reduce trauma and fully eliminate offset.

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Description

The invention relates to medicine, in particular to spinal surgery, and can be used in the treatment of fractures-dislocations of the cervical spine.

It is known that dislocations and fracture-dislocations in the cervical spine are a common type of damage and are caused by a violation of the normal relationship between the articular processes of two adjacent vertebrae. A complete dislocation, or some types of subluxations, are most often accompanied by damage to the ligamentous apparatus, capsule of the synovial joints, rupture of the fibrous ring of the intervertebral disc, fracture of the body and arches of the vertebra, its articular processes. Depending on the mechanism of injury, dislocations can be unilateral and bilateral, mating, etc.

The basis for the treatment of dislocations and fractures of the cervical vertebrae is the timely elimination of the conflict between the contents of the spinal canal and the damaged vertebra, i.e. removal of the posterior-inferior articular process of the overlying vertebra dislocated anteriorly to the apex of the anteroposterior articular process of the underlying vertebra, its posterior movement and lowering. At the same time, these manipulations, due to the aforementioned concomitant disorders, may not be feasible and very time-consuming, as well as cause additional neurological and vascular complications due to overstretching of the vertebral artery, trauma to the spinal cord and its roots, insertion of bone fragments and disc into the vertebral channel.

Known telescopic vertebral system TeCorp [1], which allows to replace the body of the cervical vertebra and restore the intervertebral distance, as well as provide lordosis from 0 to 7 ° using modulated end plates. This system is not adapted and is not used to reposition dislocations of the vertebrae, since with its help only distraction and the creation of the corresponding lordosis are carried out, there is no reposition mechanism.

Closest to the proposed device is a universal prosthesis of the vertebral body for the treatment of fractures and dislocations and stabilization of the cervical spine [2], designed to eliminate dislocation and fracture-dislocation of the vertebra by separating the articular processes of the dislocated and underlying vertebrae and returning the displaced vertebra to its physiological position . However, with unilateral dislocations, during spinal distraction, both articular processes of the overlying vertebra rise, i.e. trauma to the intact vertebra occurs, and when it is fractured, during the displacement of the body of the dislocated vertebra and installation to the articular sites, the process can move to the spinal canal.

Existing methods for reposition of dislocations of the cervical vertebrae are currently based on the principle of leverage. So, the method according to Rüsch-Gueter [3] includes: 1) traction over the head; 2) with a unilateral dislocation perform lateral flexion in the direction opposite to the dislocation, with the axis of inclination at the level of dislocation; and with bilateral dislocation - one side is conditionally taken as “healthy”; 3) rotation of the head and neck towards dislocation. During the operation, the torso is fixed to the table with straps, or a special belt, on the patient’s head, a Glisson loop is fixed, the straps of which are tied to the lower back of the surgeon standing at the head of the patient. An assistant is standing on the side. Then carry out the above methods. However, this requires additional devices and an assistant, and, most importantly, there is no visual control and dosed distraction with the dislocated vertebra moving posteriorly, which does not always allow us to obtain the desired result, and various complications may even develop.

A known method of treating injuries of the cervical spine [4], including discectomy and spinal fusion with a plate fixed in a state of deformation on adjacent vertebral bodies, where the reduction of the displaced vertebra is carried out with a compression (reduction) screw, and the plate is used as a support. The disadvantages of this method include the impossibility of repositioning with coupled and unilateral dislocations, since the anatomical relationships of the articular processes are not taken into account, the element of distraction is completely absent.

The essence of the claimed invention consists in the combination of essential features sufficient to achieve the desired technical result, which allows you to fully eliminate the displacement of the posterior-lower articular process of the overlying vertebra dislocated anteriorly.

The technical result consists in increasing the efficiency of the reduction of bilateral dislocations and fracture-dislocations of the cervical vertebrae, reducing the complexity and trauma of manipulations, and the possibility of preventing complications.

The essence of the method for correcting the positions of displaced articular processes of the cervical vertebrae, with their bilateral dislocation, includes placing the patient on the table in a supine position, with a roller placed under the shoulders, under general anesthesia, standard access to the anterior structures of the cervical spine, resection of the anterior part of the vertebral body located under his dislocated, or broken, body, with the removal of the above- and underlying discs and bone fragments. A device for correcting the positions of the displaced articular processes of the cervical vertebrae is used, comprising a composite body of a head and a cylindrical base, upper and lower supporting platforms having pointed protrusions on the end surfaces. The upper supporting platform is the upper end of the head, the lower supporting platform is made at the same time installed vertically, and in the center, by a threaded rod having four longitudinal grooves and a groove at the free end. On the lateral surface of the supporting platform, aligned with the grooves, longitudinal notches are applied. A glass is installed on the rod, having a through hole in the center of the bottom, equipped with a protrusion under the longitudinal grooves of the rod, and a notch, a pine protrusion. On a vertical threaded rod, inside the glass, a nut is installed having radial through holes. A vertical rod with a glass and nut mounted on it is located in a stepped, cylindrical cavity. A thread is made on the outer surface of the lower part of the base and the inner surface of the glass, which makes the connection between the cylindrical base and the glass flush. A window is made along the outer surface of the glass and the cylindrical base, from the bottom of the glass, to a height exceeding the height of the nut, by longitudinal cutting of the surface by half the diameter. A T-shaped protrusion is made in the upper part of the cylindrical base, the protruding lateral parts of which are guides for mates of a reciprocal shape located in the lower part of the head having a T-shaped protrusion in the upper part that is identical to the protrusion of the cylindrical base. The head and base of the composite housing are connected by a threaded rod having smooth ends whose diameter is less than the diameter of the middle threaded part of the rod. The end of the rod is equipped with a blind hole for the socket wrench, located in the bushing, having a thread on the outer side surface and a slot at the end. A rod with a sleeve is installed in the through hole of the composite housing perpendicular to its longitudinal axis. On the basis of the composite housing, blind holes are made for mounting the holding tool. The device is placed in the formed "niche", and the head of the composite body is brought into a position corresponding to the degree of displacement of the dislocated vertebra using a socket wrench installed in the hole at the end of the threaded rod. In this case, the patient's head is tilted forward by an angle of at least 10 °. Distraction of the lesion area is carried out by rotating the nut along a vertical threaded rod, made integral with the lower supporting platform. Using radial holes on the nut housing, the device is held by a holding tool installed in holes on the side surfaces of the housing. The reposition is carried out, for which by rotating the threaded rod with a socket wrench in the opposite direction, the displaced vertebra is brought to its physiological position.

Bringing the head of the composite body of the device to a position corresponding to the degree of displacement of the dislocated vertebra provides the ability to install the device.

Tilting the patient’s head forward by an angle of at least 10 ° with bilateral dislocation of the cervical vertebrae allows one to raise the anterior articular processes displaced anteriorly from the upper vertebral notch, than the mated dislocation translates into a dislocation with a high standing of the articular processes, with a slight dilution.

During distraction of the lesion area by rotation of the nut along a threaded vertical rod, made integral with the lower supporting platform, using radial holes on the nut body, the introduction of pointed protrusions on the contact pads of the device, thereby securing the device in the created niche.

Holding the device with a holding tool installed in the holes on the side surfaces of the body during the distraction of the lesion area helps prevent distortions and displacements in the position of the device.

Control over manipulations ensures the correctness of their implementation.

The design of the device is illustrated by illustrations, where:

In FIG. 1 shows a front view of the device;

In FIG. 2 is a side view;

In FIG. 3 is a top view;

In FIG. 4 - section aa.

A device for correcting the positions of displaced articular processes of the cervical vertebrae contains a support platform 1, the end surface of which is decorated with pointed protrusions, made integral with the threaded rod 2 installed vertically and in the center, having four longitudinal grooves 3 and a groove 4 at the free end. On the lateral surface of the support platform 1, coaxially with the grooves 3, longitudinal notches are applied 5. On the rod 2 there is a glass 6 having a through hole 7 in the center of the bottom, equipped with a protrusion 8 for the longitudinal grooves 3 of the rod 2, and a notch 9, a pine protrusion 8. On a vertical threaded rod 2, inside the cup 6, a nut 10 is installed having radial through holes 11. The rod 2 with the cup 6 mounted on it and the nut 10 is located in a stepped, cylindrical cavity 12, made along the axis and open with a large diameter down to the cylindrical base 13 of the composite housing 14. On the outer surface of the lower part of the base 13 and the inner surface of the glass 6, a thread 15 is made, ensuring the connection of the parts 13 and 6 flush. On the outer surface of the cup 6 and the base 13, from the bottom of the cup 6, to a height exceeding the height of the nut 10, a longitudinal section of the surface by half the diameter is made window 16. The upper end of the composite housing 14 is equipped with a head 17 mounted on the base 13, in the upper part which has a T-shaped protrusion 18. The protruding lateral parts 19 of the protrusion 18 are guides for mates of the reciprocal shape located in the lower part of the head 17 having in the upper part a T-shaped protrusion 20 identical to the protrusion 18 of the base 13. The head 17 and the base 13 the main body 14 are connected by a threaded rod 21 having smooth ends, the diameter of which is smaller than the diameter of the middle threaded part of the rod 21, and installed in diametrically located holes of the composite housing 14. The end 22 of the rod 21 is equipped with a blind hole 23 for the socket wrench, is located in the passage bush 24, having a thread on the outer side surface, and a slot 25 at the end. The rod 21 with the sleeve 24 is installed in the through hole of the composite housing 14 perpendicular to its longitudinal axis, while the thread for the threaded sleeve 24 is cut in the hole only in the part belonging to the base 13, and the thread for the middle part of the threaded rod 21 is on the part belonging to the head 17 of the composite body 14. The upper end of the head 17 is the upper supporting platform of the device and has pointed protrusions identical to the protrusions on the supporting platform 1. The lateral protrusions 26 of the T-shaped protrusion 20 of the head 17 are guides for Of the reciprocal form, located in the lower part of the end plate 27, on the inner horizontal surface of which, above the grooves for the side protrusions 26, a rectangular recess 28 is made. The upper surface of the plate 27 has a horizontal section 29, equipped with notches, and sections 30, beveled at different angles and 31. Under the horizontal section 29 of the lining 27, along the grooves under the guide protrusions 26, a blind, threaded hole 32 is placed for installing the holding tool. On the basis of 13, the composite housing 14 is made blind holes 33 for installing a holding tool.

Device application

Under general anesthesia, in the patient’s position on the back with a roller placed under the shoulders and an inserted gastric tube, the front structures of the cervical spine are opened with standard access. After detecting the area of damage, using the cutters, the front parts of the vertebral body located under the displaced vertebra are resected. The anterior sections of the spinal canal are revised, the upper and lower discs and bone fragments, if any, are removed.

A device for correcting the positions of the displaced articular processes of the cervical vertebrae is assembled into the resulting “niche”, assembled without using the end plate 27. In this case, the head 17 of the composite body 14, using the socket wrench installed in the hole 23, at the end 22 of the threaded rod 21 is brought into position corresponding to the degree of displacement of the dislocated vertebra. Distraction of the affected area is performed, for which by rotating the nut 10 through the window 16, using a special tool (not shown), alternately introducing the working end into the radial holes 11, the composite case 14 is lifted relative to the lower bearing pad 2. When the nut 10 is rotated in a cylindrical cavity 12 of larger diameter, open to the bottom of the cylindrical base 13, the step formed by the transition to the cavity of a smaller diameter prevents the nut 10 from moving along the rod 2. The glass 6, fastened by a protrusion 8 with a longitudinal the azim 3 of the threaded rod 2, moves upward together with the composite body 14. In this case, the pointed protrusions located on the upper end of the head 17, which is the upper supporting platform, and similar protrusions on the lower supporting platform 1, are embedded in healthy, pre-processed vertebral bodies, reliably they hold the device in a “niche” and carry out distraction until the translational movement of the housing 14 is completely blocked along the vertical, threaded rod 2. This ensures the separation of the articulated articular process Cove vertebrae. The dislocated articular process is returned to its physiological position by reverse rotation of the threaded rod 21 with a socket wrench installed in the blind hole 23. Rotating, the shaft 21 having smooth ends installed in diametrically located holes of the composite housing 14 interacts with the thread on the part of the hole belonging to the head 17 of the composite housing 14 carries the head 14 along in the forward and reverse direction. If necessary, the device can be removed from the niche of the spine by pulling on the holding device - the threaded connection will prevent slipping. Layered seams.

Thus, using the proposed technical solution, carry out both transverse and longitudinal, metered movement of the vertebra.

Information sources

1. NEUROMED Product Catalog 09/10, p. 15.

2. RF patent No. 2482818, A61F 2/44, BI No. 15, 2013

3. N.E. Polishchuk et al. “Damage to the spine and spinal cord”, “Book Plus”, Kiev, 2011, p. 91-92.

4. RF patent No. 2434598, A61B 17/56, BI No. 33, 2011

Claims (1)

A method for correcting the positions of displaced articular processes of the cervical vertebrae during their bilateral dislocation, including placing the patient on the table in the supine position with a roller placed under the shoulders under general anesthesia, standard access to the anterior structures of the cervical spine, resection of the anterior part of the vertebral body under his dislocated or broken body, with the removal of the upper and lower discs and bone fragments, characterized in that they use a device for correcting the positions of displaced articular processes cervical vertebrae, comprising a composite body of a head and a cylindrical base, upper and lower supporting platforms having pointed protrusions on the end surfaces, the upper supporting platform is the upper end of the head, the lower supporting platform is integral with the threaded rod installed vertically, and in the center, having four longitudinal grooves and a groove at the free end, on the side surface of the support platform, coaxially with the grooves, longitudinal notches are applied, a glass having a center bottom is installed on the rod a through hole equipped with a protrusion under the longitudinal grooves of the rod and a notch, a pine protrusion, on a vertical threaded rod, inside the glass, a nut is installed having radial through holes, a vertical shaft with a glass and nut mounted on it is located in a stepped, cylindrical cavity, along the outer the surface of the lower part of the base and the inner surface of the glass is made thread, providing a connection of the cylindrical base and the glass flush on the outer surface of the glass and cylindrical of the base, from the bottom of the glass, to a height exceeding the height of the nut, by a longitudinal cut of the surface by half the diameter, a window is made, a T-shaped protrusion is made in the upper part of the cylindrical base, the protruding lateral parts of which are guides for the grooves of the reciprocal shape located in the lower part a head having a T-shaped protrusion at the top that is identical to the protrusion of a cylindrical base, the head and base of the composite housing are connected by a threaded rod having smooth ends whose diameter is less than the diameter the middle threaded part of the rod, the end of the rod is equipped with a blind hole for the socket wrench, is located in the bushing having threads on the outer side surface and the slot at the end, the rod with the sleeve is installed in the through hole of the composite housing perpendicular to its longitudinal axis, blind are made on the basis of the composite housing holes for installing the holding tool, the device is placed in the formed "niche", and the head of the composite housing is displayed in a position corresponding to the degree of displacement of the dislocated about the vertebra, using a socket wrench installed in the hole at the end of the threaded rod, the patient’s head is tilted forward by an angle of at least 10 °, the affected area is distracted by rotating the nut along a vertical threaded rod integral with the lower supporting platform, using radial holes on the nut body, the device is held by a holding tool installed in the holes on the side surfaces of the body, reposition is carried out, for which the socket wrench is turned by turning the threaded rod In the opposite direction, the displaced vertebra is brought to its physiological position.

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