RU2645960C2 - Growing four-plate structure for treatment of curvature, injuries and diseases of the spine in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to orthopedic vertebrology and is intended for surgical treatment of scoliosis, kyphosis, injuries and spine diseases in growing children. Growing four-plate structure for treating curvatures, injuries and diseases of the spine in children contains four plates, clamps for the spines of the vertebrae, ties, end clamps under the clamps for the spines of the vertebrae, intermediate clamps under the clamps for the spines of the vertebrae, clamps under the couplers, connecting screws for the end clamps under the clamps for the spines of the vertebrae, fixing screws for clamps for screeds, conical nuts for mentioned connecting and fixing screws. Four plates are oblong, elastic, curved respectively physiological bends of the spine, with possibility of lying in pairs along the spine to the right of the left in the paravertebral zones. Plates in pair are overlapped. Protruding ends of the plates have holes for the connecting screws, with the possibility of fastening a pair of projecting end of the plate to the cranial vertebra, and the other to the caudal vertebra. Clamps for the arches of the vertebrae consist of a hook, a threaded column and a conical nut. Hook has a sublaminar bar, pointed and curved upwards, and a supra-lath bar with a threaded hole for a threaded post. Threaded stand is made with a false nut, and also on one end with a self-tapping and a laminar part with a thread on the other end. Intermediate clamps under the clamps for the arches of the vertebrae are U-shaped. One side bar is made of elongated and has outside the tapered hole for the rack and the cone nut, from the inside a recess under the plates adjacent to the web, other lateral bar is made shorter and forms together with the transverse bar and the above-mentioned notch a compartment for a pair of plates with dimensions, they allow the plates to move relative to each other without sticking. End springs under the clamps for the arches of the vertebrae are U-shaped. One side bar is made elongated and has outside a tapered aperture for the posts and a conical nut, and from the inside a recess beneath the plates adjacent to the web. Other lateral bar is made shorter and forms a plate compartment together with the transverse bar and the above-mentioned notch. Bridge between the slats has a tapered hole for the connecting screws. Each screed is made in the form of a flat plate with a pointed end, a semicircular head and threaded holes along the plate for the fixing screw. Screeds are designed to eliminate lateral curvature of the spine. Clamps under the screeds are U-shaped. One side bar is made elongated and has oval hole for the screed. Other lateral bar is made shorter. Plates or plates are placed between the side plates. Clamps are installed in pairs on the right and left pairs of plates. All elements of the construction have a surface covered with titanium oxide 25–30 mcm thick, purified from impurities by electrochemical method.

EFFECT: invention provides for the elimination of subcutaneous swelling of the attachment blocks and transverse end plates, achievement of a given and necessary vertebrae deformation in the curvature zone, ensuring the safety of the spinal cord during surgical intervention, ensuring smooth sliding of the working plates in the clamps along the growing spine, ensuring, during the child's growth, sliding plates without a significant shift of the plates up with loss of operational correction of the thoraco-vertebral complex, exclusion of the use of repeated surgical intervention for a long time as the child's physiological growth, creating structure with sufficient elasticity to ensure a constant distraction, ensuring reduction of postoperative complications and shortening of the patient's stay in the hospital, ensuring the accelerated rehabilitation of the patient after surgery.

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Description

The invention relates to medicine, namely to orthopedics, to a growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children and can be used in traumatologic and orthopedic, surgical and other hospitals for the surgical treatment of scoliosis, kyphosis and other pathology of the spine in growing children.

A device for the surgical treatment of scoliosis, consisting of two elastic plates, connecting their mounting blocks made in the form of two hooks and studs with an elongated groove, connected by threaded racks of hooks passing through the groove and fixed by nuts, and the clamps are mounted on the studs according to the purpose and / or earrings in contact with the plates (see RF patent No. 2077283, IPC АВВ 17/70, 02.16.1995), adopted as a prototype.

However, the known device for the surgical treatment of scoliosis with its use has the following disadvantages:

- the use of a large sagittal profile of the device leads to a noticeable subcutaneous swelling of the mounting blocks and transverse fenestrated plates,

- insufficiently ensures the preservation of the spinal cord during surgery,

- has limited vertebral rotation in the curvature due to the introduction of the uprights into the fenestrated plate and their location in the same plane,

- with an increase in the growth of the child does not provide unhindered sliding of the working plates in the clamps along the spine,

- does not provide during the growth of the child sliding plates without a significant shift of the plates up with the loss of surgical correction of the thoracic vertebral complex,

- does not exclude the use of repeated surgery as the physiological growth of the child,

- does not have elasticity to create constant distraction,

- does not provide a reduction in postoperative complications and a reduction in the length of stay of the patient in the hospital,

- does not provide accelerated rehabilitation of the patient after surgery.

The objective of the invention is the creation of a growing four-plate structure for the treatment of curvatures, injuries and diseases of the spine in children.

The technical result is the elimination of subcutaneous bulging of the attachment blocks and transverse fenestrated plates, the achievement of the desired and necessary vertebral rotation in the curvature zone, the preservation of the spinal cord during surgery, ensuring the smooth sliding of the working plates in the clamps along the growing spine, ensuring the sliding of the plates during the growth of the child without a significant shift of the plates up with the loss of the surgical correction of the thoraco-vertebral complex, is switching off the use of repeated surgical intervention for a long time as the child grows physiologically, creating a structure with sufficient elasticity to ensure constant distraction, reducing postoperative complications and shortening the patient's hospital stay, ensuring accelerated rehabilitation of the patient after surgery.

The technical result is achieved by the fact that a growing four-plate design is proposed for the treatment of curvatures, injuries and diseases of the spine in children, containing four plates, clamps for vertebral arches, couplers, end clamps for vertebral clamps, intermediate clamps for clamps for vertebral arches, clamps for screeds, connecting screws for end clamps for clamps for vertebral arches, fixing screws for clamps for screeds, flare nuts for the mentioned connecting and fixing screws Comrade, the four plates are made oblong, elastic, curved according to the physiological bends of the spine, with the possibility of being arranged in pairs along the spine from right to left in the paravertebral zones, the plates are paired with an overlap, the protruding ends of the plates have holes for connecting screws with the possibility of attaching one protruding end of the plate in a pair to the cranial vertebra, and the other to the caudal vertebra, the clamps for the vertebral arches consist of a hook, a threaded stand and a flare nut, a hook ok has a sublaminar strip pointed and bent up, and a nadlaminar strip with a threaded hole for a threaded stand, a threaded stand made with a false nut, and also at one end with a self-tapping notch and a laminar part with a thread on the other end, intermediate clamps for clamps for vertebral arches made U-shaped, with one side bar made elongated and has an outside conical hole for the stand and flare nut, inside a recess for plates adjacent to the jumper, the other side bar is made is shorter and forms, together with the transverse bar and the aforementioned recess, a compartment for a pair of plates with dimensions that allow the plates to move relative to each other without sticking, the end springs for clamps for vertebral arches are made U-shaped, and one side bar is elongated and has an outside conical the hole for the uprights and the flare nut, and inside the recess for the plates adjacent to the jumper, the other side strip is shorter and forms, together with the transverse strip and the aforementioned recess, a compartment for plates, the jumper between the slats has a conical hole for the connecting screws, each screed is made in the form of a flat plate with a pointed end, a semicircular head and threaded holes for the fixing screw located along the plate, and the screeds are designed to eliminate lateral curvature of the spine, clamps for screeds are made P- shaped, moreover, one side bar is made elongated and has an oval hole for the screed, the other side bar is shorter, the plates or plate are placed between the side strips, while the clamps are installed in pairs on the right and left pairs of plates, all structural elements have a surface coated with titanium oxide 25-30 microns thick, cleaned of impurities by the electrochemical method. Moreover, the plates are made of titanium and are arranged in pairs to the right and left of the spinous processes. In this case, one of the pair of working plates ends in the area of transition of kyphosis to lordosis, and the second ends at the installation site of the first or second cranial hook. In this case, 20-26 sublaminar hooks were used. In this case, the hooks on the concave side of the curvature are installed under the arches of each vertebra of the curvature arch and under the arches of neutral vertebrae. In this case, the hooks on the convex side are installed in the cranial and caudal sections on the neutral vertebrae and are not installed during the curvature arc. In this case, the flare nuts after wrapping on the racks and removing excess shanks of the racks form an even surface with no protruding elements with intermediate clamps. Moreover, due to the fastening of the working plates to the cranial and caudal vertebrae, with an increase in the growth of the child, the structure lengthens independently without additional intervention. In this case, the fixing screws are made with a thread on the end and a groove for fixing the screeds after lateroextension. In this case, before implantation, all structural elements are subjected to electrochemical cleaning of the surface to create a homogeneous titanium substrate. Moreover, all elements are made of titanium alloys and coated with a film of titanium oxide with a thickness of 25-30 microns.

Among the essential features characterizing the proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children, the following are distinguishing:

- the design contains four plates, clamps for vertebral arch clamps, couplers, end clamps for vertebral clamp clamps, intermediate clamp clamps for vertebral arch clamps, clamp clamps, connecting screws for end clamp clamps for vertebral arch clamps, fixing screws for clamp clamps flare nuts for said connecting and fixing screws,

- the implementation of the four plates oblong, elastic, curved according to the physiological bends of the spine, with the possibility of placing in pairs along the spine from right to left in paravertebral zones,

- the location of the plates in a pair of overlaps, while the protruding ends of the plates have holes for connecting screws with the possibility of fastening in a pair of one protruding end of the plate to the cranial vertebra, and the other to the caudal vertebra,

- the clamps for the vertebral arches consist of a hook, a threaded stand and a flare nut, the hook has a sublaminar bar, pointed and curved up, and a nadlaminar bar with a threaded hole for the threaded strut,

- execution of a threaded stand with a false nut, as well as at one end with a self-tapping notch and a laminar part with a thread at the other end, intermediate clamps for clamps for vertebral arches are made U-shaped, with one side bar made elongated and has an outside conical hole for the stand and flare nut, inside a recess for plates adjacent to the jumper, the other side strip is shorter and forms, together with the transverse strip and the above recess, a compartment for a pair of plates with compartments allowing movement the plates relative to each other without their adhesion,

- making end clamps for clamps for vertebral arch U-shaped, moreover, one side bar is elongated and has an outside conical hole for the uprights and a conical nut, and an inside recess for plates adjacent to the jumper, the other side bar is shorter and forms together with the transverse the strip and the aforementioned recess compartment for the plate, the jumper between the strips has a tapered hole for the connecting screws,

- the implementation of each screed in the form of a flat plate with a pointed end, a semicircular head and threaded holes for the fixing screw located along the plate, and the screeds are designed to eliminate lateral curvature of the spine,

- the execution of the clamps under the couplers are U-shaped, with one side bar made elongated and has an oval hole for the coupler, the other side bar made shorter,

- the placement of the plates or plates between the side strips, while the clamps are installed in pairs on the right and left pairs of plates,

- all structural elements have a surface coated with titanium oxide with a thickness of 25-30 μm, purified from impurities by the electrochemical method,

- the implementation of the plates of titanium coated with their film of titanium oxide with a thickness of 25-30 microns and their location in pairs to the right and left of the spinous processes,

- one of a pair of working plates ends in the area of transition of kyphosis to lordosis, and the second ends at the installation site of the first or second cranial hook,

- the use of 20-26 pieces of sublaminar hooks, while the hooks on the concave side of the curvature are installed under the arches of each vertebra of the arch of the curvature and under the arches of the neutral vertebrae, and the hooks on the convex side are installed in the cranial and caudal sections of the neutral vertebrae and are not installed throughout the curvature arc ,

- creation after tightening the flare nuts on the racks and removing excess shanks of the racks with intermediate clamps of a flat surface that does not have protruding elements.

- lengthening the structure independently with an increase in the growth of the child without additional interventions due to the fastening of the working plates to the cranial and caudal vertebrae,

- the implementation of the fixing screws with a thread at the end and a groove for fixing the screeds after lateroextension,

- performance before implantation of all structural elements of the electrochemical surface cleaning to create a homogeneous titanium substrate.

The use of the proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children in clinical conditions has shown its high efficiency. The growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children, when used, ensured the exclusion of subcutaneous swelling of the attachment blocks and transverse fenestrated plates, ensured the preservation of the spinal cord during surgery, ensured the desired and necessary vertebral rotation in the curvature zone, and ensured unhindered sliding working plates in the clamps along the growing spine, provided slip during the growth of the child plates without loss of operating correction torakovertebralnogo complex. At the same time, an exception was made for the use of repeated surgical intervention for a long time as the child grows physiologically, a design with sufficient elasticity to ensure constant distraction was achieved, a reduction in the risk of postoperative complications and a reduction in the patient's hospital stay with accelerated rehabilitation of the patient after surgery.

The essence of the proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children is illustrated by the drawings, where in FIG. 1 shows a four-plate assembly as shown in FIG. 2 - plates, in FIG. 3 shows plates in an extension circuit; FIG. 4 - sublaminar hook, in FIG. 5 - rack, in FIG. 6 - clamp, in FIG. 7 - flare nut, in FIG. 8 - intermediate clamp and end clamp, in FIG. 9 - fastening the plate to the end clamp, in FIG. 10 — end clamp screw; FIG. 11 - movable plates in standard clamps, in FIG. 12 is a coupler with a fixing screw, and in FIG. 13 - clamp for screed.

The proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children (Fig. 1) contains four plates 1 with hooks 2, posts 3 and clamps 4, which are attached to the posts with flare nuts 5. The hooks 2 and posts 3 form a clamp and limit space (compartment) for placing the vertebral arch.

Plate 1 (Fig. 2 and 3) in the amount of 4 pieces have a length of up to 440 mm, and the length and bends of the working plates can vary during the operation. The plates 1 have openings 6 at the ends for connection with end clamps, and a pair of plates can be moved apart in opposite directions (Fig. 3) as the child grows. Clips, end clamps, and also clamps for couplers are installed on plates 1.

The sublaminar hook 7 (Fig. 4) has a lunar shape, which is formed by a sublaminar strap, pointed and slightly curved upwards, as well as a nadlaminar strap 8 with a threaded hole 9 for the rack. The rack 3 (Fig. 5) has a shank 10 with a thread along the entire length, a false nut 11 and a laminar part with a thread 12. The false nut 11 fixes the rack in the sublaminar hook 7 and also limits the length of the rack laminar section 12 inserted into the sublaminar hook 7. After installing the rack in the hook 7, a clamp is formed (Fig. 6) with the coverage of the half-arch of the vertebra, which makes it impossible to displace the hook. In the flare nut 5 (Fig. 7), a hole 13 is made with a thread for twisting it onto the rack using a cross-shaped slot 14.

The intermediate clip (Fig. 8) has a U-shape with an elongated upper bar 15, on which there is a conical hole 16 for the rack, a vertical bar 17 and a lower shortened bar 18. The space of the intermediate clip is slightly larger than the dimensions of the working plates, which allows free movement them relative to each other and relative to the clamp. An additional hole 19 for the screw on the side plate 17 is additionally made on the end clamp. After aligning the end clamp hole 19 with the hole 6 on the plate 1, a connecting screw 20 is passed through them (Fig. 10), as a result of which the plate is attached by the end clamp to the plate 1 ( Fig. 9).

The mobility of the structure along the vertical axis (Fig. 11) is ensured by the fact that the clamps do not have a rigid fastening with working plates, which makes it possible to freely move the working plates inside the intermediate clamp only along the vertical axis. In this case, the clamps are rigidly connected to the hook using the stand (Fig. 5) and the flare nut 14. After tightening the flare nut into the tapered hole and removing the excess of the shank of the stand, a flat surface of the structure is formed.

The design kit also includes couplers 21 (Fig. 12) with a fixing screw 22 to eliminate lateral curvature of the spine in the frontal plane. The coupler 21 is a flat plate 3 mm × 65 mm with a pointed end, and also has five threaded holes 23. The fixing screw has a thread with a pitch of 2.5 mm and a groove to prevent spontaneous twisting.

The clamp for the screed (Fig. 13) has a compartment for placing the plates 1. The screeds together with the clamps form a closed loop fixing the working plates, including in the sagittal and frontal planes, in which the working plates move freely along the vertical axis. The freedom of movement of the plates 1 is ensured by the fact that the compartment dimensions are 7 mm × 11 mm, which is larger than the sizes of the two plates 6 mm × 10 mm.

All structural elements are made of titanium alloys VT6, VT14. The surface of the structure is prepared by electrochemical cleaning to clean the surface of the titanium alloy from contaminants and prepare the substrate for oxidation to remove the electrical potential from the surface and prevent metal from migrating into the surrounding tissue, as well as to reduce friction between moving elements.

Thus, the proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children stabilizes the working plates in the frontal and sagittal planes, as well as screeds and clamps for screeds additionally stabilize the working plates in the frontal and sagittal planes, while there remains the possibility of mutual movement of the working plates along the vertical axis inside the intermediate clamps and elongation of the structure as the child grows.

The proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children is placed during surgery on the patient's spine.

The proposed design can also be used to reposition and treat compression fractures in growing children, as well as to stabilize the spine in other conditions.

Thus, the dynamic four-plate design provides multi-plane correction of the thoraco-vertebral complex, maintains the achieved correction and does not interfere with the growth of the child.

The practical use of the proposed growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children made it possible to exclude subcutaneous swelling of attachment blocks and transverse fenestrated plates, ensured the preservation of the spinal cord during surgery, made it possible to achieve the desired and required vertebral rotation in the curvature zone, and to ensure unhindered sliding of the working plates in the clamps along the growing spine, to ensure in the process growth of a child sliding plates without loss of surgical correction of the thoracic vertebral complex. At the same time, the exclusion of the use of repeated surgical intervention for a long time as the physiological growth of the child was achieved, the creation of a structure with sufficient elasticity for constant distraction was ensured, the risk of postoperative complications and the duration of the patient's stay in the hospital with accelerated rehabilitation of the patient after surgery were reduced.

Claims (11)

1. A growing four-plate design for the treatment of curvatures, injuries and diseases of the spine in children, containing four plates, clamps for vertebral arches, screeds, terminal clamps for vertebral arch clamps, intermediate clamps for vertebral arch clamps, clamp clamps, connecting screws for end clamps for clamps for vertebral arches, fixing screws for clamps for screeds, flare nuts for the mentioned connecting and fixing screws, four plates are oblong, elastic them, curved according to the physiological bends of the spine, with the possibility of pairwise spacing along the spine from right to left in the paravertebral zones, the plates are paired with an overlap, the protruding ends of the plates have holes for connecting screws with the possibility of fastening one pair of protruding end of the plate to the cranial vertebra, and the other to the caudal vertebra, the clamps for the vertebral arches consist of a hook, a threaded stand and a flare nut, the hook has a sublaminar strap, pointed and bent upward, and a nadlaminar bar with a threaded hole for a threaded stand, a threaded stand made with a false nut, and also at one end with a self-cutting notch and a laminar part with a thread at the other end, intermediate clamps for clamps for vertebral arches are made U-shaped, one the side bar is elongated and has a tapered hole for the stand and flare nut on the outside, a recess under the plate adjacent to the jumper, the other side bar is shorter and forms together with the transverse bar and you the indicated recess compartment for a pair of plates with dimensions that allow the plates to move relative to each other without sticking, the end springs for clamps for vertebral arches are made U-shaped, with one side bar made elongated and has an outside cone for the rack and flare nut, and inside a recess for the plates adjacent to the jumper, the other side plate is shorter and forms, together with the transverse plate and the aforementioned recess, a compartment for the plate, the jumper between the plates has a tapered hole Hole for connecting screws, each screed is made in the form of a flat plate with a pointed end, a semicircular head and threaded holes for the fixing screw located along the plate, and the screeds are designed to eliminate lateral curvature of the spine, clamps under the screeds are made U-shaped, and one side bar is made elongated and has an oval hole for the screed, the other side plate is shorter, the plates or plate are placed between the side plates, with the clamps installed They are mounted in pairs on the right and left pairs of plates, all structural elements have a surface coated with titanium oxide 25-30 μm thick and cleaned of impurities by the electrochemical method. 2. The construction according to claim 1, characterized in that the plates are made of titanium and are arranged in pairs to the right and left of the spinous processes. 3. The construction according to claim 1, characterized in that one of the pair of working plates ends in the area of transition of kyphosis to lordosis, and the second ends at the installation site of the first or second cranial hook. 4. The construction according to claim 1, characterized in that 20-26 sublaminar hooks are used. 5. The construction according to claim 1, characterized in that the hooks on the concave side of the curvature are installed under the arches of each vertebra of the curvature arch and under the arches of neutral vertebrae. 6. The construction according to p. 1, characterized in that the hooks on the convex side are installed in the cranial and caudal sections on the neutral vertebrae and are not installed along the curvature arc. 7. The construction according to claim 1, characterized in that the flare nuts, after wrapping on the racks and removing excess shanks of the racks, form an even surface with no protruding elements with intermediate clamps. 8. The design according to claim 1, characterized in that, due to the attachment of the working plates to the cranial and caudal vertebrae, with an increase in the growth of the child, the structure lengthens independently without additional intervention. 9. The construction according to claim 1, characterized in that the fixing screws are made with a thread on the end and a groove for fixing the couplers after latex expansion. 10. The design according to p. 1, characterized in that before implantation is subjected to electrochemical cleaning of the surface to create a homogeneous titanium substrate. 11. The design according to p. 1, characterized in that all the elements are made of titanium alloys and coated with a film of titanium oxide with a thickness of 25-30 microns.

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