| 摘要 |
FIELD: medicine.SUBSTANCE: scoliotic spinal column is approached; a short apical rod and a second long rod positioned along the gibbus are inserted and fixed; a scoliotic curve is de-rotated from a frontal to sagittal plane. A third long rod is inserted and fixed along a convex side for rigid fixation thereof; a dorsal spondylosyndesis is created with bone grafts to be placed between the vertebras and a metal retainer laid along the spinal column. Screws are additionally inserted transpedicularly in Roy-Camille point along all the vertebras of the expected spondylosyndesis from a superior neutral vertebral to a vertebra found in the cranial direction from the inferior neural one with the inferior neutral vertebra is not instrumented. Inserting the screws is followed by performing a posterior (Smith-Petersen) osteotomy in apical and para-apical regions. Mounting a short apical rod at the level of a scoliotic curve apex and a long rod positioned along the gibbus onto a concave side of the scoliotic curve involves pre-fixing the apical rod and a rod positioned along the gibbus with retainer rings left loose. A rod rotator is then used to de-rotate the scoliotic curve from the frontal to sagittal plane simultaneously by the apical and long rods positioned along the gibbus. That is followed by additional segmental corrective medial vertebral rotation by heads of the implanted transpedicular screws. Having the retainer rings of the mounted system loose, a partial facetectomy of the fixed and underlying vertebras along the convexital arch; the facetectomy involves using a straight chisel to transect and remove a part of an inferior articular process of the instrumented vertebra, as well as a part of a superior articular process of the neural non-instrumented vertebra along a concave surface of the lumbar curve to achieve a rotational displacement of the instrumented scoliotic curve in the frontal plane in the posterior spine; and in the anterior spine - by elasticity of an intervertebral disk when compressing its convexital side. That is followed by distracting a concave rod onto a distal convexital screw, as well as on a cranial rod retainer placing the distal instrumented vertebra and all the underlying vertebras in the horizontal position and creating compression in an interarticular cavity, and the scoliotic spinal column is fixed completely to the apical rod and a rod positioned along the gibbus by tightening the retainer rings on the transpedicular screws; after the third long rod has been rigidly fixed on the convex side of the scoliotic curve, and the dorsal spondylosyndesis has been created by means of the bone grafts, the wound is closed.EFFECT: method enables providing the more effective elimination of a gross scoliotic spinal deformity in three planes, achieving the reliable and desired parameters of the gross spinal deformity correction with the reliable stabilisation of the spinal column and the reliable multilevel fixation of the spinal column, and preventing the patient's disability and increasing the patient's quality of life.2 ex |
