Patent RU-2407477-C1 (RU)
Inventor: VETRILEH STEPAN TIMOFEEVICH
IPC: A61B17/56
Filed: 2009-10-16
Granted: 2010-12-27
Abstract: FIELD: medicine. 
     SUBSTANCE: invention relates to field of medicine, namely to orthopedics, and can be applied in mini-invasive surgical treatment of nonspecific hematogenic osteomyelitis of thoracic spine. Essence of method lies in carrying out surgery on affected locomotor segments of spine. After carrying out examination of affected spine part with application of radiography, computer-aided tomography and magnetic resonance tomography localisation of inflammatory process and its extension are detected. Under control of thoracosope and optoelectronic converter all stages of surgery are carried out, whose volume is selected depending on detected extension of destruction in spine-motor segment, induced by nonspecific inflammatory process. When diagnosing nonspecific hematogenic osteomyelitis of spine in chronic-recurrent form or in primary-chronic form with affection of thoracic spine with not more than on fourth destruction of vertebra bodies of affected spine-motor segment, under intravenous or combined anesthetisation with application of artificial ventilation of lungs in position of patient on left side carried out is one cut of skin on anterior axillary line, one cut on posterior axillary line of right half of chest 1-2 cm long, through which in thoracic cavity two thorascopic ports are installed. Then deflation of right lung is performed, thorascope is introduced in thoracic cavity and examination of thoracic cavity is carried out. After that, through second thorascopic port fan-shaped retractor is introduced, by which deflated lung is moved aside. Then transcutaneous puncture of intervertebral space of affected spine-motor segment is carried out with 7-10 cm indent from its spinous process to the right side at angle of 30°-60° and discography is carried out by introduction into the area of pathological nidus of contrast substance in volume 0.5-1 ml with following estimation of its expansion in intervertebral space of affected spine-motor spine segment. Then directly above nidus of affection using topographic-anatomical landmarks, defined during thoracosopic revision and by results of discography, on posterior axillary line thoracosopic port is installed, through which into thoracic cavity electric monopolar coagulator is introduced and under control of thoracosope cut of parietal pleura above affected spine-motor segment, as well as hemostasis are carried out. Fibrous ring of affected intervertebral disk is cut by electric monopolar coagulator, from thoracosopic port coagulator is removed, through it destructor is introduced and pathological tissues are removed from intervertebral space by forward-rotary motions of destructor, alternating them with manipulations on removal of pathological tissues with application of tongs and cutting pliers on long branches. Curettage of joined surfaces of affected spine-motor spine segment is carried out by curette on long handle, cavity formed in intervertebral space is washed with solution of antiseptics and spondylodesis is performed by "Collapan" granules, which contain antibacterial medications deflated lung is inflated, in pleural cavity active drainage is placed, wounds are sutured. 
     EFFECT: application of claimed invention allows to achieve during surgical interference reliable depressurisation of pathological nidus, localized in joined closing plates and intervertebral space of spine-motor segment, insure reliable removal of pathological tissues from area of joined closing plates and intervertebral space, insure reliable introduction into area of infectious-inflammatory nidus of antibacterial medications, insure reliable mechanical destruction of closing plates for creation of conditions for formation of inter-body spondylodesis, reduce duration of surgery as well as post-operational period, insure early social rehabilitation of patient. 
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