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Synthes VEPTR, Техническое руководство

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Patient positioning and cranial exposure remain the same
for all types of VEPTR constructs described on pages 8 to 9
 regardless of the construct being implanted.

Primary Procedure

20

Synthes

VEPTR

Technique Guide

1

Patient positioning

Place the patient in a lateral decubitus position similar to that
required for a standard thoracotomy. 

To protect against brachial plexus injury, do not flex the
shoulder more than 90°.

2

Cranial exposure

Make a J-shaped thoracotomy incision without disrupting
the periosteum overlying the ribs. 

Retract the skin flaps. 

Continue the incision and elevate the paraspinal muscles
 medially only to the tips of the transverse processes. 

Gently elevate the scapula to expose the middle and poste-
rior scalene muscle.

Содержание VEPTR

Страница 1: ...VEPTR Vertical Expandable Prosthetic Titanium Rib A new treatment concept for paediatric three dimensional thoracic deformities Technique Guide...

Страница 2: ......

Страница 3: ...uments are required For further details contact your local Synthes representative Table of Contents Image intensi er control Treatment Concept 3 Indications 4 Contraindications 5 Construct Options 6 I...

Страница 4: ...2 Synthes VEPTR Technique Guide...

Страница 5: ...ts VEPTR devices control and may correct scoliosis Devices are attached perpendicularly to the patient s natural ribs superior at tachment point and to more caudal ribs a lumbar vertebra or to the ili...

Страница 6: ...due to absent ribs Progressive thoracic congenital neurogenic or idiopathic scoliosis without rib abnormality Hypoplastic thorax syndromes Jeune s Syndrome Jarcho Levine Syndrome Cerebro costal mandib...

Страница 7: ...Age below 6 months Known allergy to any of the device materials Infection at the operative site Warnings and precautions Patients implanted with the VEPTR should not be braced The VEPTR device is des...

Страница 8: ...VEPTR Technique Guide Construct Options The VEPTR set contains 220 mm and 70 mm radius constructs 220 mm radius constructs are used to treat most of the VEPTR indications and are the standard VEPTR c...

Страница 9: ...riosteum to enable anterior and posterior osteotomies Perform anterior and posterior osteotomies from ribs three through eight Distract the mobilized chest segment postero laterally Place retractors s...

Страница 10: ...Ring 3 Lock for Rib Support 4 Lumbar Extension Rod 5 Extension Bar 6 Closure for Extension Bar 7 Lamina Hook Rib to ilium Attaches from rib to ilium Components available in 220 mm radius 1 Cranial Rib...

Страница 11: ...mm radius Rib to rib 220 mm radius 1 Cranial Rib Support 2 Closing Half Ring 3 Lock for Rib Support 4 Caudal Rib Support 5 Extension Bar 6 Closure for Extension Bar Rib to rib 70 mm radius 1 Cranial...

Страница 12: ...220 mm radius available in sizes 4 13 in neutral right and left angulation Art No Angulation Sizes 497 065 497 069 Neutral 4 8 497 225 497 229 Neutral 9 13 497 071 497 075 Right angled 4 8 497 230 497...

Страница 13: ...ed Art No 497 129 Closing Half Ring for Rib Support large Locks Titanium Alloy TAN Lock for Rib Support blue connects the Closing Half Ring to the Cranial Rib Support or the Caudal Rib Support Art No...

Страница 14: ...sizes 4 13 Art No Sizes 497 103 497 112 4 13 In 70 mm radius available in sizes 4 11 Art No Sizes 497 115 497 122 4 11 Lumbar Extension Rod Titanium Alloy TAN Attaches the Extension Bar to the Lamina...

Страница 15: ...crew secures the placement Art No Angulation 497 261 Left angled 497 262 Right angled Ala Hook Pure Titanium Used with the Lumbar Extension Rod and Extension Connector to attach to the ilium Available...

Страница 16: ...nector 5 0 6 0 Titanium Alloy TAN Connects the Ala Hook to the Lumbar Extension Rod Accepts 5 0 mm and 6 0 mm rods Art No 498 167 Extension Connector 5 0 6 0mm Rod 2 0mm Pure Titanium Holds osteotomiz...

Страница 17: ...d 497 128 from the constructs for expan sion procedures or removing constructs 388 453 or Holding Forceps for Closing Half Ring for 388 465 VEPTR For holding and placing the Closing Half Ring around t...

Страница 18: ...rt Goes around the Extension Bar and is used with the Iron for Rib Support 388 461 Holding Forceps for Rib Support Holds the Cranial and the Caudal Rib Supports 388 462 Lock Removal Device for VEPTR U...

Страница 19: ...s the same shape as the rib support devices 388 468 Holding Forceps for Extension Bar For holding the Extension Bar and pushing it over the Cranial Rib Support and Caudal Rib Support 388 471 Rib Distr...

Страница 20: ...88 486 Foot for Rib Retractor for No U22 64010 Fits in the Rib Retractor to distract the ribs 388 493 Inserter for Rib Support Lock Used to pick up and hold the locks 497 125 and 497 128 and attach th...

Страница 21: ...construct Ala Hook for rib to ilium constructs 6 1 Select the appropriate lumbar extension 6 2 Determine contour and cut to length if necessary 6 3 Insert caudal Distraction Lock 6 4 Insert caudal im...

Страница 22: ...ubitus position similar to that required for a standard thoracotomy To protect against brachial plexus injury do not flex the shoulder more than 90 2 Cranial exposure Make a J shaped thoracotomy incis...

Страница 23: ...eral 388 488 Clip for Rib Support for No 388 494 388 489 Clip for Closing Half Ring for No 388 494 388 493 Inserter for Rib Support Lock 388 494 Pliers for Closing Half Ring and Rib Support 398 408 Pe...

Страница 24: ...teum adjacent to the lung Take care to preserve the soft tissue surrounding the rib to protect rib vascularity and the neurovascular bundle 3 3 Select proper Cranial Rib Support Choose a 220 mm or 70...

Страница 25: ...teum and the rib Rotate the rib support into the correct position For the medial construct seat as medial as possible to the transverse process 3 5 Select proper Closing Half Ring size Based on the pa...

Страница 26: ...Rib Support The Closing Half Ring and Cranial Rib Support now should be aligned Note If the Cranial Rib Support and Closing Half Ring are not aligned prepare the Pliers for Closing Half Ring and Rib S...

Страница 27: ...nsert the lock into the aligned holes of the Cranial Rib Sup port and the Closing Half Ring With a hammer gently tap inserter to seat the lock The Lock Crimper or the lateral Lock Inserter should be u...

Страница 28: ...8 mm length 210 mm 399 130 Bone Spreader speed lock width 12 mm length 270 mm Assemble the Feet for Rib Retractor to the Retractor Distract ribs using the Rib Retractor assembly as needed Bone Spread...

Страница 29: ...ilium or rib to lumbar lamina construct Measure to the caudal rib when using a rib to rib con struct The measurement in centimeters will correspond to the cor rect Extension Bar size For example if th...

Страница 30: ...r Rib Support 388 459 Iron for Extension Bar 388 461 Holding Forceps for Rib Support 388 466 Positioner for Rib Support 388 468 Holding Forceps for Extension Bar 388 475 Lock Inserter lateral 388 493...

Страница 31: ...er The length of the rod portion of the lumbar extension should be at least equal to the distance between the thoracolumbar junction and the planned caudal implant When using a Lamina Hook or Ala Hook...

Страница 32: ...from the underside of the lamina to ensure good bony contact with the Lamina Hook and to leave the inter spinous ligament intact Resect enough ligamentum flavum for the hook to pass Choose the approp...

Страница 33: ...est The tip of the periosteal elevator should be just lateral to the Sacro iliac joint Choose the appropriate Ala Hook 45 or 90 left or right The correct Ala Hook should have the upper end lying media...

Страница 34: ...ion Take care to remain within the paraspinous muscles Use Rod Holding Forceps to insert the rod portion of the lumbar extension assembly to reach the hook Ala Hook Use for rib to ilium construct Thre...

Страница 35: ...and Holding For ceps for Rib Support to slide the cranial end of the Extension Bar over the Cranial Rib Support Alternatively the Iron for Extension Bar and the Iron for Rib Support can be used to ali...

Страница 36: ...g the Lock Crimper or lateral Lock Inserter A 6 8 If using a lamina hook distract if necessary and tighten Using the 2 5 mm Hex Screwdriver place a Fixation Ring for Rod cranial to the hook onto the r...

Страница 37: ...461 Holding Forceps for Rib Support 388 464 Spreader for Rib Support 388 466 Positioner for Rib Support 388 468 Holding Forceps for Extension Bar 388 471 Rib Distraction Pliers 388 472 Distractor for...

Страница 38: ...ound the rib Based on the patient s anatomy select the appropriate Clos ing Half Ring standard or large Using the Holding Forceps for Closing Half Ring seat the Closing Half Ring over the contralatera...

Страница 39: ...he Closure is fully seated Use the Rib Distraction Pliers Distractor for Extension Bar or the Spreader for Rib Support to distract the device until the caudal hole in the Extension Bar is aligned with...

Страница 40: ...r Extension Bar through palpation and or radiographic marker Make a transverse or longitudinal incision over the closure 3 Remove the lock Required instruments 388 452 Lock Removal Pliers for VEPTR 38...

Страница 41: ...until the device is adequately lengthened Use the Temporary Distraction Pins as placehold ers to assist distraction 5 Final locking Required instruments Standard Hammer 388 456 or Lock Crimper for VEP...

Страница 42: ...of the previous thora cotomy incision may be used Unlock the device by removing the golden Closure s for Ex tension Bars using the Lock Removal Pliers Remove the required components and insert the ne...

Страница 43: ......

Страница 44: ...0123 036 000 421 SM_706950 AB 51060016 Synthes 2007 Subject to modifications Presented by 036 000 421 ABh...

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