METHOD FOR SURGICAL TREATMENT OF PUBIC SYMPHYSIS OF PELVIC RING

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to traumatology, and can be used for treating pubic symphysis of the pelvic ring. In the preoperative period, three-dimensional visualization of involved pubic bones of pelvis is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to assess the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when multilayer helical computed tomography is performed. After the anesthetic support, the patient's position on the back and before the surgical intervention, passive urine catheter is inserted transurethrally into the urinary bladder. Symphysis is exposed with a supersymphysis transverse incision of the skin and an approach along the upper edge of the pubic articulation to the fascia and bone. Two abdominal rectus muscles are separated from the points from the abduction and shifted subperiosteal to pubic tubercles without injuring pubic tubercles at the point of their attachment to the inguinal ligament. That is followed by a prevesical blunt abruption of the fascial plate with displacing it with the anterior wall of the bladder inward. Affected areas of pubic symphysis are reiterated using nippers on both sides of pubic bones until their healthy portion. Then, not bringing together resected pubic bones, through the incision along the superior frontal edge of pubic bones implant is a metal plate made from titanium alloy or from stainless medical steel with thickness of 5 mm and width of 12 mm with holes for fixing screws arrangement, made as bone of pubic articulation in form of sector of flat ring with rounded angles. Plate has 6 or 8 holes for fixing screws. Fixing of metal implant plate 6 or 8 fixing screws, placing them in previously made blind holes in bones of pubic articulation of pelvic ring, and the volume of the formed bone cavity of the postresection defect of the pubic bones is filled with granules of the complex alloplastic preparation based on hydroxyapatite containing 58–82 wt% of collagen and impregnated as an antibacterial agent with aqueous solutions of aminoglycoside and/or oxazolidinoid with concentration of 20–50 mg/ml. Aminoglycoside antibacterial aqueous solution of complex alloplastic preparation is represented by tobramycine, and the oxazolidinone antibacterial aqueous solution of the complex alloplastic preparation is represented by linozolide. Two drainages are inserted, one into retention space and the second one – in front of pubic joint. After performing the control pelvic X-ray examination of the correctness of the metal implant installation, hemostasis is controlled and the layer wound closure. Aqueous solution of the antibacterial preparation linozolid in its mixture with the aqueous solution of the antibacterial tobramycin preparation can be selected from 18 to 82 vol%.;EFFECT: method provides reliable anatomical recovery of pelvis shape and support function with simultaneous absence of multiplane displacements of fixed bones, pain syndrome reduction, retention of patient's motor activity in early postoperative period, elimination of dyspareunia with normalization of sexual function, absence of infectious damages of surrounding tissues with simultaneous preservation of blood supply and innervation of tissues, as well as eliminating abnormal support function of lower extremities by filling the volume of formed bone cavity of postresection defect with granules of complex alloplastic preparation based on hydroxyapatite impregnated with antibacterial agent.;1 cl, 5 ex