METHOD FOR SURGICAL TREATMENT OF LONG-STANDING FRACTURES OF THE BONES OF ANTERIOR SEMICIRCLE OF PELVIS IN MEN WITH AXIAL FIXATION OF METAL FIXING PLATE

摘要

FIELD: medicine; traumatology.SUBSTANCE: invention relates to medicine, namely to traumatology, it can be used for the surgical treatment of long-standing fractures of the bones of the anterior semicircle of the pelvis in men. The method of multilayer spiral computed tomography is used to determine the spatial visualization of the affected pelvic pubic bones with the identification and determination of the sub-pubic angle of the transition of the upper branch of the patient's pubic bone into the lower symphysial surface in relation to the horizontal plane of the sciatic-pubic branches of the pubic bones of the reconstructed pelvic ring of the patient. Magnetic resonance imaging is used to assess the condition of the surrounding soft tissues, vascular and nervous structures. According to the results of the research, an individual fixing metal plate is made. After the anesthesia, a catheter is inserted transurethrally into the bladder to drain urine. An extraperitoneal surgical access is performed in the lower third of the anterior abdominal wall by incision in the suprapubic area of the anterior abdominal wall. The rectus abdominis muscles are withdrawn anteriorly and laterally. From the inner surface of the anterior semicircle of the pelvis, the soft tissues of the pelvis together with the bladder are bluntly withdrawn. The periosteum and Cooper's ligament are dissected along 3-4 cm along the upper edge of the upper branch of the pubic bone on the side of the localization of the long-standing fracture. The symphysial surface of the pubic bones is skeletonized. Through the access, a metal fixing plate is inserted into the pelvic cavity until it coincides with the proximal border of the acetabulum and until the middle of the distal part of the fixing plate coincides with the middle of the pubic joint according to the inlet view. The plate is made in the form of a curved horizontal plane with extreme sections for placement on the iliac and pubic bones of the reconstructed pubic joint of the patient's pelvic ring. The inner radius of the contour bend in the horizontal plane of the plate is selected with a radius of curvature from 49 mm to 58 mm. On each extreme section of the plate curved in the horizontal plane, 3 to 5 holes with a diameter of 3 to 5 mm are made symmetrically to the center of the plate with a conical chamfer for placing the fixing screws. The center-to-center distance of the holes is selected from 7 to 12 mm. The chamfers are made on the plate on the side opposite to the side intended for contact with the surface of the pubic bone. The diameter of the cylindrical part of the holes corresponds to the diameter of the screws used. The plate is provided with a flat closed horseshoe-shaped locking element bent at an angle to the plane of the plate bent in the horizontal plane. The angle of the bend of this element is made corresponding to the subpubic angle of the flow of the upper branch of the patient's pubic bone into the lower symphysial surface in relation to the horizontal plane of the sciatic-pubic branches of the pubic bones of the reconstructed pelvic ring of the patient, and the branches of the horseshoe-shaped closed fixing element are located at an angle α from 28° to 36° to the vertical axis of the plate. The vertical branches of the pubic bones are repositioned until they come into contact and the plate is axially fixed along the upper surface of the pubic arch and along the symphysial surface of the pubic joint of the pelvic ring with screws in previously made blind holes in the bones of the pubic joint. An X-ray control is performed. Drains are installed in the Retzius' space and in front of the pubic joint. A control radiography, control of hemostasis and layer-by-layer suturing of the wound are performed. The plate is made of titanium alloys or medical stainless steel with a thickness of 1 to 3 mm and a width of 10 to 15 mm. On each branch of the bent horseshoe-shaped closed fixing element of the plate, symmetrically to the center, two pairs of holes are made with a diameter of 3 to 5 mm with a conical chamfer to place the screws. The first pair of holes is made in the middle part of each branch of the fixing element along the longitudinal axis of the branch with a distance between the centers of the holes from 10 mm to 11 mm; the second pair is made in the lower part of the fixing element. The holes are arranged one above the other on the axis at an angle β from 14° to 16° to the vertical axis of the curved semi-oval plate with a distance between the centers of the holes from 7 mm to 9 mm. ;EFFECT: method provides anatomical restoration of the shape and supporting function of the pelvis, maintaining the patient's motor activity in the early postoperative period, reducing the rehabilitation time and improving the quality of life due to the axial fixation of the anterior half-ring of the pelvis with a plate.;3 cl, 3 ex