METHOD OF SURGICAL TREATMENT OF NON-UNITED FRACTURES AND FALSE JOINTS OF TUBULAR BONES Russian patent published in 2013 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be used in treatment of patients with slowly consolidating, non-united fractures and false joints of tubular bones in conditions of surgical, traumatological and other hospitals. Pre-operative determination of displacement type, position and localisation of bone fragments is performed by method of standard radiography and computed tomography. Puncture biopsy of bone and soft tissue fragments from nidus of patient's tubular bone affection is performed 5-6 days before operation with further determination of presence and character of obligatory intracellular viral infection. Superselective angiographic analysis of microvasculature to capillary link is carried out. Drug valtrex in dose 500 mg 2 times per day is administered to patient 2-4 days before operation. Osteosynthesis or reosynthesis with resection of ends of bone fragments, opening of bone marrow canals and with bone stimulation is performed to patient in the process of surgery. If obligatory intracellular viral infection is identified in puncture biopsy of bone and soft tissue fragments from nidus of affection of patient's tubular bone, resection of bone fragments is performed in extended volume until "blood dew", i.e. sections with satisfactory intraosteal blood supply, appears. Cortocotomy with further distraction of bone regenerate by any known method is additionally carried out. If there is no obligatory intracellular viral infection in puncture biopsy of bone and soft tissue fragments from nidus of affection of patient's tubular bone, sparing adaptive resection of bone fragments with opening of their bone marrow canals is performed. Loose filling of bone defect space with nanostructured composite implant, containing platelet-enriched autoplasma in ratio 1:(1.0-2.0) with granules of complex alloplastic hydroxyapatite-based preparation, which contains 50-60% of collagen, is carried out. Nanostructured composite implant, used for loose filling of bone defect space, additionally contains 0.08-2.8 wt % of colloidal solution of nanoparticles of zero-valent metal silver Ag°, or gold Au°, or copper Cu°, or palladium Pd°, or platinum Pt°. Size of zero-valent metal nanoparticles, introduced into nanostructured composite implant, is selected from 2 nm to 40 nm. At the stage of preparation for application of nanostructured composite implant colloidal solution of nanoparticles of zero-valent metal silver Ag°, or gold Au°, or copper Cu°, or palladium Pd°, or platinum Pt° is additionally introduced into granules of complex alloplastic hydroxyapatite-based preparation. After that, prepared granules of complex alloplastic preparation are placed in selected ratio onto layer of platelet-enriched autoplasma without mixing for further transfer into bone defect space. Part of erythrocyte mass and plasma, remaining in the process of preparation of platelet-enriched autoplasma, is returned into patient's blood stream by drop infusion in the process of surgery or at early postoperative period. Operation is completed with adaptation of fragments and their mechanical fastening by means of known metal constructions. After operation medication valtrex is administered to patient in dose 500 mg 1 time per day for 2 weeks and after that in dose 500 mg every second day for 2 weeks. Size of colloidal zero-valent metal nanoparticles, introduced into nanostructured composite implant, is selected for silver 2-25 nm, for gold 3-15 nm, for copper 2-40 nm, for palladium and platinum 17-23 nm. Colloidal zero-valent metal nanoparticles without admixtures of cations of said metals can be used in nanostructured composite implant. Platelet-enriched autoplasma, used in composition of nanostructured composite implant, is obtained from 420-450 ml blood, sampled from patient 2-4 hours before operation, with further double centrifugation, first at 2300 rev/min for 5 minutes with separation of erythrocyte mass from plasma, then plasma is centrifuged at 4000 revmin for 5 minutes with further separation of supernatant fluid and obtaining 20-30 ml of platelet-enriched autoplasma. Hydroxyapatite, used in nanostructured composite implant, has not more than 5 wt % of tricalcium phosphate Reposition of bone fragments with further metal-osteosynthesis is performed.

EFFECT: method ensures elimination of application of antibiotics and antiseptics in composition of nanostructured composite implant; elimination of considerable weakening process of reparative osteogenesis, elimination of allergic reactions of patient's organism, sufficient own virucidal activity, reliable prevention of obligatory intracellular viral infection in nidus of affection, compensation of reduction of length of patient's operated extremity.

5 cl, 5 ex