METHOD OF SURGICAL TREATMENT OF OLD ACHILLES TENDON RUPTURES Russian patent published in 2013 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and can be used in treatment of Achilles tendon ruptures. After performing preoperative ultrasonic and magnetic resonance determination of character of Achilles tendon ruptures, medial 10-15 cm long peritendinous access to injured Achilles tendon is performed with patient in lying on abdomen position under spinal cord anesthesia. In the process of access in sharp and blunt way after dissection of skin, subcutaneous adipose cellular tissue and paratenon, distal and proximal stumps of ruptured Achilles tendon with ends deformed in bulb-like way are visualised with constant homeostatsis by means of electrocoagulator. After that patient's foot, that is being operated, is brought into equinus position with distal and proximal ends of Axchilles tendon being approached to each other. Economic excision of ends of tendon stumps, deformed in bulb-like way, is performed. After excision of non-viable degeneratively changed scar tissues autotendoplasty is carried out, in the process of which 3-5 cm long tendon flap is cut out on proximal stump of Achilles tendon, is "overthrown" by 180° and sewn into preliminarily prepared bed in proximal part of distal stump of ruptured Achilles tendon. Defect which is formed in the place of cutting out tendon flap is eliminated by application of 2-3 interrupted sutures from non-absorbable suture thread. After that, gel-like nanostructured composite implant, containing platelet-enriched autoplasm in 1:(1-2) ratio with granules of complex hydroxyapatite-based autoplastic preparation, containing 50-60 wt % of collagen, is incorporated into tendoplasty area on entire surface of circumference of sewn ends of Achilles tendon. Applied gel-like nanostructures composite implant additionally contains 0.08-2.8 wt % of colloid solution of nanoparticles of zero-valent metal silver Ag⁰. Selected size of colloid zero-valent silver nanoparticles, introduced into gel-like nanostructured composite implant is from 2 nm to 25 nm. At the stage of preparation to application of gel-like nanostructured composite implant colloid solution of nanoparticles of zero-valent metal silver Ag⁰ is additionally introduced into granules of complex alloplastic preparation. After that, prepared granules of gel-like complex alloplastic preparation are placed in selected ratio on the layer of platelet-enriched autoplasm without mixing for further incorporation into the area of tendoplasty. Part of erythrocyte mass and plasma, remaining in the process of producing platelet-enriched autoplasm, is returned into patient's bloodstream intravenously by drop infusion during surgery or in early postoperative period. After operation medication vobenzim in dose 500 mg 3 times per day for 2 weeks and aevit in dose 500 mg 3 times per day for 3 weeks are administered to patient. Colloid zero-valet nanoparticles of silver without admixture of silver cations can be used in nanostructured composite implant. Platelet-enriched autoplasm, used in composition of nanostructured composie implant, is obtained from 420-450 ml of blood sampled from patient 2-4 hours before operation, with following double centrifugation first at 2300 rev/min for 5 minutes with separation of erythrocyte mass from plasma, then plasma is centrifuged at 4000 rev/min for 5 minutes with further separation of supernatant liquid and obtaining 20-30 ml of platelet-enriched autoplasm.

EFFECT: method ensures tightening of tendon-muscle complex, required for diastasis elimination and blood supply improvement, absence of wound complications, creation of favourable conditions for Achilles tendon union, absence of edge necrosis of ruptured ends of Achilles tendon with simultaneous increase of patient's life quality.

3 cl, 3 ex