METHOD FOR SURGICAL TREATMENT OF UNUNITED FRACTURES AND FALSE JOINTS OF CYLINDRICAL BONES IN SHORTAGE OF SOFT TISSUE IN PROJECTION OF UNUNITED FRACTURES AND FALSE JOINTS Russian patent published in 2014 - IPC A61B17/58 B82Y5/00 A61K31/525 A61K33/06 A61K33/38 A61K35/16 A61K38/39 A61P19/08 A61B6/00 A61M1/02 

FIELD: chemistry.

SUBSTANCE: invention relates to medicine and specifically to trauma surgery and orthopaedics, and can be sued for surgical treatment of ununited fractures and false joints of cylindrical bones when there is a shortage of soft tissue. The method involves, 5-6 days before an operation, performing needle biopsy of bone and soft tissue fragments from the damage centre of the cylindrical bone and determining presence and nature of obligate intracellular viral infection (OIVI). Super-selective angiographic analysis of the microvascular channel to the capillary link is also performed. Valtrex is administered to the patient 2-4 days before the operation in a dose of 500 mg twice a day. Further, the method involves performing osteosynthesis or re-osteosynthesis with resection of the ends of bone fragments, opening marrowy canals, bone stimulation and batting the space of the bone defect with a gel-like nanostructured composite implant. In the presence of OIVI, resection of bone fragments is carried out in a larger volume until the onset of "pinpoint bleeding", i.e. to areas with satisfactory intrabone blood supply. The composite implant contains thrombocyte-rich autoplasma, mixed in ratio of 1:(1-2) with granules of a complex alloplastic preparation (CAP) based on hydroxyapatite which contains 50-60 wt % collagen. The composite implant also contains either 0.08-2.8 wt % colloidal solution of nanoparticles of zero-valent silver metal Ag⁰, or gold Au⁰, or copper Cu⁰, or palladium Pd⁰, or platinum Pt⁰, or 5-12 wt % nanoparticles of said metals in dry form. The nanoparticles have size of 2-40 nm. A colloidal solution of said nanoparticles or colloidal nanoparticles of said metals in dry form is added to the CAP granules. Further, the prepared granules of the gel-like complex alloplastic preparation are laid in a selected ratio on the layer of thrombocyte-rich autoplasma, without mixing, for subsequent transfer into the bone defect space. In case of performing resection of bone fragments in a larger volume until the onset of "pinpoint bleeding", corticotomy is further performed on the cylindrical bone being operated on, with subsequent distraction of the bone regenerate using any existing method. Further, the bone fragments are repositioned, followed by metallo-osteosynthesis. Before wound suturing, the surface of the area with shortage of soft tissue in the projection of the ununited fracture and false joints is covered by a semi-permeable flexible plate made of the complex alloplastic preparation based on hydroxyapatite, which contains 50-60 wt % collagen. The plate has thickness of 0.25-1.2 mm. The surface area of the plate is 10-20% greater than the area with shortage of soft tissue in the corresponding projection. The part of the erythrocyte mass remaining from preparing the thrombocyte-rich autoplasma and the plasma are returned into the bloodstream of the patient by intravenously using a drip during the surgical procedure or in the early post-operation period. After the operation, valtrex is administered to the patient in a dose of 500 gm once a day for two weeks and then in a dose of 500 mg every other day for two weeks.

EFFECT: method provides reliable prevention of OIVI at a damage centre, normalisation of local microcirculation of blood, avoiding ischemic processes, and compensation for the shortening of the length of the limb of the patient being operated on while preventing weakening of the process of reparative osteogenesis and allergic reactions of the body.

6 cl, 4 ex