METHOD OF SURGICAL TREATMENT OF MALIGNANT GROWTHS WITH THE DEFEAT OF THE COTYLOID CAVITY, WING OF ILIUM AND PROXIMAL FEMUR WITH RESECTION OF COTYLOID CAVITY AND FIXATION OF COTYLOID COMPONENT OF ENDOPROSTHESIS IN SACRUM Russian patent published in 2020 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used in surgical management of patients with malignant neoplasm of pelvic bone in conditions of oncological hospitals. In the preoperative period prior to surgical management, spatial visualization of involved bone structures of pelvic and femoral bones is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to evaluate the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when performing multilayer spiral computed tomography. In the patient's position, an arcuate incision of skin and subcutaneous fat along an iliac crest from an anterior superior iliac spine to a projection of a greater ischial incision are performed in an anesthetized healthy segment. Using the electric knife, the skin flap is separated along the external surface of the iliac bone, the inguinal ligament is transected, the fibers of the external abdominal oblique muscle are dissected at the attachment point to the iliac bone, and the retroperitoneal approach to iliac vessels is performed with the iliac vessels visualization. Skeletonized an anterior spines of iliac bone with excision of sartorius muscle and rectus femoris muscle. Incision on the anteriolateral surface of the femur is prolonged more caudally, a femoral neurovascular bundle is visualized and its stroke is monitored. Hip joint is accessed, the proximal femoral part is separated from the surrounding tissues and 2–3 mm from the distal edge of the tumor, the femoral osteotomy is performed for the subsequent placement of the femoral component of the oncology endoprosthesis. Gluteus muscles are dissected in layers with visualization, separation, dressing and intersection of the lower and upper gluteus vascular bundles. Muscles of the internal group of pelvic muscles are transected, an access to the ischial nerve and an iliac joint is visualized and the sciatic nerve is visualized and its location is monitored during the osteotomy. If the malignant growth of the pubic and sciatic bones is affected, the upper and lower branches of the affected pubic bone are skeletonized and the pubic-femoral and ileo-femoral ligaments are crossed, the pubic symphysis is dissected, then from the surrounding tissues an affected ischial bones are separated and a sacral-tubercular and sacral-sinus ligaments are transected. Iliac-iliac articulation is visualized on both sides, its dissection is performed using an electric knife and a line of osteotomy with an indentation from the tumor edge is marked by 2–3 cm. Further, using the saw, an osteotomy is performed along a sacroiliac joint and a previously planned osteotomy, removed with a single unit pelvic bone together with part of femoral bone and malignant neoplasm without its opening, observing the principle of ablastics with capturing healthy tissues, hemostasis at all stages of single unit isolation. Then, using scans, a canal is formed in the sacrum through its lateral mass, intervertebral disk L5-S1 to the center of the vertebral body L5. Formed canal is filled with bone cement and a pedicle of the oncological endoprosthesis cotyloid component is placed in it together with a cup. Femoral intramedullary canal is treated with reamers before the femoral component of the oncology endoprosthesis is inserted. After pre-testing the components, an oncological endoprosthesis is assembled and placed, and a reparation cover made of polyethylene terephthalate fabric is placed on the femoral component of the oncological endoprosthesis. Cup of the acetabular component and the head of the femoral component are tied with a lavsan thread, after which the connected components of the oncological endoprosthesis are covered with a reparative cover, the ends of which are lined with purse-string sutures. Vascular fascicle and sciatic nerve are covered with fibers of resected muscles sewn together, layer-by-layer closure of the wound is performed with leaving two silicone drainages. Lavender component of the endoprosthesis and a cup of the cotyloid component of the endoprosthesis are tied with the lavsan thread in an amount of three to five times. After hemostasis is completed, hemostatic of local action "SURGICELL" is recorded additionally on the region of diffuse infestation.

EFFECT: method enables providing the radical removal of the affected pelvis and the proximal femoral bone of the malignant new growth, reliable restoration of functional integrity and motor abilities in malignant neoplasm involvement of cotyloid cavity and iliac wing, providing conditions for reliable preservation of anatomical support capacity of cavity and iliac wing affected by malignant neoplasm due to said methods.

3 cl, 3 ex