METHOD FOR SURGICAL TREATMENT OF PUBIC SYMPHYSIS OF PELVIC RING USING AN ALLOPLASTIC PREPARATION BASED ON HYDROXYAPATITE Russian patent published in 2020 - IPC A61B17/80 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and can be used for surgical treatment of pubic symphysis of pelvic ring. In the preoperative period prior to the surgical management, spatial visualization of involved pelvic bones is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to assess the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when multilayer helical computed tomography is performed. After the anesthesia is performed, the patient is placed on the back and prior to the surgery, the urinary tract catheter is transurethral inserted into the bladder. Symphysis is exposed with a supersymphyseal transverse incision of the skin and an approach along the upper edge of the pubic ligament to the fascia and bone. Two abdominal rectus muscles are separated from the points from the abduction and shifted subperiosteal to pubic tubercles without injuring pubic tubercles at the point of attachment of the inguinal ligament. That is followed by a prevesical blunt abruption of the fascial plate displacing it with the anterior wall of the bladder. Affected areas of pubic symphysis are resected using nippers on both sides of pubic bones until their healthy portion, then not bringing together resected pubic bones. Incision is arranged on an upper anterior edge of pubic bones as an implant a metal plate with holes for fixing screws arrangement, made in the form of a bone of the pubic articulation in the form of a sector of a flat ring with rounded angles. Plate has 6 or 8 holes for fixing screws. Plate of metal implant 6 or 8 is fixed with fixing screws, placing them in previously made blind holes in bones of pubic joint of pelvic ring. Post-excision defect of pubic bones is filled with a volume of the formed bone cavity with granules of a complex alloplastic preparation based on hydroxyapatite containing 50–80 wt% collagen and impregnated as an antibacterial agent with aqueous solutions of moxifloxacin with concentration of 20–50 mg/ml and/or aztreonam with concentration of 10–20 mg/ml. Drainages are installed: one into retention space and the second one – in front of pubic joint. After performing the control pelvic X-ray examination of the correctness of the metal implant installation, hemostasis is controlled and the wound is sutured in layers. Content of the aqueous solution of the antibacterial preparation aztreonam in its mixture with an aqueous solution of the antibacterial preparation moxifloxacin is selected from 20 to 80 vol%.

EFFECT: method provides recovery of pelvis shape and support function with simultaneous absence of multiplane displacements of fixed bones, pain syndrome relief, ensuring retention of patient's motor activity in early postoperative period, eliminating dyspareunia with normalizing sexual function for women, absence of infectious damages of surrounding tissues with simultaneous preservation of blood supply and innervation of tissues, as well as elimination of abnormal support function of lower extremities due to surgical treatment using an alloplastic preparation based on hydroxyapatite impregnated with antibacterial drugs.

1 cl, 5 ex