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 suprasymphyseal 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 finger abruption of the fascial plate displacing it with the anterior wall of the bladder inward. 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, through the made incision, a metal plate with holes for fixing screws arranged in the form of a bone of the pubic articulation in the form of a sector of a flat ring with rounded angles is placed on an upper anterior border of pubic bones as an implant. Plate has 6 or 8 holes for holding fixing screws; metal implant 6 or 8 plate is fixed with fixing screws, placing them in previously made blind holes in the bones of the pubic ligament of the 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 55–80 wt% of collagen and impregnated as an antibacterial agent with aqueous solutions of an aminoglycoside and/or glycopeptide with concentration of 15–50 mg/ml, wherein the aminoglycoside antibacterial aqueous solution of the complex alloplastic preparation is phosphomycine, and the glycopeptide of the antibacterial aqueous solution of the complex alloplastic preparation is represented by teicoplakin. Two drainages are installed, one into Retzius space and the second one – before pubic joint, after using the control pelvic X-ray examination of the metal implant installation, the hemostasis is controlled and the layered wound closure. Content of the aqueous solution of the antibacterial preparation phosphomycin in its mixture with an aqueous solution of the antibacterial preparation teicoplakin ranges from 18 to 82 vol%.

EFFECT: method provides reliable anatomical recovery of pelvis shape and support function with simultaneous absence of multiplane displacements of fixed bones, pain syndrome relief, retention of patient's motor activity in early postoperative period, elimination of dyspareunia with normalization of sexual function for women, ensuring absence of infectious injuries of surrounding tissues with simultaneous preservation of blood supply and innervation of tissues, as well as eliminating abnormal support function of lower extremities by fixing plate and alloplastic preparation based on hydroxyapatite impregnated antibacterial agent.

1 cl, 5 ex