METHOD FOR SURGICAL TREATMENT OF CHRONIC PUBIC ARTICULATION RUPTURES IN WOMEN WITH AXIAL FIXATION OF A METAL FIXING PLATE Russian patent published in 2021 - IPC A61B17/56 A61B17/80 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for the surgical treatment of chronic ruptures of the pubic articulation in women with axial fixation of a metal fixing plate. Before performing surgical treatment, the spatial visualization of the affected pubic bones of the pelvis is determined by the method for multilayer spiral computed tomography with the identification of the anatomical features of the shape and structure of the ischio-pubic branches of the pubic bones. The state of the surrounding soft tissues is assessed by the method for magnetic resonance imaging. An individual fixing metal plate is made. An access is performed, through which a fixing metal plate is passed into the pelvic cavity until it coincides with the proximal border of the acetabulum and until the middle of the distal part of the fixing plate coincides with the middle of the pubic articulation according to the inlet view. A plate in the form of a plate curved in the horizontal plane with the extreme areas of its placement on the iliac and pubic bones of the reconstructed pelvic ring of the patient, including on both sides of the pubic symphysis, while the inner radius of bending of the plate bent in the horizontal plane is selected with a radius of curvature from 49 to 58 mm, at each extreme section of the fixing and metal plate bent in the horizontal plane, 4-6 holes with a diameter of 3 to 5 mm are arranged symmetrically to the center of the plate with a conical chamfer to accommodate the fixing screws, and the center-to-center distances of the holes are selected from 7 to 12 mm. Conical chamfers are made on the plate on the side opposite to the side intended for contact with the pubic bone, while the diameter of the cylindrical part of the holes corresponds to the diameter of the fixing screws, the fixing metal plate bent in the horizontal plane is provided with a flat bent at an angle to the plane of the fixing metal plate bent in the horizontal plane a closed W-shaped fixing element rounded at its vertices, repeating the shape of the horizontal bend of the fixing metal plate. The bend angle of the rounded W-shaped closed fixing element of the plate is made corresponding to the overflow angle of the upper branch of the patient's pubic bone into the lower symphysial surface with respect to the horizontal plane of the ischio-pubic branches of the pubic bones of the reconstructed pelvic ring of the patient. The branches of the rounded W-shaped closed locking element are located at an angle α from 34° to 36° to the vertical axis of the plate bent in the horizontal plane. The convex part of each branch of the rounded W-shaped closed fixing element is made turning into a common concave part. The vertical branches of the pubic bones are repositioned until they touch and the axial fixation of the fixing metal plate is performed along the upper surface of the pubic arch and along the symphysial surface of the reconstructed pubic articulation of the patient's pelvic ring with self-tapping fixing screws. One drainage is installed in the retinal space. Control of hemostasis and layer-by-layer wound closure are performed. The fixing metal plate is made with a thickness of 1 to 3 mm and a width of 10 to 15 mm from titanium alloys or from medical stainless steel. In this case, on each branch of the rounded W-shaped closed locking element, two pairs of holes are made to accommodate the locking screws, while the first pair of holes is made in the middle part of each branch of the rounded W-shaped closed locking element, and the distance between the centers of the holes is from 10 mm up to 12 mm, the first hole of the second pair of holes is made on the convex part of each branch, and the second hole of the second pair of holes is made on the common concave part of the rounded W-shaped closed fixing element, the distance between the centers of the holes being from 9 mm to 11 mm.

EFFECT: method provides the restoration of the shape and support function of the pelvis, the absence of multiplanar displacements of the fixed bones, the patient's motor activity in the early postoperative period, reduction of the rehabilitation time due to the use of an individual fixing plate.

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