FIELD: medicine.
SUBSTANCE: invention relates to medicine, namely to traumatology and surgery, can be used for transposition of the acetabulum during pelvic osteotomy in older children and adolescents. Before performing surgical treatment, the spatial visualization of the affected pelvic bones is determined by the method for multilayer spiral computed tomography, the state of the surrounding soft tissues, vascular and nervous structures that are not visualized when performing multilayer spiral computed tomography is assessed using magnetic resonance imaging. After performing anesthesia, with the patient in the supine position with a roller under the buttock on the operated side, flexion and abduction in the hip joint of the operated lower limb, longitudinal adductor access is performed with a cut of the skin and subcutaneous tissue 7-8 cm long in the upper third of the thigh along the medial surface in the projection adductor muscles, opening their own fascia, cuting off from the place of attachment of m.adductor longus and m.gracilis, cranially. Through the fibers of the gluteal muscles, access is made to the body of the ischium, to its periacetabular zone, above and lateral to the ischial tuberosity. Protectors are inserted subperiosteally at the site of the osteotomy. Using a chisel, a transverse osteotomy of the ischium is performed, while in the upper corner of the wound, the upper branch of the pubic bone is palpated closer to the body of the pubic bone and the site of the osteotomy is isolated subperiosteally. The surgical wound is sutured leaving active drainage. An arcuate skin incision 8-10 cm long is performed in the projection of the anterior-superior iliac spine down, the subcutaneous fat and its own fascia are dissected in layers, the muscles attached to it are cut off from the anterior superior iliac spine, the iliac, middle and small gluteal muscles are cut off with a raspator into area of the body of the ilium, in the supraacetabular zone from the body of the ilium, the periosteum is peeled off and the protectors are installed in the direction of the large ischial notch. Using an oscillatory saw and then a chisel, an osteotomy of the iliac body is performed. A threaded rod with a handle is screwed into the distal osteotomized fragment with the acetabulum under image intensifier tube control in the direction from the osteotomy zone to the bottom of the acetabulum, a protector is installed on the inside of the osteotomized fragment, traction of the lower limb caudally along the axis, a rotational movement is performed for the installed threaded rod from the inside - outwards to rotate the acetabulum, while the bone fragment with the acetabulum is rotated around the femoral head outwards and downwards, completely covering the latter. The bone fragments are fixed with 3-4 pins passed through the iliac wing down and medially into the distal iliac bone fragment. In the resulting diastasis between the bone fragments of the ilium, auto- or allografts are placed, which are additionally fixed using 3 threaded pins. The wound is sutured in layers with the restoration of the anatomical integrity of the adductor muscles and muscles attached to the anterior iliac spine and with the installation of active drainage. The operated limb of the patient is fixed in a derotational boot for 11-13 weeks.
EFFECT: method ensures restoration of exact anatomical relationships in the hip joint, reliable fixation of the ilium, ischium and pubic bones in the correction position, early activation with the patient's verticalization due to surgical treatment.
1 cl, 3 ex
