FIELD: medicine.
SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of high degree spondylolisthesis using osteoinductive material impregnated with dalbavancin and/or ceftobiprol. In the preoperative period, the spatial visualization of the bone anatomical structures of the spine affected by high-grade spondylolisthesis is determined using multilayer spiral computed tomography, the state of the surrounding soft tissues, vascular and nervous structures is assessed using magnetic resonance imaging. In the patient’s prone position, after anesthesia, an incision of the skin over the spinous processes of the spine is performed, followed by dissection of the subcutaneous tissue and its own fascia, then laminectomy of L5 and S1 vertebrae is performed with bilateral foraminotomy of L5 -S1. A channel with a diameter of 14-15 mm is formed under the control of an image intensifier using a sequential set of drills with an increasing diameter through the vertebral body S1 and through the intervertebral disc L5 -S1 into the vertebral body L5 without going beyond it. A discothome is introduced into the formed canal, and the structure of the intervertebral disc is removed using it. The space formed after the removal of the intervertebral disc is filled with osteoinductive material impregnated as an antibacterial agent with aqueous solutions of dalbavancin at a concentration of 20-50 mg/ml and/or ceftobiprol at a concentration of 25-50 mg/ml. A pre-prepared cage in the form of a hollow perforated tube with a diameter of 14-15 mm, the length of which corresponds to the depth of the channel formed in the body of L5 and S1 vertebrae, is filled with osteoinductive material impregnated as an antibacterial agent with aqueous solutions of dalbavancin with a concentration of 20-50 mg/ml and/or ceftobiprol with a concentration of 25-50 mg/ml, the prepared cage is placed in the channel formed in the body of vertebrae L5 and S1. The wound is sutured with a drainage in place. Herewith, granules of a complex alloplastic preparation based on hydroxyapatite containing 80 wt.% collagen, or granules of bone-plastic biological material based on bone tissue or autologous bone crumb are used as osteoinductive material. Herewith, the content of an aqueous solution of the antibacterial drug ceftobiprol in its mixture with an aqueous solution of the antibacterial drug dalbavancin was chosen from 20 to 80% by volume. In this case, the wall thickness of the hollow perforated tube of the cage is chosen to be 0.9-1.0 mm, and the perforations of the hollow perforated tube of the cage are made round, square or diamond-shaped.
EFFECT: method provides reliable anatomical restoration of the shape and support function of L5 vertebra, absence of postoperative complications, formation of a stable bone block in high-grade spondylolisthesis, absence of infectious lesions of surrounding tissues, prevention of purulent-inflammatory processes while maintaining blood supply and innervation of tissues, as well as early patient’s social integration while improving the quality of his/her life, due to the specific features of the method.
3 cl, 5 ex
