FIELD: medicine; traumatology; orthopedics.
SUBSTANCE: invention can be used for surgical treatment of IV grade spondylolisthesis. In the preoperative period, visualization of the bone anatomical structures of the spine affected by high-grade spondylolisthesis is carried out, the condition of the surrounding soft tissues, vascular and nervous structures is assessed. 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 S1 vertebral body and through L5-S1 intervertebral disc into L5 vertebral body without going beyond it. A discothomes is introduced into the channel, 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 tobramycin at a concentration of 15–50 mg/ml and/or gentamicin at a concentration of 10–30 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 canal formed in the body of L5 and S1 vertebrae, is filled with an osteoinductive material impregnated as an antibacterial agent with aqueous solutions of tobramycin at a concentration of 15–50 mg/ml and/or gentamicin with a concentration of 10–30 mg/ml. It is placed in the canal formed in the body of L5 and S1 vertebrae, and the wound is sutured with drainage placed. Granules of a complex alloplastic preparation based on hydroxyapatite containing 60 wt. % collagen, or granules of bone-plastic biological material based on bone tissue or autologous crumb; the content of an aqueous solution of the antibacterial drug tobramycin in its mixture with an aqueous solution of tobramycin antibacterial medicinal product is selected from 20 to 80 vol. %; the wall thickness of the hollow perforated tube of the cage is 0.9–1.0 mm, and the perforations of the hollow perforated tube of the cage are round, square or diamond-shaped.
EFFECT: method ensures the absence of postoperative complications, the formation of a stable bone block, the absence of infectious lesions of surrounding tissues, the provision of reliable prevention of the occurrence of purulent-inflammatory processes while maintaining blood supply and tissue innervation, as well as early social rehabilitation of the patient with a simultaneous increase in the quality of his life due to the use of osteoinductive material impregnated with an antibiotic.
4 cl, 5 ex
