FIELD: medicine; traumatology; orthopedics.
SUBSTANCE: invention relates to the method for the surgical treatment of high-grade spondylolisthesis using an osteoinductive material impregnated with vancomycin and/or cefepime, and can be used in the treatment of patients with spinal deformities in trauma, surgical and other hospitals. 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 vancomycin at a concentration of 20–40 mg/ml and/or cefepime at a concentration of 40–50 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 an osteoinductive material impregnated as an antibacterial agent with aqueous solutions of vancomycin with a concentration of 20–40 mg/ml and/or cefepime at a concentration of 40–50 mg/ml. The cage is placed in the channel formed in the body of L5 and S1 vertebrae. The wound is sutured with a drainage in place. As an osteoinductive material, 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 autobone crumbs are used; the content of an aqueous solution of the antibacterial drug vancomycin in its mixture with an aqueous solution of cefepime 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 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 while improving his quality of life through the use of osteoinductive material impregnated with an antibiotic.
4 cl, 5 ex
