METHOD OF SURGICAL ACCESS WITH MOBILIZATION OF THE FEMORAL NEUROVASCULAR BUNDLE IN THE RESTORATION OF FRACTURES OF THE LOWER PARTS OF THE ANTERIOR COLUMN OF THE ACETABULUM Russian patent published in 2023 - IPC A61B17/56 

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: invention can be used for surgical access with mobilization of the femoral neurovascular bundle when restoring fractures of the lower sections of the anterior column of the acetabulum (AC). The method includes laying the patient on the operating table using a roller, making an incision from the pubic symphysis to the anterior-superior iliac spine, along the iliac crest, posteriorly by 2/3 of its length, separating the abdominal muscles and iliac muscles along the iliac crest, forming a window by pushing back behind the handles of the lumboiliac, iliac muscle and femoral nerve outward, and the iliac vessels — inward, with access to the upper pelvic aperture from the sacroiliac surface to the iliac-pubic eminence. Laying is performed in the position of the patient on the back, using a roller under the lower back, the lower limbs on the table, from the side of the fracture of the lower parts of the anterior column of the acetabulum, and the body of the pubic bone, the lower limb is bent at the hip and knee joints. After the window is formed, a transverse dissection of the ligamentous apparatus is performed: the pupart ligament at the anterior-superior iliac spine, the iliac-pubic ligament and the medial section of the pupart, lacunar ligament — at the tubercle of the pubic bone. Through the formed window, reposition and stabilization of bone fragments are performed. Passive movements are performed in the hip joint as much as possible. The dissected medial section of the pupart ligament, with the capture of the lacunar ligament, as well as the dissected lateral section of the pupart ligament, is sutured end-to-end. The pulsation of the popliteal artery is controlled, the wound is sutured.

EFFECT: high efficiency of anatomical restoration of fractures of the lower sections of the anterior column of the AC and the body of the pubic bone, their stabilization and exclusion of iatrogenic complications due to the creation of conditions for safe manipulations during the reposition of bone fragments.

1 cl, 3 dwg, 1 ex