METHOD FOR MINIMALLY INVASIVE SURGICAL FIXATION OF PUBIC JOINT IN POLYFOCAL INJURY OF PELVIS BY OSTEOSYNTHESIS WITH TRANSPEDICULAR FIXATION SYSTEM Russian patent published in 2024 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics. In the preoperative period, spatial visualization of the injured pubic bones of the pelvis is determined by multilayer spiral computed tomography. Magnetic resonance imaging is used to assess the state of surrounding soft tissues, vascular and nerve structures, which is not visualized when performing multilayer multispiral computed tomography. Patient is placed on his/her back on a radiolucent operating table to obtain pelvic inlet, pelvic outlet, obturative and combined outlet-obturative X-ray projections, performing all subsequent surgical operations under control of electro-optical converter throughout the surgical intervention. 5–6 cm incision of the skin and subcutaneous fat is made in a projection of a pubic symphysis with access to the injured pubic symphysis and exposing the pubic symphysis. Awl is used to perforate an intact pubic bone to form a tunnel and to measure the length of the tunnel. Tap in the tunnel is used to cut a thread and perform a parasymphetical placement of a transpedicular screw with immersion to a polyaxial head. Similarly, the second transpedicular screw is screwed into the pubic bone with the fracture, wherein the transpedicular polyaxial screw is placed in the pubic bone medial to the fracture line. After the transpedicular polyaxial screws are placed, a fixing pin with diameter of 2.5 mm and length of 300 mm with a self-tapping threaded tip is inserted into the fragment of the pubic bone by reaming using a cannulated low-speed drill until the fracture plane is crossed. Then, using dynamic image intensifier in pelvic inlet and pelvic outlet X-ray projections fixing pin is introduced in direction of roof of cotyloid cavity until reaching by threaded tip of fixing pin sursil - X-ray image of roof of cotyloid cavity. EOC-control of the fixation pin position in the obturative and combined outlet-obturative X-ray projections is performed. Fixing pin is cut with nippers at distance of 10–11 mm from the orifice, the section of the fixing pin located outside the pubic bone is bent in the distal direction and placed in the plane of the pubic bone body so that the end of the fixing pin adjoins the pubic bone. Metal tightening bar with a round, square or oval cross-section is placed in the heads of the pubic transpedicular polyaxial screws and using a torque screwdriver, the metal tightening bar is pre-fixed in the heads of the transpedicular polyaxial screws. Contractor is used to tighten pubic symphysis with elimination of vertical displacement of pubic bones and the final fixation of the metal tightening bar is performed by tightening the nuts in the heads of the transpedicular polyaxial screws, performing the final EOC control, placing the drainage in the area of the pubic articulation and the wounds sutured in layers.

EFFECT: method provides reliable fixation of pubic bone fragments, anatomical restoration of the shape and support function of the patient's pelvis with simultaneous absence of multiplanar displacements of the fixed bones, provides minimization of circulatory disorders in the area of soft tissues with simultaneous reduction of blood loss, provides reduction of rehabilitation time of patient by 13–18% with simultaneous sufficient improvement of his/her quality of life.

1 cl, 3 ex