Patent RU-2729372-C1 (RU)
Title: Method for surgical treatment of pubic symphysis of pelvic ring using an alloplastic preparation based on hydroxyapatite
Inventor: Gudushauri Yago Gogievich
IPC: A61B17/80
Filed: 2020-02-26
Granted: 2020-08-06
Abstract: FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to traumatology and can be used for surgical treatment of pubic symphysis of pelvic ring. In the preoperative period prior to the surgical management, spatial visualization of involved pelvic bones is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to assess condition of surrounding soft tissues, vascular and nerve structures not visualized when performing multilayer spiral computed tomography, performing an anesthesia in the patient's position on the back, and before the surgery, administering a urinary transurethral catheter into the urinary bladder. Symphysis is exposed with a supersymphyseal transverse incision of the skin and an approach along the upper edge of the pubic ligament to the fascia and bone. Two abdominal rectus muscles are separated from the points from the abduction and shifted subperiosteal to pubic tubercles without injuring pubic tubercles at the point of attachment of the inguinal ligament. That is followed by a prevesical blunt finger abruption of the fascial plate displacing it with the anterior wall of the bladder inward. Affected areas of pubic symphysis are resected using nippers on both sides of pubic bones until their healthy portion. Then, not bringing together resected pubic bones, through the incision is made on an upper anterior edge of pubic bone as an implant metal plate with holes for fixing screws, made in the form of a bone of the pubic articulation in the form of a sector of a flat ring with rounded angles. Plate has 6 or 8 holes for fixing screws. Plate of metal implant is fixed with 6 or 8 fixing screws, placing them in previously made blind holes in bones of pubic articulation of pelvic ring. Postresection defect bone cavity volume of pubic bones is filled by granules of complex alloplastic preparation based on hydroxyapatite containing 55–80 wt% of collagen and impregnated as an antibacterial agent with aqueous solutions of midecamycin with concentration of 15–50 mg/ml and/or cefepime with concentration of 10–20 mg/ml. Two drainages are inserted, one into retention space and the second one – in front of pubic articulation. After performing the control pelvic X-ray examination of the correctness of the metal implant installation, hemostasis is controlled and the layered wound closure. Content of cefepime as an aqueous solution in its mixture with an aqueous solution of the antibacterial preparation of midecamycin is selected from 20 to 80 vol%.EFFECT: method provides reliable anatomical recovery of pelvis shape and support function with simultaneous absence of multiplane displacements of fixed bones, pain syndrome relief, retention of patient's motor activity in early postoperative period, elimination of dyspareunia with normalization of sexual function for women, absence of infectious damages of surrounding tissues with simultaneous preservation of blood supply and innervation of tissues, as well as eliminating the abnormal support function of the lower extremities by fixing the plate and using the alloplastic preparation impregnated with the antibacterial agent.1 cl, 5 ex