Patent RU-2747697-C1 (RU)
Title: Method for surgical treatment of pubic symphysis of pelvic ring using bone-plastic biological material based on bone tissue impregnated with antibacterial agents
Inventor: Gudushauri Yago Gogievich
IPC: A61B17/56
Filed: 2020-07-27
Granted: 2021-05-12
Abstract: FIELD: medicine. 
     SUBSTANCE: invention relates to medicine, namely to traumatology and can be used for treatment of the pubic symphysis of the pelvic ring. In the preoperative period, before surgical treatment, the spatial visualization of the affected pelvic bones is determined by multilayer spiral computed tomography, and the state of the surrounding soft tissues, vascular and nerve structures that are not visualized during multilayer spiral computed tomography is evaluated by magnetic resonance imaging. After performing of anaesthetic support in the patient's back position and before the start of surgery, a passive urine removal catheter is transurethrally inserted into the bladder. The exposure of the symphysis by a transversal transversal incision of the skin and approach along the upper edge of the pubic joint to the fascia and to the bone is performed. Meanwhile the two rectus abdominis muscles are separated from their places of departure and shifted sub-periosteally to the pubic tubercles. Then pre-bubble blunt finger detachment of the fascial plate with its displacement with the anterior wall of the bladder deep is performed. The affected volumes of the pubic symphysis are resected using pliers on both sides of the pubic bones to their healthy area. Then, through the performed incision, a metal plate with holes for placing fixing screws, made in form of the bone of the pubic joint in form of a sector of a flat ring with rounded corners, is placed along the upper-anterior edge of the pubic bones as an implant. In this case, 6 or 8 holes are made in the plate to accommodate the fixing screws. The metal implant plate is fixed with 6 or 8 fixing screws, placing them in pre-made blind holes in the bones of the pelvic ring pubic joint. The volume of the formed bone cavity of the post-resection defect of the pubic bones is filled with granules of bone-plastic biological material based on bone tissue, impregnated as an antibacterial agent with aqueous solutions of vancomycin with a concentration of 20-60 mg/ml and/or ceftobiprol with a concentration of 30-50 mg / ml. Two drain tubes are installed, one of them into the retropubic space and another one in front of the pubic articulation. The concentration of an aqueous solution of the antibacterial drug vancomycin in its mixture with an aqueous solution of the antibacterial drug ceftobiprol is selected from 20 to 80 vol.%. After performing the correct installation of the metal implant using control radiography of the pelvis, hemostasis control and layer-by-layer suturing of the wound are performed.  
     EFFECT: proposed method ensures reliable anatomical restoration of the shape and supporting function of the pelvis, as well as the absence of dislocations of the fixed bones, relief of pain, preservation of the patient's motor activity in the early postoperative period, elimination of dyspareunia with normalization of sexual function in women and the absence of infectious lesions due to the use of bone-plastic biological material impregnated with antibacterial agents. 
     2 cl, 5 ex