METHOD OF SURGICAL TREATMENT OF THE PUBIC SYMPHYSIS OF THE PELVIC RING USING OSTEOPLASTIC BIOLOGICAL MATERIAL BASED ON BONE TISSUE IMPREGNATED WITH GENTAMICIN AND TOBRAMYCIN

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine and namely to traumatology. The spatial visualization of the affected pubic bones of the pelvis is carried out with the help of the method of multilayer spiral computed tomography during the preoperative period before surgical treatment. Magnetic resonance imaging is used to assess the state of the surrounding soft tissues, vascular and nerve structures which are not visualized when performing multilayer spiral computed tomography. The passive urinary diversion catheter is put into the bladder transurethrally after anesthesia is performed with a patient in the supine position and before the start of surgery. The symphysis is exposed by a suprasymphyseal transverse incision of the skin and an approach along the upper edge of the pubic joint to the fascia and to the bone, while the two rectus abdominis muscles are separated from their places of origin and shifted subperiosteally to the pubic tubercles. Then prevesical blunt finger detachment of the fascial plate is performed with its inward displacement with the anterior wall of the bladder. The affected areas of the pubic symphysis are resected using surgical nippers on both sides of the pubic bones to their healthy area. After that, without bringing the resected pubic bones closer to each other, a metal plate with holes for fixing screws, which is made in the shape of the pubic articulation bone in the form of a flat ring sector with rounded corners, is placed along the upper anterior edge of the pubic bones as an implant along the upper anterior edge of the pubic bones. After that 6 or 8 holes are made in the plate to accommodate 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 pubic articulation of the pelvic ring. The volume of the formed bone cavity of the post-resection defect of the pubic bones is filled with granules of osteoplastic biological material based on bone tissue impregnated with aqueous solutions of gentamicin with a concentration of 20-60 mg/ml and / or tobramycin with a concentration of 30-60 mg/ml. Then two drains are installed. One drain is installed in the rettium space and the second one is installed in front of the pubic joint. After the metal implant is placed in a correct position using a control X-ray of the pelvis, hemostasis control is ensured and layer-by-layer wound closure is performed. ;EFFECT: method ensures reliable anatomical restoration of the shape and support function of the pelvis with the simultaneous absence of multiplanar displacements of the fixed bones and provides sufficient preservation of a patient's motor activity in the early postoperative period. It also eliminates dyspareunia and normalizes the sexual function for women, ensures the absence of infectious lesions of the surrounding tissues with simultaneous preservation blood supply and innervation.;2 cl, 5 ex