RU2328998C1 - Method of multiple pelvic bone malunion treatment - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: vertical consolidated sacroiliac joint osteotomy is carried out. Thereafter compressive-distractive device is used for dosed elimination of pelvic rotational deformity simultaneously frontally turned to restore anatomic contours of anterior pelvic. Combined pubic bones are stably mutually fixed within symphysis.

EFFECT: elimination of pelvic rotational deformity.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with consequences of pelvic fractures.

A known method of treating chronic pelvic fractures (Cherkess-zade DI, Kamenev Yu.F., Ulashev U. U. Treatment of pelvic fractures in polytrauma. - Tbilisi, 1990. S.99-105), including sequential osteoplastic stabilization of the pubic and sacroiliac joints.

However, this technique does not provide for the restoration of the anatomical contours of the pelvic ring during rotational deformation of the pelvic bones, combined with a significant discrepancy between the pubic bones.

There is a method of treating chronic improperly fused pelvic injuries with its stable rotational deformation (Shlykov I.L. Surgical treatment of patients with consequences of pelvic ring injuries: Author. Diss. Candidate of Medical Sciences. - Ekaterinburg, 2004, 28 s). The method involves fixing the pelvis using the apparatus, performing an osteotomy of the pubic, ischial bones and lateral mass of the sacrum, reposition of the halves of the pelvis and their subsequent stabilization until consolidation.

The technique provides the complete elimination of the components of the pelvic deformity. However, the implementation of a triple osteotomy and simultaneous correction of pelvic deformity, especially its rotational component, combined with a significant discrepancy of the pubic bones, is very traumatic and involves significant blood loss.

The objective of the invention is to develop a method for the treatment of patients with improperly fused multiple fractures of the pelvic bones, which reduces the morbidity of the treatment while eliminating its rotational deformation, combined with a significant discrepancy of the pubic bones.

This problem is solved by the fact that in the method of treating patients with improperly fused multiple fractures of the pelvic bones, including violation of the integrity of the pelvic bones, their reposition and fixation using a compression-distraction apparatus, they perform vertical osteotomy of the areas of consolidated sacroiliac joints, and then rotationally eliminate the rotational displacement of the halves of the pelvis with their simultaneous rotation in the frontal plane until the anatomical contours of the anterior part of the pelvis are restored, after which the enclosed pubic bones are stably fixed to each other in the symphysis zone.

The method is illustrated by a description, an example of its practical use and illustrative material, which shows:

Figure 1 - radiograph of the pelvis of the patient before treatment;

Figure 2 - radiograph of the pelvis of the patient in the process of dosed elimination of deformation;

Figure 3 - radiograph of the pelvis of the patient in the process of fixation;

Figure 4 - radiograph of the pelvis of the patient after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, osteosynthesis of the pelvic bones is performed. When it is performed, the rods are cantilevered into the wings and bodies of both iliac bones and translucently hold the locking needles through both femurs at the level of their proximal and middle third. The free ends of the rods and spokes are mounted on external supports - arcs, rings, strips, which are interconnected by threaded rods and hinged nodes with the possibility of a multi-plane dosed movement.

Through a soft tissue incision, access to the surface of the pelvic bones and vertical osteotomy of the areas of both consolidated sacroiliac joints are performed. The operation is completed by performing control radiography, the wound is sutured with an aseptic dressing.

In the postoperative period, starting from 3-5 days, the rotational deformation of the halves of the pelvis is metered out and simultaneously rotated in the frontal plane with the pubic bones approaching in the symphysis zone until the existing diastasis is restored and thereby the anatomical contours of the anterior pelvic region and pelvic continuity are restored rings. In this case, the movement (rotational and angular rotation) of the halves of the pelvis is carried out as a single unit with fixed hips at a rate of 1.0-1.5 mm per day. Following this, the system of the apparatus is transferred to a stable fixation mode while maintaining a compressive force at the junction of the associated pubic bones. Hardware fixation of the pelvis is supported until the reconstruction of sections of the bone regenerate formed in the sacroiliac joint area and stabilization of the position of the pubic bones in the symphysis area. If necessary, the latter can be stabilized by additional surgical intervention with the installation of a connecting graft. After dismantling the device, the patient is prescribed a course of exercise therapy.

The practical implementation of the method is illustrated by the following clinical observation.

Patient M., 26 years old (IKSB No. 44452), was admitted to the hospital with a diagnosis of stable, improperly fused multiple pelvic fractures, severe deformation of the pelvic ring; interlobular diastasis 11 cm, ankylosis of the right and left hip joints.

He was injured as a result of a road accident 7.5 years ago. In view of the general serious condition, the clinical measures were initially aimed at eliminating the consequences of traumatic brain injury and damage to the abdominal organs; the treatment of damage to the pelvic bones was started only 2.5 months after the injury. As a result, the patient formed a coarse pelvic deformity with ankylosis of the hip joints and rotational installation of the lower extremities outward to the right by 80 and left by 45 degrees (Figure 1). Upon admission to the clinic, the patient hardly walked on crutches 10-15 meters.

To eliminate gross pelvic deformity, the patient underwent surgery: pelvic osteotomy in the area of consolidated sacroiliac joints on the right and left; osteosynthesis of the pelvis, right and left hips with an external fixation device.

In the course of the operation, after anesthesia and treatment of the surgical field, the rods were cantilevered into the wings of both iliac bones and translucently held the locking needles through the right and left femurs at the level of their proximal and middle third. The free ends of the rods and spokes are fixed on external supports, which are connected to each other with the possibility of metered movement.

A vertical osteotomy of the pelvic bones was performed through a soft tissue incision in the area of both consolidated sacroiliac joints. The wound was sutured in layers with an aseptic dressing.

In the postoperative period, starting from 3 days, a dosed rotational turn of the pelvic halves was performed with their simultaneous turn in the frontal plane to eliminate diastasis between the pubic bones (Figure 2). The rate of traction varied within 1.0 mm per day. After obtaining the x-ray picture of the restoration of the anatomically correct contours of the anterior part of the pelvis on the 107th day, the system of the apparatus was transferred to the stable fixation mode (Figure 3). Due to the duration of the injury, the joint of the associated pubic bones with the preservation of a diastasis of 1.2 cm between them was additionally fixed with a metal plate installed operatively. Subsequent hardware fixation was carried out for 45 days. After dismantling the apparatus, the patient underwent a course of rehabilitation therapy.

As a result of treatment, the anatomically correct shape of the pelvis and the continuity of the pelvic ring were restored, the external rotation of the halves of the pelvis was eliminated (Figure 4). At the control examination after one year, the achieved treatment result is saved. The patient has no complaints: notes the stability of the pelvis, the installation of the lower extremities is correct, walks with a cane (Figure 4). Hip arthroplasty is recommended.

Using the method in the RRC "WTO" them. Acad. G.A. Ilizarova showed that its use reduces the trauma of treatment of patients with improperly fused pelvic fractures, allowing to restore the anatomical shape, integrity and continuity of the pelvic ring during its rotational deformation, combined with a significant discrepancy between the pubic bones.

Claims (1)

A method of treating patients with abnormally fused multiple pelvic fractures, including violation of the integrity of abnormally fused pelvic bones, their reposition and fixation using a compression-distraction apparatus, characterized in that they perform vertical osteotomy of the areas of consolidated sacroiliac joints, and then rotational displacement is metered out half of the pelvis with their simultaneous rotation in the frontal plane until the anatomical contours of the anterior pelvis are restored, after whereby the combined pubic bones are stably fixed to each other in the symphysis zone.

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