The method of removing the coccyx by r. u. makaeva

 

(57) Abstract:

The invention relates to the field of medicine, for the treatment of patients with traumatic injury to the coccyx and its consequences. The technical result of the invention: improved functional results through streamlined access to the coccyx, plastics wound cavity and correction sacrococcygeal angle, to prevent the formation of hematomas, suppurations, posleoperazionny pain, disorders of defecation, the reduction in the duration of bed rest in the postoperative period. The inventive skin incision is produced from the bottom pegagogical grooves and parallel to it in the projection of the coccyx, allocate the coccyx in the midline, producing a retrograde remove it with others robovie fabrics. Ecopsychology ligament before clipping from her coccyx, allocate and take on the ligature. Produce plastic wound cavity allograft for volumetric defect replacement series "Alloplant". The wound is sutured, correction of sacrococcygeal angle fixation Ecopsychology ligaments in the wound suture U-shaped seam that eliminates deformation of the sacrococcygeal angle, keeps the act of defecation.

The invention relates to the field IU the vision of the coccyx and its consequences.

There is a method of surgical treatment of traumatic lesions of the coccyx, taken as a prototype, in which an incision is performed on the bottom pegagogical folds, fix the tip of the coccyx, mobilize her, gradually picking up in the wound, antegrade remove the coccyx, align the distal part of the 5th sacral vertebra bone cutters. The operation completed meticulous hemostasis and maximum convergence kemptville mattress sutures the edges formed in the depth of the wound cavity. The introduction of microirrigation prevent the formation of hematomas, which can easily arise in depth. Get patient permission, from 4-5 days after surgery (Aminev A. M. Guide proctology. - Kuibyshev. - 1979. - So 4. - S. 163-164).

Disadvantages of the method described above in that the incision on the bottom pegagogical folds closest to the anus, which leads to increased bacterial contamination of the wound and postoperative suture, traumatic, its edges when stitching a wound, it is difficult to connect, and it is impossible to achieve the tightness of the seam after the surgery often suppurate, scar groveway, is not cosmetic, painful.

After removal of the coccyx is formed large enough wound pemiums. The cavity is also unable tightly sew up that leads to the formation of postoperative seromas and hematomas, which are the reasons expressed cicatricial process and suppuration.

Crossing Ecopsychology ligaments, and in some cases deformation of the rectum when stitching the wound cavity and a pronounced scar process lead to changes in the natural sacrococcygeal corner and next to the disordered defecation.

Treatment of bone cutters distal part of the 5th sacral vertebrae after removal of the coccyx does not allow its well-aligned, moreover, violates the bone structure, facilitating the formation of exostosis, condemning patients to pain in the postoperative period.

The technical result of the invention: improved functional results through streamlined access to the coccyx, plastics wound cavity and correction sacrococcygeal angle, to prevent the formation of hematomas, suppurations, postoperative pain, disorders of defecation, the reduction in the duration of bed rest in the postoperative period.

For plastics the wound cavity is proposed to use allosauroidea and alltrans the dignified stroma, providing him a good frame properties and ModeLine-ing with local hemostatic effect, reduce the development of scar process in the zone of operations, replaced its own tissues of the recipient (Nigmatulin R. I. Morphological aspects of transplantation, connective tissue grafts. Abstract. Diss....Prof. the honey. Sciences. - 1996).

The method is as follows.

Surgery is performed in the position of the patient on the right side, with propositum him down on his stomach, right leg bent, left maximally bent. Anesthesia: General anesthesia or sacral anesthesia. The skin incision is produced on the left buttock in 1 centimeter from the bottom pegagogical grooves and parallel to it in the projection of the coccyx. The skin is separated from the subcutaneous tissue to the bottom pegagogical grooves, the edges of the wound to throw hooks, then allocate the coccyx in the midline. Wiggle it determines the level of the sacrococcygeal junction, cross the sacrococcygeal ligament and produce retrograde removal of the coccyx with the surrounding robovie tissues, which is then resected and trigger areas. Ecopsychology ligament before clipping from her coccyx, allocate and take a silk ligature. The distal part 5-g is to achieve the rasp should be respectively either side of the vertebra from top to bottom and from outside to inside.

Plastic wound cavity formed after removal of the coccyx, is produced using allograft, before applying the model in the form of the wound cavity, placed in the wound and fix allerheiligen threads on the sides. The wound tightly sutured anchor kemptville sutures in the midline to the skin.

Correction of sacrococcygeal angle fixation Ecopsychology ligaments in the wound suture using allergogenny thread. A bunch of fixed U-shaped seam, making 2 stitch both edges of the wound, tighten with tension, visually controlling the displacement of the anus to the outside, helping silk ligature, which is then removed.

Impose nodal joints on skin wound, the edges of which are drawn together easily, as the offset cut line away from the more dense tissues bottom pegagogical grooves reduces the tension on the wound edges, increases the tightness of the seam, prevents suppuration, makes it cosmetic.

In the first two days after surgery, the patient observes in bed: lying on your side or stomach. Stand up begins on the third day, he rolled on his stomach at the edge of the bed, dropping one, then the other leg.

The proposed method is proctology with complaints of pain in the tailbone, aggravated by sitting and physical activity, is painful straining effort, the act of defecation, feeling of incomplete emptying of the rectum. Fell ill after a fall on the buttocks 2 years ago. When the finger rectal determined declined anteriorly and sharply painful coccyx, partially filled with a dense feces vial intestine. Using radiological methods of examination are defined deformation of the tailbone toward the front at an angle, signs of damage to the sacrococcygeal joint, vials intestine feces and gases. Held earlier courses of conservative therapy effect was not given. The operation took place, consisting in the removal of the coccyx, the residual stress of the cavity correction sacrococcygeal angle by the proposed method. The postoperative course is smooth, discharged with recovery. Examined after 3 and 6 months after surgery showed complete medical and social rehabilitation.

The method of removing the coccyx, characterized in that the incision is produced in 1 cm from the bottom pegagogical grooves and parallel to it in the projection of the coccyx, allocate the coccyx in the midline and retrograde remove it with others robovie fabrics, this will take a ligature Ecopsychology ligament, and asualt, and Ecopsychology a bunch of fixed U-shaped seam in the postoperative seam for the correction of sacrococcygeal angle.

 

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SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

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5 cl, 1 dwg

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