Method for treating the cases of vertical fracture-dislocations of animal pelvic ring

FIELD: veterinary medicine.

SUBSTANCE: method involves fixing cranial and caudal regions of both pelvic bones. Bones and/or ventral pelvic half-ring fragments are reduced under apparatus-mediated fixation conditions. Residual dislocation of pelvic bones in sacroiliac symphysis zone and/or that of sacrum fragments are eliminated under apparatus-mediated fixation conditions. Iliac bones are first reduced to the level of anatomical arrangement of sacroiliac symphysis and/or sacrum fragments in particular cases of bilateral vertical fracture-dislocations of animal pelvic ring. First, intermediate fragments of the bones are juxtaposed along injury line and intermateably fixed with one of adjacent fractured bone fragments and then pelvic ring bone dislocation is eliminated in particular cases of vertical fracture-dislocations accompanied by bilateral longitudinal fracture of sacrum and/or recess branches of pubic and suture branches of ischial bones. When fixing caudal regions of pelvic bones, fixing members are introduced in particular cases in different directions into recess and suture branches of ischial bones.

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The invention relates to the field of veterinary medicine and can be used in the treatment of animals with severe unstable dislocations fractures of the pelvis, including, if the vertical offset.

Known and used in clinical practice, the treatment of vertical dislocations fractures of the pelvis (1)providing a metered reposition the bones of the pelvis with external fixation device to restore anatomically correct relationship of the pelvic ring. However, this method does not take into account the anatomical structures of the pelvic ring animals that do not allow its use in veterinary practice.

There is a method of treatment of traumatic injuries of the pelvic ring pet (2), including performing osteosynthesis pelvic bones and their fragments, reduction and stable fixation using the Ilizarov apparatus. In General this method is intended for local treatment of lesions of the individual bones of the pelvis animals and may not be used in the treatment of severe unstable vertical dislocations fractures.

The objective of the invention is to develop a method for the treatment of vertical Pereloma-dislocations of the bones of the pelvic ring animals, providing its anatomical and functional recovery at the various types of traumatic injuries.

This task is solved in that in the method of treatment of vertical dislocations fractures of the bones of the pelvic ring animals, including reposition the bones of the hip and/or their fragments by sequential rotation and displacement in perpendicular planes to associate with subsequent stable fixation with compression-distraction device, independent record cranial and caudal divisions of both pelvic bones, and then in terms of hardware fixation initially produce reposition the bones and/or fragments of the ventral half of the pelvis, and then carry out the elimination of the remaining displacement of the pelvic bone in the area of the sacroiliac joint and/or fragments of the sacrum. This is provided that:

- when bilateral vertical dislocations fractures of the pelvic ring initially carry out the offset of the iliac bone to the level of the anatomic location of the sacroiliac joints and/or fragments of the sacrum.

- vertical dislocations fractures involving bilateral longitudinal fracture of sacrum and/or vpadina branches of the pubic and suture branches of the sciatic bones, intermediate fragments of these bones original map line damage and vzaimodejstvuet with one of the adjacent fragments, and then resolve the dislocation coast is th pelvic ring;

- when you commit caudal divisions of the pelvic bone fixing elements mixed is injected into Vvedenie and suture branches of the pubic and ischial bones.

The invention is illustrated by the description, an example of its practical use, as well as illustrative material, which shows:

Figure 1 (a, b, C) Fragments of radiographs of the pelvis, direct projection:

a) the commit option caudal division of the pelvic bone multidirectional entered in the ischium spokes;

b) the commit option caudal division of the pelvic bone of one U-shape curved and two straight spokes;

C) the commit option caudal division of the pelvic bone two U-shape, izognutymi spokes.

Figure 2 Radiograph of the pelvis, a direct projection. Vertical perelomova pelvis: rupture of the left sacroiliac joint and hip joint, the displacement of the left pelvic bone in the cranio-lateral direction.

Figure 3 Radiograph of the pelvis, a direct projection. After fixing the position of the pelvic bones with their mapping in the left sacroiliac joint and pelvis seam by means of a compression-distraction apparatus; day operations.

4 is a Radiograph of the pelvis, a direct projection. After dismantling the apparatus through 35 days of fixation. Full restoration of the integrity and anatomical relationships Kostadinova rings.

5 is a Radiograph of the pelvis, a direct projection. The preservation of the achieved treatment results in a month after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field known techniques perform osteosynthesis pelvic ring using a compression-distraction apparatus. When this offline record cranial and caudal divisions of both pelvic bones, inserting fixing elements spokes, including hard courts, and rods with threaded grinding work ends, the iliac wings, as well as in body, Vvedenie and suture branches of both the pubic and ischial bones in that position, what data bone formation is occupied at the time of surgery. The free ends of the clamps fixed on the outer supports of the apparatus, which, by means of hinge assemblies and threaded rods are connected with the possibility of rotation reversal and raznomastnogo, including metered, move.

The technique of osteosynthesis caudal divisions of the pelvic bones may include various options (figa, b, C).

In particular, the tabs (spokes) can be carried out through the sciatic bump in the ischium multidirectional, i.e. in different planes. Outer ends of the spokes indirectly through brackets fixed on external support. In this case, is used as min the minimum is three smooth pointed rod-latch (spokes) (figa).

Another option fixing these departments is an introduction to the ischium at least one U-shape curved spokes and two straight needles, injected into the body of the ischial bone console, from different angles. The first pin passes through the sciatic tuber, body ischial bone and it comes in the area of the lateral edges of the sciatic arc. Console-input spokes fixed as itudinal and suture branches of the sciatic bone. Outer ends of the spokes indirectly through brackets fixed to an external support (figb).

The next option is the use of a pair of U-shape curved spokes. Initially, these spokes are conducted through the body ischial bone in different planes, and then their outer ends bent at an angle of 90° relative to their longitudinal axis and fixed to an external support (pigv).

Further, in terms of hardware fixation, based on the type of vertical Pereloma-dislocation - one or two-sided, with damage to the sacrum and/or vpadina branches of the pubic and suture branches of the sciatic bones, perform manipulations aimed at their reduction with the elimination of the existing offsets.

Moreover, if in acute injuries these manipulations are directed towards the full elimination of dislocations during operation, when the old dislocations fractures they presidual eliminate only the most serious strain components, bearing in mind that it will be fully resolved the same and in the same sequence performed by techniques gradually, during the postoperative management of the animal. While the implementation of the repositioning in terms of fixing apparatus allows for a better job, because in this case fixed to the pelvic bone more manageable.

During the removal of existing dislocations of the pelvis initially carry out a mapping of the bones and/or their fragments in ventral semiring pelvic ring. When unilateral vertical perelomova pelvic ring with a violation of engagement between the pelvic joint, thrust for support, fixing stationed pelvic bone, her first rootroot, and then partly bred in width, shift longitudinally and lead to a tight contact along the line of the pelvic joint. The achieved position after performing x-ray control register stabilization systems of the apparatus installed in the projection of the ventral half of the pelvis.

Then eliminate the remaining displacement of the bones in the area corresponding sacroiliac joint, in which the offset is installed in the projection of this part of the pelvic supports, fixed plot stationed Ilium partially rootroot on the required size and already bezdomennogo longitudinal shift lead position tight contact with the sacrum in the damaged area of the sacroiliac joint. System apparatus also stabilize in the position reached, thereby making vzaimodeistvie associated pelvic bones.

Primary reposition of fragments of the pelvic ring in its ventral part due to the anatomical structure of the skeleton of the animal and its biomechanics. These features are expressed in a largely free and safe access to the bones ventral half of the pelvis and the fact that the bones of this Department pelvis bear the bulk of the static-dynamic load. Under these conditions, the initial reposition the bones in the ventral region of the ring causes the simultaneous elimination of the most serious dislocation in the field of dorsal half of the pelvis. Taking into consideration the fact that in the area of the latter are the most important neurovascular education, this prevents mechanical damage during reposition. Thus, the proposed sequence for the reposition of fragments of ventral and dorsal semirings pelvis creates optimal conditions for performing the necessary manipulations, and for consolidation of damaged areas of the pelvic ring.

In cases of unilateral longitudinal damage to the sacrum and/or longitudinal damage vpadina branches of the pubic and suture branches of the sciatic bones exercise described by either the manipulation, but the comparison is made on the lines of fracture of the relevant bones, initially in the area of the ventral half of the pelvis, and then dorsal.

When bilateral longitudinal dislocations fractures of the pelvis specificity perform osteosynthesis is that both dislocated pelvis initially move to the level of the anatomic location of the sacroiliac joint and/or fragments of the sacrum. The method of fixation and subsequent manipulation and their sequence during reposition similar to the above.

If one or both perelomova pelvis accompanied by bilateral fracture vpadina branches of the pubic and suture branches of the sciatic bones, resulting intermediate bone fragment - "butterfly" - fix added it catches repairbot to match line breaks with one of the adjacent fragments, vzaimodejstvuet them, and then produce reposition the bones of the pelvic ring according to the above diagram. Similar techniques perform well at education as the result of bilateral damage to the pelvic bones of the intermediate portion of the sacrum. However, manipulation of the latter, aimed at its reduction, also performed after mapping and the bones and/or their fragments in ventral semicircle of the Aza.

The operation is completed by performing x-ray control and stabilization systems of the device.

In the postoperative period provide stable fixation of the achieved position of the pelvis and/or their parts using compression-distraction device to the full consolidation of the damage zone. At the same time, if you are treating chronic types of the above damages or reduction of acute injuries was not achieved, an accurate mapping of the fragments, the elimination of the remaining components of the dislocation perform by their measured offset relative to each other during the postoperative management of animals. The rate of displacement and rotation reversal in this case, set within 0,5-1,0 mm 1,0-2,0° in the day. After additional metered reposition the apparatus is switched to the mode of stable fixation, which also supports the consolidation of the damaged area.

Practical use of the method is illustrated by the following observation (example).

The dog, age 2 years, was admitted to the veterinary clinic with a diagnosis of Closed vertical unilateral perelomova bones of the pelvic ring. Radiographically - displacement of the left pelvic bone in dorso-latero-cranial direction 25 mm, outer Rota the Oia 10° , megalomania diastasis in the area of the sacroiliac joints - 8 mm, pelvic seam 12 mm (figure 2).

To restore integrity and anatomical relationships of the bones of the pelvic ring made of operation: closed osteosynthesis of bones of a basin with compression-distraction device.

During osteosynthesis, according to the proposed method, commit ventral and dorsal semirings pelvis by introducing into the iliac wings, body, Vvedenie and suture branches of the sciatic bone fixator, the free ends of which are secured on the outer supports of the apparatus. The latter were linked with the possibility of rotation reversal and raznomastnogo offset relative to each other.

Then the mixture feet made closed reposition the bones of the pelvis by a partial rotation reversal, breeding, longitudinal displacement and bringing the left pelvic bone. In this case, initially eliminate the offset in the ventral half ring of the pelvis, by comparing the fragments along the line of the pelvic joint. Mapped fragments stabilized in position tight contact with each other by creating conditions of compression with a system apparatus, fixing the pelvic area. After this has eliminated the remaining offset in the dorsal half ring of the pelvis, by bringing the iliac wing is barb and comparing the pelvic bone in the damaged area of the left sacroiliac joint. In this position, the dorsal half ring of the pelvis is also recorded by the system stabilizing apparatus installed in its projections. The operation is completed by performing x-ray control (figure 3).

In the postoperative period, within 35 days, was carried out by stable fixation damaged pelvic apparatus. By the end of the specified term, an x-ray showed consolidation of fragments along the lines of damage to anatomical structures of the pelvic ring that served as the basis for the dismantling of the apparatus (figure 4).

As a result of treatment achieved complete anatomical and functional recovery of the pelvic ring animal. Complications of pelvic organs was not observed, natural trucking without pathology; animal actively moves on four legs, the movement in the hip joints in the norm (figure 5).

Thus, using the proposed method of treatment of vertical dislocations fractures of the pelvic bones of animals provides anatomical and functional recovery of the pelvic ring with different types of traumatic injury.

Sources of information

1. RF patent №2180533, publ. 20.03.02.

2. RF patent №2162669, publ. 10.02.01.

1. The method of treatment of vertical dislocations fractures of the bones of the pelvic ring animals, including reposition the bones of the hip and/or their parts the way the sequential rotation and displacement in perpendicular planes to associate with subsequent stable fixation using the Ilizarov apparatus, wherein the offline fix the cranial and caudal divisions of both pelvic bones, then, in terms of fixing apparatus, originally produced reposition the bones and/or fragments of the ventral half of the pelvis, and then carry out the elimination of the remaining displacement of the pelvic bone in the area of the sacroiliac joint and/or fragments of the sacrum.

2. The method according to claim 1, characterized in that in the two-way vertical dislocations fractures of the pelvic ring initially carry out the offset of the iliac bone to the level of the anatomic location of the sacroiliac joints and/or fragments of the sacrum.

3. The method according to claim 1, characterized in that the vertical dislocations fractures involving bilateral longitudinal fracture of sacrum and/or vpadina branches of the pubic and suture branches of the sciatic bones, intermediate fragments of these bones original map line damage and vzaimodejstvuet with one of the adjacent fragments, and then correct the dislocation of the bones of the pelvic ring.

4. The method according to claim 1, characterized in that when you commit caudal divisions of the pelvic bone fixing elements differently administered in Vvedenie and suture branches of the pubic and ischial bones.



 

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