Method of surgical treatment of osteochondral injuries of talus block by method of mosaic autochondroplasty

IPC classes for russian patent Method of surgical treatment of osteochondral injuries of talus block by method of mosaic autochondroplasty (RU 2508060):

A61B17/56 - Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor

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FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, to method of treating osteochondral injuries of talus block by method of mosaic autochondroplasty of affected sections with their further replacement with autotransplants. Blind holes are drilled in bone block, layer of granules of complex alloplastic apparatus, containing 50-60 wt % of collagen, is laid on their bottom. After that, cylindrical osteochondral autotransplants are pressed in with cartilage out. Joint is filled with gel-like platelet-enriched autoplasma. Medial ankle is repositioned and fixed. The remaining autoplasma is returned into patient's blood stream. Granules can additionally contain 0.08-2.8 wt % of colloid solution of zerovalent metal silver nanoparticles. Size of used colloid zerovalent silver nanoparticles is selected from 2 nm to 25 nm. Quantity of blind holes is selected depending on degree of block affection. Diameter of autotransplants and diameter of holes is selected from 4 to 8 mm. Length of autotransplants and depth of holes is selected from 8 to 25 mm. Thickness of layer of granules laid on the bottom of holes is from 0.2 to 1.0 mm.

EFFECT: method ensures movement and support of ankle joint.

7 cl, 4 ex

The invention relates to medicine, namely to traumatology and orthopedics, to method surgical treatment are presented lesions block talus method of mosaic autoandrophilia, and can be used in the treatment of patients presented with lesions of the block talus in surgical, trauma and other hospitals.

There is a method of surgical treatment of chronic osteomyelitis of the talus with a defect in epithelial tissues of the foot, including the removal of a lesion in the talus and their subsequent replacement with an autograft, and then impose the primary stitches in the wound and the ankle joint is fixed in the neutral position (see RF patent №2458649, IPC A61B 17/56, 20.08.2012,).

However, the known method of surgical treatment of chronic osteomyelitis of the talus when its use has the following disadvantages:

- insufficient ensures the preservation of the functional qualities of the talus,

- provides insufficient recovery oponopono function of the ankle joint while maintaining its anatomical relations,

- does not provide sufficient visual survey locations are presented lesions block talus,

- does not provide a sufficient increase kachestwinno patient.

The objective of the invention is to provide a method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia.

The technical result is the preservation of necessary and sufficient functional qualities of the talus, ensuring the recovery oponopono function of the ankle joint while maintaining its anatomic correlations, providing sufficient visual survey locations are presented lesions block talus, as well as ensuring sufficient quality of life of the patient.

The technical result is achieved in that a method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia, including the removal of a lesion in the talus and their subsequent replacement with an autograft, and then impose the primary stitches in the wound and the ankle joint is fixed in the neutral position when performing radiographic images of the affected block of the talus bone of the ankle joint in 3 projections, and perform using multilayer spiral computed tomography and magnetic resonance imaging control determine the degree of development of subchondral lesions b is the eye of the talus bone of the ankle joint under spinal anesthesia with the patient on back after medial access to the inner ankle perform Chevron osteotomy of the inner ankle, the locations are presented lesions block talus drill using the cutting tool to the blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants, perform open externally-front access via 3-cm incision fence covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured from the donor nezagruzheny areas of the articular surface of the lateral condyle of the femur, the diameter and length of the cylindrical bone and cartilage autotransplants correspond to the diameter and the depth of the drilled holes in the zone are presented lesions block talus at the bottom of the blind holes of the zone are presented lesions block talus put a thin layer of granules complex alloplastic drug-based hydroxyapatite containing 50-60 wt.% collagen, then covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured introduce by pressing the cartilage out using a transparent tubular leader in the holes of the zone are presented lesions block talus, the volume of the ankle joint is filled gel enriched with platelets by autoplasma, after which medialine the ankle repairbot and fix using constricting loop or screw, and after the suturing of surgical wounds overlaid with aseptic bandage ankle lock rear gypsum Longuet from the toes to the upper third of the leg remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously during surgery or in the early postoperative period. Used for laying on the bottom of the blind holes of the zone are presented lesions block talus granules complex alloplastic of the drug on the basis of hydroxyapatite containing 50-60 wt.% collagen, which can optionally contain 0.08 to 2.8 wt.% the colloidal solution of nanoparticles of zero-valent metallic silver Ag⁰while the size of the used colloidal nonvalent silver nanoparticles selected from 2 nm to 25 nm. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 2-4 hours prior to surgery 420-450 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and the floor is rising 20 - 30 ml of platelet-rich autoplasma. The number drilled in the area are presented lesions block talus blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants chosen depending on the degree of development are presented lesions block talus. When this diameter is covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the diameter drilled in the area are presented lesions block talus holes selected from 4 to 8 mm. In length covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the depth drilled in the area are presented lesions block talus holes selected from 8 to 25 mm When it is placed on the bottom of the blind holes of the zone are presented lesions block talus layer of granules complex alloplastic of the drug on the basis of hydroxyapatite with a thickness of 0.2 to 1.0 mm

The method is as follows. Perform radiographic images of the affected block of the talus bone of the ankle joint in 3 projections, as well as perform using multilayer spiral computed tomography and magnetic resonance imaging control determine the degree of development of subchondral lesions block the talus bone of the ankle joint. Under spinal anesthesia with the patient on his back after medial access to the inner ankle perform Chevron osteotomy of the inner ankle.

The locations are presented lesions block talus drill using the cutting tool to the blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants. Open externally-front access via 3-cm incision perform fence covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured from the donor nezagruzheny areas of the articular surface of the lateral condyle of the femur. The diameter and length taken cylindrical bone and cartilage autotransplants correspond to the diameter and the depth of the drilled holes in the zone are presented lesions block the talus, and the number drilled in the area are presented lesions block talus blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants chosen depending on the degree of development are presented lesions block talus. The diameter is covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the diameter in svalennyh in the area are presented lesions block talus holes selected from 4 to 8 mm. Length is covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the depth drilled in the area are presented lesions block talus holes selected from 8 to 25 mm

At the bottom of blind holes zones are presented lesions block talus put a thin layer of granules complex alloplastic of the drug on the basis of hydroxyapatite containing 50 to 60 wt.% of collagen. For laying on the bottom of the blind holes of the zone are presented lesions block talus can be used granules complex alloplastic of the drug on the basis of hydroxyapatite containing 50-60 wt.% collagen, which can optionally contain 0.08 to 2.8 wt.% the colloidal solution of nanoparticles nonvalence metallic silver Ag⁰size being used colloidal nonvalent silver nanoparticles selected from 2 nm to 25 nm. Stack on the bottom of the blind holes of the zone are presented lesions block talus layer of granules complex alloplastic of the drug on the basis of hydroxyapatite with a thickness of 0.2 to 1.0 mm

Then covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured introduce by pressing the cartilage out using a transparent tubular guiding equipment carried out in the hole zones are presented lesions block talus.

The volume of the ankle joint is filled gel enriched with platelets by autoplasma. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 2-4 hours prior to surgery 420-450 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and getting 20-30 ml of platelet-rich autoplasma.

Medial ankle repairbot and fix using tightening hinges or screws, and after the suturing of surgical wounds overlaid with aseptic bandage ankle joint is fixed in the neutral position of the rear gypsum Longuet from the toes to the upper third of the leg.

Remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously during surgery or in the early postoperative period.

Among the essential features characterizing the proposed method of surgical treatment are presented lesions block talus method mosaic autocontrols the key, distinctive are:

- implementation after performing radiographic images of the affected block of the talus bone of the ankle joint in 3 projections, and perform using multilayer spiral computed tomography and magnetic resonance imaging control determine the degree of development of subchondral lesions block the talus bone of the ankle joint under spinal anesthesia with the patient on his back after medial access to the inner ankle Chevron osteotomy of the inner ankle,

the drilling locations are presented lesions block talus using a cutting tool blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants,

- implementation of open externally-front access via 3-cm incision of the fence is covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured from the donor nezagruzheny areas of the articular surface of the lateral condyle of the femur, the diameter and length of the cylindrical bone and cartilage autotransplants correspond to the diameter and the depth of the drilled holes in the zone are presented lesions block talus,

- laying on the bottom of the deaf is TVersity zone are presented lesions block talus thin layer of granules complex alloplastic of the drug on the basis of hydroxyapatite, contains 50 - 60 wt.% collagen,

- introduction covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured by driving the cartilage out using a transparent tubular leader in the holes of the zone are presented lesions block talus,

the filling volume of the ankle joint gel enriched with platelets by autoplasma,

- reposition the medial malleolus and its fixation with the use of tightening hinges or screws

- fixing after the suturing of surgical wounds overlaid with aseptic bandage ankle joint in a neutral position of the rear gypsum Longuet from the toes to the upper third of the leg,

return remaining in the manufacturing process of platelet-rich autoplasma parts erythrocyte mass and plasma in the blood stream of the patient intravenously during surgery or in the early postoperative period,

- use for laying on the bottom of the blind holes of the zone are presented lesions block talus granules complex alloplastic of the drug on the basis of hydroxyapatite containing 50 to 60 wt.% collagen, and optionally containing 0.08 to 2.8 wt.% the colloidal solution of nanoparticles nonvalence metallicheskie Ag ⁰while the size of the used colloidal nonvalent silver nanoparticles selected from 2 nm to 25 nm,

- getting used to fill the volume of the ankle joint gel enriched with platelets autoplasma taken from the patient after 2-4 hours before surgery 420 - 450 ml of blood, followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and getting 20-30 ml of platelet-rich autoplasma

- select the number drilled in the area are presented lesions block talus blind holes for the subsequent installation are presented cylindrical bone and cartilage autografts was measured depending on the degree of development are presented lesions block talus,

the choice of diameter is covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the diameter drilled in the area are presented lesions block talus holes from 4 to 8 mm

- select the length covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the depth drilled in the area are presented lesions block RAM KOs and holes from 8 to 25 mm,

- laying on the bottom of the blind holes of the zone are presented lesions block talus layer of granules complex alloplastic of the drug on the basis of hydroxyapatite with a thickness of 0.2 to 1.0 mm

Experimental studies of the proposed method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia showed its high efficiency. The proposed method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia when its use ensures the preservation of necessary and sufficient functional qualities of the talus, provides reliable recovery oponopono function of the ankle joint while maintaining its anatomic correlations, provides sufficient visual survey locations are presented lesions block talus, as well as helping to keep improving the quality of life of the patient.

Implementation of the proposed method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia is illustrated by the following clinical examples.

Example 1. Patient K., 58 years old, was admitted in 8 travmatologicheskoe Department of the fgbi "cyto them. N.N. Priorov" diagnosed with "OS is eohedrine defeat of the block right talus".

Performed x-ray images of the affected block of the talus bone of the ankle joint in 3 projections, and also performed with the use of multilayer spiral computed tomography and magnetic resonance imaging control the determination of the degree of development of subchondral lesions of the block right of the talus bone of the ankle joint. Revealed are presented defeat of the block right talus 3 degrees of development Brendt and Harty.

The patient performed surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia.

Under spinal anesthesia with the patient on his back after medial access to the inner ankle fulfilled Chevron osteotomy of the inner ankle.

Three locations are presented lesions block talus was drilled using cutting tools blind hole with a diameter of 4 mm and a depth of 18 mm for the subsequent installation of the three presented cylindrical bone and cartilage autotransplants. Open externally-front access through a 3 cm incision was performed fence three are covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured with a diameter of 4 mm and a length of 18 mm from the donor nezagruzheny plots of the joint on which ernesti lateral condyle of the femur.

At the bottom of blind holes zones are presented lesions block talus put a thin layer of 0.5 mm thick pellets complex alloplastic of the drug on the basis of hydroxyapatite containing 60 wt.% of collagen.

Then covered with articular cartilage are presented cylindrical bone and cartilage autotransplants implemented by driving the cartilage out using a transparent tubular leader in the holes of the zone are presented lesions block talus.

The amount of ankle joint filled gel enriched with platelets by autoplasma. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 2 hours prior to operation 420 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and obtaining 20 ml of platelet-rich autoplasma.

Medial ankle repairable and recorded using the tightening loop. After the suturing of surgical wounds overlaid with aseptic bandage ankle joint was fixed in neutral position the AI back plaster Longuet from the toes to the upper third of the leg.

Remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously during surgery.

As a result of surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia conserved necessary and sufficient functional qualities of the talus and have restored oponopono function of the ankle joint while maintaining its anatomic correlations, provided sufficient visual survey locations are presented lesions block talus, and sufficient improvement of the quality of life of the patient.

Example 2. The patient And.., 42 years old, was admitted in 8 travmatologicheskoe Department of the fgbi "cyto them. N.N. Priorov" diagnosis "Presented defeat block left talus".

Performed x-ray images of the affected block of the talus bone of the ankle joint in 3 projections, and also performed with the use of multilayer spiral computed tomography and magnetic resonance imaging control the determination of the degree of development of subchondral lesions of the block right of the talus bone of the ankle joint. Revealed osteo is andreline defeat block left talus 4 stages of development by Brendt and Harty.

The patient performed surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia.

Under spinal anesthesia with the patient on his back after medial access to the inner ankle fulfilled Chevron osteotomy of the inner ankle.

Four locations are presented lesions block talus was drilled using cutting tools blind hole with a diameter of 8 mm and a depth of 25 mm for the subsequent installation of the four presented cylindrical bone and cartilage autotransplants. Open externally-front access through a 3 cm incision was performed fence four are covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured with a diameter of 8 mm and a length of 25 mm from the donor does not inundate areas of the articular surface of the lateral condyle of the femur.

At the bottom of blind holes zones are presented lesions block talus put a thin layer of a thickness of 1.0 mm pellets complex alloplastic of the drug on the basis of hydroxyapatite containing 60 wt.% collagen and 2.8 wt.% the colloidal solution of nanoparticles nonvalence metallic silver Ag⁰while used colloidal nonvalence silver nanoparticles is the size of 25 nm.

The amount of ankle joint filled gel enriched with platelets by autoplasma. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 4 hours before surgery 450 ml of blood, followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and with 30 ml of platelet-rich autoplasma.

Medial ankle repairable and recorded using the tightening loop. After the suturing of surgical wounds overlaid with aseptic bandage ankle joint was fixed in the neutral position of the rear gypsum Longuet from the toes to the upper third of the leg.

Remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient within Ivanna drip during surgery.

As a result of surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia conserved necessary and sufficient functional qualities of the talus and have restored oponopono function of the ankle joint while maintaining its anatomic correlations, provided sufficient visual survey locations are presented lesions block talus, as well as adequately enhance the quality of life of the patient.

Example 3. Patient A., aged 20, arrived in 8 travmatologicheskoe Department of the fgbi "cyto them. N.N. Priorov"diagnosis "Presented defeat of the block right talus".

The patient performed surgical treatment are presented lesions block the talus bone of the right foot method mosaic the second autoandrophilia.

Under spinal anesthesia with the patient on his back after medial access to the inner ankle fulfilled Chevron osteotomy of the inner ankle.

Five locations are presented lesions block talus was drilled using cutting tools blind hole with a diameter of 6 mm and a depth of 21 mm for the subsequent installation of five presented cylindrical bone and cartilage autotransplants. Open externally-front access through a 3 cm incision was performed fence five covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured with a diameter of 6 mm and a length of 21 mm from the donor does not inundate areas of the articular surface of the lateral condyle of the femur.

At the bottom of blind holes zones are presented lesions block talus put a thin layer with a thickness of 0.2 mm pellets comprehensive ALLO-plastic drug on the basis of hydroxyapatite containing 50 wt.% collagen and 0.08 wt.% the colloidal solution of nanoparticles nonvalence metallic silver Ag⁰while used colloidal nonvalence silver nanoparticles of size 2 nm.

Then covered with articular cartilage are presented cylindrical bone and cartilage autotransplants implemented by driving the cartilage naru is in a transparent tubular leader in the holes of the zone are presented lesions block talus.

The amount of ankle joint filled gel enriched with platelets by autoplasma. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 3 hours prior to operation 440 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and obtaining 27 ml of platelet-rich autoplasma.

Medial ankle repairable and fixed using a bolt. After the suturing of surgical wounds overlaid with aseptic bandage ankle joint was fixed in the neutral position of the rear gypsum Longuet from the toes to the upper third of the leg.

Remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously in the early postoperative period.

As a result of surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia conserved necessary and sufficient functional qualities of the talus to the STI, have restored oponopono function of the ankle joint while maintaining its anatomic correlations, provided sufficient visual survey locations are presented lesions block talus, as well as adequately enhance the quality of life of the patient.

Example 4. Patient C., 35 years old, was admitted in 8 travmatologicheskoe Department of the fgbi "cyto them. N.N. Priorov"diagnosis "Presented defeat of the block right talus".

The patient performed surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia.

Under spinal anesthesia with the patient on his back after medial access to the inner ankle fulfilled Chevron osteotomy of the inner ankle.

In two locations presented poraj the deposits block the talus was drilled using cutting tools blind hole with a diameter of 5 mm and a depth of 8 mm for the subsequent installation presented two cylindrical bone and cartilage autotransplants. Open externally-front access through a 3 cm incision was performed two fence covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured with a diameter of 5 mm and a length of 8 mm from the donor does not inundate areas of the articular surface of the lateral condyle of the femur.

At the bottom of blind holes zones are presented lesions block talus put a thin layer with a thickness of 0.4 mm pellets complex alloplastic of the drug on the basis of hydroxyapatite containing 50 wt.% of collagen.

The amount of ankle joint filled gel enriched with platelets by autoplasma. Used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 3 hours prior to operation 420 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of nagoshi the offered liquid and obtain 25 ml of platelet-rich autoplasma.

Remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously in the early postoperative period.

As a result of surgical treatment are presented lesions block the talus bone of the right foot method of mosaic autoandrophilia conserved necessary and sufficient functional qualities of the talus, provided recovery oponopono function of the ankle joint while maintaining its anatomic correlations, provided sufficient visual survey locations are presented lesions block talus, and sufficient improvement of the quality of life of the patient.

1. A method of surgical treatment are presented lesions block talus method of mosaic autoandrophilia, including the removal of a lesion in the talus and their subsequent replacement with an autograft, and then impose per the ranks stitches in the wound and the ankle joint is fixed in the neutral position, characterized in that after performing radiographic images of the affected block of the talus bone of the ankle joint in 3 projections, and perform using multilayer spiral computed tomography and magnetic resonance imaging control determine the degree of development of subchondral lesions block the talus bone of the ankle joint under spinal anesthesia with the patient on his back after medial access to the inner ankle perform Chevron osteotomy of the inner ankle, the locations are presented lesions block talus drill using the cutting tool to the blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants, perform open externally-front access through a 3 cm incision fence covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured from the donor nezagruzheny areas of the articular surface of the lateral condyle of the femur, the diameter and length of the cylindrical bone and cartilage autotransplants correspond to the diameter and the depth of the drilled holes in the zone are presented lesions block talus at the bottom of the blind holes of the zone are presented lesions Blo is and talus put a thin layer of granules complex alloplastic of the drug on the basis of hydroxyapatite, containing 50-60 wt.% collagen, then covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured introduce by pressing the cartilage out using a transparent tubular leader in the holes of the zone are presented lesions block talus, the volume of the ankle joint is filled gel enriched with platelets by autoplasma, then the medial ankle repairbot and fix using tightening hinges or screws, and after the suturing of surgical wounds overlaid with aseptic bandage ankle lock rear gypsum Longuet from the toes to the upper third of the leg remaining in the manufacturing process of platelet-rich autoplasma part erythrocyte mass and plasma are returned to the bloodstream of the patient intravenously during surgery in the early postoperative period.

2. The method according to claim 1, characterized in that is used for laying on the bottom of the blind holes of the zone are presented lesions block talus granules complex alloplastic of the drug on the basis of hydroxyapatite containing 50-60 wt.% collagen, which can optionally contain 0.08 to 2.8 wt.% the colloidal solution of nanoparticles nonvalence metallic silver Ag 0while the size of the used colloidal nonvalent silver nanoparticles selected from 2 nm to 25 nm.

3. The method according to claim 1, characterized in that is used to fill the volume of the ankle joint gel enriched with platelets autoplaza obtained from the patient for 2-4 hours prior to surgery 420-450 ml of blood followed twice by centrifugation, first at 2300 rpm./min for 5 minutes with the Department of erythrocyte mass from the plasma, then the plasma is centrifuged at 4000 rpm./min for 5 minutes, followed by the separation of the supernatant liquid and getting 20-30 ml of platelet-rich autoplasma.

4. The method according to claim 1, characterized in that the number drilled in the area are presented lesions block talus blind holes for the subsequent installation are presented cylindrical bone and cartilage autotransplants chosen depending on the degree of development are presented lesions block talus.

5. The method according to claim 1, characterized in that the diameter covered with articular cartilage are presented cylindrical bone and cartilage autografts was measured, and the diameter is made in the area are presented lesions block talus holes selected from 4 to 8 mm

6. The method according to claim 1, characterized in that the length covered with articular cartilage are presented the cylindrical bone and cartilage autotransplants, and depth is made in the area are presented lesions block talus holes selected from 8 to 25 mm

7. The method according to claim 1, characterized in that the stack on the bottom of the blind holes of the zone are presented lesions block talus layer of granules complex alloplastic of the drug on the basis of hydroxyapatite with a thickness of 0.2 to 1.0 mm