Background. Bilocal extra-focal osteosynthesis with ring fixators (RF) of tibial nonunion is a method used by some authors. But there are no systematized guidelines for its implementation. This work is devoted to solving this issue. The purpose was to improve the results of the treatment of nonunions of the shin using RF constructions for bilocal osteosynthesis in complex treatment. Materials and methods. Generalized data of treatment of 17 patients with septic nonunions of the shin bones, in the treatment of which the technology of bilocal osteosynthesis with RF was used. According to the Non-Union Scoring System, all cases required complex specialized medical care with a possible positive result (scores from 51 to 75). Bilocal osteosynthesis was part of a complex surgical procedure. The important parts were as follows. The so-called blood-saving tactic was used. We used a squeezing and hemostatic tourniquet, tranexamic acid, and a topically hemostatic sponge. The rings were mounted on solid rods. Semi-closed osteotomy of the anterior and lateral walls was performed from a small incision in a fan-shaped chisel; the posterior wall of the bone was intersected by the levator with a comminuted fracture. Before comparing the reduced fragment with the fragment, they were processed. Conservative therapy was aimed at preventing infection, improving vascular activity, and normalizing metabolic processes. Conclusions. The obtained result of bilocal osteosynthesis of nonunions of the tibia should be considered encouraging and requires further application and study.
Рассмотрены виды первичного остеосинтеза и оценена их значимость как причины развития несращения у 76 больных с асептическими несращениями костей голени. Сформулированы основы применения различных видов фиксации в различных клинических ситуациях, принципы профилактики несращений костей голени. Первичный остеосинтез переломов костей голени является очень важным, но не единственным фактором, который детерминирует развитие несращения. Анализ результатов проведенного комплексного лечения при переломах костей голени свидетельствовал о существующих возможностях улучшения результатов и уменьшения процента несращений. При высокоэнергетических, а тем более открытых поражениях методом выбора (первичным и заключительным) могло быть применение кольцевых фиксаторов спицестержневого типа.
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