Prudnikov Y. Minimally invasive method of treatment of fractures of the posterior wall of the acetabulum.

Object: surgical treatment of fractures of the posterior wall of the acetabulum. Aim: to improve the results of treatment of patients with fractures of the posterior wall of the acetabulum by developing and implementing a set of measures that contribute to minimal intraoperative damage to the tissues of the hip joint area. Methods: clinical – to determine the results of treatment of patients with fractures of the posterior wall of the acetabulum; X-ray (including computed tomography) – to determine anatomical changes in the hip joint, position and size of bone fragments; pathophysiological: electromyography – to analyze the bioelectrical activity of the muscles of the lower extremities after surgery, rheovasography – to study the peripheral circulation, topographic and anatomical - to determine the localization and length of the incision during surgery, statistical – to confirm the significance of the results obtained. For the first time on the basis of three-dimensional reconstruction and with the help of anatomical landmarks on the patient's body, a method of computer preoperative calculation of the position and size of bone fragments of the acetabulum, localization of the surgical section was developed. For the first time, the minimum dimensions of surgical access, which ensure the performance of surgical intervention on the posterior wall of the acetabulum, have been scientifically substantiated and calculated. For the first time, it has been proven that the use of the proposed minimally invasive method of treatment of fractures of the posterior wall of the acetabulum to a lesser extent disrupts the functional activity of pelvic floor muscles according to electromyography than the traditional method using the Kocher-Langenbeck approach. It has been proven for the first time that the use of the proposed method of treatment accelerates the restoration of vascular function of the operated limb, especially arterial capillary blood flow, and according to rheovasography promotes better pulse blood supply to the vessels of the operated limb than when using the traditional method with Kocher-Langen access. The developed operative access for surgical treatment of fractures of the acetabulum (Pat. No. 19790 UA) makes it possible to perform surgery with less damage to the soft tissues of the joint. Based on the obtained theoretical data, a minimally invasive method of surgical treatment of patients with fractures of the posterior wall of the acetabulum is proposed, which allows to reduce the traumatisation and improve treatment outcomes. The results of the work were introduced in the department of combined trauma of the Donetsk National Medical University "Clinic of the Research Institute of Traumatology and Orthopedics" of the Ministry of Health of Ukraine, in the orthopedic and traumatological departments of the communal non-profit enterprise "Kherson Regional Clinical Hospital" of the Kherson Regional Council and the Communal non-profit enterprise "Obukhov Central District Hospital", in the Department of Emergency Traumatology and Reconstructive Surgery and the Orthopedic Arthrology and Endoprosthetics Department of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine. Traumatology and Orthopaedics.