Можливості фіксатора та кісткової пластики в лікуванні переломів і псевдоартрозів шийки стегнової кістки [Текст] / П. І. Білінський [та ін.] // Травма. - 2019. - Том 20, N 2. - С. 118-123. - Бібліогр. в кінці ст. MeSH-головна: БЕДРА ШЕЙКИ ПЕРЕЛОМЫ -- FEMORAL NECK FRACTURES (диагностика, хирургия) ПЕРЕЛОМА ИММОБИЛИЗАЦИЯ -- FRACTURE FIXATION (использование, методы) СУСТАВ ЛОЖНЫЙ -- PSEUDARTHROSIS (диагностика, хирургия) Анотація: Здійснений аналіз 46 випадків незадовільного остеосинтезу різними фіксаторами при переломах шийки стегнової кістки. Аналізувався вплив гвинтів, традиційних і блокуючих фіксаторів на зрощення фрагментів. Запропонований пристрій для остеосинтезу переломів проксимального відділу стегна Recently, the number of elderly people has been growing, and consequently, the number of femoral neck fractures (FNF) has increased. Despite the fundamental development of science and medicine, in particular, the use of high-tech techniques, good results in treating these fractures are observed only in 50 % cases, when the pseudoarthrosis occurs in 33 % of cases. In this regard, endoprosthetics are widely used in patients with FNF. The purpose was to optimize the results of treatment of patients with FNF by developing a biomechanically based method of osteosynthesis and fixator for implementation of these methods. Materials and methods. Forty-six cases of unsatisfactory use of traditional fixators in patients with FNF were analyzed. In particular, the results of osteosynthesis with compression screws, L-shaped 130° plate and DHS-fixators were studied. In addition, X-rays of patients who were operated on with PFN and G-rod and structures with blocking screws were analyzed. We studied the dependence of the results of treatment on the quality of fragments reposition, the morbidity of surgical intervention. And also, time of beginning and dosed of full load, their effect on the accretion of fragments were studied. The state of fragment edges, the amount of resorption in the contact zone depending on the dose and time of the load, the fixator design, the correctness of placement of a cervical component, the length of its threaded part and its relation to the fracture line were analyzed. It is noted that biomechanically incorrect holding of screws and plates in the femoral neck, premature load, undone autoplasty if necessary lead to unsatisfactory results. The analysis revealed the flaws of the existing designs for osteosynthesis of FNF. It served as the basis for the development of a device for osteosynthesis of fractures of the proximal femur (DOPFF patent of Ukraine No. 22283). The working core of the device has a figured T-shaped cut, which is fixed in a short plate with a through groove. Such rod with width of 9 millimeters minimally injures the femoral neck; it has a vertical shelf, which gives a derotation effect with a minimum volume. The design provides self-compression of fragments under the action of muscle strength. The small size of the rod increases the possibilities of its placement in the femoral neck, which greatly facilitates the surgical intervention. Our fixator was used in 19 patients with complicated fractures and pseudoarthrosis of femoral neck. Results. A detailed analysis of the factors leading to the development of dysregeneration indicate the importance of preoperative planning, the selection of the most optimal fixative and the application methods in every case. The developed fixator for FNF osteosynthesis and the minimally invasive technique of its use allow operate patients aged 90 years and older. It can be used in the presence of compensated somatic pathology. This simultaneously prevents the deterioration of a patient’s condition after minimally invasive intervention. Hip endoprosthetics, which is traditionally performed in elderly, is much more life-threatening intervention. Analysis of unfavorable factors of FNF and processes at the junction of fragments indicate that our fixator, the method of its application are the most biomechanically grounded. They provide fusion of fragments even in difficult situations. Due to subjective and objective factors, very few authors in modern conditions use bone plastics, which optimizes the course of reparative regeneration that significantly improves the clinical outcome. In case of unsuccessful reposition, inveterate fractures, pseudoarthrosis of the femoral neck, open reposition of fragments, osteosynthesis with DOPFF, bone autoplasty is indicated. Currently, DOPFF with a positive result was used in 182 cases with FNF. In 19 cases open reposition of fragments with bone autoplasty was used with a positive result in patients with pseudoarthrosis and complicated FNF. Conclusions. Designed DOPFF has derotation effect, minimally injuring fragments. It provides functional self-compression, optimal conditions for their fusion. The fixator in combination with cortical autoplasty is indicated in case of complicated fractures and pseudoarthrosis of the femoral neck. This technique provides the fusion of fragments, makes the patient mobile, improves the quality of his life. Osteosynthesis with DOPFF is a less life-threatening, traumatic intervention compared to endoprosthetics and can be recommended for widespread use Дод.точки доступу: Білінський, П. І. Андрейчин, В. А. Волянін, В. І. Войтичук, І. А. Дорожовець, І. С. Вільних прим. немає