卷 9, 编号 4 (2002)

Basing on the experience in treatment of 244 patients with concomitant injuries including 305 patients with open long bone fractures the authors suggest the tactics for the management of these patients. That tactics depends on the general condition of injured, pattern of brain and internal organs, as well as on the presence of complications. Open fractures in polytrauma are characterized by prevalence of fractures of the 2nd—3rd degree by AO classification, high probability of purulent complications in fracture zones due to immunity decrease, the possibility of development of Clostridium infection. The authors conclude that the majority of patients with polytrauma require 2 steps treatment of open fractures. At the first stage primary surgical immobilization for the elimination of large displacement is performed. At the second stage immediately after wound healing osteosynthesis using blocking nails with or without reaming as well as AO plates was performed. That management tactics enabled to avoid the aggravation of patient’s condition at the early stage of treatment and to achieve fracture consolidation in 193 patients. Purulent complications were observed in 20.6%) of all injureds. Chronic osteomyelitis was noted only in 3.6% of patients at follow up.

In 97 patients with fractures of femoral trochanteric zone the treatment was performed by transosseous osteosynthesis using Gorodnichenko rod device. The number of inserted rods depended on fracture pattern as well as presence or absence of osteoporosis. Experimental biomechanic study showed the firmness and stability of fixation achieved. Elaborated surgical technique ensured the precision of rods insertion, minimum traumatization of the surrounding soft tissues and bone, thus providing significant decrease of blood loss and shortening the duration of operation. In all patients including the elderly and senile patients aggravated by concomitant diseases the results were favourable. Good results were achieved in 84,5% and satisfactory in 15,5%) of cases.

The results of transosseous osteosynthesis for humerus dislocation-fractures using external fixation device were analysed. There were 9 patients with such injury. The assembling of device and tactics of treatment were described. In 8 patients follow-up period ranged from 1 to 8 years. One patient had an excellent result with full restoration of shoulder joint function. In 4 patients the outcomes were good and in 3 patients — satisfactory.

The experience in complex one-step treatment of306patients with ununited fractures, pseudoarthrosis and defects of long bones as sequelae of traumatic (260 patients) and gunshot (46 patients) injuries complicated by osteomyelitis was presented. Complex treatment included radical fistulosequestrnecrectomy up to vast resection with simultaneous mono-, bi- or polyfocal osteosynthesis by pin-, rod or pin-rod external fixation devices; various types of dermatoplasty (when required); stimulation osteogenesis; general and local target antibacterial therapy; adequate postoperative drainage; correction of immune status and metabolic therapy; rehabilitation. That method enabled to decrease more than twice the rate ofpostoperative recurrent of osteomyelitic process; considerably decrease the duration and improve outcomes of treatment.

Experimental staged study of blood flow in crus lengthening by Ilizarov was performed in 23 adult dogs. The results of electromagnetic flowmetry showed that distraction of crus tissues contributed to the decrease of the rate by volume in the femoral artery but the formation of the distraction bone regenerate - to its increase. Lengthening of the crus was accompanied by the accelerated transit of blood from the arterial bed to the venous one which was maintained by the vascular network of bone regenerate. Basing on the changes in pressure gradient it has been concluded that stimulation of blood circulation in the extremity was dependent on the responce of cardio-vascular system as a whole.

The purpose of the work was to evaluate the modern methods of diagnosis that determined the state of vegetative fibers, tunnel morphology, and surgical treatment of tunnel syndrome. There were 30 healthy individuals (control group) and 45 patients (16 with compression of the ulnar nerve in the zone of cubital canal, 27 with carpal canal syndrome and median nerve compression and 2 patients with Guyon canal syndrome). Clinical-roentgenologic methods, electroneuromyography (ENMG), ultrasonography, computer tomography, Lazer Doppler flowmetry (LDF), ultrasound dopplergraphy of wrist were used. The diagnosis of tunnel syndromes is based on a through clinical-roentgenologic and instrumental evaluation of the nerve trunk fibers function. Not only ENMG with assessment of the sensor and motor innervation is expedient but the evaluation of the neurogenic LDF indices stipulated by sympathic fibers as well. Auxiliary diagnostic method is ultrasonography of tunnel zone which provides information on the morphology of the canal structures, topography and general sizes of the nerves in the compression zone. All patients underwent surgical intervention for the decompression of nerve trunks. It is for the first time that the method of endoscopic dissection of the carpal ligament has been used at our clinic in 7 patients with early stages (I-II) of the disease. Endoscopic method of carpal canal syndrome treatment is an effective and lower invasive intervention that allows to restore the working ability of patients with early stages of the process in a short time.

The experience in treatment of 69 patients with funnel and 5 with pigeon thorax is presented. Patients over 14 years prevailed. At thoracoplasty radical subcartilagenous resection of the deformed costal cartilages was compulsory. In tunnel thorax sternocostal complex was fixed by tantalum brackets using original suturing device, Paltia plate and transfer of xiphoid process on the posterior sternum surface. In pigeon thorax Ravitch-1 operation was performed. In 76%) of patients right hemothorax that might be associated with patients’ age and use of suturing device was noted. Authors did not consider the opening of the right pleural sheet to be serious complication believing that it could be an appropriate means for surgical zone drainage. Use of such thoracoplasty techniques enabled to achieve good immediate and long term (up to 10 years) results in 98.6% of patients.

Three cases of the proximal form of congenital upper extremities ectromelia (two cases in 4 years and 1 case in 9 years old patient) are presented. The combination of symptoms of this rare malformation including the defects of the arm and forearm bones as well as aplasia of the radial rays of the wrist is described. Complex program for surgical treatment of ectromelia is suggested. The program includes the reconstruction of the arm length and formation of the shoulder using microsurgical transplantation of the fragment of the external border of the scapula, elimination of the forearm deformity by double-sided centering of the wrist, restoration of holding function using either the separation of one of triphalangeal fingers or transplantation of toes to the position of I radial ray. The results achieved in those three patients allowed to represent the new program as an alternative to the prosthetics.

At CITO Clinic of bone pathology new biocomposite material «Osteomatrix» was used in 15 patients (mainly with tumors and tumor-like diseases) for the plasty of post-resection bone defects. «Osteomatrix» is composed of bone collagen, hydroxyapatite and sulfated glycosaminoglycanes. «Osteomatrix» is produced at CITO together with «Conectbiopharm Ltd.» in the form of granules and blocks. Observation in dynamics with roentgenologic control showed good tolerance of «Osteomatrix» by patients and distinct accelerated bone regeneration in the zone of bone plasty.

Reparative regeneration of bone tissue is characterized by a multi-stage course. From the moment of bone damage to the completion of repair, i.e. Before the formation of morphologically mature bone tissue, which fills the bone defect, and the full restoration of bone function, a lot of time passes. At the same time, the general patterns of the development of the reparative process are clearly traced, and the specific features depend on the conditions in which it proceeds and on the potencies of osteogenic cellular elements.

November 21, 2002 marks the 80th anniversary of VERA MIKHAILOVNA MELNIKOVA, Doctor of Medical Sciences, Professor, Honored Scientist, who for many years headed the microbiological service of the CITO named after I.I. N.N. Priorov.

Prominent traumatologist-orthopedist of the country, professor, doctor of medical sciences IOSIF MOISEEVICH MITBREITH turned 80 years old.

On September 27, 2002, Professor G.I. Lavrishchev.