Abstacts journal "Polytrauma" 4/2013

Contents

From editor

Secondary care organization
MEDICAL AND DEMOGRAPHIC PREDICTORS OF HOSPITAL MORTALITY RELATED TO LOWER LIMB AMPUTATIONS IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE
Makarov D. N., Zoloyev G. K., Vasilchenko E.M.

Makarov D. N., Zoloyev G. K., Vasilchenko E.M.
Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia

Objective – to determine the risk factors of hospital mortality associated with limb amputations in patients with peripheral arterial disease (PAD).
Materials and methods. We performed a retrospective analysis of 656 case reports of PAD patients who underwent transtibial or transfemoral amputations. Independent factors influencing the level of hospital mortality were identified using the binary logistic regression.
Results. The hospital mortality risk increased 4.9 times in amputation at the level of femur, 3.3 times – in presence of diabetes mellitus, 2 times – in patients older than 60.
Conclusions. The risk factors of hospital mortality in PAD patients undergoing limb amputations are transfemoral amputation, age above 60, and the presence of diabetes mellitus.
Key words: atherosclerosis; diabetes mellitus; tromboangiitis obliterans; lower limb ischemia; amputation; prognosis; mortality.

Information about authors:
Makarov D.N., head of department of anesthesiology and resuscitation, anesthesiologist-intensivist, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.
Zoloev G.K., MD, PhD, professor, general director of Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.
Vasilchenko E.M., candidate of medical science, deputy general director of rehabilitation and organizational methodic work, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:
Makarov D. N., Malaya St., 7, Novokuznetsk, Kemerovo region, Russia, 654055
Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, department of anesthesiology and resuscitation
Tel: +7 (3843) 36-91-08
E-mail: root@reabil-nk.ru

References:
1. Vasil'chenko E.M., Zoloev G.K. Survival rate of patients with peripheral arterial diseases of nondiabetic genesis following lower limbs amputation. Population study. Annaly khirurgii. 2012; 3: 48-54 (In Russian).
2. Health state of population in Russia in 2005. Government report. Part 1. Medical-demographic indexes of population in health. Part 2. Incidence of population. Zdravookhranenie Rossiyskoy Federatsii. 2007; 5: 8-18 (In Russian).
3. Zoloev G.K. Obliteral arterial diseases. Surgical treatment and rehabilitation of patients with limbs amputation. Moskow; 2004 (In Russian).
4. Kuz'min V.V., Burleva E.P. Analisys of postoperative complications and mortality for high rate ampytation of patients with lower limbs gangrene. Klinicheskaya anesteziologiya i reanimatologiya. 2007; 4 (5): 34-37 (In Russian).
5. Makarov D.N., Vasil'chenko E.M., Zoloev D.G., Batiskin S.A. Analisys of causes of in-patients mortality for peripheral arterial diseases. Meditsina v Kuzbasse. 2011; 4: 50-52 (In Russian).
6. Petri A., Sjebin K. Pictorial statistics in medicine. Moskow; 2003 (In Russian).
7. Ebskov L.B. Relative mortality and long term survival for the non-diabetic lower limb amputee with vascular insufficiency. Prosthetics and Orthotics International. 1999; 23 (3): 209-216.
8. Eskelinen E., Lepantalo M., Hietala E.-M., Sell H. Lower limb amputations in Southern Finland in 2000 and trends up to 2001. Eur. J. Vasc. Endovasc. Surg. 2004; 27 (2): 193-200.
9. Holdsworth R.J., McCollum P.T. Results and resource implications of treating end-stage limb ischemia. Eur. J. Vasc. Endovasc. Surg. 1997; 13 (2): 164-173.
10. Pell J., Stonebridge P. Association between age and survival following major amputation. Eur. J. Vasc. Endovasc. Surg. 1999; 17 (2): 166-169.
11. Ploeg A.J., Lardenoye J.W., Vrancken Peeters M.-P.F.M., Breslau P.J. Contemporary series of morbidity and mortality after lower limb amputation. Eur. J. Vasc. Endovasc. Surg. 2005; 29 (6): 633-637.
12. Rommers G.M., Vos L.D.W., Groothoff J.W., Shuiling C.H., Eisma W.H. Epidemiology of lower limb amputees in the north of the Netherland: aetiology, discharge destination and prosthetic use. Prosthet. Orthot. Int. 1997; 21 (2): 92-99.
13. Rowe V., Lee W., Weaver F.A. Patterns of treatment for peripheral arterial disease in the United States: 1996-2005. J. Vasc. Surg. 2008; 49 (4): 910-917.
14. Rush D.S., Huston C.C., Bivins B.A., Hude G.L. Operative and mortality rates of above-knee and below-knee amputation. Am. Surg. 1981; 47: 36-39.
15. TASC Working Group Inter-Society Consensus for the Management of Peripheral Arteria disease. Eur. J. Vasc. Endovasc. Surg. 2007; 33 (Suppl. 1).
16. The i.c.a.i. Group. Long-term mortality and its predictors in patients with critical leg ischemia. Eur. J. Vasc. Endovasc. Surg. 1997; 14 (2): 91-95.
17. Walsh N.E., Walsh, W.S. Rehabilitation of landmine victims – the ultimate challenge. Bull WHO. 2003; 81 (9): 665-670.

TELEMEDICINE AS MECHANISM OF ENSURING AVAILABILITY TO HIGH-TECH MEDICAL SERVICES AND INNOVATIONS IN HEALTH CARE
Totskaya E.G., Pokrovskaya O.B.

Totskaya E.G., Pokrovskaya O.B.
Novosibirsk Scientific Research Institute of Traumatology and Orthopedics,
Novosibirsk, Russia

Introduction. The article reviews the actual issues of implementation of high technologies into domestic health care practice. The problems of availability of modern medical diagnostic methods for population of under-populated and remote regions are reviewed.
Objective – to substantiate the necessity of development of telecommunication methods as innovative and new technologic solutions in provision of preventive direction in health service, maintenance of remote subjects and increase of level of public service and decrease in medical services costs.
Materials and methods. During the study with the literature analysis the issues of learning of experience of telecommunication technologies in medical practice of Russian Federation and abroad were solved. The methods of statistic and economic analysis allowed to classify the main directions of activity in telemedicine technologies, to evaluate the demand for such services in Novosibirsk and Siberian Federal District, as well as to substantiate the necessity and economic efficiency of telemedicine.
Results. Within the frame of complex and social hygienic study of problems in management of innovations in health service with the participation of Interregional association “Siberian Health Service” and the leading federal medical organizations the analysis of the state (2007 – 2012) and perspectives of development of telemedicine technologies at the territory of Siberian Federal District. The actuality of administration of telemedicine technologies for practical medicine, education and management is shown.
Conclusion. The telemedicine technologies have taken the rightful place in health service. They really help to increase the quality and level of specialized medical aid, to bring the high tech types of medical aid into proximity with customers, to perform study of medical staff using resources of leading training domestic and foreign bases.
Key words: innovations; telecommunication technologies in health service; availability of qualified medical aid

Information about authors:
Totskaya E.G., candidate of medical science, senior researcher, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.
Pokrovskaya O.B., head of department of medical care management, Ministry of health care of Novosibirsk region, Novosibirsk, Russia.

Address for correspondence:
Totskaya E.G., Chapaeva St., 3-117, Novosibirsk, Russia, 630030
Tel: +7 (913) 919-01-23
E-mail: ÅTockaya@niito.ru

References:
1. Healthcare and medical science development conception in Russian Federation until 2020. [Elektronnyy resurs]. Available at: http://www.topmedicina.ru/health/koncepciya (In Russian).
2. El'sinovskaya S.O. Effective management the resources of the medical institution. Sankt-Peterburg; 2009 (In Russian).
3. Korobeynikov O.P., Trifilova A.A., Korshunov I.A. Role of the innovation in the process of the enterprise’s strategy formation. Menedzhment v Rossii i za rubezhom. 2000; 3: 32-37 (In Russian).
4. The 2008 Statistical Abstract. Table 775 - Research and Development (R&D) Expenditures by Source and Objective: 1970 to 2006. Available at: http://www.census.gov/compendia/statab/cats/science_technology/expenditures.html.
5. Science and Engineering Indicators 2008. Arlington. National Science Board. 2008. R. 4-42.
6. Korol'kov V.E. Problems of the state regulation of the investment process in the current conditions of the Russian economics, Biznes: Ekonomika. Marketing. Menedzhment. 2008; 2: 18-21 (In Russian).
7. Yudaeva K.V. Investment climate and infrastructure and their influence to the enterprises’ competitiveness. Leont'evskie chteniya. 2006; 4: 11-14 (In Russian).
8. Shchepin O.P., Gabueva L.A. Organization and economics of the entrepreneurial activity in the healthcare. Moscow : MTsFER Publ.; 2006 (In Russian).

Original researches
BIOMECHANICAL PARAMETERS OF LIMB FUNCTIONAL STATUS AFTER TREATING MULTIPLE FRACTURES OF LOWER LIMB SEGMENTS USING THE ILIZAROV FIXATOR Dolganov D.V., Dolganova T.I., Martel I.I., Karasev A.G., Naritsyn V.A.

Dolganov D.V., Dolganova T.I., Martel I.I., Karasev A.G., Naritsyn V.A.
Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia

Objective – to assess recovering the parameters of limb functional status in the long-term periods after treatment of patients with multiple fractures of lower limb bones with the Ilizarov method.
Methods: dynamometry, podography, distribution of limb weight-bearing statically and in walking. There was an examination of 89 injured subjects (age of 45.7 ± 14.08) with multiple fractures of lower limb bones in the long-term periods (2–10 years) after treatment according to Ilizarov.
Main results. Weight-bearing asymmetry of the limb involved (10–20%) continues both statically and in walking 3 years after treatment. The podogram time- and strength-related parameters conform to the standard in 89 % of observations. The recovery level for the dynamometric parameters of foot and leg flexors and extensors is determined by the involvement degree of segmental soft tissues for direct and indirect mechanism of injury. The rate of recovering the muscle strength of leg extensors is slower than that of leg flexors.
Conclusions. The maximum rate of recovery of the muscle strength of the limb involved is registered within one year after the fixator removal. Subsequently, the rate of recovery slows sharply, and the gain in dynamometry parameters doesn’t exceed 10 % over the next two years. Asymmetry of the parameters of muscle dynamometry in the femur continues two years after the fixator removal for closed double femoral fractures – up to 25 %, for open double femoral fractures – up to 70 %; and that in the leg continues up to 40 % for closed double leg fractures and to 60 % – for open double leg fractures. The recovery of limb functional status parameters is determined by range of motion in the involved limb joints. There is no gain in muscle strength when range of motion is achieved in the lower limb joints responsible for gait symmetry.
Keywords: injury; long-term results; dynamometry; podography.

Information about authors:
Dolganov D. V., candidate of biological science, leading researcher of laboratory of functional studies, Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia.
Dolganova T.I., MD, PhD, leading researcher of laboratory of functional studies, Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia.
Martel I.I., MD, PhD, head of scientific clinical laboratory of traumatology, Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia.
Karasev A.G., MD, PhD, leading researcher of scientific clinical laboratory of traumatology, Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia.
Naritsyn V.A., head of traumatology department #3, Russian Scientific Center “Restorative Traumatology and Orthopedics by the name of G.A. Ilizarov”, Kurgan, Russia.

Address for correspondence:
Dolganova T.I., Kuybysheva St., 5-51, Kurgan, Russia, 640020
Tel: +7 (912) 529-80-12
E-mail: rjik532007@rambler.ru

References:
1. Edmonds J., Bertouch J. The core curriculum: History and examination: Pap. Undergrad. Educ. Rheimatol., Challenges, Millenium, Sentosa, Singapore, June 13-15, 1997. J. Rheumatol. 1999; 26 (Suppl. N 55): 33-34.
2. Gurko N.S., Volodina Ju.V. Kiprenskij Ju.V. The analysis of the reasons of incomplete structurally functional restoration of skeletal muscles after heavy traumatic injury of an extremity. Patologicheskaya fiziologiya i eksperimental'naya terapiya. 1991; 6: 50-53 (In Russian).
3. Ceroni D., Martin X.E., Farpour-Lambert N.J., Delhumeau C., Kaelin A. Assessment of muscular performance in teenagers after a lower extremity fracture. J. Pediatr. Orthop. 2010; 30 (8): 807-812.
4. Tipton K.D., Wolfe R.R. Exercise, protein metabolism and muscle growth: [Conference of the Gatorade Sports Science Institute, Couer d’Alene, Idaho, June, 2000]. Int. J. Sport Nutr. And Exercise Metab. 2001; 11 (1): 109-132.
5. Kawabata Y., Senda M., Oka T., Yagata Y., Takahara Y., Nagashima H., Inoue H. Measurement of fatigue in knee flexor and extensor muscle. Acta Ìedóñà Okayama. 2000. 54 (2): 85-90.
6. Martel' I.I Ilizarov's method in treatment of open injuries of the lower extremities. Saarbrücktn : LAP LAMBERT Academic Publishing GmbH & Co. KG; 2012 (In Russian).
7. Shhurov V.A., Dolganov D.V., Dolganova T.I., Atmanskij I.A. (Rossiya). The device for determination of force of muscles of a hip Pat. ¹ 35703; 2003 (In Russian).
8. Shhurov V.A. (Rossiya). The device for an angulodinamometry Pat. ¹ 2029536; 1992 (In Russian).
9. Vitenzon A.S. Regularities of normal and pathological walking of the person. Moscow : Zerkalo-M; 1998 (In Russian).
10. Gajdyshev I.P. Solution of scientific and engineering tasks by means of Excel, VBA and C/C+++. Sankt-Peterburg : BXB-Peterburg; 2004 (In Russian).

CLINICAL AND BIOMECHANICAL RESULTS OF SURGICAL TREATMENT OF L4 DEGENERATIVE SPONDYLOLISTHESIS
Krutko A.V., Peleganchuk A.V.

Krutko A.V., Peleganchuk A.V.
Novosibirsk Scientific Research Institute of Traumatology and Orthopedics,
Novosibirsk, Russia

Objective - to estimate the efficacy of surgical treatment of L4 degenerative spondylolisthesis using 360 degrees fusion either combined with dynamic interspinous fixation of the superjacent spinal segment or not.
Material and Methods. Prospective study included analysis of information obtained on stages of the surgical treatment in 97 patients with clinical signs of the L4 degenerative spondylolisthesis. Patients underwent clinical anamnestic, neurological, radiological, radiopaque and biomechanical examinations, MRI and multi-layer spiral CT studies, and questionnaire survey.
Results. Analysis of the biomechanical parameters in our patients with degenerative spondylolisthesis of the L4 vertebra showed somewhat better results in group with dynamic interspinous implant in comparison with no-implant group. Evaluation of postoperative pain dynamics showed lower mean pain intensity at 3 to 6 months and at 1 year after decompression and stabilizing surgery in both groups of patients. However, the regional pain syndrome intensity assessed with VAS was almost twice as lower in the implant group at 3-, 6-, and 12 months follow-up.
Conclusion. The combination of rigid and dynamic fixation in the treatment of degenerative spondylolisthesis provides 15% increase in the number of good results as compared with stand-alone rigid fixation due to elimination of pain by means of unloading of the posterior support complex of the superjacent spinal segment.
Keywords: degenerative spondylolisthesis; surgical treatment; spinal biomechanics

Information about authors:
Krutko A.V., candidate of medical science, senior researcher, head of neurosurgery department #2, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.
Peleganchuk A.V., junior scientist, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Address for correspondence:
Peleganchuk A.V., Frunze St., 17, Novosibirsk, Russia, 630094
The office of Novosibirsk Scientific Research Institute of Traumatology and Orthopedics
Tel: +7 (913) 200-68-07
E-mail: APeleganchuk@niito.ru

References:
1. Gladkov A.V. The Clinical biomechanical analysis in the optimization of the diagnostics and treatment of the deformations of the spine. Dr. med. nauk. Avtoref. dis. Novosibirsk; 1997 (In Russian).
2. Krutko A.V., Peleganchuk A.V., Kozlov D.M., Gladkov A.V., Ahmet'janov Sh.A. Correlation dependence of the clinical morphological manifestations and biomechanical parameters in patients with degenerative spondylolisthesis of L4. Travmatologiya i ortopediya Rossii. 2011; 4: 44-52 (In Russian).
3. Simonovich A.E., Markin S.P., Bajkalov A.A., Hrapov D.V. Treatment of the degenerative disorders of lumbar department of the spine with use of interspinal dynamic implants of Coflex and Diam. Hirurgiya pozvonochnika. 2007; 1: 21-28 (In Russian).
4. Hvisjuk N.I., Chikunov A.S., Arsenij A.K. Degenerative spondylolisthesis. Kishinev : Êàðòÿ Ìîëäîâåíÿñêý; 1986 (In Russian).
5. Bird H.A., Eastmond C.J., Hudson A., Wright V. Is generalized joint laxity a factor in spondylolisthesis? Scand. J. Rheumatol. 1980; 9: 203–205.
6. Matsunaga S., Sakou T., Morizono Y. et al. Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine 1990; 15: 1204–1210.
7. Park P., Garton H.J., Gala V.C., Hoff J.T., McGillicuddy J.E. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine. 2004; 29 (17): 1938–1944.
8. Rosenberg N.J. Degenerative spondylolisthesis: predisposing factors. J. Bone Joint Surg. Am. 1975; 57: 467–474.
9. Sengupta D.K., Herkowitz H.N. Degenerative Spondylolisthesis Review of Current Trends and Controversies. Spine. 2005; 30 (Suppl. 6): S71-S81.
10. Shin’ya Okuda, Motoki Iwasaki, Akira Miyauchi, Hiroyuki Aono, Masahiro Morita, Tomio Yamamoto. Risk Factors for Adjacent Segment Degeneration After PLIF. Spine. 2004; 29 (14): 1535–1540.

New medical technologies
CONSEQUENT TREATMENT OF DAMAGES IN PUBIC AREA WITH USE OF THE NEW FIXATOR FOR PATIENTS WITH CONCOMITANT PELVIC INJURIES
Byalik E.I., Fayn A.M

Byalik E.I., Fayn A.M.
Sklifosovsky Research Institute for Emergency Medicine
Scientific Research Institute of Rheumatology,
Moscow, Russia

Background. Fixation of damages in pubic area with reconstructive plates in many cases does not provide sufficient stability, especially in severe concomitant injuries.
Objective – to improve efficiency of consequent treatment of pubic area injuries through the development of methodology of the external fixation of pelvis and application of the original external fixator.
Materials and methods. We applied our new plate for fixation of damages in pubic area in 315 patients of the main group. In 63 patients of the control group the osteosynthesis of such damages was made with reconstructive plates.
Results. In 15 cases in the control group (23.8 %) we observed migration of plates and screws and their fractures. There was no fixator failure in any patient of the main group. Excellent and good functional results were achieved in 78.2 % of the patients in the main group and in 61.8% of patients in the control group.
Conclusion. The original plate showed the high efficiency in treatment of anterior pelvic ring injuries.
Key words: unstable pelvic injuries; external pelvic fixation; internal pelvic fixation; reconstructive plate; original plate.

Information about authors:
Byalik E.I., MD, PhD, leading researcher of laboratory of rheumoorthopedics and rehabilitation, Scientific Research Institute of Rheumatology, Moscow, Russia.
Fayn A.M., candidate of medical science, leading researcher of department of concomitant and multiple trauma, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.

Address for correspondence:
Fayn A.M., Bolshaya Sukharevskaya square, 3, Moscow, Russia, 129090
Tel: +7 (495) 620-11-34
E-mail: finn.loko@mail.ru

New medical technologies
CONSEQUENT TREATMENT OF DAMAGES IN PUBIC AREA WITH USE OF THE NEW FIXATOR FOR PATIENTS WITH CONCOMITANT PELVIC INJURIES
Byalik E.I., Fayn A.M.

Byalik E.I., Fayn A.M.
Sklifosovsky Research Institute for Emergency Medicine
Scientific Research Institute of Rheumatology,
Moscow, Russia

Background. Fixation of damages in pubic area with reconstructive plates in many cases does not provide sufficient stability, especially in severe concomitant injuries.
Objective – to improve efficiency of consequent treatment of pubic area injuries through the development of methodology of the external fixation of pelvis and application of the original external fixator.
Materials and methods. We applied our new plate for fixation of damages in pubic area in 315 patients of the main group. In 63 patients of the control group the osteosynthesis of such damages was made with reconstructive plates.
Results. In 15 cases in the control group (23.8 %) we observed migration of plates and screws and their fractures. There was no fixator failure in any patient of the main group. Excellent and good functional results were achieved in 78.2 % of the patients in the main group and in 61.8% of patients in the control group.
Conclusion. The original plate showed the high efficiency in treatment of anterior pelvic ring injuries.
Key words: unstable pelvic injuries; external pelvic fixation; internal pelvic fixation; reconstructive plate; original plate.

Information about authors:
Byalik E.I., MD, PhD, leading researcher of laboratory of rheumoorthopedics and rehabilitation, Scientific Research Institute of Rheumatology, Moscow, Russia.
Fayn A.M., candidate of medical science, leading researcher of department of concomitant and multiple trauma, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.

Address for correspondence:
Fayn A.M., Bolshaya Sukharevskaya square, 3, Moscow, Russia, 129090
Tel: +7 (495) 620-11-34
E-mail: finn.loko@mail.ru

References:
1. Dyatlov M.M. Complex pelvic injuries. What to do? Gomel' : Belarus', 2006; 65-67, 477 (in Russian).
2. Sokolov V.A. Polytrauma. Moscow : GOETAR-Media., 2006; 157-168, 335-337, 348-357, 380-383 (in Russian).
3. Gerbershagen H.J., Dagtekin O., Isenberg J. Chronic pain and disability after pelvic and acetabular fractures--assessment with the Mainz Pain Staging System. J. Trauma. 2010; 69 (1): 128-136.
4. Hou Z., Smith W.R., Strohecker K.A. Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012; 35 (3): 319-324.
5. Majeed S.A. Grading the outcome of pelvic fractures. J. Bone Joint Surg. 1989; 71-B: 304-306.
6. Pape H.C. Management of fractures in the severely injured influence of the principle of «damage control orthopaedic surgery». Unfallchirurg. 2003; 106 (2): 87-96.
7. Scalea T. Optimal timing of fracture fixation: have we learned anything in the past 20 years. J. Trauma. 2008. 65: 253-260.
8. Smith W., Williams A., Agudelo J. Early predictors of mortality in hemodynamically unstable pelvis fractures. J. Orthop. Trauma. 2007; 21: 31–37.

CLOSED INTRAMEDULLARY NAILING IN TREATMENT OF FOREARM SHAFT FRACTURES
Chelnokov A.N., Lazarev A.Y.

Chelnokov A.N., Lazarev A.Y.
Chaklin Ural Scientific Research Institute of Traumatology and Orthopedics,
Ekaterinburg, Russia

Introduction. Closed nailing has not been widely accepted in the treatment of forearm shaft fractures because of difficulties of closed restoration of atomy, in particular, rotational alignment of the radius and restoration of radial bow to prevent functional deficit.
Objective – to develop surgical technique of closed fixator-assisted forearm nailing.
Materials and methods. Closed intramedullary nailing was performed in 144 patients with forearm fractures (121 (84 %)) and non-unions (23 (16 %)). There were lesions of both bones in 57 (39.6 %), ulna - 54 (37.5 %), radius - 33 (22.9 %). For fixator-assisted nailing we used a device consisted of a half-ring proximally and a ring distally. The distal part of the forearm was fixed in neutral rotaton regardless of the fracture level. For rotational control of the proximal fragment of the radius a joystick K-wire was used. Interlocking and non-locking nails were used. The ulna was nailed first.
Results. Patients demonstrated fast functional recovery. Full range of motions occurred in 1 month after the surgery in 112 (78 %) of patients, and in 2 months in 140 (97%). DASH functional score improved from 21 ± 3.9 in 1 month to 3.7 ± 1.9 in 2 months. Non-union of the ulna occurred in 5 cases (3.4 %), of the radius - in 1 case (0.7 %). Exchange reamed nailing was performed in ulna and plating with bone grafting in the radius nonunion.
Conclusion. The technique provides good alignment of both bones which results with quick functional recovery and high union rate. Closed nailing can be treatment of choice in forearm shaft fractures. Negative perception of forearm nailing is caused mostly by in adequacy of conventional reduction and nailing techniques rather than implant designs.
Key words: fractures; forearm; closed intramedullary nailing; Ilizarov device.

Information about authors:
Chelnokov A.N., candidate of medical science, head of traumatology department, Chaklin Ural Scientific Research Institute of Traumatology and Orthopedics, Ekaterinburg, Russia.
Lazarev A.Y., junior research scientist, Chaklin Ural Scientific Research Institute of Traumatology and Orthopedics, Ekaterinburg, Russia.
Address for correspondence:
Chelnokov A.N., Bankovskiy pereulok, 7, Ekaterinburg, Russia, 620014
Tel: +7 (905) 804-91-23
E-mail: alex61@gmail.com

References:
1. Ivannikov S.V., Oganesyan O.V., Shesternya N.A. External osteosynthesis of forearm fracture. Moscow : BINOM. Laboratoriya znanij : Medicina. 2003; (In Russian).
2. Òransosseous osteosynthesis of diaphyseal fractures of the forearm by Ilizarov’s method. Sost.: G.A. Ilizarov, S.I. Shved, K.U. Kudzaev [i dr.]. Kurgan : VKNC «VTO»; 1990 (In Russian).
3. Pisarev V.V., L'vov S.E., Oshurkov Ju.A., Kaluckov V.V., Kulygin V.N., L'vov A.S. Infectious complications of surgical wounds after metal osteosynthesis of closed fractures of long bones. Travmatologiya i ortopediya Rossii. 2008; 2: 14-19 (In Russian).
4. Puseva M.Je., Solomin L.N., Mihajlov I.N., Korzun A.N., Grishin M.M. Improving transosseous osteosynthesis of diaphyseal fractures of the forearm. Travmatologiya i ortopediya Rossii. 2006; 2: 246-247 (In Russian).
5. Crenshaw À.Í., Perez Å.À. Radius and ulna. In: Campbell's Operative Orthopaedics. 11th ed.. Eds.: S.T. Canale, J.H. Beaty. Philadelphia : Mosby Elsevier, 2008; 3410-3463.
6. Gao H., Luo C.F., Zhang C.Q., Shi H.P., Fan C.Y., Zen B.F. Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail: short-term results in eighteen patients. J. Orthop. Trauma. 2005; 19 (6): 384-391.
7. Heim D. Forearm shaft fractures. In: AO Principles of fracture management. Eds.: T.P. Rüedi, W.M. Murphy. Stuttgart-New York : Thieme-Verlag, 2000; 341-355.
8. Lee Y.H., Lee S.K., Chung M.S., Baek G.H., Gong H.S., Kim K.H. Interlocking Contoured Intramedullary Nail Fixation for Selected Diaphyseal Fractures of the Forearm in Adults. J Bone Joint Surg. Am. 2008; 90: 1891-1898.
9. Rodriguez-Merchan E.C., Gomez-Castresana F. Internal fixation of nonunions. Clin. Orthop. Relat. Res. 2004; 419: 13-20.
10. Weckbach A., Blattert T.R., Weisser Ch. Interlocking nailing of forearm fractures. Arch. Orthop. Trauma Surg. 2006; 126: 309-315.

Clinical aspects of surgery
Kolobova O.I.
PATHOGENETIC CHARACTERISTICS OF LESIONS IN LOWER LIMB DISTAL ARTERIA IN PATIENTS WITH DIABETIC FOOT

Kolobova O.I.
Altay State Medical University,
Barnaul, Russia

Diabetic foot syndrome of ischemic type is conditioned by predominant lesion of leg and foot arteria which are situated in the region of excessive orthostatic arterial pressure. Previously it was clinically found the role of orthostatic angiohypertension and angiospasm of lower extremities in pathogenesis of thromboangitis which has clinicoanatomic similarity with diabetic foot that does not exclude generality of development mechanisms.
Objective – to study the role of orthostatic angiohypertension of lower limbs in lesion of lower limb arteria in diabetes mellitus.
Methods. Using leg and foot renovasography, 30 patients with diabetes mellitus were examined. In 22 patients the signs of lower limb peripheric arteria lesions were found. In 8 patients the signs of arteria lesion were not found.
Results. In the patients with diabetes mellitus without clinical signs of obliterating lesion of peripheric arteria, as well as in healthy persons, in vertical position the orthostatic tonic reaction of lower limb vessels was observed. In several cases the identified changes had signs of angiospasm that was connected with disorder of vascular tone neurohumoral regulation. It favored development of distal angitis of lower limbs and local ischemic disorders. In diabetic foot syndrome the reactivity of arteria of feet and legs is significantly decreased because of restructuring and neuropathy.
Conclusion. In formation of distal angitis in lower limbs in patients with diabetic foot syndrome the important role belongs to regionary orthostatic angiohypertension.
Key words: diabetes mellitus; diabetic foot; orthostatic distal angiohypertension; angiospasm; distal angitis of lower limbs.

Information about author:
Kolobova O.I., MD, PhD, professor of chair of hospital surgery, Altay State Medical University, Barnaul, Russia.
Address for correspondence:
Kolobova O.I., Molodyozhnaya St., 30 – 55. Barnaul, Russia, 656015
Tel: +7 (3852) 62-35-50
E-mail: ogic@yandex.ru

References:
1. Dedov I.I., Udovichenko O.V., Galstjan G.R. Diabetic foot. Moscow; 2005 (In Russian).
2. International agreement on the Diabetic Foot. Moscow; 2000 (In Russian).
3. Sum C.F., Lim S.C., Tavintharan S. Periferal arterial disease in diabetes foot care. Singapore Med. J. 2008; 49: 21-93.
4. Gervaziev V.B., Perfil'ev A.P., Flat I.M. i dr. Arterial system and the microcirculation in the lower extremities. Barnaul; 1980 (In Russian).
5. Savel'ev V.S., Koshkin V.M., Nosenko L.V. Peripheral makrogemodinamics with atherosclerosis obliterans of the lower extremities and type 2 diabetes. Angiologija i sosudistaja hirurgija. 2003; 1: 9-20 (In Russian).
6. Jubickaja N.S., Antonjuk M.V., Veremchuk L.V. i dr. The role of tumor necrosis factor in the development of metabolic syndrome. Terapevticheskiy Arhiv. 2009; 11: 59-63 (In Russian).
7. Tilg H.I., Moschen A.R.Inflammatory mechanisms in the regulation of insulin resistance. Mol. Med. 2008; 14 (3-4): 222-231.
8. Shoelson S.E., Lee J. , Goldfine A.B. Inflammation and insulin resistance. J. Clin. Invest. 2006; 116: 1793-1801.
9. Gervaziev V.B. Orthostatic distal angiohypertension of lower extremities. Physiological and pathogenic aspects. Khirurgija. Zhurnal im. N.I. Pirogova. 2005; 3: 66-69 (In Russian).
10. Gillfillan R.S. The effect of peripheral nerve interruption sympathetic paralysis on the blood presion in the human arteriity. Surgery. 1958; 43 (5): 758-767.
11. Campa O.P., Melaragno E., Bellisario G. et al. Ñhange the reactivity of the arteries of the lower extremities with a change of position. Cor. et vasa. 1965; 7 (3): 190-198.
12. Fomina I.G., Saltykov B.B., Koroleva T.V. i dr. Diagnosis of microcirculatory disorders in patients with type 2 diabetes and coronary heart disease. Klinicheskaja medicina. 2004; 2: 36-39 (In Russian).
13. Targer G., Bertolini L., Zenari L. Increased plasma markers of inflammation and their association with microvascular complications in type I diabetic patients without clinically manifestations of macroangiopathy. Diab. Med. 2005; 22 (8): 999-1004.
14. Dadvani S.A., Uspenskij L.V., Lapchinskij V.A. i dr. Diagnosis and treatment of diabetic angiopathy of the lower extremities. Hirurgija. Zhurnal im. N.I. Pirogova. 1994; 5: 36-38 (In Russian).

Functional, instrumental and laboratory diagnostics
Filatov E. V., Ovchinnikov O. D., Trebushchenko N. V.
MICROBIAL COMPOSITION CHARACTERISTICS OF PRESSURE SORES IN THE COURSE OF TRAUMATIC DISEASE OF THE SPINAL CORD

Filatov E. V., Ovchinnikov O. D., Trebushchenko N. V.
Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia

Study subject - 247 patients with traumatic disease of the spinal cord who were admitted to the department of neurosurgery in 2002-2004 and had pressure sores.
Objective - to study the microbial composition of pressure sores, its correlation with the duration of wound and with prior admissions.
Materials and methods. We studied the microbial composition of pressure sores in 131 (53.0%) patients. Microbiological study of the pressure sores was performed prior to surgical treatment and during conservative treatment in order to choose optimal antibacterial therapy.
Results. We found that Staphylococcus aureus and Pseudomonas aeruginosa prevailed in the structure of the microbial agents of pressure sores. When pressure sores had existed less than 3 months or more than 1 year the microbiological study found monoculture of some pathogenic organism. The microbial picture of wounds existing more than 3 months and less than 1 year involved associations of organisms.
Conclusion. Thus, associations of different organisms were seen in patients who had spent most of the time in hospital, while patients who had been at home most of the time had monocultures.
Field of application: surgery, traumatology, neurosurgery, microbiology, rehabilitation.
Key words: traumatic disease of the spinal cord; pressure sores; microbial composition of wound.

Information about authors:
Filatov E.V., neurosurgeon, head of neurosurgery department, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.
Ovchinnikov O.D., traumatologist-orthopedist, neurosurgery department, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.
Trebushchenko N.V., bacteriologist, clinical diagnostic laboratory, Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:
Filatov E. V., Malaya St., 7, Novokuznetsk, Kemerovo region, Russia, 654055
Novokuznetsk Scientific Practical Center of Medicosocial Expertise and Rehabilitation of Disabled Persons, neurosurgery department
Tel: +7 (3843) 37-58-20
E-mail: root@reabil-nk.ru

References:
1. Surgical treatment of skin and pressure ulcers: guidance. Ed.: B.I. Li, B.L. Gerc. Moscow : Medicina; 2003 (in Russian).
2. Antibiotic prophylaxis of major infections in surgery: methodic guidelines. Sost.: E.A. Ekamasova, A.E. Voynovskiy, A.S. Kovalev [i dr.] ; Glavnyy voennyy klinicheskiy gospital' vnutrennikh voysk MVD Rossii. Moscow; 2009 (in Russian).
3. Leont'ev M.A., Ovchinnikov O.D., Filatov E.V. The prevalence and treatment approach of pressure wounds in spinal patients in a special medical center. In: The XVII Russian National Congress abstracts "Chelovek i ego zdorov'e". Sankt-Petersburg : Chelovek i ego zdorov'e, 2006; 156 (in Russian).
4. Pilipajtite L., Rimdejka R., Rajnis D. i dr. Dependence variation of the microbial landscape of burns is associated with the human natural flora in therapeutic pathway of burns department. In: Journal of research articles of the Republican scientific conference of the Gomel State Medical University. Gomel', 2010; 12-13 (in Russian).
5. Savchenko P.A., Filatov E.V. Pressure ulcers plastic surgery. Voprosy rekonstruktivnoj i plasticheskoj hirurgii. 2003; 3: 16–20 (in Russian).
6. Surgical skin and soft tissues infections : russian national recommendations. Ed. V.S. Savel'ev. Moscow, 2009; 92 (in Russian).
7. Filatov E.V. Surgical treatment of pressure ulcers in patients with spinal cord injury. Meditsina v Kuzbasse. 2003; Spetsvypusk 2: Aktual'nye problemy reabilitatsii invalidov : tezisy dokladov Vserossiyskoy konferentsii: 100–101 (in Russian).
8. Filatov E.V., Leont'ev M.A., Ovchinnikov O.D. M Recent approaches to surgical treatment of pressure wounds in patients with spinal cord injury. Journal of the Kuzbass research center. Kemerovo, 2006; 2: Innovative technologies in medicine and healthcare practice: 157-159 (in Russian).
9. Filatov E. V., Leont'ev M. A. Surgical treatment of pressure ulcers in patients with traumatic spinal cord disease. In: Journal of scientific articles of the Republican scientific-practical conference with international participation. Gomel', 2011; 55-57 (in Russian).
10. Lyder C. H. Pressure ulcer prevention and management. JAMA, 2003; 289: 223-226.

CLINICAL RADIAL DIAGNOSTICS OF AXIAL DISLOCATION IN SEVERE TRAUMATIC BRAIN INJURY
Shchedrenok V.V., Potemkina E.G., Simonova I.A., Moguchaya O.V., Sebelev K.I.

Shchedrenok V.V., Potemkina E.G., Simonova I.A., Moguchaya O.V., Sebelev K.I.
Russian Polenov Neurosurgical Institute,
Saint-Petersburg, Russia

Object of research - morphometric measurements of area of the foramen magnum with radiologic methods (multispiral CT and MRI) in severe craniocerebral trauma.
Objective - studying of opportunities of radiologic methods of research in diagnostics of axial dislocation of brain in severe craniocerebral trauma with quantitative assessment of degree of infringement of the brain stem in the foramen magnum.
Materials and methods. Complex clinical and radiological examination of 119 patients with severe craniocerebral trauma in the acute period was conducted. Complex inspection included neurologic survey, assessment of extent of violation of consciousness according to Glasgow coma scale, ultrasonography of the head, chest and abdomen cavities, CT and MRI. In the different time terms after trauma 89 patients were operated for intracranial hematoma and brain crush injury locations, among them – 48 victims (54 %) during first 6 hours after admission.
Results. CT and MRI of the brain and craniovertebral region in the axial view were used for evaluation of the area of the foramen magnum (S1). Later there was an examination of the total area of the tonsils of the cerebellum (S2) displaced into the foramen magnum, with the subsequent calculation of coefficient (Co) of infringement of the brain stem in the foramen magnum using the formula: Co = S2:S1×100 %. At the value of coefficient of infringement of the brain stem in the foramen magnum to 20 % the degree of infringement was considered as moderate, at the value of an indicator from 21äî 30 % – considerable and at the coefficient of infringement of the brain stem in the foramen magnum more than 30 % – expressed.
Conclusions. Radiological diagnostics in severe craniocerebral trauma with calculation of coefficient of infringement of the brain stem allows allocating quantitatively three degrees of the axial dislocation of the brain: moderate, considerable and expressed. Each degree of the axial dislocation has its own clinical neurologic symptoms with the important signs in the view of dissociation of deep reflexes and muscular tone on the longitudinal axis of the body, and also the absence of corneal and oculocephalic reflexes. Multispiral CT as the method of emergency inspection has the high diagnostic efficiency (within 81.8 - 87.1%).
Key words: severe craniocerebral trauma; axial dislocation; radiological diagnostics.

Information about authors:
Shchedrenok V.V., MD, PhD, professor, leading researcher, Russian Polenov Neurosurgical Institute, Saint-Petersburg, Russia.
Potemkina E.G., candidate of medical science, PhD candidate, Russian Polenov Neurosurgical Institute, Saint-Petersburg, Russia.
Simonova I.A., candidate of medical science, PhD candidate, chief physician, Russian Polenov Neurosurgical Institute, Saint-Petersburg, Russia.
Moguchaya O.V., MD, PhD, professor, chief of medical care quality department, Russian Polenov Neurosurgical Institute, Saint-Petersburg, Russia.
Sebelev K.I., MD, PhD, docent, chief of X-ray department, Russian Polenov Neurosurgical Institute, Saint-Petersburg, Russia.

Address for correspondence:
Shchedrenok V.V., Mokhovaya St., 21-23, 34, Saint-Petersburg, Russia, 191028
Tel: +7 (921) 656-14-48
E-mail: ovm55@yandex.ru

References:
1. Agadzhanjan V.V., Pronskih A.A., Ust'janceva I.M. i dr. Polytrauma. Novosibirsk; 2003 (In Russian).
2. Agadzhanjan V.V., Ust'janceva I.M., Pronskih A.A. i dr. Polytrauma. Urgent help and transportation. Novosibirsk; 2008 (In Russian).
3. Vasil'ev A.Ju., Malyj A.Ju., Serova N.S. The analysis of results of radiologic methods of research on the basis of the principles of evidential medicine. Moscow; 2008 (In Russian).
4. Gumanenko E.K. Polytrauma. Actual problems and new technologies in treatment. In: Novye tehnologii v voenno-polevoj hirurgii i hirurgii povrezhdenij mirnogo vremeni : materialy mezhdunarodnoj konferencii. Sankt-Peterburg, 2006; 4-14 (In Russian).
5. Dorovskih G.N., Ahadov T.A., Semchenko V.V. MR tomography in diagnostics of acute craniocereberal trauma. Omsk; 2007 (In Russian).
6. Zaharova N.E., Kornienko V.N., Potapov A.A., Pronin I.N. Neurovisualization of structural and hemodynamic violations brain injury. Moscow, 2013 (In Russian).
7. Kolesov V.Ju. MR tomography in urgent diagnostics of craniocereberal trauma. In: Radiologija-2007 : materialy Vserossijskogo kongressa luchevyh diagnostov. Moscow, 2007; 174–175 (In Russian).
8. Krylov V.V., Carenko S.V. Diagnostics and principles of treatment of secondary injuries of brain. Nejrohirurgija. 2005; 1: 4-8 (In Russian).
9. Ladejshhikov V.M. Optimization of diagnostics and complex treatment of victims with the combined trauma. Dr. med. sci. Avtoref. dis. Samara; 2008 (In Russian).
10. Shumilina N.Ju., Pasynok S.F. Urgent CT diagnostics in acute craniocereberal trauma and vascular pathology of brain. In: Radiologija-2008 : materialy II Vserossijskogo nacional'nogo kongressa po luchevoj diagnostike i terapii. Moscow, 2008; 321-322 (In Russian).
11. Shchedrenok V.V., Dorovskih G.N., Moguchaja O.V. i dr. Clinical and radiologic diagnostics of the isolated and combined craniocereberal trauma. Saint-Petersburg; 2012 (In Russian).

Researches of young scientists
EMERGENCY SURGERY OF SPINE INJURY COMPLICATIONS
Ershov O.A.

Ershov O.A.
Vologda Regional Clinical Hospital,
Vologda, Russia,
Yaroslavl State Medical Academy,
Yaroslavl, Russia

The tactics of management of patients with complicated spine trauma in Vologda Regional Clinical Hospital is presented.
Objective – to improve the outcomes of treatment using emergency single-step neural structure decompression and transpedicular spondylodesis in patients of Vologda region with spinal cord injury.
Methods. The results of treatment of 85 patients were analyzed. 41 patient in the main group received surgical treatment during the first 24 hours after trauma. 44 patients had treatment after 24 hours.
Results. The better functional outcomes of treatment were observed in the patients of the main group.
Conclusion. Emergency decompressive stabilizing surgery results in better functional outcomes of treatment.
Key words: Volodga regional hospital; complicated spine injury.

Information about author:
Ershov O.A., neurosurgeon, neurosurgery department, Vologda Regional Clinical Hospital, Vologda, Russia; postgraduate, chair of traumatology, orthopedics and military field surgery,Yaroslavl State Medical Academy, Yaroslavl, Russia.

Address for correspondence:
Ershov O.A., Poshehonskoe shosse, 23, Vologda, Russia, 160001
Tel: +7 (911) 515-08-03
E-mail: oleg-e-v@mail.ru

References:
1. Vetrilje S.T., Kolesov S.V., Borisov.A.K. i dr. Clinical management of severe spinal injuries with the use of modern technology. Hirurgija pozvonochnika. 2004; 3: 33-39 (In Russian).
2. Leont'ev M.A. The epidemiology of spinal cord injury and frequency of complete anatomical spinal cord injury. Aktual'nye problemy reabilitacii invalidov. Novokuzneck, 2003; 37-38 (In Russian).
3.Vaccaro A.R., Rihn J.A., Ryan D.F., Tucker W.S., Mandell P.J., Blackett W.B. Medical expert testimony. Journal of Bone and Joint Surgery (Am). 2010; 92(15): E24 1-4.

Experimental investigations
OSTEOPLASTY IN EXPERIMENTAL VERTEBRAL OSTEOMYELITIS
Ardashev I.P., Chernitsov S.V., Protskaya I.Y., Ivanova O.A., Bunina O.G.

Ardashev I.P., Chernitsov S.V., Protskaya I.Y., Ivanova O.A., Bunina O.G.
Kemerovo State Medical Academy,
Kemerovo, Russia

Objective - to analyze the effect of Kostma osteoplastic material on the processes of bone tissue regeneration in experimental vertebral osteomyelitis.
Materials and methods. The experiments were performed in the male rat tail vertebrae. To study the osteogenesis processes the osteomyelitic defects were filled with Kostma. Clinical observations, radiological and morphological study of specimen (from different animals) were used in 1, 3 and 6 months after operation.
Results. The signs of osteoclastic bone resorption and osteoblastic bone formation are observed when Kostma is used for osteoplasty of osteomyelic spinal defects. This suggests the existence of osteogenic activity and capacity for biodegradation. Osteoblasts form a newly generated bone tissue around Kostma fragments with development of bone block. The absence of connective tissue capsule testifies to a high degree of the material biocompatibility.
Conclusion. The developed experimental model of rat vertebral osteomyelitis allows investigating processes of reparative osteogenesis and the effect of Kostma on it. Using of the Kostma osteoplastic material favors the biotransformation and formation of the bone block within 6 months after replacement of a vertebral osteomyelitic defect, because the transplant takes part in reparative osteogenesis. Surgical debridement of vertebral osteomyelitic process with use of Kostma promotes formation of the bone block and full regress of the inflammatory events with absence of recurrence, and leads to recover of an animal.
Keywords: backbone; osteomyelitis; osteogenesis; biomaterial.

Information about authors:
Ardashev I.P., MD, PhD, professor, head of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Veretelnikova I.Y., postgraduate of chair of traumatology, orthopedics, military field surgery, restorative medicine, anesthesiology and resuscitation, Kemerovo State Medical Academy, Kemerovo, Russia.
Chernitsov S.V., candidate of medical science, orthopedist-traumatologist, Clinical Hospital #5, Kemerovo, Russia.
Ivanova O.A., bacteriologist, bacteriologic laboratory, Podgorbunsky City Clinical Hospital #3, Kemerovo, Russia.
Bunina O.G., head of clinical diagnostic laboratory, Podgorbunsky City Clinical Hospital #3, Kemerovo, Russia.

Address for correspondence:
Veretelnikova I.Y., Lenina prospect, 77a-33, Kemerovo, Russia, 650066
Tel: +7 (913) 303-79-06
E-mail: akihabara@list.ru.

References:
1. Ardashev I.P., Grigoruk A.A., Plotnikov G.A. Possible complications after iliac bone grafting. In: Sovremennye tehnologii v travmatologii i ortopedii. Moscow, 1999; 191-192 (In Russian).
2. Ardashev I.P., Gazizov R.F. Experimental vertebral osteomyelitis. In: Problemy mediciny i biologii. Ch.1. Voprosy hirurgii, travmatologii, ortopedii i morfologii. Kemerovo; 2001 (In Russian).
3. Berchenko G.N., Kesjan G.A., Urazgil'deev R.Z. at al. Comparative experimental and morphologic investigation of influence of some calcium- phosphate materials used in traumatologo-orthopedical practice on activation of reparative osteogenesis. Biomaterialy, 2006; 6: 2-7 (In Russian).
4. Bojarkina S.K. Destructive tubercular, staphylococcal and mixed bone affection and their repair characteristics after plasty in experiment. In: Mehanizmy formirovanija i zazhivlenija destruktivnyh form tuberkuleza. Moscow, 1979; 108-112 (In Russian).
5. Gorelov Å.À. Characteristics or repairing processes after regional perfusion of limb at severe tuberculosis in experiment. In: Mehanizmy formirovanija i zazhivlenija destruktivnyh form tuberkuleza. Moscow, 1979; 112-115 (In Russian).
6. Kirilova I.A. Method of preparation of bioactive bone graft. Patent RF, N 2223104; 2004 (In Russian).
7. Kirilova I.A., Fomichev N.G., Podorozhnaja V.T. New materials for bone plasty from the point of view of modern conceptions of bone grafts. Hirurgija pozvonochnika. 2007; 2: 66-70 (In Russian).
8. Kornev Ê.V. Experimental model of tubercular spondylitis. Vestnik hirurgii. 1959; 11: 12-17 (In Russian).
9. Omel'janenko N.P., Mironov S.P., Denisov-Nikol'skij Ju.I. Modern possibilities for optimization of bone reparative osteogenesis. Vestn. travmatologii i ortopedii. 2002; 4: 85-88 (In Russian).
10. Ponomarev I.P., .Maksimenko D.V. Experimental substantiation of implantation of Kolapol KP-3 into postoperative osteomyelitic defects. Vestnik RGMU. 2003; 2/28: 65 (In Russian).
11. Privalov V.A., Svetlakov A.L., Kushakovskij O.S., Jebert L.Ja., Giniatullin R.U., Svetlakova I.A., Jarovoj N.N. Experimental model of pyogenic osteomyelitis. Patologicheskaja fiziologija i jeksperimental'naja terapija. 2000; 1: 26-29 (In Russian).
12. Sysoljatin S.P., Kirilova I.A., Pochueva N.Ju. Clinico-experimental substantiation of using “Kostma” in parodentium surgery. In: Materialy IV Vserossijskogo kongressa «Hirurgicheskaja stomatologija i cheljustno-licevaja hirurgija» i Vserossijskogo simpoziuma «Novye tehnologii v stomatologii». Novosibirsk, 2005; 146-150 (In Russian).
13. Hundadze I.T. Tubercular spondylitis. Ortopedija, travmatologija, protezirovanie. Tbilisi, 1963; 3: 20-25 (In Russian).
14. Chernicov S.V. Formation of anterior spondylosyndesis in spine injuries using biocomposite and bone plastic materials (experimental study). Kand. med. nauk. Avtoref. dis. Novosibirsk, 2009 (In Russian).
15. Bojescul J.A., Polly D.W. Jr., Kuklo T.R., Allen T.W., Wieand K.E. Backfill for iliac-crest donor sites, randomized study of coralline hydroxyapatite. Am. J. orthopedies. 2005; 34 (8): 377-382.

Reviews
INTRACRANIAL PRESSURE MONITORING: PRESENT AND PROSPECTS
(report 1)
Gorbachev V.I., Likholetova N.V., Gorbachev S.V.

Gorbachev V.I., Likholetova N.V., Gorbachev S.V.
Irkutsk State Medical Academy of Postgraduate Education,
Irkutsk, Russia

Objective – to review the modern methods of intracranial pressure control.
Invasive monitoring, mainly external ventricular drainage, still remains a “gold standard” îf neuromonitoring in treatment of patients with brain injury, but this manipulation can be not always feasible, because of contra-indications or absence of neurosurgery in this hospital. Now the attention of experts is drawn by the researches devoted to comparison of values of intracranial pressure, measured invasive and noninvasive methods.
This review presents the various techniques of noninvasive control of intracranial hypertension: radiological methods, including a computer tomography and a magnetic resonance imaging, a transcranial Doppler, analysis of encephalograms, audiological methods, ophthalmoscopy and others.
Noninvasive methods have a set of advantages, thus it are less exact in comparison with direct measurement of intracranial pressure, however each of them is potentially perspective.
Key words: intracranial pressure; monitoring.

Information about authors:
Gorbachev V.I., MD, PhD, professor, head of chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
Likholetova N.V., postgraduate, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
Gorbachev S.V., resident, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

Address for correspondence:
Gorbachev V.I., Yubileyny district, 100, Irkutsk, Russia, 664049
Irkutsk State Medical Academy of Postgraduate Education
Tel: +7 (902) 566-63-89
Å-mail: gorbachevvi@yandex.ru

References:
1. Gorbachev V.I., Kovalev V.V., Petrov S.I., Dobrynina Yu.V., Petrova I.L., Man'kov A.V. Diagnostics and treatment of intracranial gipertenzionny syndrome. Irkutsk: GIUV; 2008 ( In Russian).
2. Gorbachev V.I., Kovalev V.V. Dislocation syndrome. Irkutsk: GIUV; 2008 (In Russian).
3. Akopian G., Gaspard D.J., Alexander M. Outcomes of blunt head trauma without intracranial pressure monitoring. American Surgeon. 2007; 73 (5): 447–450.
4. Beer R., Lackner P., Pfausler B., Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J. of Neurology. 2008; 255 (11): 1617–1624.
5. Bekar A., Dogan S., Abas F. Risk factors and complications of intracranial pressure monitoring with a fiberoptic device. J. of Clinical Neuroscience. 2009; 16 (2): 236–240.
6. Bennett T.D., Riva-Cambrin J., Keenan H.T., Korgenski E.K., Bratton S.L. Variation in Intracranial Pressure Monitoring and Outcomes in Pediatric Traumatic Brain Injury. Arch. Pediatr. Adolesc. Med. 2012; 166 (7): 641-647.
7. Bershad E.M., Humphreis W.E., Suarez J.I. Intracranial hypertension. Seminars in Neurology. 2008; 28 (5): 690–702.
8. Binz D.D., Toussaint L.G., Friedman J.A. Hemorrhagic complications of ventriculostomy placement: a meta-analysis. Neurocritical Care. 2009; 10 (2): 253–256.
9. Brainin M., Bornstein N., Boysen G. Acute neurological stroke care in Europe: Results of the European stroke care inventory. Eur. J. Neurol. 2000; 7: 5-10.
10. Bratton S.L., Chesnut R.M., Ghajar J. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J. of Neurotrauma. 2007; 24 (1): 59–64.
11. Bulger E.M., Nathens A.B., Rivara F.P., Moore M., MacKenzie E.J., Jurkovich G.J. Management of severe head injury: Institutional variations in care and effect on outcome. Crit. Care Med. 2002; 30: 1870-1876.
12. Cremer O.L., van Dijk G.W., Brekelmans G.J. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit. Care Med. 2005; 33: 2207-2213.
13. Czosnyka M., Smielewski P., Lavinio A., Czosnyka Z., Pickard J.D. A synopsis of brain pressures: which? when? Are they all useful? Neurological Research. 2007; 29 (7): 672–679.
14. Dasic D., Hanna S.J., Bojanic S., Kerr R.S. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. British J. of Neurosurgery. 2006; 20 (5): 296–300.
15. Eide P.K., Sæhle T. Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure? Acta Neurochirurgica. 2010; 152 (6): 989–995.
16. Fakhry S.M., Trask A.L., Waller M.A., Watts D.D. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. Cent. Nerv. 2004; 56: 492-499.
17. Fichtner J., Güresir E., Seifert V., Raabe A. Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis. J. of Neurosurgery. 2010; 112 (4): 840–846.
18. Forsyth R.J., Wolny S., Rodrigues B. Routine intracranial pressure monitoring in acute coma. Cochrane Database of Systematic Reviews. 2010; 3: Article ID CD002043.
19. Gambardella G., Zaccone C., Cardia E. Intracranial pressure monitoring in children: Comparison of external ventricular device with the fiberoptic system. Childs Nerv. Syst. 1993; 9: 470–473.
20. Gardner P.A., Engh J., Atteberry D., Moossy J.J. Hemorrhage rates after external ventricular drain placement: clinical article. J. of Neurosurgery. 2009; 110 (5): 1021–1025.
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REPORT ABOUT THE XVII JUBILEE ALL-RUSSIAN SCIETIFIC PRACTICAL CONFERENCE «MULTI-PROFILE HOSPITAL: PROBLEMS AND SOLUTIONS»
Petukhova O.V.

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