Leading article

 POLYTRAUMA, THE WAYS OF DEVELOPMENT 

Agadzhanyan V.V., Kravtsov S.A.

Agadzhanyan V.V., Kravtsov S.A.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to define the practical directions for solving the issues of increasing efficiency in rendering specialized medical assistance, decreasing mortality and disability, reducing treatment period and social adaptation in patients with polytrauma.

Materials and methods. The literature review for 60 year period was performed. The search included available definitions of polytrauma, criterions for injury and state severity, diagnostics, treatment, epidemiology and statistics without language limitation. Retrospective and perspective analysis of results of treatment for 2,112 patients with polytrauma for the last 15 years was used.

Discussion. The international and Russian literature includes multiple publications with active discussions of polytrauma terminology, but in Russian Federation it did not result in any consensus decision about this term. During 13^th International conference of polytrauma in Aachen the following definitions were accepted as relevant and recommendable for using: ISS > 15 or AIS ≥ 3 for at least two regions of the body; necessary consideration of at least 1 of 5 standardized pathologic states: hypotension, GCS, acidosis, coagulopathy and the age > 70. Formation of the precise definition of polytrauma allows continuation of practical construction of polytrauma registries for solving two main objectives: warranty of quality of medical assistance in individual medical facilities and implementation of developed high tech and evidence based methods for organization, diagnostics and treatment.

Conclusion. The main definition of polytrauma has been formed. Its criterions have been determined which are simple and available for all medical facilities accepting patients with severe injuries. We are completely agreed with these offers and recommend them as the basis for implementation into the scientific practical activity of Russian medicine. Presence of these criterions allows developing and implementing the main national registries of polytrauma beginning from trauma centers at all levels. For better understanding potential positive moments which will be initiated by Russian national registry of polytrauma new researches and discussions are obligatory. Realization of our desires is possible only with participation of Ministry of Health of Russian Federation.

Key words: polytrauma; criterions for severity of injury and state; terminology; registers.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, director of Federal Scientific Clinical Center of the Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kravtsov S.A., MD, PhD, head of center of resuscitation, intensive care and anesthesiology, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Kravtsov S.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Òåë.: +7 (384-56) 2-39-99

E-mail: info@gnkc.kuzbass.net

References:

1.        Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2.        Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AKh. Polytrauma. Septic complications. Novosibirsk : Nauka Publ., 2005. 391 p. Russian

3.        Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, et al. Polytrauma. Emergency Aid and Transportation. Novosibirsk : Nauka Publ., 2008. 320 p. Russian

4.        Agadzhanyan VV, Agalaryan AKh, Ustyantseva IM, Galyatina EA, Dovgal DA, Kravtsov SA, et al. Polytrauma. Treatment of Children. Novosibirsk : Nauka Publ., 2014. 244 p. Russian

5.        Agadzhanyan VV, Kravtsov SA, Zheleznyakova IA, Kornev AN, Pachgin IV. Integration of criteria for degree of polytrauma severity with the international classification of diseases. Polytrauma. 2014; (1): 6-14. Russian

6.        Gumanenko EK. Objective estimation of injury severity. Saint Petersburg, 1999. 109 p. Russian

7.        Sokolov VA. Multiple and concomitant injuries. Moscow : GEOTAR-Media Publ., 2006. 512 p. Russian

8.        Shatalin AV, Kravtsov SA, Agadzhanyan VV. The main factors influencing mortality in patients with polytrauma transported to a specialized trauma center. Polytrauma. 2012; (3): 17-21. Russian

9.        Baker SP,O’Neill B, Haddon W Jr., Long WB. The Injury Severity Score: a method for describing patients with multiple and evaluating emergency care. J. Trauma. 1974; 14 (3): 187-196.

10.    Border JR, LaDuca J, Seibel R. Priorities in the management of the patient with polytrauma. Prog. Surg. 1975; 14: 84-120.

11.    Bosk CL, Dixson-Woods M, Goeschel CA, Pronovost PJ. Reality check for checklists. Lancet. 2009; 374 (9688): 444-445.

12.    Butcher NE, Enninghost N, Sisak K, Balogh ZJ. The definition of polytrauma: variable interrater versus intrarater – a prospective international study among trauma surgeons. J. Trauma Acute Care Surg. 2013; 74 (3): 884-889.

13.    Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW Jr., et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J. Trauma. 1990; 30 (11): 1356-1365.

14.    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger E.P, et all. A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 2009; 360 (5): 491-499.

15.    Levy SM, Senter CE, Hawkins RB, Zhao JY, Kao LS, Lally KP, et al. Implementing a surgical checklists: more than checking a box. Surgery. 2012; 152 (3): 331-336.

16.    Mahajan RP. The WHO surgical checklist. Best Pract. Clin. Anaesthesiol. 2001; 25 (2): 161-168.

17.    Nolan B, Zakirova R, Bridge J, Nathens AB. Barriers to implementing the World Health Organization’s Trauma Care Checklist: A Canadian single-center experience. The Journal of Trauma and Acute Care Surgery. 2014; 77( 5): 679-683.

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19.    Pape H-C, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am. J. Surg. 2002; 183 (6): 622-629.

20.     Pape H-C, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et all. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann. Surg. 2007; 246 (3): 491-499, discussion 499-501.

21.    Pape H-C, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited: an international consensus process and proposal of the new “Berlin definition”. The Journal of Trauma and Acute Care Surgery. 2014; 77 (5): 780-786.

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23.    Tscherne H. The treatment of the seriously injured at an emergency ward [in German]. Chirurg. 1966; 37 (6): 249-251.

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Secondary care organization

Significance of early interhospital transportation in complex treatment of patients with acute spine and spinal cord injury

Agadzhanyan V.V., Yakushin O.A., Shatalin A.V., Novokshonov A.V.

Agadzhanyan V.V., Yakushin O.A., Shatalin A.V., Novokshonov A.V.

Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia

Objective – to estimate efficiency of early interhospital transportation in complex treatment of patients with injuries to the spine and the spinal cord.

Materials and methods. During 2008-2014 the teams of instant readiness of the clinical center realized 73 transportations for the patients with spine and spinal cord injury (SSCI) from the medical facilities of Kemerovo region. There were 33 (45.2 %) patients with isolated spine and spinal cord injuries, and 40 (54.8 %) patients with diagnosed polytrauma with SSCI as the main or concurrent injury. Severity of traumatic injuries was estimated with Injury Severity Score (ISS). The mean ISS value was 32.6 ± 0.4. Only 60.3 % of the patients were transported by the instant readiness teams to the Clinical Center of Miners’ Health Protection within the first 24 hours after spine and spinal cord injuries, on the second day – 6 (8.2 %) patients. The remaining 31.5 % of the patients were admitted in later periods (day 3 and later).

Results. There were no lethal outcomes and worsening states during interhospital transport. 14 patients with spine and spinal cord injuries died at the stage of hospital treatment (19.1 % of the total number of transported patients). Postsurgical mortality was 15.3 %. Unsatisfactory outcomes of treatment were observed in 27.1 % of the cases; all patients were operated within 3 or more days. Good and satisfactory results of treatment were in 72.9 % of patients transported from other medical facilities and operated within 2 days after injuries.

Conclusion. The optimal time for transfer of patients with spine and spinal cord injuries to a specialized center is the first 24 hours after trauma. In case of transfer after 3 days the number of unsatisfactory surgical results increases up to 27.1 %. Early interhospital transportation and timely surgical treatment allow achieving good and satisfactory results in 72.9 % and 1.5-fold reducing terms of hospital treatment in comparison with medical economic standards.

Key words: spinal cord injuries; spinal trauma; interhospital transfer.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, director, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Yakushin O.A., candidate of medical science, traumatologist-orthopedist, neurosurgery department #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Shatalin A.V., MD, PhD, deputy director of medical issues, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Novokshonov A.V., MD, PhD, head of neurosurgery center, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Yakushin O.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (38456) 9-53-58

E-mail: Yakushin-GNKC@rambler.ru

References:

1. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2. Grandi D, Sueyn E. Spinal cord injury : translated from English. Moscow : BINOM Publ., 2008. 124 p. Russian

3. Grin AA. Surgical treatment for patients with spine and spinal cord injuries with concomitant trauma. Dr. med. sci. abstracts diss. Moscow, 2008. 48 p. Russian

Grin AA. The problems of organization and treatment for patients with spine and spinal cord injuries (comments for the article by AN. Barinov and EN. Kondakov «Organization of assistance for patients with spine and spinal cord injury in Arkhangelsk region»). Neurosurgery. 2011; (3): 79-81. Russian

5. Zobnin AV, Pronskikh AA, Bogdanov SV, Yakushin OA. A clinical case of treatment for the patient with polytrauma. Polytrauma. 2011; (4): 94-99. Russian

6. Krylov VV, Grin AA. Spinal cord injury. Moscow, 2014. 420 p. Russian

7. Savchenko SA. Reconstructive surgery of spinal cord in case of its traumatic injury (the experimental clinical study). Cand. med. sci. abstracts diss. Moscow, 2005. 22 p. Russian

8. Stepanov GA. New techniques of reconstructive spinal cord microsurgery in severe injury. Moscow : SCIENCE-PRESS Publ., 2011. 120 p. Russian

9. Traumatology and orthopedics : 4-volume manual for physicians. Vol. 4: Injuries and diseases of pelvis, chest, spine and head. Use of DTC in traumatology and orthopedics. The principles of experimental studies in traumatology and orthopedics. Kornilov NV, Gryaznukhin EG, editors. Saint Petersburg : Hippocrates Publ., 2006. 624 p. Russian

10. Usikov VD, Vorontsov KE, Kuftov VS, Ershov NI. Short term results of surgical treatment for spine-spinal cord injuries in the thoracic and lumbar regions. Traumatology and orthopedics of Russia. 2014; (2): 37-44. Russian

11. Shatalin AV, Kravtsov SA, Agadzhanyan VV. The main factors influencing on mortality in patients with polytrauma transported to a specialized trauma center. Polytrauma. 2012; (3): 17-22. Russian

12. Yakushin OA, Novokshonov AV, Fedorov MYu, Vaneev AV. Tactics of surgical treatment for patients with spine and spinal cord injuries with polytrauma. Polytrauma. 2014; (4): 32-39. Russian

13. Yakushin OA, Novokshonov AV, Agadzhanyan VV. Use of microsurgical reconstructive surgery for patients with injuries to spinal cord and its meninges. Polytrauma. 2015; (1): 16-22. Russian

New medical technologies

EFFECTS OF INTERSPINOUS DISTRACTOR ILKODA ON THE BIOMECHANICS OF THE MOTION SEGMENT OF THE LUMBAR SPINE

Davydov E.A., Nazarov A.S.

Davydov E.A., Nazarov A.S.

Polenov Neurosurgical Institute, the branch of North-Western Federal Medical Research Center, Saint Petersburg, Russia

Objective – to estimate the effects of the interspinous distractor ILKODA on the biomechanics of the operated motion segment of the lumbar spine.

Materials and methods. The analysis of surgical treatment of 35 patients with interspinous dynamic stabilization has been conducted. The interspinous distractor ILKODA was implanted in 17 patients for the instability treatment, in 18 patients for instability prevention in the operated motion segment. Biomechanics of motion segment was assessed by means of measuring the height of the anterior and posterior parts of the intervertebral disc, the height of the intervertebral foramen, segmental Cobb angle, and translation in an unstable segment before operation and after 12 months.

Results. The interspinous distractor ILKODA effectively fixes an unstable motion segment, regardless of the type of segmental instability. However, it doesn’t affect degeneration of the intervertebral disc.

Conclusion. The dynamic stabilization with interspinous distractor ILKODA is an effective minimally invasive surgical treatment for the motion segment instability.

Key words: lumbar spine; motion segment; segmental instability; dynamic stabilization; biomechanics.

Information about authors:

Davydov E.A., MD, PhD, professor, senior researcher, Polenov Neurosurgical Institute, the branch of North-Western Federal Medical Research Center, Saint Petersburg, Russia.

Nazarov A.S., postgraduate student, Polenov Neurosurgical Institute, the branch of North-Western Federal Medical Research Center, Saint Petersburg, Russia.

Address for correspondence:

Nazarov A.S., Mayakovskogo St., 12, Saint Petersburg, Russia, 191014.

Tel: +7 (812) 272-81-35.

E-mail: nazarow_alex@mail.ru

References:

1.             Senegas J, Vital JM, Pointillart V, Mangione P. Long-term actuarial survivorship analysis of an interspinous stabilization system. Eur. Spine J. 2007; 16 (8): 1279-1287.

2.             Phillips FM, Voronov LI, Gaitanis IN, Carandang G, Havey RM, Patwardhan AG. Biomechanics of posterior dynamic stabilizing device (DIAM) after facetectomy and discectomy. Spine J. 2006; 6 (6): 714-722.

3.             Markin SP. Posterior dynamic stabilization in surgical treatment of the lumbar spine degenerative changes. Cand. med. sci. diss. Novosibirsk, 2010. 135 p. Russian.

4.             Lindsey DP, Swanson KE, Fuchs P, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine. 2003; 28 (19): 2192-2197.

5.             Fuchs PD, Lindsey DP, Hsu KY, Zucherman JF, Yerby SA. The use of an interspinous implant in conjunction with a graded facetectomy procedure. Spine. 2005; 30 (11): 1266-1272.

6.             Tsai K, Murakami H, Lowery GL, Hutton WC. A biomechanical evaluation of an interspinous device (Coflex) used to stabilize the lumbar spine. Journal of Surgical Orthopaedic Advances. 2006; 15 (3): 167-172.

7.             Lafage V, Gangnet N, Sénégas J, Lavaste F, Skalli W. New interspinous implant evaluation using an in vitro biomechanical study combined with a finite-element analysis. Spine. 2007; 32 (16): 1706-1713.

8.             Richards JC, Majumdar S, Lindsey DP, Beaupré GS, Yerby SA. The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine. 2005; 30 (7): 744-749.

9.             Celik H, Derincek A, Koksal I. Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height? Turk. Neurosurg. 2012; 22 (1): 50-54.

10.         Aleynik AYa. Dynamic interspinous elastic stabilization in the treatment of the disc herniation and spinal stenosis of the lumbar spine. Cand. med. sci. diss. Nizhny Novgorod, 2014. 165 p. Russian.

11.         Swanson KE, Lindsey DP, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspinous implant on intervertebral disc pressures. Spine. 2003; 28 (1): 26-32.

12.         Wilke H, Drumm J, Häussler K, MacK C, Steudel WI, Kettler A. Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure. European Spine Journal. 2008; 17 (8): 1049-1056.

13.         Zheng S, Yao Q, Cheng L, Xu Y, Yuan P, Zhang D, et al. The effects of a new shape-memory alloy interspinous process device on the distribution of intervertebral disc pressures in vitro. Journal of Biomedical Research. 2010; 24 (2): 115–123.

14.         Anasetti F, Galbusera F, Aziz HN, Bellini CM, Addis A, Villa T et al. Spine stability after implantation of an interspinous device: an in vitro and finite element biomechanical study. Journal of Neurosurgery: Spine. 2010; 13 (5): 568-575.

15.         Davydov EA, Nazarov AS, Kollerov MYu. Biomechanical rationale of the interspinous distractor ILKODA usage in clinical practice. Laboratory investigation. Russian Neurosurgical Journal named after Professor A.L. Polenov. 2014; 6 (3): 31-36. Russian

Anesthesiology and critical care medicine

ASSESSMENT OF PERFUSION IN POLYTRAUMA

Kosovskih A. A., Churlyaev Yu.A., Kan S. L., Fomkin O.G., Dantsiger D.G., Kirsanov T.V.

Kosovskih A. A., Churlyaev Yu.A., Kan S. L., Fomkin O.G., Dantsiger D.G., Kirsanov T.V.

Novokuznetsk State Institute of Postgraduate Medicine,

City Clinical Hospital #1,

Novokuznetsk, Russia

Objective - to evaluate the changes of capillary blood flow and central hemodynamics at the background of infusion-transfusion therapy in polytrauma.

Materials and methods. The study was conducted in 19 patients with multiple injuries. The analysis of the dynamics of volume infusion, mean arterial pressure, heart rate, rate of urine output, central venous pressure, and central venous oxygen saturation was carried out. Microcirculation was evaluated with laser Doppler flowmetry with estimation of microcirculation index, standard deviation, and blood oxygen saturation in the tissue. The correlation analysis of all indicators was carried out. Additionally, the victims were divided into 2 groups depending on the moment of blood transfusion. The first group consisted of 9 persons who received transfusion within the first day of hospital stay. The second group consisted of 10 persons with transfusion on the second day.

Results. At the background of intensive care the changes in tissue perfusion were not accompanied by significant fluctuations in heart rate and central venous oxygen saturation. Changes in mean arterial pressure, central venous pressure and diuresis rate were detected only on the third day, while microcirculatory disorders of spastic nature could be identified in the 1st day, and their resolution on the background of the complex intensive care unit was observed on 2^nd day. Transfusion as part of infusion therapy improved the condition of capillary blood flow due to volume replacement and entry of donor red blood cells into the bloodstream.

Conclusion. Isolated analysis of public available values of hemodynamics monitoring does not fully reflect changes in peripheral blood flow. Laser Doppler flowmetry method with tissue oximetry is an essential component for dynamic monitoring of blood circulation since it identifies changes in capillary blood flow during infusion-transfusion therapy in polytrauma.

Key words: polytrauma; microcirculation; perfusion; saturation; hemodynamics; infusion-transfusion therapy.

Information about authors:

Kosovskikh A.A., assistant of chair of anesthesiology and critical care medicine, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Churlyaev Yu.A., head of chair of anesthesiology and critical care medicine, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Kan S.L., docent of chair of anesthesiology and critical care medicine, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Fomkin O.G., assistant of chair of anesthesiology and critical care medicine, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Dantsiger D.G., head of chair of healthcare organization and public development, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Kirsanov T.V., anesthesiologist-intensivist, department of resuscitation and intensive care #2, City Clinical Hospital #1, Novokuznetsk, Russia.

Address for correspondence:

Kosovskikh A.A., Prospect Stroiteley, 5, Novokuznetsk, 654057, Russia

Tel: +7(905) 907-45-16

E-mail: Akosovskih@gmail.com

References:

1.                Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2.                Shteinle AV. Pathologic physiology and modern principles of treatment of severe concomitant injuries (part 1). Siberian Medical Journal. 2009; (3): 119-127. Russian

3.                Zilber AP. Clinical physiology in anesthesiology and critical care medicine. Moscow : Medicine Publ., 1984. 480 p. Russian

4.                Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008; 134 (1): 172-178. doi: 10.1378/chest.07-2331.

5.                 Moroz VV, Bobrinskaya IG, Vasilyev VYu, Spiridonova EA, Tishkov EA, Suryakhin VS. Shock : the manual for students, residents, postgraduates and doctors. Moscow, 2011. 32 p. Russian

6.                 Kuzkov VV, Kirov MYu. Invasive monitoring of hemodynamics in intensive care and anesthesiology : the monography. Arkhangelsk : Northern State Medical University Publ., 2008. 244 p. Russian

7.                Krupatkin AI, Sidorova VV. Laser doppler flowmetry of blood microcirculation. Moscow : Medicine Publ., 2005. 256 p. Russian

8.                Basic course for anesthesiologist : the manual. Nedashkovsky EV, Kuzkov VV, eds. Arkhangelsk : Northern State Medical University Publ., 2010. 238 p. Russian

9.                Kozlov VI, Azizov GA, Gurova OA, Litvin FB. Laser doppler flowmetry for estimating state and disorders in blood microcirculation. Moscow, 2012. 32 p. Russian

10.           Sidorov VV, Gusakov VM. Laser technologies for complex non-invasive diagnostics of microhemodynamics, oxygen transport and state of metabolic processes in biological tissue. Medicine and High Technologies. 2013; (1): 42-46. Russian

11.           Rebrova OYu. Statistic analysis of medical data: use of STATISTICA applied software. Moscow : MediaSfera Publ., 2002. 312 p. Russian

12.           Ryabov GA. Hypoxia of critical states. Moscow : Medicine Publ., 1988. 287 p. Russian

13.           Human physiology. Vol. 2. Schmidt R., Tevs G, 3d edition. Moscow : Mir Publ., 2005. 314 p. Russian

14.            Kosovskikh AA, Churlyaev YuA, Kan SL, Lyzlov AN, Kirsanov TV, Vartanyan AR. Central hemodynamics and microcirculation in critical states. General Critical Care Medicine. 2013; IX (1): 25-29. Russian

15.            Bagnenko SF, Shakh BN, Lapshin VN, Teplov VM, Strakhov IV. Diagnostics of microcirculatory disorders and prevention of reperfusion disorders in patients with concomitant shock-producing injury. Emergent Medical Assistance. 2008; 9 (3): 23-37. Russian

16.           Creteur J, Neves AP, Vincent J-L. Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation. Critical Care. 2009; 13(Suppl. 5): S11 doi:10.1186/cc8009.

THE INDICATORS ASSOCIATED WITH LETHAL OUTCOMES IN PATIENTS WITH TRAUMATIC SHOCK

Stukanov M.M., Yudakova T.N., Maksimishin S.V., Girsh A.O., Stepanov S.S.

Stukanov M.M., Yudakova T.N., Maksimishin S.V., Girsh A.O., Stepanov S.S.

 Omsk First Aid Station,

Omsk City Clinical Hospital named after A.N. Kabanov,

Omsk State Medical Academy,

Omsk, Russia

Objective – to identify and to define information significant clinical laboratory values associated with lethal outcomes in patients with traumatic shock at hospital stage.  

Materials and methods. The study covered 75 patients with traumatic shock of degree 3 who were distributed into 3 groups for estimation of clinical, laboratory and instrumental parameters which were used for informational statistical search of the values associating with unfavorable outcomes.

Results. It was found that decrease in body temperature (up to 35.7°C), pH in venous blood (up to 7.19), ionized calcium in venous blood (up to 0.3 mmol/L), increasing lactate in venous blood (up to 4.1 mmol/L) and activated partial thromboplastin time (up to 59 sec) were associated with development of lethal outcomes in the patients with degree 3 traumatic shock.

Conclusion.  Statistically significant indicators associating with lethal outcomes in patients with traumatic shock are body temperature, venous blood pH, levels of ionized calcium and lactate in venous blood, and APPT.

Key words: traumatic shock; the indicators associating with lethal outcomes.

Information about authors:

Stukanov M.M., candidate of medical science, head physician, Omsk First Aid Station, Omsk, Russia.

Yudakova T.N., candidate of medical science, head of intensive care unit, Omsk City Clinical Hospital named after A.N. Kabanov, Omsk, Russia.

Maksimishin S.V., candidate of medical science, deputy head physician of anesthesiology and resuscitation, City Clinical Hospital of Emergency Medical Aid #1, Omsk, Russia.

Girsh A.O., MD, PhD, professor of chair of anesthesiology and critical care medicine, Omsk State Medical Academy, Omsk, Russia.

Stepanov S.S., MD, PhD, professor of chair of histology with embryology course, Omsk State Medical Academy, Omsk, Russia.

Address for correspondence:

Yudakova T.N., Pereleta St., 7, building 3, 48, Omsk, Russia, 644112

+7 (950) 339-10-02

E-mail: tatyudakova@mail.ru

References:

1.                  Intensive therapy : national guidelines. Gelfand BR, editor. Moscow : Medicine Publ., 2009. 954 ð. Russian

2.                  Advanced trauma life support (ATLS®): the ninth edition. ATLS Subcommittee. American College of Surgeons’ Committee on Trauma International ATLS working group. J. Trauma Acute Care Surg. 2013; 74 (5): 1363-1366.

3.                  Carlino W. Demage control resuscitation from major haemorrhage in polytrauma. Eur. J. Orthop. Surg. Traumatol. 2013; 31: 1012-1019.

4.                  Kortbeek JB, Al Turki SA, Ali J, Antoine JA, Bouillon B, Brasel K, et al. Advanced trauma life support, thå edition, the evidence for change. J. Trauma. 2008; 64: 1638-1650.

5.                  Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. Management of Bleeding Following Major Trauma: An Updated European Guideline. Crit. Care. 2010; 14(2): 1210-1221.

6.                  About the approval of rules of clinical use of donor blood and (or) its components : the order by Russian Ministry of Health from April, 2, 2013, N 183n. 29 p. Russian

7.                  Ustyantseva IM, Khokhlova OI. The features of laboratory diagnostics of critical conditions in patients with polytrauma. Polytrauma. 2013; (3): 81-90. Russian

8.                  Rebrova OYu. Statistical analysis of medical data: application of STATISTICA applied software. Moscow : Medicine Publ., 2006. 305 ð. Russian.

9.                  Stukanov MM., Mamontov VV, Girsh AO, Yudakova TN. Associativity of infusion therapy and severity of state in patients with traumatic shock. Polytrauma. 2011; (4): 41-46. Russian

10.              Brohi K, Cohen MJ, Canter MT. Acute traumatic coagulopathy initiated by hypoperfusion: modulated through the protein c pathway? J. Trauma. 2008; 64: 1211-1217.

11.              Khaykin IV, Rozanov IE, Maylova GE. Some mechanisms of development of multiple organ insufficiency in victims with severe concomitant trauma. Military Medical Journal. 2007; (3): 55-57. Russian

12.              Stukanov MM, Mamontîv VV, Maksimishin SV, Girsh AO, Chugulev IA, Ivanov KA. Influence of the balanced and unbalanced infusion therapy on parameters of system haemodynamics, electrolytic and acid-base balances in patients with traumatic shock. Bulletin of Ural Medical Academic Science. 2011; (2): 26-30. Russian

Clinical aspects of traumatology and orthopedics 

PREDICTOR ESTIMATION OF OUTCOMES OF TREATMENT IN PATIENTS WITH ACETABULAR INJURIES

Milyukov A.Yu.

Milyukov A.Yu.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Acetabular injuries take one of the leading places according to their severity – 10-12 % of all injuries. Such injuries require reconstructive operations, total endoprosthetics and result in high rates of persistent disability. As result, objective estimation of long term results in this category of patients can promote correction of further tactics.

Objective – to investigate the determining factors of probability of development of degenerative changes in the hip joint as result of injuries to the acetabulum and femoral head.

Materials and methods. The study included 269 patients with acetabular injuries. The injury type was estimated with the operational classification which has been developed in Clinical Center of Miners’ Health Protection. The classification is based on the anatomic biomechanical principle of injury estimation. Different types of injuries to femoral head were found in 145 patients. After exclusion of 40 patients who received primary endoprosthetics and the patients with lost two-way communication the subgroup was established: 83 patients with dislocation, fractures and fracture-dislocations of the femoral head. They received long term examination of the results according to degenerative dystrophic changes in the hip joint.

RESULTS. The analysis of formation of the predictors was realized in the patient groups with their specific principles of dominating injuries: dislocation, fracture and fracture-dislocation in femoral head. The predictor estimation of treatment outcomes in the patients with injuries to the acetabulum and femoral head was defined and presented. This estimation is based on the own classification relying on estimation of degree of stability in the hip joint. The dominating factors were found which influenced on development of degenerative changes in the hip joint after injuries to the acetabulum and femoral head.

CONCLUSION. The predictor estimation of treatment outcomes in the patients with acetabular injuries found that probability of coxarthrosis increased after dislocation of femoral head in 3d sector, uncorrected dislocation of the joint within 2 hours after injury, in fractures of femoral head in upper semisphere and in synthesized fractures of femoral head. A fracture-dislocation of femoral head was the most severe injury resulting in maximal probability of coxarthrosis.

Key words: acetabular injury; classification of fractures; outcomes of treatment.

Information about authors:

Milyukov A.Y., MD, head of traumatology department, Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. 

Address for correspondence:                  

Milyukov A.Y., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Scientific Clinical Center of Miners’ Health Protection

Tel.: +7 (384-56) 9-52-76

E-mail: info@gnkc.kuzbass.net

References:

1. Andronesku A. Pediatric Anatomy. Bucharest: Meridiane Publ., 1970. 363 p. Russian
2. Ankin LN, Petrik TM, Ankin NL. The experience of surgical treatment of acetabular fractures. Orthopedics, Traumatology and Prosthetics. 2008; (1): 22-25. Russian
3. Arkhipov-Baltiysky SV. Ligamentum capitis femoris-ligamentum incognita. Kaliningrad, 2004. 112 p. Russian
4. Danilov IM, Chirkova AM, Makrushin VD, Chegurov OK. Aseptic necrosis of femur head as a complication of its traumatic dislocation. Bulletin of Traumatology and Orthopedics named after N.N. Priorov. 2001; (1): 24-28. Russian
5. Bashurov ZK, Medvedeva MI, Yuryev GV. Treatment for patients with acetabular fractures: the guidelines. Leningrad, 1984. 18 p. Russian
6. Lazarev AF. Surgical treatment for pelvic injuries. Dr. med. sci. abstracts diss. Moscow, 1992. 21 p. Russian
7. Milyukov AYu. Surgical tactics and organization of specialized medical assistance for patients with isolated multiple and concomitant pelvic injuries. Dr. med. sci. abstracts diss. Íîâîñèáèðñê, 2013. 45 p. Russian
8. Milyukov AYu. Tactic features of sequential differential medical assistance for patients with pelvic injuries at prehospital stage and during transportation. Genius of Orthopedics. 2012; (4): 24-28. Russian
9. Milyukov AYu. The classification of acetabular injuries. Medicine and Education in Siberia. 2012; (2). URL: http: www.ngmu.ru/cozo/mos/article/text.php. Russian
10. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian
11. Prokhorenko VM. Primary and revision hip joint endoprosthetics. Novosibirsk : Novosibirsk Research Institute of Traumatology and Orthopedics Publ., 2007. 345 p. Russian
12. Muller ME, Allhover M, Schneider R, Willinegger H. The manual for internal osteosynthesis: the technique recommended by AO group (Switzerland) : translated into Russian. 3d edition, supplemented and revised. Moscow, 1996. 750 p. Russian
13. Serebryakov SV, Cheremsin VM, Pozdnyakova OF. Spiral computer tomography for diagnostics of acetabular injuries. In: From future to present : the materials from Nevsky radiologic forum. Saint-Petersburg, 2003. p. 113-115. Russian
14. Skovran YaR, Zorya VI, Krasnov SA. Aseptic necrosis of femur head as a complication of its traumatic dislocation. Bulletin of Traumatology and Orthopedics named after N.N. Priorov. 2001; (1): 24-28. Russian
15. Scales, tests and questionnaires in medical rehabilitation : the manual. Belov AN, Shchepetov ON, eds. Moscow : Antidor Publ., 2002. 440 p. Russian
16. Shchetkin VA, Puzin SN, Yakimov SA. Medicosocial consequences of acetabular fractures and fracture-dislocations. Medicosocial Expertise and Rehabilitation. 1999; (2): 32-35. Russian
17. Kim YT, Ninomiya S, Tachibana Y, Tanabe T, Yano Y. Acetabular labrum entrapment following traumatic posterior dislocation of the hip. J. Orthop. Sci. 2003; 8 (2): 232-235.
18. Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J. Bone Joint Surg. Br. 1992; 74-B: 711-715.
19. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open redaction. Preliminary report. J. Bone Joint Surg. 1964. 46-A (8): 1615-1646.
20. Brenneman FD, Katyal D, Boulanger BR, Tile M, Redelmeier DA. Long-term Outcomes in Open Pelvic Fractures. J. Trauma. 1997; 42 (5): 773-777.
21. Maroudas A, Bauliss M, Venn MF. Further studies on the composition of human femoral håàd cartilage. Ann. Reum. Dis. 1980; 39 (5): 514-523.
22. Moed BR, Yu PH, Gruson KI. Functional outcomes of acetabular fractures. J. Bone Joint Surg. Am. 2003; 85-A: 1879-1883.
23. Pape HC. Damage-control orthopedic surgery in polytrauma: Influence on the clinical course and its pathogenetic background. European instructional lectures. 2009; 9: 67-74.
24. Tile M. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore : Williams & Wilkins, 1995. 480 ð.
25. Yamamoto Y, Ide T, Ono T, Hamada Y. Usefulness of arthroscopic surgery in hip trauma cases. Arthroscopy. 2003; 19 (3): 269-273.
26. Vailas JC, Hurwitz S, Wiesel SW. Posterior acetabular fracture dislocations: fragment size, joint capsule and stability. J. Trauma. 1989; 29: 1494-1496.
27. Davis JW, Moore FA, McIntyre RC Jr, Cocanour CS, Moore EE, West MA. Western Trauma Association Critical Decisions in Trauma: Management of pelvic fracture with homodynamic instability. The Journal of trauma: injury, infection, and critical care. 2008; 65 (5): 1012-1015.

PREVENTION OF CONTRACTURES IN TREATMENT OF INJURIES TO ELBOW JOINT

Kalantyrskaya V.A., Kluchevsky V.V., Perova À.À.

Kalantyrskaya V.A., Kluchevsky V.V., Perova À.À.

Yaroslavl State Medical Academy,

Solovyev Clinical Emergency Hospital, Yaroslavl, Russia     

At the present time ulnar injuries take place in one-third of patients with polytrauma. Such injuries take the first place according to the number of posttraumatic complications and lead to persistent disability in 29.9 % of cases. 30-60 % of patients need for different functional restorative operations.

Objective – to develop protocols for conservative and surgical treatment and rehabilitation program for patients with ulnar joint injuries with aim of preventing contractures and improving functional outcomes.

Materials and methods. Among 99 patients with conservative treatment the long term outcomes were examined in 53 (53.5 %) patients. The outcomes were good and excellent in 49 (92.4 %). Among 296 operated patients the outcomes were examined in 204 (68.9 %). The results were good and excellent in 178 (87.2 %) patients. No patients with ulnar joint injury, who received timely specialized assistance, became disabled.

Results. As result of development of the protocols for conservative and surgical treatment and the program for rehabilitation for patients with ulnar injuries the good and excellent results were observed in 84.4 % of patients after conservative treatment and 86.3 % of patients after surgery. There were no disabled persons.

Key words: fracture; contracture; immobilization; elbow joint.

Information about authors:

Kalantyrskaya V.A., candidate of medical science, head of department of hand, plastic and reconstructive surgery, Solovyev Clinical Emergency Hospital, Yaroslavl, Russia.

Klyuchevsky V.V., MD, PhD, professor, head of chair of traumatology and orthopedics, Yaroslavl State Medical Academy, Yaroslavl, Russia.

Perova V.A., traumatologist-orthopedist, department of hand, plastic and reconstructive surgery, Solovyev Clinical Emergency Hospital, Yaroslavl, Russia.

Piskun M.S., surgeon, resident, chair of traumatology and orthopedics with course of plastic surgery, Solovyev Clinical Emergency Hospital, Yaroslavl, Russia.

Address for correspondence:

Kalantyrskaya V.A., Zagorodny Sad St., 11, Yaroslavl, Russia, 150003

Solovyev Clinical Emergency Hospital

Tel:+7 (4852) 72-68-26; +7 (910) 97-05-09

E-mail: kalan.v@mail.ru

References:

1.      Babovnikov AV. Diagnosis and treatment of fractures of the bones forming the elbow joint. Dr. med. sci. abstract diss. Ìoscow, 2008. 27 p. Russian

2.       Wilk KE, Reinold MM, Andews JR. Reabilitation of the thrower’s elbow. Clin. Sports Med. 2004; (23): 197-204.

3.       Morrey BF, Tanaka S. The posttaumatic stiff elbow. Clin. Orthop. Rel. Res. 2009; (431): 26.

4.      Smith J, Morrey BF, Sotelo JS. Principles of Elbow Rehabilitation. Philadelphia, 2009 by the Mayo Clinic. P. 140-170.

5.      Hotchkiss RN. Fractures and dislocation of the elbow. In: Rockwood and Green’s Fractures in adult. Philadelphia. 2011; (4): 980-981.

6.      Evans PJ, Nandi S, Maschke S, Hoyen HA. Prevention and Treatment of Elbow Stiffness. J. Hand Surg. 2009; (34): 769-778.

7.      Skoroglyadov AV, Litvina EA, Morozov DS. Treatment of intraarticular fractures of the distal humerus. Medical care. 2008; (3): 63-71. Russian

8.      McKee MD, Jupiter JP. Fractures of the Distal Humerus. In: Browner BD. Skeletal Trauma, Basic Scienñe, Management and Reconstruction. 2008; (2): 173.

9.      Morrey B, An KN. Functional evaluation of elbow. In: Morrey B. The elbow and its disorders. W.B. Saunders, 2007. p. 74-83.

10.       Green DP, O`Brien ET. Open reduction of carpal dislocations: indication and operative techniques. J. Hand Surg. 1978; (3): 250-265.

11.       Ilizarov GA. A discovery: general biological property of tissue to response to dosed elongation in view of growth and regeneration. Issues of invention : Bulletin of Research and Patent Information. 1989; (15): 89-112. Russian

Functional, instrumental and laboratory diagnostics

ESTIMATION OF CONSISTENCY OF RESULTS OF DIFFERENT METHODS OF BONE DENSITOMETRY IN DIAGNOSTICS OF OSTEOPOROSIS IN WOMEN

Zakharov I.S.

Zakharov I.S.

Kemerovo State Medical Academy,

Kemerovo, Russia

Objective – to conduct the comprehensive assessment of bone mineral density in women of different ages by means of dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT).

Materials and methods. The study included 261 women. For all women DXA and QCT were performed within 1–2 weeks. The age of the patients was 40 years and older.

Results and discussion. Blend–Altman method showed the consistency of the results of DXA and QCT. The women under the age of 60 had no significant differences in the results of DXA and QCT (p = 0.1). After this age the rate of diagnosed osteoporosis was higher with QCT than with X-ray densitometry. The examination of correlation in the general sample between the results of the presented methods of densitometry showed the positive statistically significant relationship (r = 0.68, p = 0.001). With increasing age, the strength of the relationship decreased.

Key words: bone mineral density; osteoporosis; dual energy X-ray absorptiometry; quantitative computed tomography

Information about the author:

Zakharov I.S., candidate of medical science, docent, department of obstetrics and gynecology #1, Kemerovo State Medical Academy, Russia.

Address for correspondence:

Zakharov I.S., Voroshilova St., 22a, Kemerovo, Russian Federation, 650029

Tel: +7 (3842) 46-51-62.

E-mail: isza@mail.ru

References:

1. Bainbridge KE, Sowers M, Lin X. Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women. Osteop. Int. 2004; 15 (6): 449–446.
2. Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J. Bone Miner. Res. 2004; 19 (4): 532–536.
3. Povoroznyuk VV, Grigoryeva NV. Menopause and musculoskeletal system. Kiev, 2004. 512 p. Russian
4. Smetnik VP. Medicine of menopause. Yaroslavl: Litera Publ., 2006. 848 p. Russian
5. Gavisova AA, Burduli AG, Olkhovskaya MA. Osteoporosis in young women. Osteoporosis and Osteopathy. 2010; (2): 14–16. Russian
6. Zakharov IS, Kolpinskiy GI. Evaluation of bone mineral density in women of different age groups, taking into account regional specificities. Bulletin of Russian Scientific Center of Radiology by Russian Ministry of Health. 2014; (14). URL: http: vestnik.rncrr.ru/vestnik/v14/papers/zakharov_v14.htm (25.12.2014). Russian
7. Zakharov IS. Imaging diagnosis of osteoporosis – current state of problems. Polytrauma. 2015; (1): 69–73. Russian
8. Bansal SC, Khandelwal N, Rai DV. Comparison between the QCT and the DEXA scanners in the evaluation of BMD in the lumbar spine. Journal of Clinical and Diagnostic Research. 2011; 5 (4): 694–699.
9. Pickhardt PJ, Lee LJ, del Rio AM. Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J. Bone Miner. Res. 2011; 26 (9): 2194–2203.
10. Zakharov IS. Features of bone densitometry in postmenopausal women. Medical Radiology and Radiation Safety. 2015; 60 (2): 56–59. Russian
11. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; (1): 307–310.
12. Smolev DM. Features of densitometric diagnosis of osteoporosis in elderly patients. Cand. med. sci. abstracts diss. Moscow, 2005. 21 p. Russian

Researches of young scientists

THE ANALYSIS OF SHORT TERM RESULTS IN PATIENTS AFTER PRIMARY TOTAL HIP JOINT ENDOPROSTHETICS

Milyukov A.Yu.., Ustyantsev D.D., Gilev Ya.Kh., Mazeev D.V.

Milyukov A.Yu.., Ustyantsev D.D., Gilev Ya.Kh., Mazeev D.V.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to estimate short term results of treatment in patients after primary total hip joint endoprosthetics with use of low invasive surgical approaches and appropriate drug therapy.

Materials and methods. The analysis included results of treatment in 1,012 patients after primary total hip joint endoprosthetics (1,093 operations) for 2008-2014. 81 patients received bilateral operations. There were 445 men and 567 women. The mean age was 56.6 at the moment of surgery. For implantation the following hip joint endoprosthetics devices were used: DePuy, Sanatmetal, Stryker, Zimmer, ESI, Biomed, Plus Orthopedics, Aesculap, Wrigth.

Cementless implant fixation was used in 79 %, cement – in 9 %, mixed fixation – in 12 %. The rubbing pairs in the offered systems were metal-metal, ceramics-ceramics, metal-polyethylene.  

Surgical tactics included minimal invasive surgical approach according to Watson-Jones (MIS AL). The size of skin incision was not higher than 9-10 cm. Before surgical wound suturing we used layer-by-layer infiltrative introduction of drugs with mixed-type effects consisting in local and systemic analgesia, neuromodulation and immune stimulation. 

Clinical estimation of treatment results was realized with Harris Evaluation System of the Hip.

Results. The postsurgical analysis of clinical functional results of primary endoprosthetics in the patients with hip joint pathology showed that excellent and good results could be observed in 8.5 % and 68.4 % correspondingly, satisfactory results – in 18.9 %, unsatisfactory ones – in 4.2 %. As for treatment of idiopathic coxarthrosis, excellent, good and satisfactory results were in 97.2 %; for dysplastic coxarthrosis – in 94.2 %; for aseptic necrosis in femoral head – in 91.9 %; for posttraumatic coxarthrosis – in 98.2 %; for rheumatoid arthritis – in 94.4 %.

Conclusion. Positive effects in terms of degenerative and posttraumatic diseases of the hip are possible with appropriate tactics of primary total hip joint endoprosthetics consisting in minimal invasive surgical approach, optimal way of endoprosthesis fixation, intrasurgical infiltration of surgical wound with mixed action drugs and activation of patients within the first 24 hours after surgery.

Key words: endoprosthetics; degenerative and posttraumatic disease of the hip joint.

Information about authors:

Milyukov A.Yu., MD, PhD, head of department of traumatology and orthopedics #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Ustyantsev D.D., surgeon, department of traumatology and orthopedics #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Gilev Ya.Kh., traumatologist-orthopedist, department of traumatology and orthopedics #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Mazeev D.V., traumatologist-orthopedist, department of traumatology and orthopedics #2, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Milyukov A.Yu., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: +7 (384-56) 9-52-76

E-mail: info@gnkc.kuzbass.net

References:

1. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2. Barnett E, Nordin BE. The radiological diagnosis of osteoporosis: a new approach. Clin. Radiol. 1960; 11: 166-174.

3. Burchard R, Leppek R, Schmitt J, Lengsfeld M. Volumetric measurement of periprosthetic bone remodeling; prospective 5 years follow-up after cemented total hip arthroplasty. Arch. Orthop. Trauma Surg. 2007; 127: 361-368.

4. D'Aubingne M, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J. Bone Joint Surg. 1954; 36-A: 451-475.

5. Delank KS, Drees P, Menzel N, Hansen T, Duschner H, Eckardt A. Increased polyethylene wear after cementless ABG I total hip arthroplasty. Arch. Orthop. Trauma Surg. 2006; 126: 509-516.

6. Dorr LD, Luckett M, Conaty JP. Total hip arthroplasties in patients younger than 45 years. A nine-to ten-year follow-up study. Clin. Ortop. Relat. Res. 1990. (260): 215-219.

7. Dreinhofer KE, Schwarzkopf SR, Haas NP, Tscherne H. Isolated traumatic dislocation of the hip. Long- term results in 50 patients. The British editorial society of bone and joint surgery. 1994; 76-B (1): 6-12.

8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment of mold arthroplasty. J. Bone Joint Surg. 1969; 51-A: 737-755.

9. Ito H, Kaneda K., Matsuno T. Osteonecrosis of the femoral head: simple varus intertrochanteric osteotomy. The journal of bone and joint surgery. 1999; 81-B (6): 969-968.

10. Jimenes ML. Total hip arthroplasty after acetabulum fracture In: 69-th Annual Meeting Proceedings : Dallas, 13-17 February 2002. Dallas, 2002. p. 541.

11. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J. Bone Joint Surg. Am. 2007; 89 (4): 780-785.

12. Kuzin VV, Donchenko SV, Kholodaev MYu. The process of osteointegration in cementless hip joint endoprosthetics. In: Endoprosthetics in Russia : All-Russian Monothematic Collection of Scientific Articles. Kazan ; St. Petersburg, 2005. p. 40-41 Russian

13. Lozano-Calderón SA, Shen J, Doumato DF, Greene DA, Zelicof StB. Cruciate-retaining vs posterior-substituting inserts in total knee arthroplasty : functional outcome comparison. The Journal of Arthroplasty. 2013; 28 (2): 234–242.

14. Milyukov AYu. Surgical tactics and organization of specialized medical aid for patients with isolated multiple and concomitant pelvic injuries. Dr. med. sci. abstracts diss. Novosibirsk, 2013. 45 p. Russian

15. Nazarian S, Tisserand Ph, Brunet Ch, Muller ME. Anatomic substantiation of transgluteal approach to the hip joint. Margo Anterior. 2005; (2): 1-7. Russian

16. Perekhodov SN, Volodin YuS, Ismailov KhG, Zhiburt EB. The algorithm for patient preparation for hip joint endoprosthetics. In: Endoprosthetics in Russia : All-Russian Monothematic Collection of Scientific Articles. Kazan ; St. Petersburg, 2008. p. 30-35. Russian

17. Prokhorenko VM. Primary and revision hip joint endoprosthetics. Novosibirsk : Novosibirsk Scientific Research Institute of Traumatology and Orthopedics Publ., 2007. 345 p. Russian

18. The manual for hip joint endoprosthetics. Tikhilov RM, Shapovalov VM, editors. Saint Petersburg, 2008. 324 ñ. Russian

Case history

Possibilities of compensatory retrograde venous perfusion of an extremity in replantation

Afanasyev L.M., Ezhov A.A., Guselnikov S.S.

Afanasyev L.M., Ezhov A.A., Guselnikov S.S.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to demonstrate the clinical case with the patient with traumatic rupture of the upper extremity at the level of the middle one-third of the brachium, with tissue perfusion at the brachium level realized with retrograde venous perfusion after replantation.

Materials and methods. The patient I., age of 19, underwent medical treatment in the department of microsurgery, traumatology and orthopedics #3 with the clinical diagnosis: “Full traction rupture of the left upper extremity at the level of middle-proximal one-third of the brachium. Posthemorrhagic anemia of middle severity. Traumatic shock of degree II”.

The relative contraindications to replantation at admission were traction mechanism of the injury (the left upper extremity was drawn into the wheel of the mechanic industrial machine); the defect along 28 cm of the humeral artery and traction rupture of the nerve stems in the brachial plexus from the level of the subclavian artery; long term exposure (1 hour and 50 minutes) of the  arterial hemostatic tourniquet in the region of the axillary cavity, and the time of replant ischemia (4.5 hours). Replantation of the left upper extremity was performed despite of above-mentioned contraindications.

Results. The surgery was performed during 7.5 hours: replantation of the left brachium. The initiation of perfusion was made after 10 hours of ischemia. The patient was discharged for follow-up on 79^th day. There were no signs of perfusion disorders in the replanted extremity. Prehensile function of the hand and the fingers restored two years after replantation.

Conclusion. During replantation of the upper extremity (at the brachium level) with the autovenous graft for humeral arterial plastics the perfusion in skin, muscles and other soft tissues at the humerus level was realized with retrograde way through the restored veins and venous arterial shunts in the muscles and the soft tissues of the brachium.

Key words: limb replantation; microsurgery; humeral artery plastics with autovenous graft; primary external fixation.

Information about authors:

Afanasyev L.M., MD, PhD, head of department of traumatology and orthopedics #3, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Ezhov A.A., surgeon, department of traumatology and orthopedics #3, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Guselnikov S.S., traumatologist-orthopedist, department of traumatology and orthopedics #3, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Afanasyev L.M., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 2-40-31

E-mail: info@gnkc.kuzbass.net

References:

1. Datiashvili RO. Limb replantation. Moscow : Medicine Publ., 1991. 240 p. Russian
2. Belousov AE, Gubochkin NG. About complex estimation of results of emergency microsurgical operations in limb injuries. Bulletin of Surgery named after I.I. Grekov. 1984; 132 (3): 110-113. Russain

Experimental investigations

INFLUENCE OF PRESCRIPTION OF DEXAMETHASONE AND ADRENALINE ON CHANGES OF MORPHOMETRIC INDICES IN INTERNAL ORGANS AFTER EXPERIMENTAL MULTIPLE ORTHOPEDIC TRAUMA

Bocharov S.N., Vinogradov V.G., Lebed M.L., GumanenkoV.V., Golubev S.S., Lepekhova S.A.

Bocharov S.N., Vinogradov V.G., Lebed M.L., GumanenkoV.V., Golubev S.S., Lepekhova S.A.

Scientific Center of Reconstructive and Restorative Surgery,

Irkutsk State Medical University,

Irkutsk Regional Clinical Consultory Diagnostic Center,

Irkutsk, Russia

Objective – to study the influence of dexamethasone and adrenaline on the morphometric indices in the heart, lungs, the liver and kidneys in rabbits after multiple orthopedic trauma.

Materials and methods. Researches were conducted on 45 Chinchilla rabbits. The control group consisted of 10 intact rabbits. Model of orthopedic trauma in two extremities with fixation of fragments with external fixation devices was reconstructed in 35 animals. Standard postoperative treatment in main group #1 (n = 22) included anesthetization, antibiotic prophylaxis and intravenous therapy. Treatment in the main group #2 (n = 13) included adrenaline and dexamethasone apart from standard treatment. Morphometric research of the specimens of the heart, lungs, the liver and kidneys was conducted with use of software microscopic video system Quantimet 550IW with the in-built package of statistic morphometric programs Q-win for digital analysis of pathomorphological and cytological material.

Results. Degenerative-dystrophic changes in the liver, kidneys and the heart were less apparent in the main group # in comparison with the main group #1. At the same time the rabbits in the main group #2 had significant increase in thickness of interalveolar septum (+51.7 % to the control value in comparison with +24.6 % in the main group #1) that implies interstitial pulmonary edema.

Conclusion. The results of morphometric research of lungs show that additional prescription of adrenaline and dexamethasone for the laboratory animals after multiple orthopedic trauma intensified interstitial pulmonary edema, while less expressiveness of dystrophic changes in the liver, kidneys and the heart in these rabbits could be caused by the decrease of lifespan after trauma.

Key words: rabbit; multiple orthopedic trauma; internal organs; morphometry; adrenaline; dexamethasone.

Information about authors:

Bocharov S.N., MD, PhD, professor, leading researcher, Scientific Center of Reconstructive and Restorative Surgery, Irkutsk State Medical University, Irkutsk, Russia.

Vinogradov V.G., MD, PhD, professor, head of department of traumatology, orthopedics and military surgery, Irkutsk State Medical University, Irkutsk, Russia.

Lebed M.L., candidate of medical science, intensivist, Scientific Center of Reconstructive and Restorative Surgery, Irkutsk, Russia.

Gumanenko V.V., traumatologist-orthopedist, City Clinical Hospital # 3, Irkutsk State Medical University, Irkutsk, Russia.

Golubev S.S., candidate of medical science, head of department of pathomorphology and cytology, Irkutsk Regional Clinical Consultory Diagnostic Center, Irkutsk, Russia.

Lepekhova S.A., PhD, head of scientific department of experimental surgery with vivarium, Scientific Center of Reconstructive and Restorative Surgery, Irkutsk, Russia.

Address for correspondence:

Bocharov S.N., Bortsov Revolyutsii St., 1, Irkutsk, Russia, 664003

Tel.: +7 (3952) 29-03-68         

Å-mail: bocharov@irk.ru

References:

1.             Traumatic disease and its complications. Seleznev SA, Bagnenko SF, Shapot YuB, Kurygin AA, editors. Saint-Petersburg : Polytechnique Publ., 2004. 414 p. Russian

2.             Bocharov SN, Vinogradov VG, Lebed ML, Kirpichenko MG, Gumanenko VV, Golubev SS, et al. Changes in morphometric indices of internals after multiple orthopedic trauma in experiment. Polytrauma. 2011; (4): 89–93. Russian

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Reviews

THE FEATURES OF MORPHOLOGICAL STRUCTURE AND PROCESSES OF BONE REMODELING IN THE FEMORAL HEAD WITH DEFORMING ARTHROSIS OF VARIOUS ORIGINS

Davydov D.A.

Davydov D.A.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Osteoarthrosis is the most common pathology of the joints significantly impairing the quality of life of patients and is one of the main causes of temporal and permanent loss of labour capacity, with disability in 11% to 38% of cases. These factors demonstrate steady tendency to growth. According to the modern concepts, OA is considered as a heterogeneous group of diseases of different etiology, but with similar clinical, pathogenetic and histopathological manifestations.

The aim of this review is presentation of the main histopathological characteristics of cartilage and bone tissues in the femoral head in coxarthrosis.

The review provides the assessment system for histopathological changes in the articular hyaline cartilage proposed by Osteoarthritis Research Society International (OARSI). The classification includes 6 stages. 

There are some described common histopathological signs of deforming arthrosis of the hip joint which characterize severity of dystrophic and necrotic changes in the articular cartilage. Also there are histopathological characteristics of the cartilage and bone tissue in the femoral head depending on the origin of coxarthrosis.

The special attention is paid to various immunohistochemical methods for investigating bone remodeling in the femoral head with deforming arthrosis which show significant prevalence of resorption processes over the processes of synthesis.

Conclusion. Despite the fact that the main histopathological characteristics of the structure of the femoral head in osteoarthritis are determined, the immunohistochemical features of remodeling processes are not described to the full degree. Until the present time there is no clear pathomorphological picture of deforming arthrosis of the hip joint with consideration of immunohistochemical status. It is especially important to conduct comprehensive research work for the processes of remodeling with use of immunohistochemistry (including estimation of neovascularity capacity, apoptosis of cellular elements of bone tissue and bone marrow, determining the activity of osteoblasts and osteoclasts in the bone tissue in the femoral head). The obtained histopathological information will give more detailed and complete picture of the pathogenesis and identify the prevailing factors of this pathological process.

Key words: osteoblast; osteoclast; remodeling; classification of osteoarthrosis; tissue histopathology; immunohistochemistry.

Information about authors:

Davydov D.A., physician of anatomic pathology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Davydov T.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, 652509, Russia

Tel: 8 (384-56) 9-55-80

E-mail: irmaust@gnkc.kuzbass.net

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