Abstracts journal "Polytrauma" 1/2016

Secondary care organization

Optimization of arrangement of medical aid in road traffic accidents with participation of legal support from service of average commissioners

Minasov B.Sh., Afanasyeva N.V., Gaponov V.N.

Minasov B.Sh., Afanasyeva N.V., Gaponov V.N.

Bashkir State Medical University,

Ufa, Bashkortostan

Currently, arrangement of medical aid for victims of road traffic accidents has grown out from the limits of strictly departmental approach. Optimization of efficiency of such activity without legal support from services of average commissioners is not possible at the present time.

Objective – to improve the quality of arrangement of assistance for victims of road traffic accidents.

Results. Use of the measures of legal support from average commissioners resulted in appearance of some possibilities for accompanying the patient not only during period of hospital treatment, but also within the whole period of treatment and rehabilitation (from the moment of admission to the hospital from the accident site till full recovery including outpatient aftercare and health resort treatment).

Conclusion. Legal support from services of average commissioners is one of the efficient tools of complex approach to arrangement of medical aid at the modern level of social development. A patient with associated injuries requires significant material and financial costs, which significantly increase the volume of compulsory medical insurance. An average commissioner is a universal specialist in the fields of road traffic safety and basic insurance business who assists with preparation of necessary documents for insurance payment.

Legal support significantly improves outcomes, expertise and monitoring of such social phenomenon. It can be efficiently used both in daily clinical practice and in making administrative solutions.

Key words: victims of road traffic accidents; associated injury; services of average commissioners in health issues; civil responsibility insurance.

Information about authors:

Minasov B.Sh., head of chair of traumatology and orthopedics, Bashkir State Medical University, Ufa, Russia.

Gaponov V.N., average commissioner, Ufa, Russia.

Afanasyeva N.V., assistant of chair of traumatology and orthopedics, Bashkir State Medical University, Ufa, Russia.

Address for correspondence:

Afanasyeva N.V., Petropalovskaya St., 51-8, Ufa, Bashkortostan, 45006

Tel: +7 (917) 405-95-50

E-mail: natalymed@rambler.ru

References:

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2. Arrangement and realization of emergency medical aid for road accident victims. Bagnenko SF, Stozharov VV, Miroshnichenko AG, eds. Saint Petersburg, 2011. 400 p. Russian

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5. Mironov SP, Eskin NA, Ochkurenko AA, Andreeva TM, Popova MM. The current state of traumatologic and orthopedic assistance for the population of Russia. In: The materials of Õth Anniversary convention of traumatologist-orthopedists / Central Institute of Traumatology and Orthopedics. Moscow, 2014. p. 3. Russian

6.Litvin YuA, Sushko AA. Prevented damage in road traffic accidents as the indicator of efficient realization of the Concept of safety of road traffic in Republic of Belarus. Problems of Management. 2011; (2): 80-87. Russian

Russian

8. Ivanov PA, Zadneprovskiy NA, Bondarev NA. The offers for improvement of arrangement of assistance for polytrauma. In: Modernization of assistance for patients with severe associated injury : TRAUMA 2013 [Electronic resource] : the anniversary scientific educational conference dedicated to 80th anniversary of chair of traumatology, orthopedics and military field surgery named after N.I. Pirogov, 10th anniversary of chair of traumatology and orthopedics of Institute for Continuing Education of Federal Medical and Biological Agency, Moscow, November, 7-8, 2013. M., 2013. 1 electronic optical disk. Russian

9. Minasov BSh, Sirodzhov KKh, Sabirov RM, Karimov KK, Yakupov RR. Orthopedic DAMAGE-CONTROL for pelvic injuries in patients with polytrauma. In: Traumatology and Orthopedics. 2014. (3-4): The materials of 2nd convention of traumatologist-orthopedists of Kazakhstan, October, 2-3, 2014, Astana. p. 354.) Russian

10. Traumatic Brain Injury (TBI) and long bone fractures in Polytrauma Patients. Alois Karlbauer Salzburg, Austria, the report of the speech în AO Trauma symposium. St. Petersburg, Russia Feb. 2015

ARRANGEMENT OF MEDICAL AID FOR VICTIMS OF ROAD TRAFFIC ACCIDENTS AT PREHOSPITAL STAGE OF MEDICAL EVACUATION

Baranov A.V., Klyuchevsky V.V., Barachevsky Yu.E.

Baranov A.V., Klyuchevsky V.V., Barachevsky Yu.E.

Northern State Medical University,

Arkhangelsk, Russia

Yaroslavl State Medical University,

Yaroslavl, Russia

Severodvinsk City Hospital of Emergency Aid #2,

Severodvinsk, Russia

Objective – to analyze the literature data concerning medical care organization for road traffic injuries at prehospital stage. The results of Russian and foreign researches are presented in the article.

CONCLUSION. The ways of medical aid optimization at prehospital stage by means of repeating control of knowledge of the basics of emergency aid for drivers are suggested. We revealed the necessity of protocol functioning of the disaster medicine territorial centers in the system of the uniform dispatching service for reduction of the response time of emergency services and improvement of medical aid quality at prehospital stage. The most common defects of medical aid at prehospital stage of evacuation, as well as risk factors for adverse outcomes in road traffic injuries are shown.

Key words: road traffic accidents; road traffic injuries; prehospital medical evacuation; medical aid; associated injury.

Information about authors:

Baranov A.V., candidate of medical science, traumatologist-orthopedist, research associate of central scientific laboratory, Northern State Medical University, Arkhangelsk, Russia.

Klyuchevsky V.V., MD, PhD, professor, head of traumatology, orthopedics and military surgery department, Yaroslavl State Medical University, Yaroslavl, Russia.

Barachevsky Yu.E., MD, PhD, docent, head of chair of mobilization training of health care and disaster medicine, Northern State Medical University, Arkhangelsk, Russia.

Address for correspondence:

Baranov A.V., Gagarina St., 14-73, Arkhangelsk, Russia, 163000

E-mail: Baranov.shyrik@mail.ru

Tel: +7 (960) 000-52-27

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37. Popov AA, Novikov OM, Khovalyg DA, Popova EA. Comparative analysis of road traffic accidents in the Republic of Tuva in 2006-2008. Emergency Medical Aid. 2009; (3): 50-52. Russian

38. Popov AA, Chikun VI, Popova EA, Rostovtsev SI, Vyatskin IE, Lyubchenko AA, et al. The delivery of emergency medical care in road traffic injuries in the Krasnoyarsk region. Medicine and Education in Siberia. 2012; (2): 51. Russian.

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New medical technologies

SURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS WITH INTERSPINOUS IMPLANTABLE DEVICES

Bersnev V.P., Dragun V.M., Mikailov S.Yu., Kudziev A.V.

Bersnev V.P., Dragun V.M., Mikailov S.Yu., Kudziev A.V.

Leningrad Regional Clinical Hospital,

North-Western State Medical University named after I.I. Mechnikov,

Russian Scientific Neurosurgery Institute named after Professor A.L. Polenov, the branch of North-western Federal medical Research Center,

Saint Petersburg, Russia

Despite the fact that the modern literature describes the various methods of surgical treatment of lumbar degenerative stenosis, there is a topical question about effective stabilization of spinal motion segment after surgery, microsurgical discectomy, as well as about the algorithm of implantation of various types of low invasive implants.

Objective – on the basis of the results of objective tests and clinical symptoms to select the optimal tactics of surgical treatment of degenerative-dystrophic diseases causing lumbar stenosis.

Materials and methods. The patients were divided into two groups. The first group of 56 patients underwent surgical treatment with implantation of an interspinous device after decompressive hemilaminectomy. The second group of 58 patients received only microdiscectomy. The patients underwent clinical amnesic, neurologic and radiographic examinations. Dynamics was assessed with intensity of pain according to 10-point visual analogue scale (VAS) and the severity of violations of the functional activity of patients according to Oswestry disability index (ODI).

Results. Both studied groups showed a significant clinical improvement in VAS and ODI within two years of observation. The analysis of the radiologic data of the patients with lumbar stenosis showed better results in the group of dynamic interspinous implants in comparison with the group without it.

Conclusion. Application of interspinous dynamic devices for lumbar spinal stenosis gives several advantages: low invasiveness, simplicity of implementation, absence of injuries to surrounding tissues. Our results are encouraging for further search for ways to improve existing methods of surgical treatment, but there is a need to continue work for more strict selection of patients for each type of implant devices.

Key words: lumbar spinal stenosis; dynamic stabilization; microdiscectomy; surgical treatment.

Information about authors:

Bersnev V.P., MD, PhD, professor, chair of neurosurgery, North-Western State Medical University named after I.I. Mechnikov, head of department of trauma surgery, Russian Scientific Neurosurgery Institute named after Professor A.L. Polenov, Saint Petersburg, Russia.

Dragun V.M., candidate of medical science, docent of chair of neurosurgery, North-Western State Medical University named after I.I. Mechnikov, deputy chief physician of surgery, Leningrad Regional Clinical Hospital, Saint Petersburg, Russia.

Mikailov S.Yu., postgraduate, chair of neurosurgery, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.

Kudziev A.V., neurosurgeon, Leningrad Regional Clinical Hospital, Saint Petersburg, Russia.

Address for correspondence:

Mikailov S.Yu., Prospect Prosveshcheniya, 14, Saint Petersburg, Russia, 195247

Tel: +7 (981) 125-15-55

E-mail: samur86@mail.ru

References:

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2. 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: 50-54.

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5. Lee N, Shin DA, Kim K, Yoon DH, Ha Y, Shin HC, et al. Paradoxical radiographic changes of Coflex interspinous device with minimum two-year follow-up in lumbar spinal stenosis. World Neurosurg. 2015; Sep 7. pii: S1878-8750(15)01085-2.

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7. Park YS, Kim YB, Lee DG, Kim KT, Nam TK. Dynamic stabilization with an interspinous process device (the Wallis system) for degenerative disc disease and lumbar spinal stenosis. Korean J. Spine. 2008; 5: 258-263.

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

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10. Park S, Yoon SH, Hong Y-P, Kim K, Chung S-K, Kim H-J. Minimum 2-Year Follow-Up Result of Degenerative Spinal Stenosis Treated with Interspinous U (Coflex™). J. Korean Neurosurg. Soc.2009; 46(4): 292-299.

11. Verhoof OJ, Bron JL, Wapstra FH, van Royen BJ. High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur. Spine J. 2008; 17(2): 188-192.

12. Wiseman CM, Lindsey DP, Fredrick AD, Yerby SA. The effect of an interspinous process implant on facet loading during extension. Spine (Phila Pa 1976). 2005; 30(8): 903-907.

13. Yoon SM, Lee SG, Park CW, Yoo CJ, Kim DY, Kim WK. Late complications of the single level ‘interspinous U’ in lumbar spinal stenosis with mild segmental instability. Korean J. Spine. 2008; 5: 89-94.

14. Xu C, Mao F, Wang X, Lin Y, Xu H. Application of the Coflex Interlaminar Stabilization in Patients With L5/S1 Degenerative Diseases: Minimum 4-Year Follow-up. Am. J. Ther. 2015; Aug 18. [Epub ahead of print]

Anesthesiology and critical care medicine

DYNAMICS OF OSMOLARITY AND ELECTROLYTIC STRUCTURE OF BLOOD PLASMA IN PATIENTS WITH TRAUMATIC SHOCK DURING DELIVERY OF VARIOUS OPTIONS OF INFUSION THERAPY

Girsh A.O., Stukanov M.M., Chernenko S.V., Korzhuk M.S., Stepanov S.S., Malyuk A.I.

Girsh A.O., Stukanov M.M., Chernenko S.V., Korzhuk M.S., Stepanov S.S., Malyuk A.I.

Emergency Aid Station,

Kabanov City Clinical Hospital #1,

Omsk State Medical University,

Omsk, Russia

Objective – to research the dynamics of values of osmolarity and electrolytic composition of blood plasma in patients with traumatic shock of degree 3 in use of various options of volemic replacement.

Materials and methods. The study included 50 patients with traumatic shock of degree 3. They were distributed into two groups in dependence on a type of infusion therapy: the patients of the first group received 0.9 % sodium chloride + modified starch, and the patients of the second group – isotonic sterofundin + 4 % modified starch. The examinations were conducted upon admission to ICU, in 12 hours and, henceforth, during 3 days.

Results. It was found that that the type of infusion therapy with 0.9 % sodium chloride + modified starch caused increase in osmolarity and natrium and chloride ions, and decrease in level of potassium and ionized calcium ions in the blood plasma in the patients with traumatic shock of degree 3.

Conclusion. It is appropriate to use isotonic sterofundin in combination with 4 % modified starch in infusion therapy for patients with traumatic shock of degree 3.

Key words: traumatic shock; osmolarity.

Information about authors:

Girsh A.O., MD, PhD, docent of chair of general surgery, Omsk State Medical Academy, Omsk, Russia.

Stukanov M.M., candidate of medical science, chief physician, Emergency Aid Station, Omsk, Russia.

Chernenko S.V., candidate of medical science, docent of chair of general surgery, Omsk State Medical University, Omsk, Russia.

Korzhuk M.S., MD, PhD, professor, head of chair of general surgery, Omsk State Medical University, Omsk, Russia.

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

Malyuk A.I., candidate of medical science, deputy chief physician of surgery, Kabanov City Clinical Hospital #1, Omsk, Russia.

Address for correspondence:

Girsh A.O., Severnaya St., 204, building 1, 143, Omsk, Russia, 644052

Tel: +7 (3812) 666-995; +7 (923) 681-40-60

E-mail: agirsh@mail.ru

References:

1. 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.

2. Girsh AO, Stukanov MM, Yudakova TN, Mamontov VV, Maksimishin SV. The modern methodology of infusion therapy for patients with shock. Modern Technologies in Medicine. 2012; (3): 73–77. Russian

3. About confirmation of the rules for clinical usage of donor blood and (or) its components : the order by Russian Health Ministry, April, 2, 2013, N 183n. 29 p. Russian

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

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

6. Stukanov MM, Mamontov VV, Maksimishin SV, Girsh AO. Associativity between infusion therapy and weight of condition of patients with traumatic shock. Polytrauma. 2011; (4): 41–46. Russian

7. Girsh AO, Stukanov MM, Ìamontov VV, Yudakova TN, Chugulev IA, Maksimishin SV, et al. Clinical prospects of use of the balanced crystalloid solutions in the program of infusional therapy at a pre–hospital stage. Òhe Emergency Medical Service. 2010; (4): 45–50. Russian

8. Gerasimov LV, Moroz VV. Water electrolytic and acid–base balance in critically ill patients. General Critical Care Medicine. 2008; (4): 79–84. Russian

9. Cotton BA. The cellular, metabolic and systemic consequences of aggressive fluid resuscitation strategies. Shock. 2006; 26(2): 115–121.

10. Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br. J. Anaesth. 2008; 101(2): 141–150.

11. Mehta D, Malik AB. Signaling mechanisms regulating endothelial permeability. Physiological Reviews. 2006; 86: 279–367.

12. Stukanov MM, Yudakova TN, Maksimishin SV, Girsh AO. Interrelation of indexes of cardiovascular system and endothelial dysfunction in patients with traumatic shock. Polytrauma. 2015; (3): 24-30. Russian.

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Clinical aspects of surgery

ANALYSIS OF THE RESULTS OF TREATMENT OF PERFORATED DUODENAL ULCERS

Podoluzhny V.I., Ivanov S.V., Radionov I.A.

Podoluzhny V.I., Ivanov S.V., Radionov I.A.

Kemerovo State Medical Academy,

Kemerovo, Russia

The article is devoted to the long-term results of treatment of patients with perforated duodenal ulcers.

Subject of study: patients with perforated duodenal ulcers and healthy volunteers.

Objective – to conduct the analysis of the annual number of operations for perforated duodenal ulcer, the role of acid peptic aggression in ulcerogenesis, the results of acid-reducing interventions and percentage of contamination with helicobacteriosis.

Materials and methods. The number of operations for perforated duodenal ulcer was analyzed for the period from 1971 to 2015, as well as the percentage of stomach contamination with Helicobacter pylori in 67 operated patients, and the long-term results of surgical treatment of perforated duodenal ulcer after suturing in combination with selective proximal vagotomy in 85 patients (the continuous observation method was used).

Results. The number of operations for perforated duodenal ulcer significantly increased during the years of economic instability and social insecurity, apparently, as a consequence of the implementation of psychosocial and social somatic ulcerogenesis mechanisms. The acid-peptic aggression plays an important role in the mechanisms of the disease. Selective proximal vagotomy and ulcer closure without further treatment are accompanied by disease recurrence in 7.3 % of the cases.

Conclusion. Helicobacter infection is present in only 65.7 % of patients with perforated duodenal ulcer. Postsurgical eradication therapy does not reduce the frequency of recurrence.

Key words: perforated duodenal ulcer; vagotomy; eradication.

Information about authors:

Podoluzhny V.I., MD, PhD, professor, head of chair of hospital surgery, Kemerovo State Medical Academy, Kemerovo, Russia.

Ivanov S.V., candidate of medical science, docent of chair of hospital surgery, Kemerovo State Medical Academy, Kemerovo, Russia.

Radionov I.A., MD, PhD, professor, chair of hospital surgery, Kemerovo State Medical Academy, Kemerovo, Russia.

Address for correspondence:

Radionov I.A., Lenina St., 76A-45, Kemerovo, Russia, 650066

Tel: +7-961-711-86-25

E-mail: radionov3@mail.ru

References:

1. Afendulov SA, Zhuravlev GYu. Surgical treatment of patients with peptic ulcer. Moscow : GEOTAR-Media Publ., 2008. 336 ð. Russian

2. Baranov AI. Experience in the use of minimally invasive operations for perforated ulcer. Endoscopic surgery. 2009; (1): 77-78. Russian

3. Ivanov SV. Selective proximal vagotomy in the treatment of perforated pyloroduodenal ulcers. Cand. med. sci. abstracts diss. Barnaul, 1979. 14 p. Russian

4. Ivanov SV, Podoluzhny VI. Long-term results of vagotomy in the perforated pyloroduodenal ulcer. In: Abstracts VIII All-Russia Congress of Surgeons. Krasnodar, 1995. p. 101-102. Russian

5. Bolotov KS. Laparoscopic vagotomy in the treatment of patients with recurrent peptic ulcer. Cand. med. sci. abstracts diss. Kemerovo, 2015. 24 ð. Russian

6. Grekov DN. Selective proximal vagotomy by means of chemical denervation in the treatment of patients with perforated pyloroduodenal ulcers. Cand. med. sci. abstracts diss. Kemerovo, 2006. 24 ð. Russian

7. Podoluzhny VI, Grekov DN, Krasnov OA, et al. Chemical neurolysis of the stomach for perforated duodenal ulcer. In: Issues of abdominal surgery. Barnaul, 2001. p. 76-78. Russian

8. Podoluzhny VI, Krasnov OA, Grekov DN. The possibilities and perspectives of chemical neurolysis for duodenal ulcer. Medicine in Kuzbass. 2004; (3): 38-40. Russian

9. Lebedeva NB, Barbarash OL, Lebedev OV, Berns SA, Karetnikova VN. The features of the relationship of arrhythmogenicity markers and psychosomatic status in patients with myocardial infarction. Circulatory Pathology and Cardiac Surgery. 2004; (3): 57-59. Russian

10. Barbarash OL, Lebedeva NB, Karetnikova VN, Berns SA, Kashtalap VV, Barbarash LS. Pro-inflammatory cytokines and depression in myocardial infarction. Cardiovascular Therapy and Prevention. 2011; (2): 53-59. Russian

11. Zherlov GK. The choice of radical surgery in patients with sutured perforated gastroduodenal ulcers. Surgery. 2005; (3): 18-22. Russian

12. Kurbanov FS. Minimal surgery for treatment of perforated duodenal ulcer. Surgery. 2011; (3): 44-49. Russian

13. Kurygin ÀÀ. Long term results of surgical treatment of patients with perforated gastroduodenal ulcers. Herald of Surgeryi. 1999; (1): 20-24. Russian

14. Nishanov FN. Current status of surgical treatment of perforated duodenal ulcers. Herald of Surgery. 2011; (5); 97-100. Russian

15. Repin VN. Selection of surgical techniques for perforated ulcers of the stomach and duodenum. Herald of Surgery. 2011; (2): 48-51. Russian)

16. Rybachkov VV, Dryazhenkov IG. Complicated gastroduodenal ulcers. Surgery. 2005; (3): 27-29. Russian

17. Podoluzhny VI. The results of various operations for peptic ulcer from the viewpoint of the functional state of the stomach. Dr. med. sci. diss. Omsk, 1998. 45 ð. Russian

18. Freston JW. Management of peptic ulcers: emerging issues. World J. Surg. 2000. 24(3): 250-255.

19. Khetsuriani ShG. Prevalence of multiple resistance to antibiotics among Hp strains isolated from patients with some gastroduodenal diseases. Therapeutic Archive. 2006; (2): 19-21. Russian

20. Shapovalyants SG. Immediate and long-term results of laparoscopic suturing of perforated duodenal ulcers. Endoscopic Surgery. 2009; (1): 150-151. Russian

Clinical aspects of traumatology and orthopedics

TREATMENT TACTICS FOR PATIENTS WITH MULTIPLE UNILATERAL SHAFT FRACTURES OF THE HIP AND THE LEG ASSOCIATED WITH ABDOMINAL AND RETROPERITONEAL INJURIES

Samed-Zade R.R.

Samed-Zade R.R.

Azerbaidzhan State Institute of Postgraduate Medicine named after A. Aliev, Baku, Azerbaidzhan

Objective – to make the comparative analysis of osteosynthesis techniques and time of its carrying out in patients with multiple unilateral shaft fractures of the hip and the leg associated with abdominal and retroperitoneal injuries.

Materials and methods. During 2006-2012 the author observed 93 patients with multiple unilateral shaft fractures of the hip and the leg associated with abdominal and retroperitoneal injuries. Open fractures were classified according to Gustilo R.B., Anderson J.T. (1976). 36 patients received conservative treatment, 57 patients – osteosynthesis. The patients were distributed into 2 groups: the group A – conservative treatment, the group B – surgical osteosynthesis.

Results. Among 93 patients we examined 79 men (84.9 %) and 14 women (15.1 %). 76.3 % of the patients were working age persons (age of 21-60). The main causes of the injuries were road traffic accidents, from which 88 patients (94.6 %) suffered. Right-side injuries were identified in 51 patients (54.8 %), left-side injuries – in 42 (45.2 %). Closed fractures were identified in 32 patients (34.4 %), hip fractures – in 11 (11.8 %), leg fractures – in 21 (22.6 %). Open fractures were found in 61 patients (65.6 %) including 19 patients (31.2 %) with hip fractures and 42 (68.8 %) patients with leg fractures.

Fractures of DCP in the region of the hip happened in 4 patients after initiation of early load. The plates were removed. Recurrent osteosynthesis was made with nails and the rod device. Pin-track osteomyelitis developed in 8 patients (5 hips, 3 legs), slow consolidation of leg bones – in 9, mixed contracture of the knee joint – in 12 (7 surgical cases, 5 non-surgical cases). The long term results were estimated with the classification by Jonner R. and Wruhs O. (1983). The results of conservative treatment were excellent in 19 patients, good – in 9, satisfactory – in 8 (4.3 at average). The results of surgical osteosynthesis were excellent in 31 patients, good – in 7, satisfactory – in 11, non-satisfactory – in 8 (4.1 at average).

Conclusion. Patients with multiple ipsilateral fractures of lower extremities associated with abdominal and retroperitoneal injuries should be observed and treated in multidisciplinary hospitals or in departments of associated injury with enough number of employees. Upon admission of patients with the above-mentioned injuries, along with anti-shock treatment and surgical interventions, it is necessary to carry out skeletal traction, which is one of the methods of anti-shock treatment and the efficient independent technique of conservative treatment with some possibilities for preparing the patient for further surgical osteosynthesis. Among the techniques of surgical osteosynthesis one should decide in favor of metal devices, which allow persistent and stable osteosynthesis, early activity and development of motions in both segments.

Key words: polytrauma; ipsilateral fractures of the lower extremity; osteosynthesis; abdominal and retroperitoneal injuries.

Information about the author:

Samed-Zade R.R., candidate of medical science, docent of chair of traumatology and orthopedics, Azerbaidzhan State Institute of Postgraduate Medicine named after A. Aliev, Baku, Azerbaidzhan.

Address for correspondence:

Samed-Zade R.R., S. Rustama St., 35-54, Baku, Azerbaidzhan, 1022

Tel: + 994 (50) 670-19-17; +994 (12) 440-49-83

E-mail: srasim@mail.ru

References:

1. Agadzhanyan VV. Treatment of patients with polytrauma for last 10 years. Polytrauma. 2006; (3): 5-8. Russian

2. Pape H-C. Immediate fracture fixation – which method? Comments on the John Border memorial lecture, Ottawa, 2005. Journal of Orthopaedic Trauma. 2006; 20(5): 341-350.

3. Byalik EI, Sokolov VA, Semenova MN, Evdokimova NV. The features of treatment of long bones in patients with polytrauma. Bulletin of Traumatology and Orthopedics named after N.N. Priorov. 2002; (4): 3-8. Russian

4. Weninger Ð, Figl M, Spitaler R, Mauritz W, Hertz H. Early undreamed intramedullary nailing of femoral fractures is safe in patients with severe thoracic trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 2007; 62(3): 692-696.

5. Boz U, Ulusal AE, Sertoz Z. Treatment of open tibial fractures with Ilizarov method. SICOT/SIROT 2002. XXII World Congress : Abstract Book. San Diego, 2002. P. 618.

6. Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage Control Orthopedics: Evolving concepts in the treatment of patients who have sustained orthopedic trauma. Instr. Course Lect. 2005; 54: 447–462.

7. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J. Bone Jt Surg. 1976; 58: 453-458.

8. Giannoudis PV, Pape H-C. Prañtical proñedures in orthopaedic trauma surgery. Cambridge University Press, 2007. – 334 p.

9. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin. Orthop. 1983; 178: 7-25.

10. Heuwinkel R, Schweikert C-H, Ritter G. Osteosynthese-Zeitpunkt und ubermassige knochenheubildmny beim Schzdelhirntraume. Akt. Traumatol. 1978; 8(6): 447-452.

11. Krettek C, Simon RG, Tscherne H. Management priorities in patients with polytrauma. Langenbecks Arch Surg. 1998; 383(3): 220-227.

12. Sterk J, Willy C, Gerngross H. Femur osteosynthesis in the polytrauma patient – considerations for reasonable surgery time frame from the viewpoint of military service medical treatment. Langenbecks Arch Chir Suppi Kongressbd. 1997; 114: 1005-1010.

13. Agadzhanyan VV, Agalaryan AKh. The scientific organizational technologies for rendering assistance for patients with polytrauma with dominating injuries to internal organs. Polytrauma. 2012; (3): 5–8. Russian

14. 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.

Functional, instrumental and laboratory diagnostics

The level of expression of vascular endothelial growth factor (VEGF) and tartrate-resistant acid phosphatase (TRAcP) in femoral head bone tissue in coxarthrosis

Davydov D.A., Ustyantseva I.M., Agadzhanyan V.V., Avdalyan A.M., Lushnikova E.L.

Davydov D.A., Ustyantseva I.M., Agadzhanyan V.V., Avdalyan A.M., Lushnikova E.L.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Laboratory of molecular and genetic characteristics of tumors, Altay department of Blokhin Russian Cancer Research Center,

Barnaul, Russia

Institute of Molecular Pathology and Pathologic Morphology,

Novosibirsk, Russia

Estimation of the level of TRAcP expression is a conventional method for assessment of resorption activity of osteoclasts. Hypoxia after hemodynamic disorders in bone tissue of the femoral head influences on progression of coxarthrosis. One of the promoters of angiogenesis is vascular endothelial growth factor. Estimation of its expression level is an objective way of estimation of tissue response to hypoxia.

Objective – to make the analysis of expression of VEGF and TRAcP in bone tissue of the femoral head with deforming arthrosis of the hip joint.

Materials and methods. The morphologic study included 95 femoral heads which were removed during hip endoprosthetics in the patients with clinically confirmed diagnosis of coxarthrosis of stages 3-4 who were admitted to the department of traumatology and orthopedics, Regional Clinical Center of Miners’ Health Protection. For identification of the vessels of microcirculatory bed we used CD34 antibody (QBEnd/10, Ventana). Vascular endothelial growth factor was estimated with VEGF antibody (SP28, Spring Bio). Resorption activity of osteoclasts was made with TRAcP antibody (9C5, Cell Marque). NIS-Elements software (version BR 4.30.00) was used for measurement of optical density (conventional units) of the level of cytoplasmic expression of VEGF and TRAcP and for estimation of the square of the vessels of microcirculatory bed (µm²).

Results and discussion. The conducted estimation of expression of VEGF and TRAcP indicates the specific characteristics of bone tissue with the above mentioned nosologic types of coxarthrosis.

Conclusion. The comparative analysis of the morphometric and molecular biologic characteristics of femoral head tissues with various nosologic types of coxarthrosis shows some specific features. The most specific manifestations of the certain morphologic and molecular biologic signs were identified for each nosologic type of coxarthrosis.

Key words: vascular endothelial growth factor; acid phosphatase; osteoclast; osteoblast; coxarthrosis.

Information about authors:

Davydov D.A., anatomical pathologist, anatomic pathology department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Ustyantseva I.M., Doctor of Biological Sciences, professor, deputy chief physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Avdalyan A.M., MD, PhD, professor, head of laboratory, laboratory of molecular and genetic characteristics of tumors, Altay department of Blokhin Russian Cancer Research Center, Barnaul, Russia.

Lushnikova E.L., Doctor of Biological Sciences, professor, director of Institute of Molecular Pathology and Pathologic Morphology, Novosibirsk, Russia.

Address for correspondence:

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

Tel: +7 (384-56) 9-55-80

E-mail: denis260586@rambler.ru

References:

1. Cui M, Kanemoto S, Cui X, Kaneko M, Asada R, Matsuhisa K, et al. OASIS modulates hypoxia pathway activity to regulate bone angiogenesis. Sci. Rep. 2015; 12(5): 16455. doi: 10.1038/srep16455.

2. Endo-Munoz L, Cumming A, Rickwood D, Wilson D, Cueva1 C, Ng C, et al. Microenvironment and immunology loss of osteoclasts contributes to development of osteosarcoma pulmonary metastases. Cancer Res. 2010; 70(18): 7063–7072. doi: 10.1158/0008-5472.CAN-09-4291

3. Hadi HA, Smerdon G, Fox SW. Osteoclastic resorptive capacity is suppressed in patients receiving hyperbaric oxygen therapy. Acta Orthop. 2015; 86(2): 264-269. doi: 10.3109/17453674.2014.964621.

4. Lane NE, Brandt K, Hawker G, Peeva E, Schreyer E, Tsuji W, et al. OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis Cartilage. 2011; 19: 478–482.

5. Lee HP, Lin YY, Duh CY, Huang SY, Wang HM, Wu SF, et al. Lemnalol attenuates mast cell activation and osteoclast activity in a gouty arthritis model. J. Pharm. Pharmacol. 2015; 67(2): 274-85. doi: 10.1111/jphp.12331.

6. Lin YY, Jean YH, Lee HP, Chen WF, Sun YM, Su JH, et al. A soft coral-derived compound, 11-epi-sinulariolide acetate suppresses inflammatory response and bone destruction in adjuvant-induced arthritis. PLOS ONE. 2013; 8(5): e62926. doi: 10.1371/journal/pone.0062926

7. Ma WY, Zhuang L, Cai DX, Zhong H, Zhao C, Sun Q. Inverse correlation between caveolin-1expression and clinical severity in psoriasis vulgaris. J. Int. Med. Res. 2012; 40(5): 1745-1751.

8. Sung B, Prasad S, Yadav VR, Gupta SC, Reuter S, Reuter S, et al. RANKL signaling and osteoclastogenesis is negatively regulated by cardamonin. PLoS One. 2013; 8: e64118.

9. Walsh DA, McWilliams DF, Turley MJ, Dixon MR, Franse`s RE, Mapp PI, et al. Angiogenesis and nerve growth factor at the osteochondral junction in rheumatoid arthritis and osteoarthritis. Rheumatology. 2010; 49: 1852–1861. doi:10.1093/rheumatology/keq188

10. Waris V, Sillat T, Waris E, Virkki L, Mandelin J, Takagi M, et al. Role and regulation of VEGF and its receptors 1 and 2 in the aseptic loosening of total hip implants. J. Orthop. Res. 2012; 30(11): 1830-1836. doi: 10.1002/jor.22138.

11. Xing Y, Wang R, Chen D, Mao J, Shi R, Wu Z, et al. COX2 is involved in hypoxia-induced TNF-α expression in osteoblast. Sci. Rep. 2015; 12(5): 10020. doi: 10.1038/srep10020.

12. Yamaguchi R, Yamamoto T, Motomura G, Ikemura S, Iwasaki K, Zhao G, Bone and cartilage metabolism markers in synovial fluid of the hip joint with secondary osteoarthritis. Rheumatology (Oxford). 2014; 53(12): 2191-2195. doi: 10.1093/rheumatology/keu253

Researches of young scientists

The experience in interventional analgesia technique for spondylarthrosis of facet joints of the thoracic and lumbar spine

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

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

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

According to the epidemiologic data, more than 70 % of patients complain about spinal pain during the first attendance. In 10-20 % of employable age patients acute pain converts to chronical pain causing 80 % of medical costs for treatment of back pain. Inflammation of the facet joints is the cause of back pain in 10 % of patients.

Objective – by means of administration of interventional analgesia for the facet joints to improve results of treatment of patients with facet syndrome with degenerative dystrophic spinal changes and consequences of spine and spinal cord injury.

Materials and methods. During 2014 on the basis of the neurosurgery center of Regional Clinical Center of Miners’ Health Protection the treatment procedures were conducted for 130 patients (71 women [54 %], 59 med [46 %]) with chronical vertebrogenic pain syndrome at the background of degenerative dystrophic changes and consequences of spinal cord injury. The mean age of the patients was 50.6 ± 10.8. The radiologic examination identified some degenerative dystrophic processes of the spine in 97 %. The consequences of spine and spinal cord injury were identified in 3 %.

Results. The intensity of pain feelings decreased from 6.3 ± 0.4 points to 2.5 ± 0.3 points 2 days after analgesia according to the visual analogue scale. The examination of the lumbar spine before analgesia and 2 days after it showed increasing maximal level of flexion in the lumbar spine (by 28 degrees at average) and increasing level of extension (by 18 degrees).

Conclusion. Interventional analgesia of the facet joints showed the efficacy in 92 % of the cases (pain syndrome regressed in 68 % within 1-2 days; intensity of pain syndrome decreased by 4 points according to the visual analogue scale in 24 % of the cases).

Key words: spondylarthrosis; interventional analgesia; facet joints.

Information about authors:

Sidorov A.V., neurologist, neurology department #2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

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

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Novokshonov A.V., MD, PhD, head of neurosurgery department #2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Sidorov A.V., Lesnoy Gorodok St., 29a-4, Leninsk-Luznetsky, Kemerovo region, Russia, 652509

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

E-mail: sidorovalexsey@mail.ru

References:

1. Podchufarova EV, Yakhno NN. Back pain. Moscow : GEOTAR-Media Publ., 2014. 368 p. Russian

2. Sidorov AV, Yakushin OA, Novokshonov AV. Use of interventional analgesia technique for spondylarthrosis of facet joints of thoracic and lumbar spine. In: The multidisciplinary hospital: the interdisciplinary aspects of medicine : the materials from XIXth All-Russian scientific practical conference, Leninsk-Kuznetsky, Russia, September, 11, 2015. Kemerovo : Primula Publ., 2015. p. 68-69. Russian

3. Shchedrenok VV, Moguchaya OV, Sebelev KI, Zuev IV. Spine and spinal cord diseases: clinical radial diagnostics and treatment. Saint Petersburg : Leningrad Regional Institute of Education Development Publ., 2015. 494 p. Russian

4. Lutsik AA, Shevelev IN, Perlmutter OA, Shulev YuA, Konovalov NA, Grin AA, The committee of neurosurgical pathology of the spine and the spinal cord by Association of neurosurgeons of Russia. Diagnostics and treatment of acute spine and spinal cord injury (the recommendation protocol). Novokuznetsk, 2006. 36 p. Russian

5. Filatov EV. Surgical treatment of decubital wounds in patients with traumatic disease of the spinal cord. Polytrauma. 2010; (4): 51-55. Russian

6. Fisher Yu. Local treatment of pain : translated from German. Levin OS, edited. 5th edition. M. : MEDpress-inform Publ., 2013. 192 p. Russian

7. Pavlenko SS. Pain in lower back. Novosibirsk, 2007. 172 p. Russian

8. Khabirov FA. The manual for clinical neurology of the spine. Kazan : Medicine Publ., 2006. 518 p. Russian

9. Kraemer J, Theodoridis T. Spinal injection techniques. New York : Thieme Publishing Group, 2009. 253 p.

10. Brummett CM, Cohen SP. Facet Joint Pain. In: Raj’s Practical Management îf Pain. Benzon HT, Wu CL, Rathmell JP, Turk DC, Argoff CE, eds. 4^th ed. London : Mosby Elsevier, 2008. p. 1003-1038.

Reviews

Variability of standards of diagnostics, prevention and treatment of venous thrombosis in patients in traumatology and orthopedics

Agadzhanyan V.V., Vlasova I.V., Vlasov S.V.

Agadzhanyan V.V., Vlasova I.V., Vlasov S.V.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Currently, venous thrombosis and pulmonary embolism are the common complications after injuries. However, most trauma centers do not have necessary standardization for their prevention and treatment.

Materials and methods. The domestic and foreign literature was investigated for identification of the common protocols and algorythms for diagnostics and surgical prevention of thromboembolic complications in traumatology and orthopedics.

Results and discussion. The main method of diagnostics of deep venous thrombosis in the lower extremities is duplex scanning. However its use in orthopedic and traumatological practice is quite variable. In some clinics the protocols of ultrasonic examination do not include the muscular veins of the leg. There are some differences in estimation embolic potential of clots. There are no clear criteria for prescription of duplex scanning in specified time.

Pharmacologic prevention is widely used worldwide. However, significant variability is associated with used agents, frequency, dosage and duration of administration. It is based on the facts that symptomatic anticoagulant therapy should not increase risk of bleeding, is initiated only after arrest of bleeding in bones, cavities and the cranium, and should consider concurrent pathologic states.

There is no international uniform concept of surgical prevention of pulmonary embolism. Despite of the efficiency in prevention of thromboembolic complications, cava filters are not safe because of significant amount of complications at all stages of treatment. The alternative for cava filters is surgical treatment of thrombosis in the system of inferior vena cava, with some differences in location, suturing materials and realization of thrombectomy.

Conclusion. It is necessary to implement and research the modern high tech methods for prevention and treatment of posttraumatic pulmonary embolism. Such studies will allow developing clear recommendations and will eliminate unreasonable variability. All of it will increase the quality and improve treatment in traumatology and orthopedics.

Key words: thrombosis; embolic complications.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasova I.V., candidate of medical science, head of department of functional diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasov S.V., candidate of medical science, head of department of anesthesiology and resuscitation, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Vlasov S.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: + 7 (384-56) 2-34-70; + 7 (384-56) 9-54-68

E-mail: svlasof@rambler.ru

References:

1. Bandle J, Shackford SR, Sise CB, Knudson MM. Variability is the standard: The management of venous thromboembolic disease following trauma. The Journal of Trauma and Acute Care Surgery. 2014; 76(1): 213-215.

2. Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a Strategy of Thrombus Removal. Eur. J. Vasc. Endovasc. Surg. 2007; 33(3): 351-360.

3. Mezhebitskaya LO, Trofimova EYu, Sokolov VA, Semenova MN. Ultrasonicc examination of vessels in diagnostics and prediction of outcomes of thromboembolic complications in patients with polytrauma. Ultrasonic and Functional Diagnostic. 2006; (5): 84-91. Russian

4. Gaitini D. Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound. J. Clin. Ultrasound. 2006; 34(6): 289-297.

5. Pisarev VV, Lvov SE, Kutyreva OI, Molchanov OS. The features of antegrade blood flow and venous thromboembolic complications in patients with leg and hip fractures. Traumatology and Orthopedics of Russia. 2009; (2): 33-38. Russian

6. Ho WK, Hankey GJ, Lee CH, Eikelboom JW. Venous thromboembolism: diagnosis and management of deep venous thrombosis. Med. J. Aust. 2005; 182(9): 476–481.

7. Kearon Ñ. Natural history of venous thromboembolism. Circulation. 2003; 107(23, Suppl. 1): I22–I30.

8. Goodacre S, Sampson F, Stevenson M, Wailoo A, Sutton A, Thomas S, et al. Measurement of the clinical and cost effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol. Assess. 2006; 10(15): 1–168.

9. Ro A, Kageyama N, Fukunaga T. Significance of the soleal vein for the pathogenesis of deep vein thrombosis leading to acute massive pulmonary thromboembolism. Masui. 2007; 56(7): 801–807.

10. Goldina IM, Trofimova EYu, Kungurtsev EV, Mikhaylov IP, Lemenev VL, Malygina MA. The features of clinical and ultrasonic diagnostics of acute venous thrombosis of deep veins of the leg. Ultrasonic and Functional Diagnostics. 2009; (2): 60-70. Russian

11. Rose SC, Zwiebel WJ, Murdock LE, Hofmann AA, Priest DL, Knighton RA, et al. Insensitivity of color Doppler flow imaging for detection of acute calf deep venous thrombosis in asymptomatic postoperative patients. J. Vasc. Interv. Radiol. 1993; 4(1): 111–117.

12. Rusin VI, Popovich YaM, Korsak VV, Boldizhar PA, Nebylitsin YuS. Surgical prevention of pulmonary thrombembolia in deep venous thrombosis of the popliteal and femoral segment. News of Surgery. 2013; 21(4): 118-124. Russian

13. Marushchak EA, Zubarev AP. The role of ultrasonic diagnostics in determination of surgical tactics in patients with floating thrombosis of deep veins of the system of vena cava inferior. Medical Visualization. 2013; (3): 121-128. Russian

14. Khubutiya MSh, Goldina IM, Trofimova EYu, Mikhaylov IP, Kungurtsev EV. The problems of ultrasonic diagnostics of embologenic thrombosis. Diagnostic and Interventional Radiology. 2013; 7(2-2): 29-39. Russian

15. Goldina IM, Trofimova EYu, Mikhaylov IP, Kungurtsev EV. The role of the length of a floating clot in indications for thrombectomy. Ultrasonic and Functional Diagnostics. 2013; (6): 71-77. Russian

16. Trofimova EYu, Goldina IM, Lemenev VL, Kungurtsev EV, Mikhaylov IP. The level of acute embologenic venous thrombosis as a predictive criterion of risk of development of pulmonary embolism. Ultrasonic and Functional Diagnostics. 2008; (5): 66-75. Russian

17. Vlasov IV, Tleubaeva NV, Vlasov SV, Pronskikh IV. Diagnostics of thrombotic processes in the veins of lower extremities in outpatient practice. Polytrauma. 2011; (3): 65-75. Russian

18. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation. 2011; 123(16): P. 1788-1830.

19. Tleubaeva NV, Vlasova IV, Vlasov SV, Agadzhanyan VV. The factor analysis of the data of ultrasonic examination of lower extremity hemodynamics in patients with osteoarthrosis of big joints. Polytrauma. 2008; (3): 57-61. Russian

20. Vlasov SV, Vlasova IV. Risk factors of thromboembolic complications in patients with polytrauma. Polytrauma. 2013; (2): 42-47. Russian

21. Borisov DB, Krylov OV, Uvarov DN. Perisurgical analgesia in total endoprosthetics of hip joint. Anesthesiology and Critical Care Medicine. 2009; (4): 70-73. Russian

22. Kapranov SA. Endovascular surgery for disease of venous system: the possibilities and perspectives. Phlebology. 2007; 1(1): 29-37. Russian

23. Zhukov BN, Kostyaeva EV, Kostyaev VE, Katorkin SE. The problems of rehabilitation and restorative treatment for patients with deep venous thrombosis in lower extremities. Herald of Restorative Medicine. 2009; (4): 54–59. Russian

24. Jaff MR, Goldhaber SZ, Tapson VF. High utilization rate of vena cava filters in deep vein thrombosis. Thromb. Haemost. 2005; 93(6): 1117-1119.

25. Mismetti P, Rivron-Guillot K, Quenet S. Décousus H, Laporte S, Epinat M, et al. A Prospective Long-term Study of 220 Patients With a Retrievable Vena Cava Filter for Secondary Prevention of Venous Thromboembolism. Chest. 2007; 131(1): 223-229.

26. Assifi MM, Bagameri G, Dimuzio PJ, Eisenberg JA. Management of infected caval filter with simultaneous aortic pseudoaneurysm and retroperitoneal perforation: a case report and literature review. Vascular. 2012; 20(4): 225-228.

27. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J. Thromb. Haemost. 2007; 5(3): 632-634.

28. Kirienko AI, Mishnev OD, Tsitsiashvili MSh, Agafonov VF. The problem of postsurgical venous thromboembolic complications in surgical practice. Angiology and Vascular Surgery. 2003; 9(1): 61-66. Russian

29. Zatevakhin II, Shipovskiy VN, Zolkin VN, Lazarev RA, Maarov KB. The rheolytic catheter thrombectomy for giant floating clot. Angiology and Vascular Surgery. 2006; 12(3): 41-44. Russian

30. Osadchiy AI. Surgical prevention of recurrent pulmonary embolism. The indications for cava filters and the possibilities. Medicine of Critical States. 2013; (2): 122-126. Russian

31. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease : American College of Chest Physicians Evidence Based Clinical Practice Guidelines (8th ed). Chest. 2008; 133(6 Suppl.): 454S–545S.

32. Vlasova IV, Vlasov SV, Pronskikh IV, Agalaryan AKh, Kuznetsov AD. Ultrasonic picture of outcomes of dressing of femoral vein in patients with floating clots. Polytrauma. 2013; (2): 61-66. Russian

SURGICAL TREATMENT OF LOCALIZED INJURIES TO ARTICULAR SURFACE: THE CURRENT STATE OF THE ISSUE

Gerasimov S.A., Tenilin N.A., Korytkin A.A., Zykin A.A.

Gerasimov S.A., Tenilin N.A., Korytkin A.A., Zykin A.A.

Privolzhsky Federal Research Medical Centre,

Nizhny Novgorod, Russia

The objective of the review is to assess the modern methods of surgical treatment of localized cartilage defects of articular surface and their efficiency depending on location, depth, size and prescription of an injury, the state of cartilage surface and patient's age.

Conclusion. Despite of the wide range of the methods for treating localized injuries to the articular cartilage from osteoperforation methods to tissue bioengineering, none of them results in complete organ-specific recovery of the cartilaginous hyaline tissue. Nevertheless, with every new method, surgeon scientists are getting closer to solving this problem.

Key words: cartilage; cartilage defect; chondropathy; chondroplasty.

Information about authors:

Gerasimov S.A., traumatologist-orthopedist, department of orthopedics (for adults), Privolzhsky Federal Research Medical Centre, Nizhny Novgorod, Russia.

Tenilin N.A., MD, PhD, leading researcher of pediatric orthopedic department, Privolzhsky Federal Research Medical Centre, Nizhny Novgorod, Russia.

Korytkin A.A., candidate of medical science, head of department of orthopedics (for adults), Privolzhsky Federal Research Medical Centre, Nizhny Novgorod, Russia.

Zykin A.A., junior research associate, department of orthopedics (for adults), Privolzhsky Federal Research Medical Centre, Nizhny Novgorod, Russia.

Address for correspondence:

Gerasimov S.A., Verkhnevolzhskaya naberezhnaya, 18, Nizhny Novgorod, Russia, 603155

Tel: +7 (831) 436-01-60

E-mail: gerasimoff@list.ru

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The innovative technologies in the domestic production of dressing materials

Laklakyan V.A.

Laklakyan V.A.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to estimate the problems of development of qualitative, safe and efficient medical dressing production, to substantiate the choice of the necessary application properties in development of the domestic production of the new dressing material – radiopaque gauze wads.

Materials and methods. The study is based on the review and the analysis of the published articles dedicated to production of medical items, i.e. dressing materials. The study included the methods for harmonization and classification of the application properties of dressing materials, the methods for profile formation and estimation of assigned usefulness during development of the new domestic production of medical gauze wads on the basis of experience of OOO Meditsinskiy Stil, Leninsk-Kuznetsky.

Results. The article reviews some problems of production of the new qualitative, safe and efficient domestic medical dressing items – gauze wads. The problem was solved with the analysis of consumption preferences and estimation of the chosen application properties at the example of OOO Meditsinskiy Stil. As result of examination of the consumption preferences, the estimation of development of the rational, efficient and safe dressing material was made.

Conclusion. The domestic production of gauze wads by OOO Meditsinskiy Stil showed significant improvements in view of use of the new technologies and development of the ideal dressing material made of hygroscopic materials with the following consumption features: providence of gas exchange, removal of excessive effusion, protection of the wound from pathogenic organisms and from contamination with microparticles, prevention of additional damaging the wound, inward curve of the edges of the gauze wad to prevent appearance of fibers on the surface of the wound, available radiopaque fibers, hypoallergenicity, sterility, easy use without preliminary preparation.

Key words: Russian production of medical dressing materials; radiopaque gauze wads.

Information about the author:

Laklakyan V.A., director of OOO Meditsinskiy Stil, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Laklakyan V.A., Lesnoy Gorodok St., 52/2, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 2-39-95; +7 (905) 904-65-56

E-mail: medstyllk@mail.ru

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