Abstracts journal "Polytrauma" 3/2016

Original researches

High tibial osteotomy – the alternative to total knee joint replacement in gonarthrosis of the third stage?

Byalik V.E., Makarov S.A., Byalik E.I., Arkhipov S.V., Alekseeva L.I.

Nasonova Scientific Research Institute of Rheumatology,

Moscow, Russia

Osteoarthrosis is the most common disease of joints associated with age and leading to development of functional insufficiency and subsequent loss of working capability in adults. 86 % of cases are associated with knee osteoarthrosis in working age individuals.

Objective – to study the efficiency of high tibial osteotomy in gonarthrosis of 3rd stage.

Materials and methods. High tibial osteotomy was conducted for 23 patients (26 cases) in 2003-2016. The men/women ratio was 2:1. The efficiency of surgical intervention was estimated with VAS and KSS.

Results. According to VAS and KSS, the time course of pain (before surgery, 3 months and one year after it) was: VAS – 74, 20, 13 mm, KSS – 70, 136, 149 correspondingly. 25 of 26 short term outcomes were good and excellent.

Conclusion. The received results are similar with the results after total knee joint replacement. It is necessary to study middle and long term results of high tibial osteotomy in gonarthrosis of 3rd stage.

Key words: osteoarthrosis; working age; knee joint; high tibial osteotomy.

Information about authors:

Byalik V.E., junior research associate, laboratory of rheumoorthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Makarov S.A., candidate of medical science, chief of laboratory of rheumoorthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Byalik E.I., MD, PhD, professor, leading researcher, laboratory of rheumoorthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Arkhipov S.V., MD, PhD, professor, leading researcher, laboratory of rheumoorthopedics and rehabilitation, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Alekseeva L.I., MD, PhD, professor, chief of department of metabolic diseases of bones and joints, Nasonova Scientific Research Institute of Rheumatology, Moscow, Russia.

Address for correspondence:

Byalik V.E., Kashirskoe shosse, 34a, Moscow, Russia, 115522

Tel: +7 (964) 510-98-62

e-mail: DoctorBjalik@yandex.ru

References:

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13. Reva MA, Chegurov OK, Kaminsky AV, Maksimov AL, Efimov DN. Usage of correcting osteotomy of leg bones and total knee joint replacement in complex treatment of gonarthrosis with disorder of biomechanical axis of the lower extremity. Genius of Orthopedics. 2012; (3): 66-71. Russian

14. Makushin VD, Chegurov OK, Georgievskikh NI. Time course of intraosseous pressure after high tibial osteotomy in patients with gonarthrosis. Genius of Orthopedics. 2003; (4): 101-103. Russian

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27. Benedetto KP, Golovakha ML, Orlyansky VA et al. The results of high valgus osteotomy of the tibia in varus gonarthrosis. URL : http://www.national-zdorov.ru/userfiles/file/dvcvh8lapmnr1dpckw4jgk3mrsztfgyo.pdf). Russian

28. Zykin AA. Correcting osteotomy in treatment of deforming arthrosis of knee joint: dissertation by candidate of medical science. Nizhny Novgorog. 2015. P. 74-108. Russian

29. Grigoryan BA, Onoprienko GA, Buachidze OSh. The perspectives of usage of correcting surgery for gonarthrosis. Human and his health : the materials from 8th Russian national congress. Saint Petersburg, 2003. P. 44) Russian

30. Zykin AA, Korytkin AA, Tenilin NA, Gerasimov SA, Kortikov SN, Zakharova DV. The system of staged treatment of gonarthrosis of stages 2-3. URL : http://www.science-education.ru/pdf/2015/5/143.pdf.) Russian

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32. Ho-Rim Choi, Yukiharu Yasegawa, Seiji Kondo, Takuya Shimizu, Kunio Ida, and Hisashi Iwata High tibial osteotomy for varus gonarthrosis: a 10- to 24- year follow-up study. Journal of Orthopaedic science. 2001; (6): 493- 497.

33. Tuukka Niinimäki High tibial osteotomy and unicompartmental knee arthroplasty. The treatment of isolated medial osteoarthritis of the knee- a registry-based study in Finland. ACTA Universitatis Ouluenis. 2013. Available at: http://jultika.oulu.fi/files/isbn9789526203300.pdf

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New medical technologies

Modern technologies in complex treatment of patients with polytrauma and dominating chest injury

Tseymakh E.A., Bondarenko A.V., Menshikov A.A., Bombizo V.A.

Altay State Medical University,

Barnaul, Russia

Objective – to increase the efficiency of complex treatment of patients with severe associated injury and dominating chest injury with use of the low invasive curative techniques.

Materials and methods. The analysis included the results of treatment of 226 patients with severe associated chest injuries. The main group (102 patients) received the modern low invasive interventions (local differentiated fibrinolytic therapy, valve bronchial blocking, videothoracoscopy, rib fixation. The comparison group (124 patients) received the conventional treatment (blind draining of pleural cavities, thoracotomy etc.).

Results. The medico-diagnostic algorithm for management of patients with severe associated chest injury has been developed. The indications for the following procedures have been formulated: emergent thoracotomy, urgent videothoracoscopy, local fibrinolytic therapy for clotted hemothorax and posttraumatic pleural empyema, valve bronchial blocking for tense and longstanding non-spreading pneumothorax, osteosynthesis of fragmentary rib fractures.

Conclusion. Use of the developed low invasive techniques of treatment allowed decreasing the amount of the operated patients and increasing the amount of the patients discharged with recovery.

Key words: severe associated injury with dominating chest injury; hemothorax; pneumothorax; fragmentary fractures of ribs; treatment.

Information about authors:

Tseymakh E.A., MD, PhD, professor, pro-rector for research, head of chair of operative surgery and topographic anatomy, Altay State Medical University, Barnaul, Russia.

Bondarenko A.V., MD, PhD, professor, chief of traumatology department No.2, Regional Clinical Hospital of Emergency Medical Aid, professor of chair of traumatology, orthopedics and military field surgery, Altay State Medical University, Barnaul, Russia.

Menshikov A.A., candidate of medical science, resident of traumatology department No.2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Bombizo V.A., candidate of medical science, chief physician, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Address for correspondence:

Tseymakh E.A., Lenina prospect, 40, Barnaul, Russia, 656038

Tel: +7 (3852) 36-61-24; +7 (3852) 24-48-73, +7 (905) 986-41-07

E-mail: yea220257@mail.ru

REFERENCES:

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9. Tseymakh EA, Levin AV, Shoykhet YaN, Zimonin PE, Tseymakh IYa, Samulyenkov AM, et al. Use of endobronchial valves in treatment of spontaneous pneumothorax. Pulmonology. 2009; (6): 118-122. Russian

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11. Tseymakh EA, Kuznetsov SYu, Bondarenko AV, Smirnova OI, Menshikov AA. Application of the cryoplasmic-antienzyme complex in the treatment of patients with severe associated injury. Polytrauma. 2010; (4): 45-50. Russian

Anesthesiology and critical care medicine

Prevention of venous thromboembolic complications in abdominal and pelvic gunshot wounds

Zubritsky V.F., Koltovich A.P., Shabalin A.Yu., Indeykin A.V., Nikolaev K.N., Kapustin S.I., Vardanyan A.V., Yakovlev A.E., Taubaev B.M., Taibov R.Z.

Main Clinical Hospital of Ministry of Internal Affairs of the Russian Federation, Moscow, Russia

Main Military Clinical Hospital of Internal Troops of Ministry of Internal Affairs of the Russian Federation,

Balashikha, Moscow region, Russia

Russian Scientific Research Institute of Hematology and Transfusiology,

Saint Petersburg, Russia

Russian Medical Academy of Postgraduate Education,

Moscow, Russia

Kirov Military Medical Academy,

Saint Petersburg, Russia

Combat surgical abdominal trauma is a usual event of all wars and local armed conflicts. It is characterized by extensive damages, severity and development of complications. Gunshot wounds cause the imbalance in the hemostatic system, hypercoagulation and occurrence of pathological thrombus formation with subsequent embolism in the pulmonary artery branches.

Objective – to improve the methods of prevention of venous thromboembolic events (VTE) in persons with gunshot abdominal and pelvic wounds at the stages of evacuation.

Material and methods. The presented analysis of the treatment outcomes and the modern methods of VTE prevention included 311 patients with gunshot injuries to the abdominal cavity, the retroperitoneal space and the pelvis after combat operations at various stages of their treatment. Medical assistance was provided on two stages of evacuation. VTE prevention was conducted with the pharmacological (unfractionated heparin, low molecular weight heparins) and mechanical (elastic bandaging for the lower extremities, pneumocompression, electromyostimulation) techniques. Monitoring the effectiveness of the preventive measures included ultrasound scanning of the lower limbs, the examination of the indicators characterizing the state of blood coagulation, the examination of genetic predisposition to thrombosis.

Results. The effectiveness of the complex prevention of VTE has been shown for the whole period of treatment at the evacuation stage, with reducing the incidence of venous thrombosis from 17.8 % to 4.8 %. The low specificity of the D-dimer test was found in the patients with abdominal and pelvic wounds. It was found that the hemostatic disorders persisted for more than 35 days after injury and maintained the high risk of blood clots. It is necessary to conduct the long-term prevention of VTE. The examination of genetic defects identified 1-4 mutations in the hemostasis system components in 60 % of the patients with VTE.

Conclusion. The complex prevention of VTE and controlling its efficiency should be carried out at all stages of evacuation. Duration of prophylaxis should be determined by the presence of the risk factors for VTE.

Key words: abdominal injuries; wounds; prophylaxis; venous thrombosis; thrombophilia.

Information about authors:

Zubritsky V.F., MD, PhD, professor, chief surgeon of Ministry of Internal Affairs of the Russian Federation, Main Clinical Hospital of Ministry of Internal Affairs of the Russian Federation, Moscow, Russia.

Koltovich A.P., MD, PhD, senior surgeon, Main Clinical Hospital of Ministry of Internal Affairs of the Russian Federation, Moscow, Russia.

Shabalin A.Yu., candidate of medical science, senior surgeon, Main Military Clinical Hospital of Internal Troops of Ministry of Internal Affairs of the Russian Federation, Balashikha, Moscow region, Russia.

Indeykin A.V., candidate of medical science, chief of surgery department, Main Military Clinical Hospital of Internal Troops of Ministry of Internal Affairs of the Russian Federation, Balashikha, Moscow region, Russia.

Nikolaev K.N., candidate of medical science, surgeon, Main Military Clinical Hospital of Internal Troops of Ministry of Internal Affairs of the Russian Federation, Balashikha, Moscow region, Russia.

Kapustin S.I., doctor of biological science, chief of laboratory, Russian Scientific Research Institute of Hematology and Transfusiology, Saint Petersburg, Russia.

Vardanyan A.V., MD, PhD, professor of surgery chair, Russian Medical Academy of Postgraduate Education, Moscow, Russia.

Yakovlev A.E., candidate of medical science, chief of scientific research department of Scientific Research Center (Moscow), Kirov Military Medical Academy, Saint Petersburg, Russia.

Taubaev B.M., deputy chief of intensive care unit, Main Clinical Hospital of Ministry of Internal Affairs of the Russian Federation, Moscow, Russia.

Taibov R.Z., deputy commander of separate medical battalion, Main Military Clinical Hospital of Internal Troops of Ministry of Internal Affairs of the Russian Federation, Balashikha, Moscow region, Russia.

Address for correspondence:

Nikolaev K.N., Vishnyavskoe shosse, 101, Balashikha, Moscow region, Russia, 143915

Tel: +7 (495) 524-89-89, äîá. 46-63

Å-mail: kostya-gospital2016@mail.ru

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THE EFFECT OF ENTERAL NUTRITIONAL SUPPORT ENRICHED WITH GLUTAMINE ON THE DEVELOPMENT OF NOSOCOMIAL INFECTIOUS COMPLICATIONS IN PATIENTS WITH TRAUMA OF THE CHEST AND ABDOMEN

Ponomarev S.V., Sorokin E.P., Leyderman I.N., Sirazutdinova A.V.

City Clinical Hospital No.9,

Izhevsk State Medical Academy, Izhevsk, Russia,

Ural State Medical University, Ekaterinburg, Russia

Objective – to conduct the analysis of development of nosocomial infectious complications in ICU patients with severe trauma of the chest and abdomen, to estimate the relationship with the tactics of nutritional support.
Materials and methods. A randomized prospective study included the medical records of 90 patients with severe combined and isolated trauma of the chest and abdomen for the period from 2013 to 2016. There were 2 groups: the main group (45 patients) and the control group (45 patients). The main group received hypercalorical (1,360 kcal/l), hypernitrogenous (67 g/l of protein) enteral nutrition enriched with glutamine (20 g/l). The control group received isocalorical (1,000 kcal/l), isonitrogenous (protein – 38 g/l) enteral nutrition. Nutritional status was assessed on the dynamics of total protein, albumin and absolute lymphocyte count on the days 1, 3, 5, 7 and 10 in the ICU. The development of extrapulmonary and pulmonary nosocomial infectious complications were recorded for all the time spent on hospital care, using algorithms and epidemiological diagnostics of nosocomial infection (CDC, USA).

Results. The strategic aim (the amount of delivered protein – 1.1 g/kg/day) was achieved on 3rd day in the main group and only on 7th day in the control group. Dynamics of changes in indicators of nutritional status in both groups clearly shows the efficacy of enteral nutrition enriched with glutamine. Its use reduces the risk of infectious complications in the posttraumatic period by 2.4 % (χ-square with Yates ' correction = 3.94, the number of degrees of freedom df = 1, p = 0.047). The chance of developing of nosocomial infectious complications in the group of standard nutrition is 2.5 times higher than in the group with the immune diet (OR = 2.5 [1.1-5.8] p = 0.034).

Conclusion. Hypercalorical, hypernitrogenious enteral nutrition enriched with glutamine allows faster achieving the desired level of delivered protein and energy. Its administration decreases the rates of nosocomial infectious complications.

Key words: nosocomial infectious complications; severe trauma of the chest and abdomen; nutritional support; glutamine; protein and energy needs in trauma.

Information about authors:

Ponomarev S.V., postgraduate of chair of surgical diseases with course of anesthesiology and critical care medicine, Izhevsk State Medical Academy, anesthesiologist-intensivist, City Clinical Hospital No.9, Izhevsk, Russia.

Sorokin E.P., candidate of medical science, docent of chair of surgical diseases with course of anesthesiology and critical care medicine, Izhevsk State Medical Academy, City Clinical Hospital No.9, Izhevsk, Russia.

Leyderman I.N., MD, PhD, professor of chair of anesthesiology, critical care medicine and transfusion, Ural State Medical University, Ekaterinburg, Russia.

Sirazutdinova A.V., resident of chair of surgical diseases with course of anesthesiology and critical care medicine, Izhevsk State Medical Academy, Izhevsk, Russia.

Address for correspondence:

Ponomarev S.V., Pushkina St., 130-191, Izhevsk, Russia, 426076

Tel: +7 (922) 685-81-13

E-mail: sp1975@bk.ru

References:

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

2. Galyatina EA, Agalaryan AKh, Sherman SV. Analysis of results of surgical treatment of abdominal injuries in children with polytrauma. Polytrauma. 2013; (3): 43-50. Russian

3. Korolev VM. Epidemiological and clinical aspects of the combined trauma. Far East Medical Journal. 2011; (3): 124-128. Russian

4. Ponomarev SV, Sorokin EP, Leyderman IN, Sirazutdinova AV. The structure of mortality and quality of nutritional support in patients with chest and abdomen injuries. Emergency Medicine. 2016; (1): 38-43. Russian

5. Kim H. Glutamine as an immunonutrient. Yonsei Med. J. 2011; 52(6): 892-897.

6. Bagnenko SF, Pivovarova LP, Malyshev ME, Ariskina OB, Osipova IV. Functional impairment of neutrophil granulocytes in combined mechanical trauma. Infection in Surgery. 2013; 11(1): 26-29. Russian

7. Samokhvalov IM, Gavrilin SV, Badalov IV, Petrov AN, Rud AA, Meshakov DP, et al. The features of visceral infectious complications in patients with severe associated trauma. Infection in Surgery. 2013; 11(3): 23-26. Russian

8. Meshakov DP. Intensive care in victims of severe concomitant injury to the head and chest. Journal of Anesthesiology and Intensive Care. 2012; 9 (2): 22-26. Russian

9. Samokhvalov IM, Nedomolkin SV, Gavrilin SV, Meshakov DP. Prolonged mechanical ventilation in elderly and senile victims with severe injuries. Journal of Anesthesiology and Intensive Care. 2012; 9(1): 28-35. Russian

10. Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011; 37: 601–609.

11. Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013; 381(9864): 385–393.

12. Berkasova IV, Vereshchagin EI, Valeeva VA, Chikinev YuV, Drobyazdin EA. Correction of nucleic acid metabolism in the perioperative period in patients with benign diseases of the esophagus. Medicine and Education in Siberia. (the electronic journal) 2012; (6). URL: http://www.ngmu.ru/cozo/mos/article/text_full.php?id=881. Russian (

13. Zvyagin AA, Rodionova SS. Pharmaceutical parenteral nutrition for patients with sepsis (literature review). Herald of Intensive Care. 2011; (4): 23-29. Russian

14. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr. Clin. Pract. 2014; 29(1): 29-43.

Clinical aspects of neuro-surgery

RECONSTRUCTIVE PROCEDURES IN TREATMENT OF PATIENTS WITH TRAUMATIC DISEASE OF THE SPINAL CORD

Agadzhanyan V.V., Yakushin Î.À., Novokshonov À.V.

Novosibirsk Scientific Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan,

Novosibirsk, Russia,

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to estimate the efficiency of the late reconstructive procedures using the microsurgical techniques in treatment of patients with traumatic disease of the spinal cord.

Materials and methods. The materials are based on the treatment of 69 patients with traumatic disease of the spinal cord. The mean age of the patients was 34.01 ± 12.7. More than 70 % of the patients were the men at their most productive age from 20 to 49. The highest amount of the injuries was at the lumbar spine – 27 cases (39.1 %). The thoracic spine injuries accounted for 24 (34.8 %) and the cervical spine injuries made 18 (26.1 %) cases. 36.3 % of the patients with traumatic disease of the spinal cord underwent the decompressive stabilizing procedures. There were some reconstructive procedures of the spinal cord and its membranes in 63.7 % of the patients using the microsurgical techniques and optical magnification.

Results. Use of the microsurgical reconstructive technologies for the spinal cord and its membranes has led to the improvement in the compromised functions of the spinal cord, and the satisfactory or good results were achieved in 61 % of the cases.

Conclusion. The microsurgical operations for the spinal cord and its membranes reconstruction provide the volumetric integrity of the spinal cord at the level of its injury. Normal circulation of the cerebrospinal fluid in injury to the spinal cord and its membranes is restored only after plastic surgery of the dura mater.

Key words: spinal injury; spinal cord and its membranes injuries; microsurgery.

Information about authors:

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

Yakushin O.A., candidate of medical science, traumatologist-orthopedist, neurosurgery department No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Novokshonov A.V., MD, PhD, head of neurosurgery department No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

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

Tel: +7 (384-56) 9-53-58; +7 (905) 075-53-73

E-mail: Yakushin-GNKC@rambler.ru

References:

1. Bulyubash ID. Psychic status of the patients with consequences of the spinal injury: depression and distress reaction. Medical and social assessment and rehabilitation. 2011; (1): 54-57. Russian.)

2. Kotova ÎÀ, Bulyubash ID, Baykova IA. Psycho-emotional features of the patients undergoing a spinal injury (literature review). The Journal of the Grodno State Medical University. 2013; (4): 17-21. Russian

3. Neurosurgery : physicians guide : 2 volumes. Dreval ON, ed. Moscow : Litterra Publ., 2013. Vol. 2. Lectures, seminars, clinical works. 864 p. Russian

4. Agadzhanyan VV, Agalaryan AKh, Ustyantseva IM, Galyatina ÅÀ, Dovgal DA, Kravtsov SA, et al. Polytrauma. Treatment of children. Novosibirsk : Nauka Publ., 2014. 248 p. Russian

5. Spine trauma. Surgical techniques. Patel VV et al., editors. Berlin ; Heidelberg : Springer, 2010. 413 p.

6. Gaydar BV, Korolyuk ÌÀ, Kropotov SP. Transplantation of the nervous tissue in spinal cord injuries: possibilities and perspectives. Clinical medicine and pathophysiology. 1996; (1): 102-114. Russian

7. Neurosurgery. The European manual : 2 volumes. Lumenta H, et al, eds. Moscow: Panfilov Publisher ; BINOM. Knowledge Laboratory Publ., 2013. Vol. 2. 699 p. Russian

8. Stepanov GA. The new methods of the reconstructive microsurgery of the spinal cord in severe injury. Moscow : SCIENCE-PRESS Publ., 2011. 103 p. Russian

9. Usikov VD, Vorontsov KE, Kuftov VS, Ershov NI. The short-term and long-term results of surgery of spine and spinal cord injury at the thoracic and lumbar levels. Traumatology and Orthopedics of Russia. 2014; (2): 37-44. Russian

10. Baytinger VF, Golubev IO. Clinical anatomy of the hand (part V). The functional methods of examination of the hand blood supply. The problems of the reconstructive and plastic surgery. 2011; (4): 21-27. Russian

Clinical aspects of traumatology and orthopedics

THE CHARACTERISTICS OF CONSERVATIVE TREATMENT OF FRACTURES OF THE DISTAL RADIAL BONE IN ELDERLY PATIENTS

Zenin V.I., Ardashev I.P., Ardasheva E.I., Fokin A.P., Ostolskaya G.B., Shternis T.A.

Gorbunova City Hospital No.1,

Kemerovo State medical Academy,

Kemerovo, Russia

Fractures of the distal one-third of the radial bone refer to the most frequent damages. Their rate is about 40 – 50 % of all injuries to the bones of the upper extremities. The most common category of victims is older people leading the active way of life.

Objective – to study the results of conservative treatment of fractures of the distal radial bone and quality of life in elderly patients.

Materials and methods. The conservative treatment was conducted for 24 patients (older than 60) with fractures of the distal one-third of the radial bone. The treatment included analgetic therapy, closed simultaneous reposition of bone fragments, anti-inflammatory therapy, vascular therapy, physical therapy, vitamin therapy, rehabilitation treatment. The following methods were used: clinical, radiological techniques, estimation of hand functioning, multi-slice spiral computed tomography, ultrasonic dopplerography, electromyography, dynamometry.

Results. The complex regional pain syndrome (CRPS) developed in 9 (37 %) cases, neuropathy of median nerve took place in 5 (20 %) cases, the secondary displacement and wrong consolidation – in 4 (16 %).

Conclusion. Conservative treatment of fractures of the distal radial bone in elderly patients leads to unsatisfactory results, and is accompanied by high rate of complications, functional failure and reduced quality of life in patients with mainly intraarticular fractures.

Key words: fracture of distal part of the radial bone in older people; CRPS; neuropathy of median nerve; malunion fracture of distal metaepiphysis of the radial bone.

Information about authors:

Zenin V.I., traumatologist-orthopedist, outpatient traumatology department, Gorbunova City Hospital No.1, Kemerovo, Russia.

Ardashev I.P., MD, PhD, professor, head of chair of traumatology, orthopedics and military field surgery, anesthesiology and critical care medicine, Kemerovo State Medical Academy, Kemerovo, Russia.

Ardasheva E.I., assistant of chair of traumatology, orthopedics and military field surgery, anesthesiology and critical care medicine, Kemerovo State Medical Academy, Kemerovo, Russia.

Ostolskaya G.B., head of outpatient traumatology department, Gorbunova City Hospital No.1, Kemerovo, Russia.

Fokin A.P., physician of ultrasonic diagnostics, Gorbunova City Hospital No.1, Kemerovo, Russia.

Shternis T.A., candidate of medical science, docent of chair of public health and medical informatics, Kemerovo State medical Academy, Kemerovo, Russia.

Address for correspondence:

Zenin V.I., Vesennyaya St., 9a, Kemerovo, Russia, 650099

Outpatient traumatology department, Gorbunova City Hospital No.1

Tel: +7 (3842) 36-41-67; +7 (923) 489-29-01

E-mail: zeninvi@ mail.ru

References:

1. Nana AD, Lichtman DM. Distal-third forearm fractures. URL : www.emedicine.com/ orthoped / topic 79.htm. Accessed 2005.

2. Keller M, Steiger R. Open reduction and internal fixation of distal radius sxtension fractures in women over 60 years of age with dorsal radius. Hand chir. Microchir. Plast. Chir. 2006; 38: 82–89.

3. Gummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch. Med. 1989; 149: 2445–2448.

4. Beherrie AW, Beredgiklian PK, Bozentka DG. Functional outcomes after open reduction and internal fixation for triatmen of displaced distal radius fractures in patients over 60 years of age. J. Îrthop. Trauma. 2004. 18: 680–686.

5. Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patien-reported functional outcomes in an eldery cohort with conservatively treated fractures. J. Hand Surg. Am. 2004; 29(6): 1121–1127.

6. Beumer A, MacQueen MM. Fractures of the distal radius in lou-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop. Scand. 2003; 74: 98–100.

7. Greval R, MacDermit JC. The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages bat mitigated in older patients. J. Hand Surg. Am. 2007; 32: 6962–6970.

8. Chung KC, Watt AJ, Kotsis SV. Treat ment of unstable distal radius fractures with the volar locking peating system. J. Bone Joint Surg. 2006; 88: 2687–2694.

9. Kreder HJ, Hanel DP, Agel J, McKee M, Schemitsch EH, Trumble TE, et al. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomized, controlled trial. J. Bone Joint Surg. Br. 2005; 87(6): 829–836.

10. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the eldery patient. J. Haud Surg. Am. 2004; 29: 96–102.

11. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos. Int. 2005; 16(2): 80–84.

12. Handoll HH, Madhok R. Surgical interventions for treatig distal radial fractures in adults. Cochrane. Database 3 rd Rev. 2003; (4): CD003209.

13. Chung KC, Squitieri L, Kim HM. Comparativ outcomes studi using the volar locking plating system for distal radius fractures in both young adults older than 60 years. J. Hand. Serg. Am. 2008; 33: 809–819.

14. Marx VO. Orthopedic diagnosis : a hands-on–guide. Minsk : Science and technology Publ., 1978. 512 p. Russian

Functional, instrumental and laboratory diagnostics

TIME COURSE OF PERIPROSTHETIC BONE MINERAL DENSITY AFTER SHORT-STEM HIP ARTHROPLASTY

Aladyshev N.A., Ezhov I.Yu.

Volga District Medical Centre under Federal Medical and Biological Agency,

Nizhny Novgorod, Russia

Objective – to study the time course of bone mineral density around the short-stem component of the hip joint after 6, 12 and 24 months after surgery, to assess the functional status of patients (Harris hip score), to find complications.

Materials and methods. A prospective study included observation of 100 patients aged 20 to 68 years with osteoarthritis and femoral head aseptic necrosis. The patients received hip replacement. The study included radiography, X-ray dual-energy absorption densitometry, examination of the functional status (Harris hip score) and analysis of complications.

Results. Increase in bone mass was noted in all zones by Gruen at 6th month of the follow-up after the operation. The results were the same at 12 and 24 months. The low-impact type of access resulted in early activation of the patients with good functional results according to Harris hip score in comparison with the basic values. The results persisted up to 24 months after surgery.

Conclusion. The use of short stems gives good functional results and low complication rate (previously loosening) in young patients with satisfactory state of bone tissue. It is confirmed by the data of densitometry and the questionnaires (Harris hip score).

Key words: hip replacement; a short stem; bone mineral density

Information about authors:

Aladyshev N.A., traumatologist-orthopedist, department of traumatology and orthopedics, Volga District Medical Centre under Federal Medical and Biological Agency, Nizhny Novgorod, Russia.

Ezhov I.Yu., MD, PhD, head of department of traumatology and orthopedics, Clinical Hospital No.4, Volga District Medical Centre under Federal Medical and Biological Agency, professor of chair of surgery of postgraduate education faculty, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia.

Address for correspondence:

Aladyshev N.A., Tropinina St., 41A, Nizhny Novgorod, Russia, 603137

Tel: +7 (987) 537-44-87

Å-mail: aladyshevniklajj@rambler.ru

References:

1. Zagorodniy NV. Hip joint endoprosthetics. The foundations and practice. Moscow : GEOTAR-Media Publ., 2013. 701 p. Russian

2. Dall DM, Grobbelaar CJ, Learnmoth ID, Dall G. Charnley low-friction arthroplasty of the hip. Long-term results in South Africa. Clin. Oprthop. 1986; (211): 85-90.

3. Malchau H, Herberts P, Ahnfelt L. Prognosis of total hip replacement in Sweden. Acta Orthop. Scand. 1993; 64(5): 497-506.

4. Lord GA, Hardy JR, Kummer FJ. An uncemented total hip replacement. Clin. Opthop. 1979: 141: 3-16.

5. Huiskes R. Failed innovation in total hip replacement. Acta Opthop. Scand. 1993: 64: 699-716.

6. Murray DW, Carr AJ, Bulstrode CJ. Which primary hip replacement? JBJS. 1995; 77-B: 520-527.

7. Amastutz HC. Arthroplasty of the hip. The search for durable component fixation. Clin. Orthop. 1985; 200: 343-361.

8. Engh CA. The influence of stem size and extent of porous coating on femoral resorption after primary cementless hip arthroplasty. Clin. Orthop. 1988; 231: 7-28.

9. d’Imporzano M, Pierannunzii L. Minimally invasive total hip replacement. Journal of Orthopaedic Traumatology. 2006; 7: 42–50.

10. Renkawitz T, Santori FS, Grifka J, Valverde C, Morlock MM, Learmonth ID. A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial. BMC Musculoskeletal Disorders. 2008; 9: 147-152.

11. Westphal FM, Bishop N, Honl M, Hille E, Püschel K, Morlock MM. Migration and cyclic motion of a new short-stemmed hip prosthesis – a biomechanical in vitro study. Clinical Biomechanics (Bristil Avon). 2006; 21(8): 834–840.

12. Santori, F.S. & Santori, N. (2010). Mid-term results of a custom-made short proximal loading femoral component. The Journal of Bone and Joint Surgery, British Vol.92, No.9, pp. 1231-1237, 2010.

13. Reimeringer M, Nuño N, Desmarais-Trépanier C, Lavigne M, Vendittoli PA. The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis. Comput. Methods Biomech. Biomed. Engin. 2013; 16(11): 1221-1231.

14. Makarov SA. Changes in bone mineral density around the implant in total cementless hip joint replacement in patients with rheumatoid diseases : Cand. med. sci. diss. Moscow, 2004. 102 p. Russian (Ìàêàðîâ Ñ.À. Èçìåíåíèå ìèíåðàëüíîé ïëîòíîñòè êîñòíîé òêàíè âîêðóã èìïëàíòà ïðè òîòàëüíîì áåñöåìåíòíîì ýíäîïðîòåçèðîâàíèè òàçîáåäðåííîãî ñóñòàâà ó áîëüíûõ ðåâìàòè÷åñêèìè çàáîëåâàíèÿìè : äèñ. êàíä. ìåä. íàóê. Ì., 2004. 102 ñ.)

15. Albanese CV, Santori FS, Pavan L, Learmonth ID, Passariello R. Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems: 37 patients followed for 3 years. Acta Orthop. 2009; 80(3): 291-297.

16. Götze C, Ehrenbrink J, Ehrenbrink H. Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty. Z. Orthop. Unfall. 2010; 148(4): 398-405.

17. Schmidt R, Gollwitzer S, Nowak TE, Nowak M, Häberle L, Kress A, Forst R, Müller LA. Periprosthetic femoral bone reaction after total hip arthroplasty with preservation of the collum femoris : CT-assisted osteodensitometry 1 and 3 years postoperatively. Orthopade. 2011; 40(7): 591-598.

Rehabilitation

ORGANIZATIONAL TECHNOLOGIES OF MEDICAL REHABILITATION IN TRAUMATOLOGY

Tsarik G.N., Korbanova T.N.

Kemerovo Institute of Socioeconomic Problems in Healthcare,

Kemerovo, Russia

The health status of citizens requires continuous development of medicine. It is necessary to provide the qualitative breakthrough in the healthcare system. The medical branches need for some innovations in the fields of prevention, diagnosis, treatment and rehabilitation.

Objective ̶ improving the efficiency of medical rehabilitation on the basis of innovative technologies for organization of medical maintenance for the population by means of increasing amount of beds in departments of medical rehabilitation of traumatology profile and improvement in quality of rendering medical aid.

Materials and methods. The complex social hygienic study was conducted with use of the techniques: historical, sanitary, statistical, monographical, economical and mathematical techniques, the systemic approach and analysis, immediate observation, modelling, expert estimates. The analysis of the contingency tables was conducted with Pearson’s test. The value of p = 0.05 was considered as the critical level of statistical significance, with the null hypothesis in case of higher p values.

The demand for the medical rehabilitation techniques was estimated on the basis of the analysis of the public health in the population of Kemerovo region, i.e. in the patients with disorders in the locomotor system and the connective tissue.

Results. Evaluation of the effectiveness of the implemented technologies of medical rehabilitation in the Kemerovo region was carried out using two three-year observation periods (2009-2011 and 2012-2014.). Provision with the specialized traumatological hospital beds for the implementation of technologies of medical rehabilitation increased from 0.0063 (0.0062-0.0064) bed days per capita in 2009-2011 to 0.007 (0.0069-0.0071) in 2012-2014 (p = 0.005). The diseases of blood circulation system, injuries, poisoning and tumors were the main causes of mortality in the first (2009-2011) and the second (2012-2014) follow-up periods.

The second period of observation showed a decrease in mortality from injuries and poisoning from 246.0 (243.4-248.6) to 202.5 (200.3-204.7), (p = 0.0001) per 100,000 of the population (p = 0.982). There was a reduction in the working age population mortality due to external causes from 306.2 (304.6-307.8) to 262.5 (261.1-263.9), (p = 0.0001) due to an increase in deaths from road traffic accidents from 10.9 (10.8-11.0) to 17.4 (17.3-17.5), (p = 0.0001).

The development of medical rehabilitation has contributed to increasing the availability of rehabilitation treatment, quality of care and efficiency of patient care.

Conclusion. As result of implementation of the innovation system of the organizational technologies of medical rehabilitation, the restructurisation of the bed fund in the medical facilities was realized by means of the increasing amount of beds for rehabilitation that improved the effectiveness of treatment of patients and the use of resources in the regional health services.

The time intervals of temporary loss of working capability have reduced. The primary disability rates and the rates of mortality among the population have shown the positive time trends.

The implementation of the organizational technologies of medical rehabilitation has contributed to medical, social and economic performance.

Key words: trauma care; medical rehabilitation; rehabilitation treatment; rehabilitation technology.

Information about authors:

Tsarik G.N., MD, PhD, professor, chief of chair of public health, healthcare and medical informatics, Kemerovo State Medical Academy, director of Kemerovo Institute of Socioeconomic Problems in Healthcare, Kemerovo, Russia.

Korbanova T.N., leading specialist of the department of health protection in the population of Kemerovo region, Kemerovo, Russia.

Address for correspondence:

Korbanova T.N., Serebryany Bor St., 15a-188, Kemerovo, Russia, 650070

Tel: +7 (923) 601-89-99

Å-mail: hott811@hotmail.ru

REFERENCES:

1. Vvedenskaya ES, Kobzeva LF. The need for restructuring medical care to the population above working age. Problems of social hygiene, healthcare and history of medicine. 2013; (2): 24-27. Russian

2. Izmerov NF, Denisov EI, Morozova TV. Health protection for workers: harmonization of terminology, legislation and practices according to the international standards. Occupational Medicine and Industrial Ecology. 2012; (8): 1-7. Russian

3. Izmerov NF, Denisov EI, Prokopenko LV, Sivochalova OV, Stepanyan IV, Chelishcheva MYu, et al. The methodology for the detection and prevention of occupational diseases. Occupational Medicine and Industrial Ecology. 2010; (9): 1-7. Russian

4. Izmerov NF, Tikhonova GI. Health problems of the working population of Russia. Problems of forecasting. 2011; (3): 56-70. Russian

5. Letter of the Ministry of health and social development of the Russian Federation from 23 December, 2008, No.10093-TG "About medical assistance for employees of the entities included in the list of organizations of separate industries with especially dangerous working conditions" [Electronic resource]. URL : Consultant.ru"document/cons_doc_EXP_441410/(accessed 17.04.2014). Russian

6. Mironov SP, Arutyunov AT, Mkrtumyan AM, Turzin PS. The formation of the method for calculating the costs of paid educational services provided by the public medical educational institution of additional professional education. Kremlin medicine. 2009; (3): 87-93. Russian.

7. The order by the government of the Russian Federation from 24 December, 2007, No.921 (edited on December 31,2008) "About the order of providing the federal budget grants (from the Federal fund of obligatory medical insurance) for the budgets of the territorial funds of obligatory medical insurance for realization of additional health examination of working individuals in 2008-2009" [Electronic resource]. Moscow, 2007. – URL : http://www.glavbukh.ru/edoc/?docId=499051426&modId=99#axzz2yfvSNkWj (date of access: 26.03.2014). Russian

8. Zakharenkov VV, Danilov IP, Oleshchenko AM, , Panaiotti EA, Burdeyn AV, et al. Evaluation of occupational and environmental health risk of workers in the aluminium industry. Bulletin of East-Siberian Scientific Center of RAMS Siberian Department. 2009; (1): 30-33. Russian

9. Zakharenkov VV, Viblaya IV, Burdeyn AV, Kolyado VB. Organizational aspects of regional system of health protection labor (on the example of Kemerovo region). Problems of Healthcare Management. 2009; (3): 27-29. Russian

10. Kress JP, Hall JB. ICU-Acquired Weakness and Recovery from Critical Illness. N. Engl. J. Med. 2014; 370(9062): 1626–1635.

11. Danilova NV. Improving the organization of rehabilitation treatment and rehabilitation of the working population. Healthcare in the Russian Federation. 2009; (4): 23-27. Russian

12. Prilipko NS, Bolshakova TM. Population's need for assistance in rehabilitation medicine. Journal of rehabilitation medicine. 2010; (4): 2-4. Russian

13. Norton R, Kobusingye O. Injuries. N. Engl. J. Med. 2013; 368(18): P. 1723–1730.

Case history

A clinical case of posttraumatic recovery of functional capability of the hand in a child

Ezhov A.A., Dovgal D.A.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to demonstrate the clinical case of treatment of the child (age of 2 years and 9 months) with severe hand injury in two anatomic regions treated with single-stage maximal reconstruction of anatomic structures, despite of the extensive wounds of the hand.

Materials and methods. The patient B., born in 2013, with the clinical diagnosis: “Long term compression of the right hand. Multiple tear-contused wounds of the hand and the fingers with detachment of soft tissues. Decompensated ischemia of the fingers 3, 4. Injuries to the flexor tendons of the fingers 2-4 and digital arteries of the finger 3. Injuries to the digital nerve of the finger 5 and the common digital nerves of the fingers 2-3, 3-4, 4-5. An opened longitudinal fracture of the proximal phalanx of the finger 4 without displacement. Epiphysiolysis of the proximal phalanx of the finger 3. The state after surgical preparation of the wounds of the right hand from May 30, 2016. Traumatic shock of degree 1”.

The relative contraindications for maximal full recovery of the injured anatomic structures of the hand were injury mechanism – the right hand was under long term compression (at least 2 hours) in the hasher worm and the body frame of the electrical mincing machine; an injury to the hand at the level of the palm and the fingers that resulted in the injury to the anatomically significant structures at two levels; small sizes of the injured anatomical structures of the hand; presence of multiple tear-contused wounds of the hand with detachment of soft tissues; high contamination of the hand wounds with small metal parts after extraction of the hand from the mincing machine with use of the special tools by the employees of the Ministry of Emergency Situations of Russia. Despite of the above-mentioned relative contraindications, surgical treatment was performed for maximal reconstruction of the anatomic structures: secondary surgical preparation of the wounds of the right hand; microsurgical suture of the digital artery of the finger 3, angiolysis of the common digital arteries of the fingers 2-3, 3-4, 4-5; microsurgical suture of the digital nerve of the finger 5 and the common digital nerves of the fingers 2-3, 3-4, 4-5; microsurgical suture of the digital nerve of the finger 5 and the common digital nerves of the fingers 2-3, 3-4 and 4-5; suture of flexor tendons of the right fingers 2-3, 3-4, 4-5 according to Rozov.

Results. No signs of blood circulation disorders in the microcirculatory bed of soft tissues were found after surgical treatment of the severe hand injury. The wound healing was accompanied by primary intention. The patient was discharged in satisfactory condition for outpatient treatment on 24th day after surgical intervention.

Conclusion. During realization of surgical aid in treatment of severe injuries to the hand in children the necessary condition is reconstruction of maximal amount of injured anatomical structures, despite of presence of soft tissue detachment of the segment, signs of disordered perfusion in the microcirculatory bed of tissues and wound contamination. This condition prevents recurrent surgical interventions and gives good functional outcomes of the hand.

Key words: severe hand injury in children; microsurgery; hand injury at several levels.

Information about authors:

Ezhov A.A., surgeon, department of traumatology and orthopedics No.3, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics No.4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ezhov A.A., 7th district, 9, Leninsk-Kuznetsky, Russia, 652509

Tel: +7 (384-56) 9-55-72

E-mail: surgeon86@mail.ru

References:

Shapovalov VM, Trapeznikov AV, Gubochkin NG. Mistakes and complications in surgery of the upper extremity In: VIIth convention of traumatologist-orthopedists of Russia : abstracts of reports. Novosibirsk, 2002. Vol. 2. p. 311-312. Russian
Grishin IG, Azolov VV, Vodyanov NM. Treatment of hand injuries at stages of evacuation. Moscow, 1985. 191 p. Russian
Kornilov NV. Complex reconstructive treatment of patients with consequences of associated injuries to tendons and nerves of the forearm and the hand. Dr. med. sci. abstracts diss. Leningrad, 1986. 30 p. Russian
Belousov AE, Tkachenko SS. Microsurgery in traumatology. Moscow : Medicine Publ., 1988. 224 p. Russian

A clinical case of successful treatment of a child with polytrauma

Sinitsa N.S., Dovgal D.A., Obukhov S.Yu., Bogdanov A.V., Stafeeva N.V.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Currently, one can observe the significant increase in the amount of patients with polytrauma. At the moment of admission most patients are characterized by severe or extremely severe condition with events of traumatic shock. Wide implementation of low traumatic surgical techniques gives some possibilities for early osteosynthesis for fractures in children with polytrauma.

Objective – by the example of the clinical case to show the short term outcomes of treatment of the patient with polytrauma with use of the low invasive osteosynthesis techniques for opened fractures of the long bones.

Materials and methods. The short term outcomes of treatment of the child with polytrauma are presented. Skeletal trauma was a dominating injury: opened fractures of the femur and the tibia, partial rupture of the sacroiliac joint, rupture of the pubic articulation. The child was admitted with the events of traumatic shock determined by the injuries and bleeding. The first day included secondary surgical preparation of the wounds, low invasive osteosynthesis of the fractures of the femur and the tibia with tense nails. Osteosynthesis of the pelvic bones was performed with the rod device on the second day. The rehabilitation measures were initiated on the second day of treatment in the intensive care unit. The results of X-ray examination and the functional capability of the injured extremity are presented. Treatment of the pathology is described at the stage of treatment in the intensive care unit and in the department of traumatology and orthopedics.

Results. The child was in the intensive care unit for 4 days, in the department of traumatology and orthopedics – for 29 days. The positive time course was noted at the background of conducted surgical treatment and complex infusion therapy. Full range of motions in the injured extremity restored on 21st day after trauma. On 32nd day the child could independently move with additional support. The child was discharged in good condition on 33rd day.

Conclusion. Complex treatment of multiple skeletal injuries including timely low invasive osteosynthesis, appropriate infusion therapy and early activation of rehabilitation significantly improves the quality of the patient’s life and favors more complete restoration of lost functions.

Key words: polytrauma; low invasive osteosynthesis; children.

Information about authors:

Sinitsa N.S., candidate of medical science, head of department of traumatology and orthopedics No.4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Dovgal D.A., traumatologist-orthopedist, department of traumatology and orthopedics No.4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Obukhov S.Yu., traumatologist-orthopedist, department of traumatology and orthopedics No.4, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Bogdanov A.V., anesthesiologist-intensivist, intensive care unit, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Stafeeva N.V., anesthesiologist-intensivist, department of anesthesiology, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Dovgal D.A., 7th district, 2-74, Leninsk-Kuznetsky, 652509, Russia

Tel: +7 (384-56) 9-55-53

E-mail: denis_dovgal@mail.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. 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

3. Ankin LN, Ankin NL. Practical traumatology. The European standards of diagnostics and treatment. Moscow : Kniga-plus Publ., 2002. 480 p. Russian

4. Baindurashvili AG, Norkin IA, Solovyev KS. Injury rate and orthopedic morbidity in the children of the Russian Federation. Arrangement of specialized assistance and the perspectives of improvement. Herald of Traumatology and Orthopedics named after N.N. Priorov. 2010; (4): 13-17. Russian

5. Kuznechikhin EP, Nemsadze VP. Multiple and associated injuries to the locomotor system in children. Moscow : Medicine Publ., 1999. 336 p. Russian

Experimental investigations

FREE RADICAL OXIDATION IN THE MODELS OF ISCHEMIA

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

Kemerovo State Medical Academy, Kemerovo, Russia,

Moscow State Medicine and Dentistry University named after A.I. Evdokimov,

Moscow, Russia

The article is devoted to the study of free radical oxidation activity and antioxidant protection of blood plasma and tissues in chronic pancreatitis and myocardial infarction.

Subject of research: 175 rats with experimental chronic pancreatitis, 135 patients with primary chronic pancreatitis of alcoholic origin, 594 patients with primary Q-forming myocardial infarction.

Objective – to investigate the values of activity of lipid peroxidation and antioxidant protection in the blood of the animals and the patients, and pancreatic and liver homogenates in the rats.

Materials and methods. Toxic necrosis of biliopancreatic epithelium of the ducts with development of chronic pancreatitis in the rats was caused by introduction of dibutyltin dichloride into the vena caudalis (6 mg/kg). The liver and pancreatic homogenates of the animals were tested for malondialdehyde, diene conjugates, antioxidant activity, ceruleoplasmin in the blood serum, as well as for SOD and CAT of red blood cells. Lipid peroxidation and antioxidant activity were estimated in the patients’ serum and red blood cells.

Results. Intensifying processes of lipid peroxidation with depression of plasma antioxidant activity were observed in experimental chronic pancreatitis in the rats, in primary chronical pancreatitis in the patients and in myocardial infarction in the patients.

Key words: chronic pancreatitis; myocardial infarction; lipid peroxidation; free radical oxidation.

Information about authors:

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

Berns S.A., MD, PhD, professor of chair of internal diseases of stomatology faculty, Moscow State Medicine and Dentistry University named after A.I. Evdokimov, Moscow, Russia.

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

Address for correspondence:

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

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

E-mail: radionov3@mail.ru

References:

1. Vorontsova NL, Barbarash OL, Berns SA. Free radical oxidation and myocardium. Moscow : Russian Universities Publ. ; Kemerovo : ASTSh Publ., 2005. 154 ñ. Russian

2. Gukovsky I, Lugea A, Shahsahebi M, Cheng JH, Hong PP, Jung YJ, et al. A rat model reproducing key pathological responses of alcoholic chronic pancreatitis. Am. J. Physiol. Gastrointest. Liver Physiol. 2008; 294: G68-G79.

3. Mukhamadiyarov RA, Radionov IA, Razumov AS, Bogdanov MV. Efficiency of liposomal forms of antioxidants for correction of oxidative stress in experimental. Russian Nanotechnologies. 2015; 10(1-2): 111-115. Russian

4. Pandol SJ, Raraty M. Pathology of alcoholic pancreatitis. Pancreatology. 2007; 7(2-3): 105-114.

5. Golikov PP. Nitrogen oxide in clinical course of emergency diseases. Moscow : Medpractica-M Publ., 2004. 180 p. Russian

6. Gubergrits NB, Lukashevich GM. Ischemic pancreatopotia. Herald of Club of Pancreatologists. 2010; (1): 15-20. Russian

7. Chik J, Kemppainen E. Estimating alcohol consumption. Pancreatology. 2007; 7(2-3): 157-161.

8. Gubergrits NB, Kazyulin AAN. Metabolic pancreatology. Donetsk : Lebed Publ., 2011. 464 p. Russian

9. Schneide A, Whitcomb DC, Singer MV. Animal models in alcocholic pancreatitis-what can we learn? Pancreatology. 2002; 16: 189-203.

10. Lankin VZ, Tikhaze AK, Belenkov YuN. Free radical processes in diseases of cardiovascular system. Cardiology. 2000; (7): 48-61. Russian

11. Vladimirov YuA, Proskurina EV. Free radicals and cellular chemoluminescence. Success of Biological Chemistry. 2009; 49: 341–388. Russian

12. Evdokimova AG, Evdokimov VV. Cardiocerebral dysfunction: the risk factors and possibilities of cytoprotective therapy. Effective Pharmacotherapy. Cardiology and Angiology. 2013; (1): 16-21. Russian

13. Khristich TM. The indices of oxidative carbonyl stress, antioxidant stress and dyslipidemia in patients with chronic pancreatitis in dependence on the age. Gastroenterology. 2012; 46: 202-205. Ukrainian

14. Libis RA, Dushina AG, Oleynik EA. The features of course of chronic cardiac insufficiency with preserved left ventricle ejection fraction in patients with essential arterial hypertension. Arterial Hypertension. 2013; 19(6): 513-519. Russian

15. Fadeenko GD, Sytnik KA. Associated course of chronic pancreatitis and acid-dependent diseases. Healthcare in Ukraine. 2014; (2): 22-23. Russian

16. Sparmann G, Merkord J, Jäschke À, Nizze H, Jonas L, Löhr M, et al. Pancreatic fibrosis in experimental pancreatitis induced by dibutyltin dichloride [see comments]. Gastroenterology. 1997; 112(5): 1664-1672.

17. Merkord J, Jonas L, Weber H, Kröning G, Nizze H, Hennighausen G. Acute interstitial pancreatitis in rats induced by dibutyltin dichloride (DBTC): pathogenesis and natural course of lesions. Pancreas. 1997; 15(4): 392-401.

18. Barbarsh OL, Kashtalap VV, Karetnikova VN, Vorontsova NL, Devyatova VA, Goncharenko MV, et al. Clinical significance of values of endothelial dysfunction, oxidative stress and hemostasis in patients with myocardial infarction. Blood Circulation Pathology and Cardiosurgery. 2007; (2): 28-33. Russian

Reviews

THE HIDDEN CONSEQUENCES OF

CERVICAL SPINE INJURY

Berezutsky V.I.

Berezutsky V.I.

Dnepropetrovsk Medical Academy,

Dnepropetrovsk, Ukraine

Objective – to review the literature devoted to the problems of pathogenesis, diagnosis and treatment of the hidden consequences of cervical spine injuries.

Materials and methods: the domestic and foreign scientific publications about cervical spine injuries for the period of 2010-2016.

Conclusion. The main part of the hidden cervical spinal complications is different vertebro-visceral syndromes: vertebrogenic cerebrovascular diseases, vestibulopathy, disorders of vegetative regulation of the internal organs. Successful prevention of long-term and latent complications is possible upon condition of compulsive and detailed examination of all patients with such injuries. The examination should include ultrasonic and tomographic methods combined with differentiated approach to treatment choice (surgery, physiotherapy, drug treatment).

Key words: spinal trauma; vertebrobasilar insufficiency.

Information about the author:

Berezutsky V.I., candidate of medical science, docent of chair of propedeutics of internal medicine, Dnepropetrovsk Medical Academy, Dnepropetrovsk, Ukraine.

Address for correspondence:

Berezutsky V.I., Novokrymskaya, 5-301, Dnepropetrovsk (Dnepr), Ukraine, 49055

Tel: +38 (067) 965-31-65

E-mail: Berezut@hotmail.ru

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