From editor

Secondary care organization

ALCOHOL-RELATED ROAD-TRAFFIC ACCIDENTS ON THE FEDERAL HIGHWAY M-8 «KHOLMOGORY» IN THE ARKHANGELSK REGION

Baranov A.V.

Baranov A.V.

Northern State Medical University, Arkhangelsk, Russia

Cherepovets State University, Cherepovets, Russia

Objective – to analyze alcohol-related traffic accidents on the federal highway M-8 “Kholmogory” in the Arkhangelsk Region.

Materials and methods. We selected 906 case histories of patients (f.003/y) who were injured in accidents on the federal highway M-8 “Kholmogory”, admitted urgently and treated in hospitals of the Arkhangelsk region from January 1, 2012 to December 31, 2019. The study is a retrospective full-design documentary observation. As a criterion of statistical significance, the probability of a random error of less than 5 % (p < 0.05) using the correction for multiple comparisons (Bonferroni correction) was chosen.

Results. Injuries in alcohol-related accidents most often occurred in drivers of motorcycles. The increase in the severity of the patients’ condition by injury severity score (ISS) of concomitant injuries was associated with the increase in the proportion of victims of road accidents in a state of alcohol intoxication.

Conclusion. It was noted that up to 20 % of victims in road traffic accidents on federal highway M-8 “Kholmogory” were in state of alcohol intoxication, men predominated among all victims (p < 0.001), and injured in state of alcohol intoxication were significantly younger than sober victims (p = 0.013). The largest proportion of alcohol-related accidents was revealed in the Arkhangelsk Medical District, and their smallest number was noted in Velsky Medical District (p < 0.001). Positive dynamics was noted in reducing of the proportion of injured patients in a state of alcohol intoxication by 2018 (p = 0.002).

Key words: road traffic accident; alcohol-related traffic accidents; federal highway M-8 «Kholmogory»; Arkhangelsk region; severity of concomitant trauma by injury severity score (ISS).

Information about author:

Baranov A.V., candidate of medical science, senior researcher at department of theoretical foundations of physical culture, sports and health, Cherepovetsk State University, Cherepovetsk, Russia; researcher at central research laboratory, Northern State Medical University, Arkhangelsk, Russia.

Address for correspondence:

Baranov A.V., Pogranichnaya St., 2B, Tarnogskiy gorodok, Russia. 161560

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

E-mail: Baranov.av1985@mail.ru

REFERENCES:

1.        Agadzhanyan VV. Arrangement of medical assistance for multiple and associated injuries (polytrauma). Clinical recommendations (the treatment protocol) (the project). Polytrauma. 2015; (4): 6-19. Russian

2.        Baranov AV, Matveev RP, Barachevsky YuE, Gudkov AB. Pelvic injuries as an aspect of road traffic trauma. Postgraduate Doctor. 2012; 52(3): 389-392. Russian

3.        Kuz'min AG. Road traffic traumatism as a national problem. Human Ecology. 2011; (3): 44-49. Russian

4.        Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, Milyukov AYu, Shatalin AV. Polytrauma. An acute management and transportation. Novosibirsk : Science, 2008. 320 p. Russian

5.        Shatalin AV, Skopintsev DA, Kravtsov S A. Influence of the fluid therapy on the hematological measures in patients with polytrauma during the interhospital transportation. Polytrauma. 2011; (4): 10-16. Russian

6.        Mordovsky EA, Solovyev AG, Vyazmin AM, Kuzin SG, Kolyadko EA. Alcohol consumption on the day before death and mortality from traumas, intoxications and other effects of external causes. Human Ecology. 2014; (9): 24-29. Russian

7.        Solovyev AG, Mordovsky EA, Vyazmin AM. Demographic and social predictors of the place of death in the elderly. Advances in Gerontology. 2016; 29(5): 829-836. Russian

8.        Baranov AV. Medico-tactical characteristics of pelvic injuries in victims of road traffic and other contingencies in the conditions of the regional center of the European North of Russia (on the example of the city of Arkhangelsk. Abstracts of candidate of medical science. Arkhangelsk, 2013. 28 p. Russian

9.        Viaz'min AM, Solov'ev AG, Mordovskiĭ ÉA, Kuzin SG, Tsugulia SV. On the problem of registration of mortality associated with alcohol consumption among the population in the forensic medical practice. Forensic Medicine. 2014; 57(3): 29-33. Russian

Clinical aspects of surgery

RESULTS OF TREATMENT OF PATIENTS WITH ESOPHAGUS INJURIES IN LEVEL 1 TRAUMA CENTER
Dulaev A.K., Demko A.E., Taniya S.Sh., Babich A.I.

Dulaev A.K., Demko A.E., Taniya S.Sh., Babich A.I.

Saint Petersburg I.I. Dzhanelidze Institute of Emergency Medicine,

Saint Petersburg, Russia

Esophageal injuries are rare – 1 % of all injuries. Mortality reaches 50 %, and complications are observed in 70 % of patients. Currently, there are no unified, approved recommendations for the treatment of patients with esophageal injuries.
Objective – to analyze the results of treatment of patients with injuries (trauma, wounds) to the esophagus and to determine the objective signs of an unfavorable prognosis of the disease.

Materials and methods. A retrospective analysis of the results of treatment of 76 patients with esophageal injuries was performed. All patients were divided into 2 groups: 61 survived and 15 deceased. The features of the clinical picture, laboratory diagnostic data, performed surgical interventions, structure of complications and the cause of deaths were studied.
Results. 42 patients (67 %) of the group 1 and 9 patients (60 %) of the group 2 were hemodynamically stable at admission. There were no significant differences in the prevalence of symptoms at admission among the groups 1 and 2. Patients of the group 2 had a lower level of base excess (BE) at admission – all patients in this group had it less than -6 mmol/l, while patients in the group 1 showed 2.5 ± 2 mmol/l. 100 % of patients were operated. There were no differences in surgical access or volume of surgical intervention in patients of the groups 1 and 2. All patients who underwent surgery lasting more than 120 minutes died. Pneumonia was more common in the group 1 (39 %) than in the group 2 (20 %). Septic complications in combination with multiple organ failure were observed more often in the group 2 (46 %) than in the group 1 (18 %).

Conclusion. The combination of systolic blood pressure lower than 90 mm Hg with base excess (BE) less than -6 mmol/l at admission are objective signs of unfavorable prognosis of the disease. The duration of surgery for more than 120 minutes is an independent predictor of unfavorable prognosis of the disease. The time from the moment of injury to admission, the presence or absence of re-operation, insufficiency of esophageal sutures in the postoperative period, operative access and the volume of surgical intervention did not significantly affect the outcome of the disease.
Key words: esophageal trauma; esophageal injuries; esophageal wound.

Information about authors:

Dulaev A.K., MD, PhD, chief of unit of traumatology, orthopedics and vertebrology, Saint Petersburg I.I. Dzhanelidze Institute of Emergency Medicine, Saint Petersburg, Russia.

Demko A.E., MD, PhD, deputy chief physician of surgery, Saint Petersburg I.I. Dzhanelidze Institute of Emergency Medicine, Saint Petersburg, Russia.

Taniya S.Sh., MD, PhD, chief of associated injury unit, Saint Petersburg I.I. Dzhanelidze Institute of Emergency Medicine, Saint Petersburg, Russia.

Babich A.I., researcher of associated injury unit, Saint Petersburg I.I. Dzhanelidze Institute of Emergency Medicine, Saint Petersburg, Russia.

Address for correspondence:

Babich A.I., Korablestroitekey St., 30-176, Saint Petersburg, Russia, 199397

Tel: +7 (911) 023- 01-69

E-mail: babichmed@mail.ru

REFERENCES:

1.        Biancari F, D'Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J. Surg. 2013; 37(5): 1051-1059.

2.        Biffl WL, Moore EE, Feliciano DV, Albrecht RA, Croce M, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in trauma: diagnosis and management of esophageal injuries. J Trauma Acute Care Surg. 2015; 79(6): 1089-1095.

3.        Makhani M, Midani D, Goldberg A, Friedenberg FK. Pathogenesis and outcomes of traumatic injuries of the esophagus. Dis Esophagus. 2014; 27(7): P.630-636.

4.        Puerta VA, Priego JP, Cornejo López MÁ, García-Moreno NF, Rodríguez VG, Galindo ÁJ, et al. Management of esophageal perforation: 28-year experience in a Major Referral Center. Am. Surg. 2018; 84(5): 684-689.

5.        Savelyev VS, Kiriyenko AI, Cherkasov MF, Sedov VM, Skvortsov MB, Grigoryev EG. Surgical diseases. Moscow: GEOTAR-Media, 2014. 1400 p. Russian

6.        Skvortsov MB, Borichevsky VI. The Role of mediastinitis and its prevention in the treatment of esophageal perforations. Bulletin of the East Siberian Scientific Center of the Siberian Branch of the Russian Academy of Sciences. 2007; (4): 161. Russian

7.        Schweigert M, Sousa HS, Solymosi N, Yankulov A, Fernández MJ, Beattie R, et al. Spotlight on esophageal perforation: a multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg. 2016; 151(4): 1002–1011.

PACKING IN SURGICAL TREATMENT OF SEVERE LIVER DAMAGE

Shapkin Yu.G., Chalyk Yu.V., Stekolnikov N.Yu.,Kuzyaev T.R.

Shapkin Yu.G., Chalyk Yu.V., Stekolnikov N.Yu.,Kuzyaev T.R.

Razumovsky Saratov State Medical University, Saratov, Russia

One of the main causes of death of the working-age population is multiple and combined abdominal trauma. Among traumatic injuries of abdominal organs, liver damage occupies one of the leading places, due to the peculiarities of anatomical location and structure of parenchyma. In the end of 20th century, the concept of damage control was developed to treat this group of patients.

Objective – to conduct the analysis of the results of the clinical use of gauze packing in the framework of the damage control concept in patients with severe liver damages.

Materials and methods. The analysis included the results of surgical treatment of 248 patients with closed liver injury who had been operated at Koshelev Clinical Hospital No.6 on the basis of the general surgery department of Razumovsky Saratov State Medical University in 1976-2018. The vast majority of patients (74 %) were between the ages of 20 and 50.

Results. When studying the results of treatment of 68 patients with severe closed liver injury, three periods were allocated: 1976-1992, 1993-2008, 2009-2018. In the first period of activity of the clinic, 87.5 % of surgical interventions were represented by liver resection. Mortality in the first period was 75 %. During the second period, radical operations were supplanted by less aggressive techniques in combination with packing. This allowed reducing the frequency of deaths up to 54 %. In the third period, there was an active use of primary gauze packing, which had reduced mortality to 46 %.

Conclusion. The active clinical introduction of primary packing as a part of the damage control concept in the surgery for severe liver damage has improved the results of treatment of patients with polytrauma. Exclusion of liver resections and the use of gauze packing in order to achieve primary hemostasis can reduce mortality in severe closed liver injuries.

Key words: closed liver injury; severe liver damage; damage control; perihepatic packing.

Information about authors:

Shapkin Yu.G., MD, PhD, professor, chief of general surgery department, Razumovsky Saratov State Medical University, Saratov, Russia.

Chalyk Yu.V., MD, PhD, professor at general surgery department, Razumovsky Saratov State Medical University, Saratov, Russia.

Stekolnikov N.Yu., candidate of medical science, docent at general surgery department, Razumovsky Saratov State Medical University, Saratov, Russia.

Kuzyaev T.R., postgraduate at general surgery department, Razumovsky Saratov State Medical University, Saratov, Russia.

Address for correspondence:

Kuzyaev T.R., Gvardeyskaya St., 15, Saratov, Russia, 410033

Tel: +7 (960) 354-58-33

E-mail: timurqz@gmail.com

REFERENCES:

1. Smolyar AN, Dzhagraev K R. One-stage surgical treatment of severe closed combined liver trauma surgery. Surgery. Pirogov Journal. 2015; (2): 79-81. Russian

2.      Sigua BV, Zemlyanoi VP, Dykov AK. Blunt abdomen trauma liver damage. Bulletin of Mechnikov North-West State Medical University. 2014; 6 (3): 93-98. Russian

3.      Shapkin YuG, Chalyk YuV, Stekolnikov NYu, Gusev KA. Perihepatic paking as the first stage of damage control strategy. Annals of Surgical Hepatology. 2017; 22 (4): 89–95. Russian

4.      Rogal ML, Smolyar AN, Dzhagraev KR. Surgical treatment of closed liver injury. In: Arrangement of emergency medical care for patients during high rate of admission. Materials of the All-Russian Conference from the Third Congress of Critical Care Physicians. Moscow, October 6-7, 2016. Sklifosofsky Research Institute of Emergency Care. 2016: 39-40. Russian

5.      Timerbulatov VM, Fayazov RR, Timerbulatov ShV, Gareev RN, Nguyen KhK, Khalikov AA, et al. Surgical tactics for traumatic liver damage from the standpoint of modern technologies (clinical and experimental research) Medical Bulletin of Bashkortostan. 2012 ; 7(6): 64-69. Russian

6.      Bazaev AV, Aleynikov AV, Korolev SK, Kokobelyan AR, Rodin AG, Efremenko VA et al. Damage to the liver and spleen in patients with combined road injury. Selected issues of treatment of trauma to the chest and abdomen. 2014; 1(11): 17-19. Russian

7.      Parkhisenko YuA, Vorontsov AK, Vorontsov KE, Bezaltynnykh AA. Analysis of the results of surgical treatment of patients with trauma of the liver. Prospects for Science and Education. 2018; 1(31): 245-250. Russian

8.             Gumanenko EK. Military Field Surgery. Moscow : GEOTAR-Media, 2008.768 p. Russian

9.             Rauchfuss F, Voigt R, Götz M, Heise M, Uberrück T, Settmacher U. Damage control concept in liver trauma. Package strategies and secondary measures. Chirurg 2009; 80: (10): 923—928.

10.         Jiang H, Wang J. Emergency strategies and trends in the management of liver trauma. Front Med 2012; 6: (3): 225—233.

11.         Samokhvalov IM, Afonchikov VS, Badalov VI, Borisov MB et al. Practical Guide to Damage Control. St. Petersburg: R-COPI, 2018; 370 p. Russian

12. Shapkin VS, Grinenko ZhA. Closed and open liver damage. Moscow: Medicine, 1977. 182 p. Russian

Clinical aspects of traumatology and orthopedics 

TREATMENT OF TRAUMATIC DEFECT OF THE TIBIA DIAPHYSIS WITH METHOD OF COMBINED SEQUENTIAL BILOKAL AND LOCKING OSTEOSYNTHESIS   

Bondarenko A.V., Plotnikov I.A., Guseynov R.G.    

Bondarenko A.V., Plotnikov I.A., Guseynov R.G.  

Altay State Medical University,

Regional Clinical Hospital of Emergency Medical Care,

Barnaul, Russia

In the structure of disability caused by the consequences of injuries to the extremities, fractures of the lower leg occupy the leading place. The greatest difficulties for treatment are infected diaphysis defects after severe open fractures. In the middle of the 20th century, the outstanding domestic traumatologist-orthopedist G.A. Ilizarov proposed the bilocal combined compression-distraction osteosynthesis for replacing the diaphysis defects, which consists in the formation of a distraction regenerate when an osteotomized fragment of one of the fragments is moved through the defect zone. However, studies have shown that the main reason for the lack of consolidation was the natural extinction or complete cessation of the reparative reaction at the site of contact of the fragments.

Objective – to conduct a comparative analysis of the use of combined sequential bilocal osteosynthesis and the traditional technique of transosseous compression-distraction osteosynthesis in the treatment of post-traumatic tibial diaphysis defects.

Materials and methods. Between 2009 and 2018, in the department of severe concomitant injury of Barnaul Regional Clinical Hospital of Emergency Medical Care, 23 patients with polytrauma (PT) with ISS of 26-40 were treated. One of the components of PT was an open comminuted irregular fracture of the tibia with a defect of bone tissue. In the process of research, two groups were formed by means of random distribution – the main and control. The main group included 14 patients who received the original method of treatment, which consisted in combined sequential use of one of the fragments of transosseous osteosynthesis with Ilizarov apparatus and undreamed tibial nail (UTN) after lengthening osteotomy. The size of the tibia defect in patients of the main group ranged from 2 to 7 cm, an average of 3.9 ± 0.9 cm. The comparison group (control) consisted of 9 patients who received the traditional Ilizarov method of bilocal transosseous compression-distraction osteosynthesis. The size of the tibia defect in patients of the control group ranged from 2 to 7 cm, an average of 3.6 ± 1.6 cm. There were no statistically significant differences in the main parameters (gender, age, severity of PT, defect size, etc.) between the groups.

Results and discussion. The shorter duration of external fixation in the main group made it possible to reduce the frequency of local complications, to decrease the overall duration of treatment, and to improve highly the quality of life of patients at the stage of reconstruction of distraction regenerate. Replacing the apparatus with the locking intramedullary nail during the formation of the distraction regenerate and the fusion of fragments at the junction made it possible to achieve strong fusion of fragments at the junction, eliminating additional surgical interventions, and ensuring optimal quality of life during the reconstruction of the distraction regenerate.

Conclusion. In the period of reconstruction of bone regenerate, the use of the locking nail in bilocal osteosynthesis showed the statistically significant decrease in the incidence of local complications (p < 0.05), with 6.5-fold decrease in time of fixation with Ilizarov apparatus after completion of movement of a fragment, resulting in significant improvement in life quality and 1.4-fold decrease in total period of treatment.

Key words: bone defect; osteosynthesis; leg fractures.

Information about authors:

Bondarenko A.V., MD, PhD, professor, chief of severe and associated injury unit, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Plotnikov I.A., candidate of medical science, chief resident of severe and associated injury unit, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Guseynov R.G., traumatologist-orthopedist, severe and associated injury unit, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Address for correspondence:

Plotnikov I.A., Komsomolsky prospect, 73, Barnaul, Russia, 656038

Tel: +7 (923) 655-15-06

E-mail: Ivan_Plotnikov85@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.             Bondarenko AV, Raspopova EA, Peleganchuk VA. Treatment of opened diaphyseal fractures of the leg. Barnaul, 1999. 43 p. Russian

3.             Agadzhanyan VV, Pronskikh AA, Orlov AN. Our experience with treatment of closed diaphyseal fractures of the leg. Traumatology and Orthopedics of Russia. 1998; (2): 7-10. Russian

4.             Shevtsov VI, Makushin VD. Organ-saving surgery: intertibial synostosis with Ilizarov apparatus. Kurgan: Transurals, 2008. 583 p.   Russian

5.             Shevtsov VI, Shved SI, Sysenko YuM. Transosseous fixation for treatment of fragmented fractures. Kurgan, 2002. 331 p. Russian

6.             Barabash AP. Transosseous fixation for replacement of defects of long bones. Irkutsk, 1995. 208 p. Russian

7.             Ilizarov GA. Some issues of theory and practice of compression and distraction osteosynthesis. Transosseous compression and distraction osteosynthesis: collection of scientific works. Vol. 1. Kurgan, 1972. P. 5-33.   Russian

8.             Ilizarov GA. Clinical and theoretical aspects of compression and distraction osteosynthesis: abstracts of reports of All-Union scientific and practical conference. Kurgan, 1976. P. 7-10. Russian

9.             Ilizarov GA. Some theoretical and clinical aspects of transosseous osteosynthesis from perspectives of general biological regularities discovered by us. Experimental, theoretical and clinical aspects of transosseous osteosynthesis developed in Kurgan Research Institute of Experimental and Clinical Orthopedics and Traumatology: abstracts of reports of All-Union scientific and practical conference. Kurgan, 1986. P. 7-12.     Russian

10.         Goshko VYu. Features of union at site of conjunction of transferred non-free bone fragment in replacement of a diaphyseal defect. In: Orthopedics, Traumatology and Prosthetics: Republican Interdepartmental Collection. Kiev, 1986; 16: 33-36.    Russian

11.         Shafit SE, et al. Results of treatment of tibial defects by means of bilocal distraction-compression osteosynthesis (18 years of experience with Ilizarov’s technique). Traumatology and Orthopedics of Russia. 2004; 3: 73.   Russian

12.         Kuftyrev LM, Borzunov DYu, Bolotov DD. A variant of use of additional osteotomy for slow formation of distraction regenerate. Genius of Orthopedics. 2003; (1): 51-53. Russian

13.         Ilizarov GA, Shevtsov VI, Shestakov VA, Mirzoyan AE. Techniques for increasing the mechanical strength of union at site of conjunction of bone fragments. Guidelines. Kurgan, 1984. 17 p. Russian

14.         Ryudi TP, Bakli RE, Moran KG. AO-principles of fracture management. Vol. 2. Translated into Russian by Sitnik AA. Edition 2, revised and corrected. Berlin, 2013. P. 543-554. Russian

15.         Stetsula VI, Veklich VV. Basics of controlled transosseous osteosynthesis. Moscow: Medicine, 2003 224 p. Russian

16.         Hem A, Kormak D. Hystology. Translated from English. Moscow: Mir, 1983. Vol. 3. 293 p. Russian

17.         Lavrishcheva GI, Onoprienko GA. Morphological and clinical aspects of reparative regeneration of supporting organs and tissues. Moscow: Medicine, 1996. 208 p. Russian

18.         Ryudi TP, Bakli RE, Moran KG. AO-principles of fracture management. Vol. 2. Ttranslated into Russian by Sitnik AA. Edition 2, revised and supplemented. Berlin, 2013; 256-285. Russian

19.         Perren SM. Biomechanics and biology of internal fixation with nails and plates. Bulletin of CJSC Matis. 1995; (4-1): 1-8. Russian

20.         Fokin VA, Volna AA. Biological osteosynthesis – Status Praesens // Margo Anterior. 1999; (1): 1-2. Russian

21.         Vagner M. Concept of surgical management of fractures. Margo Anterior. 2006; (3): 1-5. Russian

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

23.         A way of treatment of opened fragmented diaphyseal fractures of the leg with bone tissue defect: the patent 2681114. Russian Federation. No. 2018104935. Bondarenko AV, Plotnikov IA, Guseynov RG; application from February 8, 2018; published on March 3, 2019. Russian

24.         Glants S. Medicobiological statistics: translated from English. Moscow: Practice, 1998. 459 p. Russian

Clinical aspects of neuro-surgery

Results of revision surgery for degenerative dystrophic diseases of the lumbosacral spine

Abakirov M.D., Nurmukhametov R.M., Mamyrbaev S.T., Al-Bavarid O.A.

Abakirov M.D., Nurmukhametov R.M., Mamyrbaev S.T., Al-Bavarid O.A.

Peoples’ Friendship University of Russia,

Central Clinical Hospital of Russian Academy of Sciences,

City Clinical Hospital No.17,

Demikhov City Clinical Hospital,

Moscow, Russia

Degenerative dystrophic diseases of the lumbosacral spine present the common problem for healthcare in the whole world. The requirement for revision surgery is still high and gives variable outcomes.

Objective – to conduct the comparative analysis of results of revision surgery for degenerative dystrophic diseases of the lumbosacral spine with use of transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF).

Materials and methods. The study included 50 patients with degenerative dystrophic diseases of the lumbosacral spine who had received revision surgery with ALIF and TLIF in 2017-2019. The patients were distributed into two groups, depending on surgery type. The group 1 included 26 patients, age of 31-84 (59.8 ± 14), treated with TLIF. There were 12 men (46.2 %) and 14 women (53.8 %). The group 2 included 24 patients, age of 23-67 (46.9 ± 12.3), operated with ALIF. The ratio men/women was 16 (66.7 %) : 8 (33.3 %).

Results. The group 2 (ALIF and TPF) showed the statistically significant results of VAS before surgery (7.3 ± 1.2; after surgery – 1.7 ± 0.4; p < 0.001), ODI before surgery (50.4 ± 11.5; after surgery – 10 ± 4.6; p < 0.001). The group 1 with decompressive stabilizing interventions with TLIF also achieved statistically significant results: presurgical VAS – 7.8 ± 0.8, postsurgical VAS – 2.7 ± 1.6, p < 0.001; presurgical ODI – 56.2 ± 10.2, postsurgical ODI – 20.6 ± 13.9, p < 0.001. However, the comparative analysis showed better values of VAS and ODI in the group 2 than in the group 1 (p < 0.001).

Conclusion. ALIF in combination with TPF as technique of revision surgery theoretically allows complex discectomy for recurrent disk hernia, prevents a recurrent incision of paraspinal muscles, with lower postsurgical pain and lower intrasurgical blood loss, and less injuries to the spinal cord and roots as result of traction. Moreover, the anterior approach to the lumbar spine allows installing bigger cages with more contact surface, resulting in correction of lumbar lordosis and recovery of sagittal balance, which is also important in revision surgery for degenerative dystrophic diseases of the lumbosacral spine. However, ALIF has some risks. One of the main complications is magistral vessel damage and retrograde ejaculation.

Key words: revision surgery; recurrent disk hernia; pseudoarthrosis; adjacent segment syndrome; ALIF; TLIF.                        

Information about authors:

Abakirov M.D., MD, PhD, professor at department of traumatology and orthopedics, Peoples’ Friendship University of Russia, traumatologist-orthopedist at vertebrology unit, Central Clinical Hospital of Russian Academy of Sciences, Moscow, Russia.

Nurmukhametov R.M., candidate of medical science, traumatologist-orthopedist, neurosurgeon, chief of vertebrology unit, Central Clinical Hospital of Russian Academy of Sciences, Moscow, Russia.

Mamyrbaev S.T., postgraduate at department of traumatology and orthopedics, Peoples’ Friendship University of Russia, Moscow, Russia.

Al-Bavarid O., postgraduate at department of traumatology and orthopedics, Peoples’ Friendship University of Russia, Moscow, Russia.

Address for correspondence:

Mamyrbaev S.T., Miklukho-Maklaya St., 6, Moscow, Russia, 117198

Tel: +7 (910) 424-04-80

E-mail: mamyrbaev-samat@mail.ru

REFERENCES:

1.        Ravindra VM, Steven SS, Abbas R, Michael CD, Roger H, Erica B, et al. Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J. 2018; 8(8): 784–794. doi: 10.1177/2192568218770769.

2.        Hosni HS, Tarek HA. Revision surgery in lumbar degenerative disease. Zagazig University Medical Journals. 2019; 25(3): 344-349 .DOI: 10.21608/ZUMJ.2019.30933.

3.        Phillips FM, Carlson GD, Bohlman HH, Hughes SS. Results of surgery for spinal stenosis adjacent to previous lumbar fusion. Journal of Spinal Disorders. 2000; 13(5): 432–437. DOI:10.1097/00002517-200010000-00011.

4.        Riccardo C, Alessandro P, Valentina M, Venceslao W, Emanuele P, Sergio P, et al. Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up. J OrthopTraumatol. 2018; 19(1): 6. DOI: 10.1186/s10195-018-0497-8.

5.        Zagorodniy NV, Abakirov MD, Dotsenko VV. Recurrent surgery for lumbar spine in degenerative diseases. New Medical Technologies. 2008; (3): 16-39. Russian

6.        Bulakhtin YuA, Bulakhtin YuYu. Surgical treatment of patients with failed back surgery syndrome. Health. Medical Ecology. Science. 2012; 1-2 (47-48): 69. Russian

7.        Kim CH, Chung CK, Park CS, Choi B, Kim MJ, Park BJ. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study. Spine (Phila Pa 1976). 2013; 38(7): 581-590. doi: 10.1097/BRS.0b013e318274f9a7.

8.        Seung-PS, Young-HJ, Hae WJ, Won RC, Chang-NK. Outcomes of revision surgery following instrumented posterolateral fusion in degenerative lumbar spinal stenosis: a comparative analysis between pseudarthrosis and adjacent segment disease. Asian Spine J. 2017; 11(3): 463–471. doi: 10.4184/asj.2017.11.3.463.

9.        Justin MD, Rachel MD, Christopher M.B. Recurrent lumbar spinal stenosis: Etiology and surgical management. Seminars in Spine Surgery. 2013; 25(4): 283-294 . doi.org/10.1053/j.semss.2013.05.009

10.    Chirchiglia D, Chirchiglia P, Murrone D. Postural instability after lumbar spinal surgery: are there any predictive factors? A case control study. Chin Neurosurg J. 2018; 4, 40. doi:10.1186/s41016-018-0147-2.

11.    Yang JC, Kim SG, Kim TW, Park KH. Analysis of factors contributing to postoperative spinal instability after lumbar decompression for spinal stenosis. Korean J Spine. 2013; 10(3): 149–154. doi: 10.14245/kjs.2013.10.3.149  

12.    Michael CG, Dante L, Peter GP, Virginie L, Kristina B, Alexandra L, et al. Risk factors for reoperation in patients treated surgically for lumbar stenosis. A subanalysis of the 8-year data from the SPORT Trial. Spine. 2016; 41(10): 901-909.

13.    Modhia U, Takemoto S, Braid-Forbes MJ, Weber M, Berven SH. Readmission rates after decompression surgery in patients with lumbar spinal stenosis among Medicare beneficiaries. Spine (Phila Pa 1976). 2013; 38(7): 591-596. doi:10.1097/BRS.0b013e31828628f5.

14.    Etminan M, Girardi FP, Khan SN, Cammisa FP Jr. Revision strategies for lumbar pseudarthrosis. Orthop Clin N Am. 2002; 33(2): 381 – 392. doi.org/10.1016/S0030-5898(02)00005-6.

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16.    Gologorsky Y, Skovrlj B, Steinberger J, Moore M, Arginteanu M, Moore F, et al. Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis: clinical article. J Neurosurg Spine. 2014; 21(4): 601-607. doi: 10.3171/2014.6.SPINE13488.

17.    Saleh SB, Belen GM, David CN. Long-Term outcomes of posterior lumbar interbody fusion using stand-alone ray threaded cage for degenerative disk disease: a 20-year follow-up. Asian Spine Journal. 2016; 10(6):1100-1105. DOI: https://doi.org/10.4184/asj.2016.10.6.1100.

18.    Leven D, Passias PG, Errico TJ, Lafage V, Bianco K, Lee A, et al. Risk factors for reoperation in patients treated surgically for intervertebral disc herniation: a subanalysis of eight-year SPORT Data. J Bone Joint Surg Am. 2015; 97(16): 1316–1325. doi: 10.2106/JBJS.N.01287.

19.    El-Sharkawiorcid M, Koptan W, Miligui YEl. Transforaminal lumbar interbody fusion (TLIF) for revision of failed posterolateral spinal fusion. Egyptian Spine Journal (ESJ). 2012; 2: 1-9. DOI: 10.21608/ESJ.2012.3784.

20.    Okuda S, Yamashita T, Matsumoto T, Nagamoto Y, Sugiura T, Takahashi Y, et al. Adjacent segment disease after posterior lumbar interbody fusion: a case series of 1000 patients. Global Spine J. 2018; 8(7): 722–727. doi: 10.1177/2192568218766488.

21.    Panjabi MM, White AA 3rd. Basic biomechanics of the spine. Neurosurgery. 1980; 7(1): 76-93. DOI: 10.1227/00006123-198007000-00014.

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24.    Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiology. 1999; 28(4), 215–219. doi:10.1007/s002560050503.

25.    Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine. 2010; 35(21): 1919–1924. doi:10.1097/brs.0b013e3181d359bd.

26.    Bartynski WS, Lin L. Lumbar root compression in the lateral recess: MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation. AJNR Am J Neuroradiol. 2003; 24(3): 348-360.

27.    Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, et al. A practical MRI grading system for lumbar foraminal stenosis. Am. J. Roentgenol. 2010; 194(4): 1095-1098. DOI:10.2214/AJR.09.2772.

28.    Choudhri TF, Mummaneni PV, Dhall SS, Eck JC, Groff MW, Ghogawala Z, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion status. J. Neurosurg. Spine. 2014; 21(1): 23-30. doi:10.3171/2014.4.SPINE14267.

29.    Cherepanov EA. Russian version of Oswestry questionnaire: cultural adaptation and validity: practical recommendations. Spine Surgery. 2009; (3): 93-98. Russian

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36.    Ralph JM, Kevin P, Ganesha KT, Prashanth JR. Anterior lumbar interbody fusion as a salvage technique for pseudarthrosis following posterior lumbar fusion surgery. Global Spine J. 2016; 6(1): 14–20. DOI http://dx.doi.org/ 10.1055/s-0035-1555656.

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Functional, instrumental and laboratory diagnostics

Monitoring of hematological parameters of inflammation in development of fatal multiple organ dysfunction in a patient with sepsis of high risk group

Ustyantseva I.M., Kulagina E.A., Aliev A.R., Goloshumov N.P., Agadzhanyan V.V.

Ustyantseva I.M., Kulagina E.A., Aliev A.R., Goloshumov N.P., Agadzhanyan V.V.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to present a clinical case of complex diagnostic approach with use of monitoring of hematological parameters of inflammation in development of fatal multiple organ dysfunction in a patient with sepsis of high risk group.

Materials and methods. The patient T., female, age of 39, was admitted to the admission unit of Regional Clinical Center of Miners’ Health Protection on December 20, 2019. There were complaints of abdominal pain, hemafecia, general uneasiness, intense weakness and respiratory embarrassment. Urgent surgery was conducted: laparotomy, revision resection of a part of small intestine, abdominal sanitation, laparostomy. Postsurgical diagnosis: “Necrosis of a part of small intestine, perforation. Purulent lymphoadenopathy of mesoileum, lymphoadenopathy of retroperitoneal lymph nodes. General purulent fibrinous peritonitis. Hepatitis C, B 20-24”.

In the intensive care unit, the hematological parameters of inflammation were estimated with Sysmex XN 1000 analyzer (Japan). Serum C-reactive protein (CRP) was measured with immunoturbidimetric method. Procalcitonin (PCT) was measured with immunochemical method. Biochemical analyses were performed with Cobas 6000 (Roche, Switzerland).

Results. The high probability of fatal multiple organ disorders was determined by massive infection focus and sepsis in combination with viral infection (hepatitis C, B20-B24). Multiresistant gram-negative flora Klebsiella pneumonia was determined as the infectious agent. The clinical manifestations of the infectious process were anemia, a trend to hypothermia (up to 35.5 °С), leucopenia, lymphocytopenia, thrombocytopenia, increasing levels of PCT and CRP. Organ failure was manifested in view of renal and respiratory insufficiency, and vascular dysfunction. Maximal SOFA was 16.

Gradually increasing intense leucopenia was accompanied by significant increase in amount of neutrophils up to 95 % and immature granulocytes (IG) (16.3 % - 27.9 %). The values of neutrophil activation NEUT-RI were 61.3 % higher than the normal reference values of NEUT-GI and RE-LYMPH. A single increase of AS-LYMP to 0.7 % was observed on the second day.

Despite of intensive therapy, the patient died on the seventh day at the background of multiple organ failure and septic shock. Tuberculosis colitis (caused by M. Tuberculosis) with perforation and peritonitis was confirmed by results of histological examination of surgical materials with Ziehl-Nilson staining for acid-resistant bacteria.           

Conclusion. The presented clinical case shows the example of use of monitoring of neutrophil activation status (NEUT-RI and NEUT-GI), immature granulocytes (IG) and lymphocytes (AS-LYMP) for estimation of intensity of systemic inflammation, generalized infectious process and progression of organ failure. Moreover, a significant increase in NEUT-RI and IG in the blood can determine the risk of development of multiple organ disorders at the background of bacterial and viral infection.

Key words: neutrophil activation status (NEUT-RI, NEUT-GI), immature granulocytes (IG), lymphocytes (AS-LYMP); monitoring; sepsis.   

Information about authors:

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.

Kulagina E.A., physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Aliev A.R., physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Goloshumov N.P., anesthesiologist-intensivist, intensive care unit, 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.

Address for correspondence:

Ustyantseva I.M., Regional Clinical Center of Miners’ Health Protection, 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 2-38-88

E-mail: irmaust@gnkc.kuzbass.net

REFERENCES:

1.       Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801-810.

2.       Rudnov VA, Kulabukhov VV. Sepsis – 3: revised key positions, potential problems and further practical steps. Herald of Anesthesiology and Critical Care Medicine. 2016; 13(4): 4-11. Russian

3.       Simpson SQ. SIRS in the time of Sepsis-3. Chest. 2018; 153(1): 34-38.

4.       Park SH, Park CJ, Lee BR, Nam KS, Kim MJ, Han MY, et al.Park SH et al. Sepsis affects most routine and cell population data   (CPD) obtained using the Sysmex XN-2000 blood cell analyzer: neutrophil-related CPD NE-SFL and NE-WY provide useful information for detecting sepsis. 2015; Int j Lab Hematol. 37(2): 190-198.

5.       Pekelharing JM, Hauss O, de Jonge R, Lokhoff J, Sodikromo   J, Spaans M, et al. Haematology reference intervals for established and novel parameters in healthy adults. Sysmex Journal International. 2010; 20(1): 1-9.

6.       Ustyantseva IM, Khokhlova OI, Agadzhanyan VV. Innovative laboratory technologies in diagnosis of sepsis. Polytrauma. 2018; (1): 52-59. Russian

7.       Ustyantseva IM, Khokhlova OI, Agadzhanyan VV. Innovative technologies in the evalution of the neutrophil funcchional activity in sepsis. Sysmex Journal International. 2019; 29 (1) 34-39.

8.       Ustyantseva IM, Kulagina EA, Aliev AR, Agadzhanyan VV. Relationship between extended inflammatory parameters of hematologic analysis (neut-ri, neut-gi, re-lymp, as-lymp) with risk of infection in polytrauma. Polytrauma. 2019; 3: 6-15. Russian

9.       Senthilnayagam B, Kumar T, Sukumaran J, M J, Rao K R. Automated measurement of immature granulocytes: performance characteristics and utiliti in routine clinical practice. Patholog Res Int. 2012; 2012: 483670.

10. Cornet E, Boubaya M, Troussard X. Contribution of the new XN-1000 parameters NEUT-RI and NEUT-WY for managing patients with immature granulocytes. Int j Lab Hematol. 2015; 37(5): e123-6.

Researches of young scientists

COSMETIC RESULTS OF RECONSTRUCTIVE NEUROSURGICAL INTERVENTIONS ON THE SKULL

Koporushko N. A., Mishinov S.V., Kangel'diev A.E., Stupak V.V.

Koporushko N. A., Mishinov S.V., Kangel'diev A.E., Stupak V.V.

Tsivyan Research Institute of Traumatology and Orthopedics,

Novosibirsk, Russia

Introduction. According to the literature, there is no single system for evaluating the result of reconstructive surgery in patients with post-trepanation defects of the skull bones. In the course of the study, a scale was created that allows evaluating the cosmetic result after performing cranioplasty. It is also necessary to conduct a comparative analysis between the two types of implants in order to determine the impact of the choice of implantable products on the cosmetic result.

Objective – to estimate the cosmetic results of reconstructive interventions in patients with skull bone defects using individual plates made using three-dimensional printing, and standard titanium implants.

Materials and methods. The clinical material consisted of 161 patients with skull bone defects operated at Tsivyan Research Institute of Traumatology and Orthopedics from 2009 to 2019. The following parameters were analyzed: average age, gender, duration of postoperative observation, the localization and size of a bone defect. The analysis of the obtained cosmetic results was performed according to the data of the scale developed by us.

Statistical processing of the obtained materials was carried out with Statistica V. 10 software. Reliability was determined with statistical methods (the Mann-Whitney test, the exact Fisher’s method). The developed scale was validated by splitting the test and calculating the Kronbach alpha.

Results. All patients were divided into two groups: the study group (80 patients with individual titanium plates installed) and the comparison group (81 patients using standard titanium implants). In the study group, all results obtained were excellent. In the comparison group, excellent cosmetic results were obtained in 76 % of cases, good results were achieved in 9 %, satisfactory ones – in 8 % and unsatisfactory – in 5 % of patients. Statistical analysis showed that the results obtained depended on the type of implant used.

Conclusion. The use of the individual implant for big and extensive cranial defects gives excellent outcomes in 100 % of cases. The use of the standard implant for patients with extensive cranial defects results in excellent results in 68 %, for subgroup with big defects – in 77.8 %.

The individual implant produced with three-dimensional printing is the method of choice in reconstructive surgery for closing extensive and big cranial defects.

Key words: cosmetic results; skull bone defect; traumatic brain injury; treatment result; cranioplasty; implant.

Information about authors:

Koporushko N. A., postgraduate at neurosurgery unit, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Mishinov S.V., candidate of medical science, senior researcher, department of neurosurgery, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Kangel'diev A.E., resident at neurosurgery unit, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Stupak V.V., MD, PhD, professor, head of research department, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Address for correspondence:

Koropushko A.V., Frunze St., 17, Novosibirsk, Russia, 630091

Tel: +7-913-765-99-21

E-mail: nickolai92@mail.ru

REFERENCES:

1. Koropushko NA, Stupak VV, Mishinov SV, Orlov KYu. Astrakov SV, Vardosanidze VK, et al. Etiology and epidemiology of acquired cranial defects in various abnormalities of central nervous system, and number of patients requiring for defect closure by the example of a big industrial city. Modern Problems of Science and Education. 2019; (2): 120-130. DOI: 10.17513/spno.28660 Russian

2. Fiaschi P, Pavanello M, Imperato A, Dallolio V, Accogli A, Capra V, et al. Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience. Journal of Neurosurgery: Pediatrics. 2016; 17(6): 705-710. https://doi.org/10.3171/2015.10.PEDS15489

3. Jaberi J, Gambrell K, Tiwana P, Madden C, R. Finn Long-term clinical outcome analysis of poly-methyl-methacrylate cranioplasty for large skull defects. Journal of Oral and Maxillofacial Surgery. 2013; 71(2): e81-e88. https://doi.org/10.1016/j.joms.2012.09.023

4. Jonkergouw J, Van de Vijfeijken SE, Nout E, Theys T, Van de Casteele E, Folkersma H, Becking AG. Outcome in patient-specific PEEK cranioplasty: a two-center cohort study of 40 implants. Journal of Cranio-Maxillofacial Surgery. 2016; 44(9): 1266-1272. https://doi.org/10.1016/j.jcms.2016.07.005

5. O'Reilly EB, Barnett S, Madden C, Welch B, Mickey B, Rozen S. Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015; 68(3): 329-338. https://doi.org/10.1016/j.bjps.2014.11.001

6. Park EK, Lim JY, Yun IS, Kim JS, Woo SH, Kim DS, Shim KW. Cranioplasty enhanced by three-dimensional printing: custom-made three-dimensional-printed titanium implants for skull defects. Journal of Craniofacial Surgery. 2016; 27(4): 943-949. https://doi: 10.1097/SCS.0000000000002656

7. Schwarz F, Dünisch P, Walter J, Sakr Y, Kalff R, Ewald C. Cranioplasty after decompressive craniectomy: is there a rationale for an initial artificial bone-substitute implant? A single-center experience after 631 procedures. Journal of Neurosurgery. 2016; 124(3): 710-715. https://doi.org/10.3171/2015.4.JNS159

8. Rotaru H, Stan H, Florian IS, Schumacher R, Park YT, Kim SG, et al. Cranioplasty with custom-made implants: analyzing the cases of 10 patients. Journal of Oral and Maxillofacial Surgery. 2012; 70(2): e169-e176. https://doi.org/10.1016/j.joms.2011.09.036

9. Goh RC, Chang CN, Lin CL, Lo LJ. Customised fabricated implants after previous failed cranioplasty. Journal of plastic, reconstructive & aesthetic surgery. 2010; 63(9):1479-1484. https://doi.org/10.1016/j.bjps.2009.08.010

10. Lee SC, Wu CT, Lee ST, Chen PJ. Cranioplasty using polymethyl methacrylate prostheses. Journal of clinical neuroscience. 2009; 16(1): 56-63. https://doi.org/10.1016/j.jocn.2008.04.001

11. Liu JK, Gottfried ON, Cole C., Dougherty WR, Couldwell WT. Porous polyethylene implant for cranioplasty and skull base reconstruction. Neurosurgical focus. 2004; 16(3): 1-5. https://doi.org/10.3171/foc.2004.16.3.14

12. Scholz M, Wehmöller M, Lehmbrock J, Schmieder K, Engelhardt M, Harders A, et al. Reconstruction of the temporal contour for traumatic tissue loss using a CAD/CAM-prefabricated titanium implant-case report. Journal of cranio-maxillofacial surgery. 2007; 35(8): 388-392. https://doi.org/10.1016/j.jcms.2007.06.006

13. Mishinov SV, Stupak VV, Koporushko NA, Samokhin AG, Panchenko AA, Krasovskii IB, et al. Titanium patient-specific implants in reconstructive neurosurgery. Biomedical Engineering. 2018; 52(3): 152-155.

14. Mishinov SV, Stupak VV, Koropushko AN. Cranioplasty: review of techniques and new technologies in development of implants. Polytrauma. 2018; (4): 82-89. Russian

15. Konovalov A, Potapov AA, Likhterman LB, Kornienko VN, Kravchuk AD, Okhlopkov VA, et al. Reconstructive and minimal invasive surgery of consequences of traumatic brain injury. Moscow, 2012. 318 p. Russian

16. Potapov AA, Kravchuk AD, Likhterman LB, Okhlopkov VA, Chobulov SA, Maryakhin AD. Reconstructive surgery of cranial defects: clinical recommendations. Association of Neurosurgeons of Russia. Moscow, 2015. 22 p. Russian

17. Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic plastic surgery. 2000; 24(3): 192-197. https://doi.org/10.1007/s002660010031

18. Fischer C.M., Burkhardt J.K., Sarnthein J., Bernays R.L., Bozinov O. Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty—a questionnaire-based single-centre study. Neurological research. 2012; 34(3): 281-285. https://doi.org/10.1179/1743132812Y.0000000007

19. Balossier A, Durand A, Achim VV, Noudel R, Hurel S, Emery E. Reconstruction of the cranial vault using CAD/CAM-fabricated glass bioceramic implants. Neuro-Chirurgie. 2011; 57(1): 21-27. DOI: 10.1016/j.neuchi.2010.08.003

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Case history

Use of venovenous extracorporeal membrane oxygenation without heparin for a patient with concomitant injury

Skopets A.A., Zharov A.S., Potapov S.I., Afonin E.S., Utegulov M.G., Kozlov D.V., Chibirov S.K., Mukhanov M.L., Shevchenko A.V., Baryshev A.G., Porkhanov V.A.

Skopets A.A., Zharov A.S., Potapov S.I., Afonin E.S., Utegulov M.G., Kozlov D.V., Chibirov S.K., Mukhanov M.L., Shevchenko A.V., Baryshev A.G., Porkhanov V.A.

Research Institute-Ochapovsky Regional Clinical Hospital No.1,

Kuban State Medical University,

Krasnodar, Russia

Objective – to discuss the possibilities of extracorporeal life support in patients with trauma profile.

Materials and methods. Patient K., female, age of 19, received a severe concomitant injury as result of a road traffic accident. On September 26, 2019, the fourth day after the road traffic accident, she was transferred from the level 2 trauma center (central regional hospital) to the level 1 trauma central where she had received six days of veno-venous extracorporeal membrane oxygenation (VV-ECMO) at the background of severe respiratory failure with extremely severe condition after the concomitant injury, unstable hemodynamics and metabolic disorders.

Results. This report presents a clinical case of successful use of VV-ECMO in a victim with severe concomitant injury with severe acute respiratory distress syndrome (ARDS) on the 5th day of the injury. The peculiarity of the case was refusal from systemic anticoagulation due to the risk of hemorrhagic complications. On the day 6, the patient was successfully weaned from VV-ECMO, and on the day 4, after being disconnected from VV-ECMO, the patient underwent osteosynthesis of the lower leg bones. On the 7th after the operation, the patient was discharged from the hospital at the place of residence in a satisfactory condition.

We described the case of successful use of VV-ECMO without heparin in the patient with severe concomitant injury complicated by the development of ARDS.

Conclusion. VV-ECMO can serve as an additional treatment method for adult patients with severe closed lung injury or acute respiratory failure resistant to traditional ventilation. In patients with severe chest trauma and concomitant hemorrhagic shock, if closely monitored, VV-ECMO can be a safe and effective life-saving method.

Key words: concomitant injury; ARDS; veno-venous ECMO; systemic anticoagulation.

Information about authors:

Skopets A.A., candidate of medical science, chief of anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, docent at department of anesthesiology, critical care medicine and transfusiology of advanced training and professional retraining faculty, Kuban State Medical University, Krasnodar, Russia.

Zharov A.S., anesthesiologist-intensivist, anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Potapov S.I., anesthesiologist-intensivist, anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Afonin E.S., anesthesiologist-intensivist, anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Utegulov M.G., anesthesiologist-intensivist, anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Kozlov D.V., anesthesiologist-intensivist, anesthesiology and reanimation unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Chibirov S.K., endovascular surgeon, unit of X-ray surgery methods of diagnosis and treatment, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Mukhanov M.L., candidate of medical science, assistant at department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Shevchenko A.V., chief of traumatology and orthopedics unit No.2, Research Institute-Ochapovsky Regional Clinical Hospital No.1, chief non-staff traumatologist-orthopedist of Krasnodar region, Krasnodar, Russia.

Baryshev A.G., MD, PhD, chief of surgery department No.1 of advanced training and professional retraining faculty, Kuban State Medical University, deputy chief physician of surgical care, Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Porkhanov V.A., MD, PhD, professor, academician of RAS, chief physician at Research Institute-Ochapovsky Regional Clinical Hospital No.1, Krasnodar, Russia.

Address for correspondence:

Skopets Alexander Alekseevich, Rossiyskaya St., 140, Krasnodar, Russia, 350086

Tel: +7 (961) 850-49-49

E-mail: alskop1961@mail.ru

REFERENCES:

1.        Paden ML, Conrad SA, Rycus PT, Thiagarajan RR. Extracorporeal Life Support Organization Registry Report. 2012. ASAIO J. 2013; 59(3): 202-210.

2.        Park PK, Napolitano LM, Bartlett RH. Extracorporeal membrane oxygenation in adult acute respiratory distress syndrome. Crit Care Clin. 2011; 27 (3):627-646.

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A CLINICAL CASE OF MULTI-STAGE
SURGICAL TREATMENT OF A PATIENT
WITH VERTEBRAL IMPLANT-ASSOCIATED INFECTION

Kochnev E.Ya., Mukhtyaev S.V., Meshcheryagina I.A., Grebenyuk L.A.

Kochnev E.Ya., Mukhtyaev S.V., Meshcheryagina I.A., Grebenyuk L.A.

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics,

Kurgan, Russia

The relevance of the work is due to the high risk of infection in the field of surgical intervention on the spine during polytrauma.

Objective – to show a clinical example of the result of multi-stage surgical treatment of a patient with polytrauma, complicated by vertebral implant-associated infection and neurological deficit.

Material and methods. Patient A., 45 years old, was operated on at the place of residence after a catastrophe due to a fracture of the L2 vertebra from the thoracolumbomotomy access. At the same time, the patient underwent osteosynthesis of the bones of the right lower leg and left tarsus. In the early postoperative period, suppuration occurred in the area of the implanted metal structure on the spine. The patient underwent a complex multi-stage surgical intervention in connection with the development of chronic osteomyelitis of the lumbar vertebrae, fistulous form, the integration of external and internal stabilizing transpedicular systems, followed by corporodesis.

Results. The patient was examined 2 years after the last stage of surgical treatment. There were no signs of purulent process, pain and reduced neurological deficit. She could walk without additional means of support.

Conclusion. The selected tactics of complex multi-stage treatment in this patient, based on the clinical picture of the disease, adherence to the sequence and principles of treatment of purulent processes, made it possible to solve all the problems in this case: to achieve persistent remission of the purulent process, to improve the patient's quality of life.

Key words: polytrauma; implant-associated infection; transpedicular fixation; interbody fusion.

Information about authors:

Kochnev E.Ya., postgraduate of the second year of study, traumatologist-orthopedist at admission department, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Mukhtyaev S.V., candidate of medical science, neurosurgeon, purulent traumatologic and orthopedic unit No.3, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Meshcheryagina I.A., candidate of medical science, neurosurgeon, chief of traumatology and orthopedics unit No.15, senior researcher of research clinical laboratory of multiple, concomitant and combat injury, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Grebenyuk L.A., candidate of biological science, senior researcher at research osteology, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.

Address for correspondence:

Kochnev E.Ya., 9 May St., 4, build. 1, 279, Kurgan, Russia, 640014

Tel: +7 (983) 575-10-71

E-mail: Newakromion@list.ru

REFERENCES:

1.                Lonjon G, Dauzac C, Fourniols E, Guigui P, Bonnomet F, Bonnevialle P. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthopaedics & Traumatology: Surgery & Research. 2012; 98(7): 788-794. DOI: 10.1016/j.otsr.2012.07.006

2.                Spina NT, Aleem IS, Nassr A, Lawrence BD. Surgical site infections in spine surgery: preoperative prevention strategies to minimize risk. Global Spine Journal. 2018; 8(4 Suppl): 31S-36S. DOI: 10.1177/2192568217752130

3.                Demura S, Kawahara N, Murakami H, Nambu K, Kato S, Yoshioka K, Okayama T, Tomita K. Surgical site infection in spinal metastasis: risk factors and countermeasures. Spine (Phila Pa 1976). 2009; 34(6): 635-639. DOI: 10.1097/BRS.0b013e31819712ca

4.                Smekalenkov OA, Ptashnikov DA, Bozhkova SA, Mikhaylov DA, Masevnin SV, Zaborovsky NS et al. Risk factors of deep infection of surgical site after spinal surgery. Genius of Orthopedics. 2019; 25(2): 219-225. DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-2-219-225) Russian

5.                Shillingford JN, Laratta JL, Reddy H, Ha A, Lehman RA Jr, Lenke LG, et al. Postoperative surgical site iInfection after spine surgery: an update from the scoliosis research society (SRS) morbidity and mortality database. Spine Deform. 2018; 6(6): 634-643. DOI: 10.1016/j.jspd.2018.04.004

6.                Warner SJ, Uppstrom TJ, Miller AO, O'Brien ST, Salvatore CM, Widmann RF, et al. Epidemiology of deep surgical site infections after pediatric spinal fusion surgery. Spine (Phila Pa 1976). 2017; 42(3): E163-E168. DOI: 10.1097/BRS.0000000000001735

7.                Thalgott JS, Cotler HB, Sasso RC, LaRocca H, Gardner V. Postoperative infections in spinal implants. Classification and analysis – a multicenter study. Spine (Phila Pa 1976). 1991; 16(8): 981–984. DOI: 10.1097/00007632-199108000-00020

8.                Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical site infection in spine surgery: who is at risk? Global Spine Journal. 2018; 8(4 Suppl): 5S-30S. DOI: 10.1177/2192568218799056

9.                Materials of the Second International Consensus Conference for Musculoskeletal Infection. Translated from English, edited by Tikhilov RM, Bozhkova SA, Shubnyak II. Saint Petersburg: Vreden ST. Petersburg Research Institute of Traumatology and Orthopedics, 2019; 69, 71, 200 p. Russian

10.           Fei Q, Li J, Lin J, Li D, Wang B, Meng H, et al. Risk factors for surgical site infection after spinal surgery: a meta-analysis. World Neurosurg. 2016; 95: 507-515. DOI: 10.1016/j.wneu.2015.05.059

11.           Spalteholz M, Gahr RH. External transpedicular spine fixation in severe spondylodiscitis – salvage procedure. GMS Interdiscip Plast Reconstr Surg DGPW. 2013; 2: Doc18. DOI:10.3205/iprs000038

12.           Prudnikova OG, Shchurova EN. Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques. Int Orthop. 2018; 42(2): 331-338. DOI: 10.3171/SPI/2008/8/2/186

13.           Doita M, Uno K, Maeno K, Shimomura T, Nishida K, Fujioka H, et al. Two-stage decompression, reduction, and interbody fusion for lumbosacral spondyloptosis through a posterior approach using Ilizarov externalfixation. J Neurosurg Spine. 2008; 8(2):186-192. DOI: 10.3171/SPI/2008/8/2/186

A CASE OF EFFECTIVE DIAGNOSIS AND TREATMENT OF A PATIENT WITH COMBINED SHOCKOGENIC TRAUMA

Girsh A.O., Chumakov P.A., Maksimishin S.V., Korzuk M.S., Malyuk A.I.

Girsh A.O., Chumakov P.A., Maksimishin S.V., Korzuk M.S., Malyuk A.I.

Kabanov City Clinical Hospital No.1,

Omsk State Medical University,

Omsk, Russia

Objective – diagnosis and targeted anti-shock therapy in a patient with a combined shockogenic trauma.

Materials and methods. The presented case included the male patient, age of 31, with the diagnosis: "Combined trauma. The closed chest injury. Heart contusion. Left lung contusion. Fracture of the rib 7 to the left. Posttraumatic exudative pleuritis. Closed abdominal injury. Liver rupture. Hemoperitoneum. Traumatic shock of 2nd degree of severity. Cardiogenic shock. Upon admission, traumatic shock was diagnosed, as well as cardiogenic shock due to the closed chest injury. It required for targeted individual anti-shock therapy.

Results. Timely early diagnosis with using echocardiography method in combination with troponin test and creatinine phosphokinase level estimation allowed to detect hemodynamically significant heart contusion in the patient. In its turn, it allowed targeted personalization of the intensive care program, taking into account the optimal correction of the main pathogenetic factors determining the severity of the patient’s general condition for a positive clinical outcome.

Conclusion. If patients with combined shockogenic trauma have anamnestic and/or clinical data on closed chest injury, it is advisable not only to carry out routine non-invasive monitoring of central hemodynamics, but also to use echocardiographic examination, troponin test, as well as determination of creatine phosphokinase in blood plasma for personalization of the anti-shock treatment program, which contributes to reduction of expression of multiple organ dysfunction syndrome.

Key words: shockogenic trauma; echocardiography.

Information about authors:

Girsh A.O., MD, PhD, docent at general surgery department, Omsk State Medical University, Omsk, Russia.

Chumakov P.A., candidate of medical science, docent at general surgery department, Omsk State Medical University, Omsk, Russia.

Maksimishin S.V., candidate of medical science, deputy chief physician of anesthesiology and reanimation, City Clinical Hospital of Emergency Medical Care No.1, Omsk, Russia.

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

Malyuk A.I., candidate of medical science, deputy chief physician of clinical care, Kabanov City Clinical Hospital No.1, Omsk, Russia.

Address for correspondence:

Girsh A.O., Krasny Put St., 135, building 1, app. 139, Omsk, Russia, 644033        

Tel: +7 (3812) 998-508; +7 (923) 681-40-60

E-mail: agirsh@mail.ru

REFERENCES:

1. Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman HL, Peralta R, Ellabib M, et al. Clinical and radiological presentations and management of blunt splenic trauma: a single tertiary hospital experience. Med Sci Monit. 2017; 12 (23): 3383-3392.

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Reversible acute ischemia caused by artery compressed by a bone fragment     

Makhambetchin M.M., Stepanov A.A.

Makhambetchin M.M., Stepanov A.A.

Scientific and Research Institute of Traumatology and Orthopedics of the Republic of Kazakhstan, Nur-Sultan, the Republic of Kazakhstan

Objective – to present a clinical case with the popliteal artery compressed by a tibial bone fragment, with development of acute ischemia in the leg, and to show a possible mechanism of displacement of a fragment in skeletal traction with sufficient load.

Materials and methods. The review presents the clinical case of development and correction of acute ischemia in the leg in a female patient, age of 64, with the closed fracture of the proximal one-third of both leg bones after a road traffic accident. The review of literature discussing the problem of popliteal artery injuries in closed fractures of bone legs was carried out.

Results. The staged treatment of the patient with the severe concomitant injury to the leg and acute ischemia in the leg and the foot was carried out. Laparotomy with intraabdominal bleeding arrest was performed. The external fixing apparatus was applied. After condition stabilization, bridging plate osteosynthesis of the tibial bone was conducted. The good functional outcome was achieved. The clinical case shows a possibility of acute arterial obstruction by means of popliteal artery compressed by a fragment of the tibia. The analysis of developed ischemia in skeletal traction, and rapid recovery of blood flow in the extremity after changing position of the leg allow describing the mechanism of artery compression.

Conclusion. Acute arterial obstruction in fractures of the proximal one-third of the tibial bone can be corrected with changing position of the limb with transition from skeletal traction to the external fixation apparatus. The adherence to Damage Control Orthopaedics, and early use of the external fixation apparatus allow eliminating the source of traumatic shock, improving patient’s care, preventing and removing the blood flow disturbance in the extremity. The external fixation apparatus as a surgical technique of orthopedic profile can be efficient for treatment of vascular complications of a fracture.

Key words: tibial bone fracture; popliteal artery; arterial compression; acute ischemia; external fixation apparatus; polytrauma; damage control.  

Information about authors:

Makhambetchin M.M., candidate of medical science, associate professor, senior researcher, Scientific and Research Institute of Traumatology and Orthopedics of the Republic of Kazakhstan, Nur-Sultan, the Republic of Kazakhstan.

Stepanov A.A., traumatologist of the highest category, chief of traumatology unit No.2, Scientific and Research Institute of Traumatology and Orthopedics of the Republic of Kazakhstan, Nur-Sultan, the Republic of Kazakhstan.

Address for correspondence:

Makhambetchin M.M., Abylay Khana prospect, 15a, Nur-Sultan, the Republic of Kazakhstan, 010000

Tel: +7 (701) 571-17-57

E-mail: murat.makhambetchin@mail.ru

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Reviews

Arrangement and strategies of prehospital care for victims in conditions of modern warfare: experience of military forces of NATO countries in Iraq and Afghanistan

Rovenskikh D.N., Usov S.A., Shmidt T.V.

Rovenskikh D.N., Usov S.A., Shmidt T.V.

EvroMedclinica Plus,

Army General Yakovlev Novosibirsk Military Institute of National Guard Forces of the Russian Federation, Novosibirsk, Russia

Objective − to describe organization and strategies of prehospital care for victims in conditions of modern warfare.

Materials and methods. The data from PubMed and Cochrane bases, and free Internet resources were analyzed.

Results. The peculiar properties of modern combat injuries during military actions of USA troops and their allies in Iraq and Afghanistan have been pointed. The algorithms of prehospital care, equipment and education of the military personnel, determined by these properties, have been described. Contemporary approaches to care of combat trauma and critical conditions and the results of their practical use have been presented.

Conclusion. The system of arrangement and strategies of prehospital medical care, which was used by NATO military forces in Iraq and Afghanistan, has resulted in the significant decrease in mortality after modern combat injuries.   

Key words: contemporary combat trauma; first aid; prehospital care.

Information about authors:

Rovenskikh D.N., candidate of medical science, oncologist, chief of oncologic service, EvroMedclinica Plus, Novosibirsk, Russia.

Usov S.A., MD, PhD, professor at department of provision of service and fighting activity of national guard forces of the Russian Federation, Army General Yakovlev Novosibirsk Military Institute of National Guard Forces of the Russian Federation, Novosibirsk, Russia.

Shmidt T.V., lieutenant-colonel of medical service, senior lecturer at department of provision of service and fighting activity of national guard forces of the Russian Federation, Army General Yakovlev Novosibirsk Military Institute of National Guard Forces of the Russian Federation, Novosibirsk, Russia.

Address for correspondence:

Usov S.A., Prospect Derzhinskogo, 2A-29, Novosibirsk, Russia, 630112

Tel: +7 (923) 135-70-84

E-mail: usovsa2005@mail.ru

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pathogenetic aspects of traumatic spinal cord injury and therapeutic perspectives (literature review)

Khokhlova O.I.

Khokhlova O.I.

Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons,

Novokuznetsk, Russia

Despite advances in medicine, rehabilitation and care, victims with traumatic spinal cord injury face serious problems, including limited mobility, loss of sensitivity, impaired internal organ function, a high incidence of secondary complications and psychoemotional disorders that affect all aspects of their lives. Currently, there is no effective treatment that promotes axon regeneration and restoration of lost neurological functions after spinal cord injury, due to the complexity and heterogeneity of its pathogenesis.  Therefore, understanding the pathophysiology of spinal cord injuries is necessary to determine therapeutic strategies.

Objective – to present the current data on the mechanisms of traumatic spinal cord injury. 

Results. It is shown that there are therapeutic targets in the mechanisms of secondary trauma that can be controlled by appropriate exogenous interventions, which allow us to optimistically consider possible therapeutic prospects. 

Conclusion. Given the complexity of pathogenesis of this pathology, several complex tasks should be considered, including regulating the intensity of inflammation and lipid peroxidation, reducing nerve cell death and scarring, restoring healthy nerve cells, promoting the functional regeneration of axons. Impressive progress has been made in this area, but much effort is still required for the results of experimental studies to be applied in clinical practice.

Key words: traumatic spinal cord injury; pathogenesis of traumatic spinal cord injury; treatment of traumatic spinal cord injury.

Information about author:

Khokhlova O.I., MD, PhD, senior researcher, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:

Khokhlova O.I., Malaya St., Novokuznetsk, Kemerovo region, Russia, 654055

Tel: +7 (3843) 36-91-26

E-mail: root@reabil-nk.ru; hohlovaoliv@rambler.ru

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