Annotations journal "Polytrauma" 1/2020

Leading article

A WORKING MODEL OF A TRAUMA REGISTER

Kasimov R.R., Makhnovskiy A.I., Zavrazhnov A.A., Ergashev O.N., Sudorgin K.E.

442nd Military Clinical Hospital,

Saint Petersburg, Russia,

Gatchina Clinical Interregional Hospital,

Gatchina, Russia

Military medical academy of S.M. Kirov,

Pavlov First Saint Petersburg State Medical University,

Saint Petersburg, Russia

Objective − development of a working version of the trauma register of the military district (regional).

Materials and methods. On the basis of the Microsoft Access XP program, the software for recording severe injuries (trauma register) has been developed. Clinical diagnoses are categorized using the ICD-10 single injury statistical codes and injury severity indices on the international Abbreviated Injury Scale (AIS). Additionally, the victims were categorized according to the circumstances of injury. At present, the register includes 227 cases of severe combined, multiple and isolated trauma accompanied by traumatic shock (coma) in military personnel in the Western military district over the past 5 years.

Results. The register consists of blocks: a general information block, a diagnosis registration block, and a state dynamics registration block. The register contains clinical and epidemiological data, dynamics of the condition of victims. With use of formulas, the program allows statistical processing of the received information.

Conclusion. The community of specialists needs a universal and automated statistical accounting tool in order to compare the results of providing assistance to victims with polytrauma, improve existing models of regional trauma systems, conduct an economic analysis of the costs of treating severe injuries, and plan the optimal amount of funding for this branch of medicine. The working version of the accounting of the causes and results of treatment of severe injuries developed by us can be the beginning of a large joint work to create a national trauma register.

Key words: trauma register; polytrauma; severe trauma; traumatic shock; accounting of severe injuries.

Information about authors:

Kasimov R.R., candidate of medical science, chief surgeon, 442nd Military Clinical Hospital, Saint Petersburg, Russia.

Makhnovskiy A.I., deputy chief physician of medical issues, Gatchina Clinical Interregional Hospital, Gatchina, Russia.

Zavrazhnov A.A., MD, PhD, professor, professor of military field surgery department, Kirov Military Medical Academy, Saint Petersburg, Russia.

Ergashev O.N., MD, PhD, professor, professor of hospital surgery department No. 2 named after F.G. Uglov, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.

Sudorgin K.E., chief of surgery department, 442nd Military Clinical Hospital of Ministry of Defence of the Russian Federation, Saint Petersburg, Russia.

Address for correspondence:

Kasimov R.R., Suvorovskiy prospect, 63, Saint Petersburg, Russia, 191015

Tel: +7 (991) 387-92-99

E-mail: rusdoc77@mail.ru

REFERENCES:

Gumanenko EK, Boyarintsev VV, Suprun TYu, Lyashedko PP. Objective estimation of injury severity: textbook. St. Petersburg, 1999. 110 p. Russian
Voynovskiy AE, Makhnovskiy AI, Shabalin AYu, Raguzin EV, Plaksa IL. Improvement in medical statistic recording of military sanitary losses. Medical Herald of MVD. 2013. 2(63): 5-8. Russian
Agadzhanyan VV. About question of development of polytrauma registry in the Russian Federation. Polytrauma. 2018. 1: 6-9. Russian
Makhnovskiy AI, Ergashev ON, Miroshnichenko AG, Kasimov RR. Experience with use of improved method of registration of multiple and associated injuries. Emergency Medical Aid. 1: 40-45. Russian
Lecky FE, Bouamra O, Woodford M, Alexandrescu R, O’Brien S.J. Epidemiology of polytrauma. In: Damage Control Management in the Polytrauma Patient. Pape HC., Peitzman A, Schwab CW, Giannoudis PV. (eds). Springer, New York, NY, 2010. P. 13-14.
Champion HC, Copes WS, Sacco WJ, Lawnick MM, Keast SC, Frey CF. The major trauma outcome study: establishing national norms for trauma care. Journal of Trauma. 1990; 30:1356–1365.
Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D. Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU. Unfallchirurg. 2000;103(5):355-363.

8. Directions for management of medical recording and accounting in Military Forces of the Russian Federation in peaceful time: confirmed by chief of Main Military Medical Administration of Defense Ministry of RF. Moscow: Burdenko Main Military Clinical Hospital, 2001. 40 p. Russian

9. About transition of agencies and facilities of health care of the Russian Federation to international statistical classification of diseases and health problems. 10th revision: the order by Health Ministry of RF, 17.05.1997, No. 170. Russian

Secondary care organization

ANALYSIS OF ROAD TRAFFIC ACCIDENTS WITH MEDICAL CONSEQUENCES ON THE FEDERAL HIGHWAY M-8 "KHOLMOGORY" IN THE ARKHANGELSK REGION

A.V. Baranov

Baranov A.V.

Northern State Medical University, Arkhangelsk, Russia

Cherepovets State University, Cherepovets, Russia

Objective − to analyze road traffic accidents with medical consequences on the federal highway M-8 "Kholmogory" in the Arkhangelsk Region.

Materials and methods. We selected 906 case histories of patients (f.003/u) who were injured in accidents on the federal highway M-8 “Kholmogory”, admitted by urgent indications 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. In the studied seven-year dynamics of the structure of road traffic accidents, an increase in the number of pedestrians to 43.3 % (p < 0.001) and a decrease in the number of passengers of vehicles to 19.4 % (p = 0.002) were found by 2018. The least severe injuries according to ISS were in car passengers (ISS = 9) [4,5; 17], and the heaviest ones – in motorcyclists (ISS = 11) [5,75; 19,25]. Among injured drivers of cars and motorcycles, men predominated (p = 0.001). Pedestrians were significantly older (p < 0.001), and motorcyclists were younger (p < 0.001) as other injured persons.

Conclusion. Reduction in the number of road accidents with medical consequences, and the number of victims and deaths over 7-year period was found (p = 0.001). The severity of the condition of victims with concomitant injury was 14 points [8; 24] on ISS that was higher than for injured with multiple or isolated injuries, with prevalence of men (p < 0.001) in all categories. The highest severity of injuries (p < 0.001) in road traffic accidents were noted in the Severodvinsk Medical District of federal highway M-8 "Kholmogory", with an average value of 12 points [6; 21], and the lowest severity – in the Arkhangelsk Medical District with the average ISS of 9 [4; 14].

Key words: road-traffic accidents; victims; federal highway M-8 "Kholmogory"; severity of injuries by ISS; circumstances of the injury; structure of injuries.

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:

Isaeva IA. Improving the treatment efficiency of patients with concomitant mechanical injuries in road traffic accidents (using the example of the Tatarstan Republic). Cand. med. sci. abstracts diss. Kazan, 2013. 20 p. Russian.
Fedotov SA. Management of health maintenance of victims in road traffic accidents in Moscow. Dr. med. sci. abstracts diss. Moscow, 2012. 42 p. Russian
Solovyev AG, Mordovsky EA, Vyazmin AM. Demographic and social predictors of the place of death in the elderly. Advances in Gerontology. 2016; (5): 829-836. Russian
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
Goncharov SF, Bystrov MV, Kudryavtsev BP. The problem of multiple and associated injury (polytrauma), the ways of solution and the role of disaster medicine service. Polytrauma. 2016; 2; 6-17.
Klyuchevskiy VV, Gural' KA, Dambaev GC, Nedashkovskiy YeV, Bobovnik SV. Traumatic shock. Yaroslavl, 2009. 288 p. Russian
Matveev RP, Gudkov SA, Bragina SV. Organization aspects of medical care delivery to casualties with road traffic accident polytraumas (literature review). Disaster Medicine. 2015; 4(92): 45-48. Russian Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, Milyukov AYu, Shatalin AV. Polytravma. An acute management and transportation. Novosibirsk : Science, 2008. 320 p. Russian
Baranov AV, Matveev RP, Barachevsky YuE., Gudkov AB. Pelvic injuries as an aspect of road traffic trauma. Doctor-graduate student. 2012; (3): 389-392. Russian
Barachevsky YuE, Klyuchevsky VV, Yur’eva MYu, Baranov AV, Kolesnikov GS. Analysis of road traffic catastrophes on federal motorway M-8 "Kholmogory". Disaster Medicine. 2015; 3(91): 19-20. Russian
Varakina ZhL, Sannikov AL. "Traumatic epidemy" in modern Russian Federation (on the example of the Arkhangelsk region). Arkhangelsk: Publishing House of NSMU, 2018. 198 p. Russian

Anesthesiology and critical care medicine

INFLUENCE OF INTESTINAL FAILURE SYNDROME ON THE CLINICAL COURSE OF TRAUMATIC DISEASE IN PATIENTS WITH THORACIC AND ABDOMINAL TRAUMA

Ponomarev S.V., Sorokin E.P., Leyderman I.N., Shilyaeva E.V.

Izhevsk State Medical Academy,

City Clinical Hospital No. 9, Izhevsk, Russia

Almazov National Medical Research Centre, Saint Petersburg, Russia

Objective − to analyze the course of traumatic disease in thoracic and abdominal injured patients with intestinal failure syndrome.

Materials and methods. A prospective study of 86 patients with thoracic and abdominal injuries who underwent treatment in the ICU was conducted. 2 comparison groups were formed. The IFS group (n = 26) included patients with intestinal failure syndrome, in the program of nutritional support of which parenteral nutrition was used. The EN group (n = 60) included patients with good tolerance for early enteral nutrition. Nutritional status was assessed by blood total protein, albumin and the absolute count of lymphocytes on days 1, 3, 5, 7 in the ICU. The development of nosocomial infectious complications was recorded for the entire stay in hospital using the Federal Clinical Guidelines “Epidemiological Surveillance of Infections Associated with the Provision of Medical Care” (2014).

Results. Early enteral nutrition as far as parenteral nutrition allow to administer the same amount of protein and energy. The dynamics of the main indicators of nutritional status in both groups statistically differed on the day 3. In the EN group, the count of blood lymphocytes was significantly higher. In the IFS group nosocomial infectious complications developed significantly more often (p = 0.027). The most significant changes were registered in infections of surgical area (p = 0.05)

Conclusion. The development of intestinal failure syndrome significantly increases the relative risk of nosocomial infectious complications and leads to a statistically significant increase in the length of stay in ICU (p = 0.005) and in the hospital (p = 0.009).

Key words: thoracic and abdominal trauma; intestinal failure syndrome; nosocomial infections; nutritional support.

Information about authors:

Ponomarev S.V., candidate of medical science, assistant of department of surgical diseases with course of anesthesiology and critical care medicine of advanced training and professional retraining faculty, Izhevsk State Medical Academy, anesthesiologist-intensivist, City Clinical Hospital No. 9, Izhevsk, Russia.

Sorokin E.P., candidate of medical science, docent of department of surgical diseases with course of anesthesiology and critical care medicine of advanced training and professional retraining faculty, Izhevsk State Medical Academy, anesthesiologist-intensivist, City Clinical Hospital No. 9, Izhevsk, Russia.

Leyderman I.N., MD, PhD, professor of department of anesthesiology and critical care medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia.

Shilyaeva E.V., anesthesiologist-intensivist, City Clinical Hospital No. 9, assistant of department of surgical diseases with course of anesthesiology and critical care medicine of advanced training and professional retraining faculty, Izhevsk State Medical Academy, Izhevsk, Russia.

Address for correspondence:

Ponomarev S.V., Maksima Gorkogo St., 150-271, 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. Korolev VM. Epidemiological and clinical aspects of the combined trauma. Far East Medical Journal. 2011; 3: 124-128. Russian

3. Mazurok VA, Golovkin AS, Bautin AE, Gorelov II, Belikov VL, Slivin OA. Gastrointestinal tract in critical conditions: the first suffers, the latter who are given attention. Bulletin of Intensive Therapy. 2016; (2): 28-37. Russian

4. Sato T, Vries RG, Snippert HJ, van de Wetering M, Barker N, Stange DE , et al. Single Lgr5 stem cells build crypt-villus structures in vitro without a mesenchymal niche. Nature. 2009; 459( 7244): 262–265.

5. Malkoch AV, Bel’mer SV. Intestinal microflora and the importance of prebiotics for its functioning. Attending Physician. 2006; (4): 60-65. Russian

6. Boston US, Slater JM, Orszulak TA, Cook DJ. Hierarchy of regional oxygen delivery during cardiopulmonary bypass. Ann. Thorac. Surg. 2001; 71(1): 260–264.

7. Zhu R, Ma XC. Role of metabolic changes of mucosal layer in the intestinal barrier dysfunction following trauma/hemorrhagic shock. Pathol Res Pract. 2018; 214(11): 1879-1884.

8. Li Z, Li J, Zhang S, Chen G, Chi S, Li X, et al. Metabolomics analysis of gut barrier dysfunction in a trauma-hemorrhagic shock rat model. Biosci Rep. 2019; 39(1): BSR20181215.

9.Armacki M, Trugenberger AK, Ellwanger AK, Eiseler T, Schwerdt C, Bettac L, et al. Thirty-eight-negative kinase 1 mediates trauma-induced intestinal injury and multi-organ failure. J Clin Invest. 2018; 128(11): 5056–5072.

10. Zhou QQ,Verne GN. Intestinal hyperpermeability: a gateway to multi-organ failure? J Clin Invest. 2018; 128(11): 4764–4766.

11. Patel JJ, Rosenthal MD, Miller KR, Martindale RG. The gut in trauma. Curr Opin Crit Care. 2016; 22(4): 339-346.

12. Derikx JP, van Waardenburg DA, Thuijls G, Thuijls G, Willigers HM, Koenraads M, et al. New insight in loss of gut barrier during major non-abdominal surgery. PLoS One. 2008; 3(12): e3954.

13. De Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study. Crit. Care. 2009; 13(3): R86.

14. Osuka A, Kusuki H, Matsuura H, Shimizu K, Ogura H, Ueyama M. Acute intestinal damage following severe burn correlates with the development of multiple organ dysfunction syndrome: a prospective cohort study. Burns. 2017; 43(4): 824-829.

15. Voth M, Duchene M, Auner B, Lustenberger T, Relja B, Marzi I. I-FABP is a novel marker for the detection of intestinal injury in severely injured trauma patients. World J Surg. 2017; 41(12): 3120-3127.

16. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal Failure score in critically ill patients: a prospective observational study. Crit Care. 2008; 12(4): R90.

THE RATIO OF EXTERNAL AND CALCULATED BLOOD LOSS IN ARTHROPLASTY OF LARGE JOINTS OF THE LOWER EXTREMITY

Lebed M.L., Kirpichenko M.G., Shamburova A.S., Sandakova I.N., Bocharova Yu.S., Popova V.S., Karmanova M.M., Fesenko M.A., Golub I.E.

Irkutsk Scientific Center of Surgery and Traumatology,

Irkutsk State Medical University, Irkutsk, Russia

One of the expected consequences of surgical aggression is perioperative blood loss. Determining the frequency of blood transfusion and identifying patients with high risk of blood transfusion are the main criteria while developing a strategy of reducing blood loss.

Objective − basing on a comparison of the volume of external perioperative blood loss and a decrease in blood hemoglobin concentration in patients after arthroplasty of large joints of the lower extremities, to conclude the effect of hidden blood loss on the development of postoperative anemia.

Materials and methods. We used data of 609 patients who underwent planned surgical intervention at the clinic of Irkutsk Scientific Center of Surgery and Traumatology. According to the volume of the surgery the following groups of clinical monitoring were formed: group 1 (primary total knee arthroplasty, n = 224), group 2 (primary total hip arthroplasty, n = 355), group 3 (revision hip arthroplasty, n = 30). Blood hemoglobin concentration was determined before the operation, during the 1^st and 3^rd–5^th days of postoperative observation. Also it was taken into account: perioperative external blood loss (during the intervention and on the first day after surgery), the frequency of transfusion of donor blood components and reinfusion of autologous drainage blood. Estimated total blood loss was determined by the degree of decrease of the hemoglobin concentration in the blood, taking into account blood transfusion.

Results. The ratio of calculated and external blood loss in the groups 1, 2 and 3 was M (P₂₅; P₇₅): 3.6 (2.6; 5.2), 3.3 (2.2; 4.5) and 1.9 (1.5; 2.7) correspondingly. The results of the study indicate that hidden blood loss significantly exceeds the volume of external perioperative hemorrhage and makes a decisive contribution to the development of postoperative anemia in patients with primary arthroplasty of large joints of the lower extremities.

Key words: joint arthroplasty; blood loss; blood transfusion.

Information about authors:

Lebed M.L., MD, PhD, head of anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, assistant of general surgery and anesthesiology unit, Irkutsk State Medical University, Irkutsk, Russia.

Kirpichenko M.G., candidate of medical sciences, anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Shamburova A.S., candidate of medical sciences, anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Sandakova I.N., candidate of medical sciences, anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Bocharova Yu.S., candidate of medical sciences, transfusiologist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Popova V.S., anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Karmanova M.M., anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Fesenko M.A., anesthetist, anesthesiology and intensive care unit, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Golub I.E., MD, PhD, professor at department of general surgery and anesthesiology, Irkutsk State Medical University, Irkutsk, Russia.

Address for correspondence:

Lebed M.L, Bortsov Revolutsii St., 1, Irkutsk, Russia, 664003

Tel: +7 (3952) 290-348

E-mail: swanmax@list.ru

REFERENCES:

Wu KT, Siu KK, Ko JY, Chou WY, Kuo SJ, Hsu YH. Tranexamic acid reduces total blood loss and inflammatory response in computer-assisted navigation total knee arthroplasty. BioMed Research International. 2019; 20199:1-7.
Carling MS, Jeppsson A, Eriksson BI, Brisby H. Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study. Journal of Orthopaedic Surgery and Research. 2015; 10(1): 48.
Goldstein M, Feldmann C, Wulf H, Wiesmann T. Tranexamic acid prophylaxis in hip and knee joint replacement. Dtsch Arztebl Int. 2017; 114(48): 824-830.
Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement. The Journal of Bone and Joint Surgery. 2014; 96(23):1937–1944.
Menendez ME, Lu N, Huybrechts KF, Ring D, Barnes CL, Ladha K, et al. Variation in use of blood transfusion in primary total hip and knee arthroplasties. J Arthroplasty. 2016; 31(12): 2757–2763.
Song K, Pan P, Yao Y, Jiang T, Jiang Q. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res. 2019; 14(1): 273.
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. The Journal of Bone and Joint Surgery-American. 2010; 92(15): 2503–2513.
Han X, Gong G, Han N, Liu M. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2018; 19(1): 430.
Bezwada HR, Nazarian DG, Henry DH, Booth REJr, Mont MA. Blood management in total joint arthroplasty. American Journal of Orthopedics (Belle Mead, N.J.) 2006; 35(10): 458–464.
Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty. Clinical Orthopaedics and Related Research. 1991; (269): 98–101.
Danninger T, Rasul R, Poeran J, Stundner O, Mazumdar M, Fleischut PM, et al. Blood transfusions in total hip and knee arthroplasty: an analysis of outcomes. Scientific World Journal. 2014; 2014: 623460.
Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am. 2014; 96(23): 1945–1951.
Kim JL, Park JH, Han SB, Cho IY, Jang KM. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: a meta-analysis. J Arthroplasty. 2017; 32(1):320–325.
Squires JE. Risks of transfusion. Southern Medical Journal. 2011; 104(11): 762–769.
Ye W, Liu Y, Liu WF, Li XL, Fei Y, Gao X. Comparison of efficacy and safety between oral and intravenous administration of tranexamic acid for primary total knee/hip replacement: a meta-analysis of randomized controlled trial. J Orthop Surg Res. 2020; 15(1): 21.
Nichols CI, Vose JG. Comparative risk of transfusion and incremental total hospitalization cost for primary unilateral, bilateral, and revision total knee arthroplasty procedures. J Arthroplasty. 2016; 31(3): 583–589.
Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. The Journal of Arthroplasty. 2013; 28(9): 1473–1476.
Liu J, Li YM, Cao JG, Wang L. Effects of knee position on blood loss following total knee arthroplasty: a randomized, controlled study. Journal of Orthopaedic Surgery and Research. 2015; 10(1): 69.
Tang JH, Lyu Y, Cheng LM, Li YC, Gou DM. Risk factors for the postoperative transfusion of allogeneic blood in orthopedics patients with intraoperative blood salvage: a retrospective cohort study. Medicine. 2016; 95(8): e2866.
Correction of hemostasis system in knee joint replacement: medical technology. Pirogov National Medicosurgical Center. Moscow, 2009; 19 p. URL: http://tranexam.ru/docs/Metod_korrekcia_sistem_gemostaza.pdf (access date: 17.02.2020). Russian
for primary and revision hip arthroplasty: medical technology. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics. Moscow, 2010; 20 p. URL: https://library.rniito.org/download/technology/fs_2010_284.pdf (access date: 17.02.2020). Russian
Order of the Ministry of Health of the Russian Federation dated April 2, 2013N 183n Moscow "On the approval of the rules for the clinical use of donated blood and (or) its components". URL: https://rg.ru/2013/08/28/donory-dok.html (access date: 17.02.2020). Russian
Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. British Journal of Anaesthesia. 2003; 90(5): 596–599.
Decree of the Government of the Russian Federation of 06.22.2019 No. 797 "On approval of the Rules for the collection, storage, transportation and clinical use of donated blood and its components and on the recognition of certain acts of the Government of the Russian Federation as invalid". URL: http://publication.pravo.gov.ru/Document/View/0001201907020007 (access date: 17.02.2020). Russian
Bocharov SN. Replenishment of blood loss in elective surgery: permission to use new medical technology FS No. 2010/157, 06.05.2010. Russian
Wang Z, Zhang HJ. Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 2018; 13(1): 242.
Miao K, Ni S, Zhou X, Xu N, Sun R, Zhuang C, et al. Hidden blood loss and its influential factors after total hip arthroplasty. J Orthop Surg Res. 2015; 10:36.
Lei Y, Huang Q, Huang Z, Xie J, Chen G, Pei F. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2018; 33(9): 2940-2945.
Sehat KR, Evans R, Newman .H. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee. 2000; 7(3): 151-155.
Liu X, Zhang X, Chen Y, Wang Q, Jiang Y, Zeng B. Hidden blood loss after total hip arthroplasty. J Arthroplast. 2011; 26(7): 1100–1105.
Gómez-Ramírez S, Bisbe E, Shander A, Spahn DR, Muñoz M. Management of perioperative iron deficiency anemia. Acta Haematol. 2019; 142(1): 21-29.

Clinical aspects of surgery

IMPROVEMENT OF SURGICAL APROACHES FOR NON-FIREARM THORACOABDOMINAL WOUNDS

Baloglanly D.A., Amarantov D.G., Zarivchatskiy M.F., Kholodar A.A., Nagaev A.S.

Perm State Medical University named after academician E.A. Wagner,

Perm, Russia

To date, some issues of surgical treatment of thoracoabdominal stab wounds (TASW) require for further improvement.

Objective − to optimize the approaches of surgical treatment of TASW by creating diagnostic and treatment algorithms that allow selecting the optimal combination of open and endoscopic operations for the treatment of TASW.

Materials and methods. Among 81 victims with TASW, 40 victims were identified who were treated using the proposed algorithms (the group 1), and 41 victims who received treatment before the algorithms were created (the group 2). To clarify the boundaries of the thoracoabdominal region, the results of 81 forensic studies of victims with TASW were studied.

Results. The specified boundaries of the thoracoabdominal region are located superiorly along the bottom edge of the 4th ribs, and inferiorly − along the line passing through the lowest point of the 10th ribs, and then along the bottom edge of the 11th and 12th ribs. An algorithm for invasive diagnosis of diaphragm injuries has been developed, which was used for the treatment of 198 victims with penetrating stab wounds of the chest and abdomen. 40 patients with TASW (the group 1) were identified, and the proposed treatment algorithm was used in their treatment. 38 (97.5 %) of group 1 patients and 35 (85.37 %) of group 2 patients recovered. In the group 1, 80 % of patients received assistance using only endoscopic operations, or in combination with open operations, while the group 2 included only 53.66 % of such patients.

Conclusion. As a result of using the developed algorithms, the results of treatment of patients with TASW were improved: the number of complications in recovered patients was reduced by 24.15 %; the number of good immediate results of treatment was increased by 33.78 %, and the duration of hospitalization was reduced by 22.46 %.

Key words: thoracoscopy; laparoscopy; wound of the diaphragm.

Information about authors:

Baloglanly D.A., student of 6th course, medicine faculty, Perm State Medical University named after academician E.A. Wagner, Perm, Russia.

Amarantov D.G., MD, PhD, professor at intermediate level surgery department No. 2 with course of hematology and transfusiology, Perm State Medical University named after academician E.A. Wagner, Perm, Russia.

Zarivchatskiy M.F., MD, PhD, professor, chief of intermediate level surgery department No. 2 with course of hematology and transfusiology, Perm State Medical University named after academician E.A. Wagner, Perm, Russia.

Kholodar A.A., candidate of medical science, thoracic surgeon, City Clinical Hospital No. 4, Perm, Russia.

Nagaev A.S., candidate of medical science, docent at chair of normal, topographic and clinical anatomy and operative surgery, Perm State Medical University named after academician E.A. Wagner, chief of thoracic surgery unit, City Clinical Hospital No. 4, Perm, Russia.

Address for correspondence:

Amarantov D.G., Kirovogradskaya St., 66-64, Perm, 614113

Tel: +7 (902) 640-21-68

E-mail: svetlam1@yandex.ru

REFERENCES:

Gareev RN, Fakhretdinov DZ, Nguyen KhK. Thoraco-Abdominal Wounds. Creative Surgery and Oncology. 2013; (1-2): 48-51. https://doi.org/10.24060/2076-3093-2013-0-1-2-48-51 Russian
Radjou AN, Balliga DK, Uthrapathy M, Pal R, Mahajan P. Injury to the diaphragm: our experience in Union Headquarters Hospital. International Journal of Critical Illness and Injury Science. 2013; 3(4): 256–261. https://doi.org/10.4103/2229-5151.124139
Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. The American Journal of Surgery. 2015; 209(5): 864–869.https://doi.org/10.1016/j.amjsurg.2014.12.023
Zaytsev DA, Kukushkin AV. Thoracoscopy in verification of damage to the diaphragm in thoracoabdominal trauma. Herald of Experimental and Clinical Surgery. 2011; 4(4): 705-709. https://doi.org/10.18499/2070-478X-2011-4-4-705-709 Russian
Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. Springerplus. 2016; 5(1): 1614. https://doi.org/10.1186/s40064-016-3291-1
Mjoli M, Oosthuizen G, Clarke D, Madiba T. Laparoscopy in the diagnosis and repair of diaphragmatic injuries in left-sided penetrating thoracoabdominal trauma: laparoscopy in trauma. Surg. Endosc. 2015; 29(3): 747–752. https://doi.org/10.1007/s00464-014-3710-8.
Balandina IA, Amarantov DG, Nagaev AS, Britok VA. Thoracoscopic treatment of basal pleural empyema. Postgraduate Medical Student. 2013; 59(4.1): 134-139. Russian
Kubachev KG, Borisov AE, Kukushkin AV, Sagitova DS. Wounds and ruptures of the diaphragm with open and closed injuries of the chest and abdomen. Annals of Surgical Hepatology. 2010; 15(1): 90-95. Russian
Ukhanov AP, Gadzhiev ShA. The use of the endovideo surgical method in the diagnosis and treatment of damage to the diaphragm. Endoscopic Surgery. 2011; 17(5): 9-13. Pussian
Abakumov MM. Surgery for combined injuries to the chest and abdomen: 30 years of experience. Tuberculosis and Lung Diseases. 2010; 87(11): 17-23. Russian
Sigua BV, Zemlyanoy VP, Danilov AM, Efimov AL. Principles for the diagnosis and treatment of thoraco-abdominal wounds with liver damage. Health − the Basis of Human Potential: Problems and Ways of Solution. 2015; 10(2):732-734. Russian
Yücel M, Özpek A, Tolan HK, Başak F, Baş G, Ünal E, et al. Importance of diagnostic laparoscopy in the assessment of the diaphragm after left thoracoabdominal stab wound: a prospective cohort study. Turkish journal of trauma and emergency surgery. 2017; 23(2):107-111. https://doi.org/10.5505/tjtes.2016.91043
Liao CH, Hsu CP, Kuo IM, Ooyang CH, Wang SY, Huang JF, et al. Factors affecting outcomes in penetrating diaphragmatic trauma. International Journal of Surgery. 2013; 11(6):492-495. https://doi.org/10.1016/j.ijsu.2013.03.014
Nikolaev AV. Topographic anatomy and operative surgery: textbook, two volumes; second edition, corrected and supplemented. Moscow: GEOTAR-Media, 2013. Vol. 2; 383 p. Russian

Clinical aspects of traumatology and orthopedics

ANALYSIS OF CAUSES OF DEATH IN A SAMPLE OF PATIENTS WITH POLYTRAUMA IN MOSCOW

Korobushkin G.V., Shigeev S.V., Zhukov A.I.

Priorov National Medical Research Center of Traumatology and Orthopedics,

Moscow, Russia

According to estimations by some foreign authors, 5.8 million people die as result of injuries each year. Most cases are associated with polytrauma. The problem of increasing survival rate in this category of patients is the maximally actual issue for trauma surgeons both in the whole world and in Russia.

Objective − to determine the main causes of severe injuries and their complications, which lead to death of victims.

Materials and methods. We studied the data of 169 forensic protocols of deaths from trauma in Moscow in December, 2017. The study included patients with polytrauma − 98 persons (ISS > 17, with an injury to at least one body region). AIS/ISS were used.

Results. Among registered clinical cases, most patients (98 persons, 58 %) died from polytrauma. The leading causes of injuries were road traffic accidents (45.9 %) and falling from height > 3 meters (37.7 %). The main proportion of patients died at the accident site (73 patients, 74.5 %). 3 (3.1 %) patients died in an ambulance car at the prehospital stage. Other 22 patients (22.4 %) died in the intensive care unit. Bleeding (5 ± 22.1 hours, p = 0.003) was the most significant and most common (75.5 %) lethal factor among other factors within the first hours after trauma, with mean ISS of 58.4 ± 19.4 (p = 0.0003). The most common complications were hemothorax (62.2 %) and hemoperitoneum (51 %). These complications appeared in patients with mean ISS of 60.8 ± 16.2 (p = 0.001). Patients with head injury could survive for a longer period: 35.2 ± 117.2 h (p = 0.327). A combination of brain trauma and blood loss was in 20.41 % of cases. ISS was estimated after death. Its mean value was 53.8. Clinical ISS was 36.8. The mean time from a telephone call to hospital admission was approximately 58 minutes. The period from an accident to a lethal outcome was 37.4 ± 141.7 hours.

Conclusion. Most patients died as result of severe associated injuries before arrival of an ambulance car. Bleeding was the earliest and most common cause of death. ISS values, which were calculated on the basis of clinical and postmortem data, show correlation. However there are some significant non-diagnosed injuries and complications. Trauma severity and death time correlate with causes of lethal outcomes. It is necessary to study the problem of mortality in patients with polytrauma in the Russian Federation in the concept of preventable deaths.

Key words: polytrauma; injury; preventable deaths.

Information about authors:

Korobushkin G.V., MD, PhD, professor, chief of 15th traumatology and orthopedics unit, Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia.

Shigeev S.V., MD, PhD, professor, chief non-staff specialist in forensic medicine, Office of Forensic Medical Expertise of Moscow Healthcare Department, Moscow, Russia.

Zhukov A.I., student of 6th course, Pirogov Russian National Research Medical University, Moscow, Russia.

Address for correspondence:

Korobushkin G.V., Priorova St.,10, Moscow, Russia, 125299

Tel: +7 (495) 450-09-45

E-mail: kgleb@mail.ru

REFERENCES:

1. Edem IJ, Dare AJ, Byass P, D'Ambruoso L, Kahn K, Leather AJM, et al. External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study. BMJ open. 2019; 9(6): e027576.

2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2012; 380(9859): 2095-2128.

3. World Health Organization. World health statistics 2016: monitoring health for the SDGs sustainable development goals. URL: https://apps.who.int/iris/handle/10665/206498

4. Pfeifer R, Halvachizadeh S, Schick S, Sprengel K, Jensen KO, Teuben M, et al. Are Pre-hospital Trauma Deaths Preventable? A Systematic Literature Review. World Journal of Surgery. 2019; 43 (10): 2438-2446.

5. Information about number of death from external causes for January - December 2017. Federal State Statistic Service. URL: https://www.gks.ru/free_doc/2017/demo/edn12-17.htm Russian

6. Kalininskaya AA, Sharafutdinova NKh, Evsyukov AA, Dzugaev AK, Mustafin RM. Organization of trauma care in rural area, and ways for its improvement. Social Aspects of Health of Population: Electronic Journal. 2009; 4. Russian

7. Kleber C, Giesecke MT, Tsokos M, Haas NP, Buschmann CT. Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World journal of surgery. 2013; 37 (5): 1154-1161.

8. Dezhurny LI, Neudakhin GV, Yurasova ED, Migliorini L, Shmitkova TI. Estimation of potential efficiency of measures for first aid for life support in victims of road traffic accidents (within the project of road safety in 10 countries − RS10. Text: electronic resource. Social Aspects of Health of Population. 2015. 2(42). Russian

9. Gubaydullin MI, Safin RZh, Zarkov SI. Defects of health care affected by road traffic accident in a hospital stage (review of domestic and foreign literature). Bulletin of the South Ural State University. Series: Education, Health, Physical Culture. 2010; 19(195): 84-88. Russian

10. Shackelford S, Eastridge BJ. Epidemiology of prehospital and hospital traumatic deaths from life-threatening hemorrhage. In: Damage Control Resuscitation. Eds Spinella P. Springer, Cham, 2020. P. 31-40.

11. Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019; 59(S2): 1423-1428.

12. Heckbert SR, Vedder NB, Hoffman W, Winn RK, Hudson LD, Jurkovich GJ, et al. Outcome after hemorrhagic shock in trauma patients. Journal of Trauma and Acute Care Surgery. 1998; 45(3): 545-549.

13. Gill W, Champion HR, Long WB, Stega M, Nolan J, Decker R, et al. A clinical experience of major multiple trauma in Maryland. Maryland state medical journal. 1976; 25(1): 55.

14. Mysaev AO, Meirmanov SK, Dyusenbaev DM, Mysaev Alt O. Road traffic injuries. Part 3. System for medical care for victims of road traffic accidents (literature review). Science and Healthcare. 2014. (2): 7-12. Russian

15. Shchedrenok VV, Ladeishchikov VM, Anikeev NV, Simonova IA, Moguchaya OV. Clinical-statistical and organizational aspects of combined craniocerebral injuries in cities with different populations. Perm medical journal. 2011; (4): 131-138. Russian

16. Motomura T, Mashiko K, Matsumoto H, Motomura A, Iwase H, Oda S, et al. Preventable trauma deaths after traffic accidents in Chiba Prefecture, Japan, 2011: problems and solutions. Journal of Nippon Medical School. 2014; 81(5): 320-327.

17. Carmichael H, Steward L, Peltz ED, Wright FL, Velopulos CG, et al. Preventable death and interpersonal violence in the United States: who can be saved? Journal of trauma and acute care surgery. 2019; 87(1): 200-204.

18. Henriksson E, Oström M, Eriksson A. Preventability of vehicle-related fatalities. Accident Analysis & Prevention. 2001; 33(4): 467-475.

19. Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World journal of surgery. 2007; 31(11): 2092-2103.

20. Rosenfeld JV, McDermott FT, Laidlaw JD, Cordner SM, Tremayne AB. The preventability of death in road traffic fatalities with head injury in Victoria, Australia. Journal of clinical neuroscience. 2000; 7(6): 507-514.

21. Cales RH, Trunkey DD. Preventable trauma deaths: a review of trauma care systems development. Jama. 1985; 254(8): 1059-1063.

22. Oliver GJ, Walter DP, Redmond AD. Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades. Injury. 2017; 48(5): 978-984.

23. Koh EY, Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, et al. Trends in potentially preventable trauma deaths between 2005-2006 and 2012–2013. The American Journal of Surgery. 2019; 218 (3): 501-506.

24. Roy N, Kizhakke Veetil D, Khajanchi MU, Kumar V, Solomon H, Kamble J, et al. Learning from 2,523 trauma deaths in India-opportunities to prevent in-hospital deaths. BMC health services research. 2017; 17(1): 142.

25. Dmitriev IV, Dorosevich AE. Social Aspects of Health of Population: Electronic Journal. 2019; 65(9). Russian

Functional, instrumental and laboratory diagnostics

DIAGNOSTIC VALUE OF INDICATORS OF HIGHER FATTY ACIDS IN EVALUATION OF DEVELOPMENT OF DELAYED CONSOLIDATION OF FRACTURES

Miromanov A.M., Mironova O.B., Staroselnikov A.N., Miromanova N.A.

Chita State Medical Academy,

Chita, Russia

Objective − determination of the diagnostic significance of higher fatty acids in the development of delayed consolidation in patients with fractures of long bones of the extremities.

Material and methods. Retrospectively (case-control), 30 patients, aged of 20 to 40, with delayed consolidation of fractures of long bones of the extremities were examined. The control group consisted of 20 almost healthy residents of similar age. Exclusion criteria were any acute pathological conditions and/or chronic concomitant diseases. Study of the parameters of higher fatty acids (C₁₃H₂₇COOH is myristic, C₁₅H₃₁COOH is palmitic, C₁₅H₂₉COOH is palmitoleic, C₁₇H₃₅COOH is stearic, C₁₇H₃₃COOH is oleic, C₁₇H₃₁COOH is linolenic, С₁₇Н₂₉СООН is α-linolenic, С₁₇Н₂₈COOH is γ-linolenic, С₁₉Н₃₃СООН is digomo-γ-linolenic, С₁₉Н₃₁СООН - arachidonic acid) was carried out using gas-liquid chromatography. To assess consolidation, the RUST scale (Radiographic Union Scale for Tibial fractures) was used. Fracture was considered consolidated in the presence of 10 or more points. Differences were evaluated using the Mann-Whitney test; the results were considered reliable at p < 0.05 (BIOSTAT).

Results. In patients with delayed consolidation, there is a decrease in the level of myristic and stearic acids (1.2 and 1.5 times, respectively), and an increase in the content of palmitic acid by 1.1 times, compared with the control (p ≤ 0.05). A decrease in the concentration of polyunsaturated fatty acids by 3.8 times in comparison with the control value was noted only due to α-linolenic acid. A decrease in the ω-6 series fatty acids was recorded as a result of a decrease in dihomo-γ-linolenic and arachidonic acids by 4.9 and 1.4 times, respectively (p ≤ 0.05).

Conclusion. With delayed consolidation of fractures of long bones of the extremities in the blood serum, a decrease in the level of saturated fatty acids is recorded − C14:0, C18:0, and an increase − C16:0, while in the group of unsaturated fatty acids, a decrease in the content of C18:3ω3, C20:3ω6 and C20:4ω6.

Key words: fractures; delayed consolidation; higher fatty acids; diagnostics.

Information about authors:

Miromanov A.M., MD, PhD, professor, chief of traumatology and orthopedics department, Chita State Medical Academy, Chita, Russia.

Mironova O.B., candidate of medical science, docent at traumatology and orthopedics department, Chita State Medical Academy, Chita, Russia.

Staroselnikov A.N., resident at traumatology and orthopedics department, Chita State Medical Academy, Chita, Russia.

Miromanova N.A., MD, PhD, docent, chief of department of pediatric infections, Chita State Medical Academy, Chita, Russia.

Address for correspondence:

Miromanov A.M., Gorkogo St., 39a, Chita, Russia, 672000

Tel: +7 (924) 386-18-16

Е-mail: miromanov_a@mail.ru

REFERENCES:

Kuzmenko DV, Lobanov GV, Shatova OP. PDGF enzymatic activity in delayed fracture consolidation. Traumatology and Orthopedics of Russia. 2017; 23(4): 78-82. DOI: 10.21823/2311-2905-2017-23-4-78-82. Russian
Traumatology: a national management. Under the editorship of G.P. Kotelnikov, S.P. Mironov. Moscow: GEOTAR-Media, 2018. 776 p. Russian
Chepeleva MV, Kuznetsova EI, Karasev AG. The immunological profile of patients with delayed consolidation of bone tissue in the long term period after a closed injury to long tubular bones. Siberian Scientific Medical Journal. 2016; 36(3): 34-40. Russian
Fischer C, Doll J, Tanner M, Bruckner T, Zimmermann G, Helbig L, et al. Quantification of TGF-β1, PDGF and IGF-1 cytokine expression after fracture treatment vs. non-union therapy via masquelet. Injury. 2016; 47(2): 342-349. DOI: 10.1016/j.injury.2015.11.007
Majidinia M, Sadeghpour A, Yousefi B. The roles of signaling pathways in bone repair and regeneration. J. Cell Physiol. 2018; 233(4): 2937-2948. DOI: 10.1002/jcp.26042
Zhao Z, Liu J, Weir MD, Zhang N, Zhang L, Xie X, et al. Human periodontal ligament stem cells on calcium phosphate scaffold delivering platelet lysate to enhance bone regeneration RSC Advances. 2019; 9: 41172-41382. DOI: 10.1039/c9ra08336g
Titov VN. Modern ideas about the pathogenesis of non-alcoholic fatty liver disease and therapeutic effects. Fatty acid metabolism and aphisiological triglycerides. Cardiological Bulletin. 2012; 7(2): 74-81. Russian
Anderson EJ, Yamazaki H, Neufer PD. Induction of endogenous uncoupling protein 3 suppresses mitochondrial oxidant emission during fatty acid-supported respiration. J. Biol. Chem. 2007; 282: 31257–31266. DOI: 10.1074/jbc.M706129200
Nixon GF. Sphingolipids in inflammation: pathological implications and potential therapeutic targets. Br. J. Pharmacol. 2009; 158(4): 982–993. DOI: 10.1111/j.1476-5381.2009.00281.x
Wahli W, Michalik L. PPARs at the crossroads of lipid signaling and inflammation. Trends Endocrinol. Metab. 2012; 23: 351–363. DOI: 10.1016/j.tem.2012.05.001
Khyshiktuev BS, Kayukova EV, Kayukov VA, Tereshkov PP. The spectrum of higher fatty acids of tumor tissue in cervical cancer with varying degrees of differentiation. Siberian Oncological Journal. 2013; (1): 47-51. Russian
Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AHRW. The radiographic union scale in tibial (RUST) fractures. J. Bone Joint Research. 2016; 5(4): 116-121. DOI: 10.1302/2046-3758.54.2000628
Ulloth JE, Casiano CA, De Leon M. Palmitic and stearic fatty acids induce caspasedependent and independent cell death in nerve growth factor differentiated PC12 cells. J. Neurochem. 2003; 84: 655–668. DOI: 10.1046/j.1471-4159.2003.01571.x
Sizova OA, Goncharova EV. Fatty acid composition of blood plasma in patients with chronic renal failure, depending on the presence of ventricular extrasystole. Transbaikal Medical Bulletin. 2018; (3): 63-70. An access regimen: http://medacadem.chita.ru/zmv (reference date: 03.20.2020). Russian
Barger PM, Kelly DP. Fatty acid utilization in the hypertrophied and failing heart: molecular regulatory mechanisms. Am J. Med Sci. 1999; 318(1): 36-42. DOI: 10.1097/00000441-199907000-00006
Namokonov EV, Miromanov AM, Khyshiktuev BS, Davydov SO, Tsyrendorzhiev DD. Pathophysiological aspects of development, diagnostics and wound infection treatment in surgery. Novosibirsk: Nauka, 2010. 112 р. Russian

Researches of young scientists

SIGNIFICANCE OF CONTROL OF INTRACRANIAL PRESSURE AND REGULATION OF SODIUM IN TRAUMATIC BRAIN INJURY IN CHILDREN

Fogel I.A., Shmakov A.N., Budarova K.V., Kokhno V.N., Elizar'eva N.L.

Novosibirsk State Medical University,

Novosibirsk, Russia

Objective − to evaluate the diagnostic and therapeutic significance of monitoring of intracranial pressure and plasma sodium concentration for intensive care of children with traumatic brain injury.

Materials and methods. A study of 40 children with severe traumatic brain injury was conducted on the basis of the surgical anesthesiology and intensive care unit of the Pediatric City Clinical Hospital in Novosibirsk. Assessment of the level of natriemia and the rate of its normalization under conditions of constant monitoring of intracranial pressure (13 patients) and in conditions of empirical correction of intensive care elements (27 patients) was performed with non-parametric statistics and ROC analysis.

Results. The incidence of hypernatremia was high in all patients, regardless of outcome (p = 0.655). Monitoring of intracranial pressure allowed stopping the increase in sodium on the second day (Se 27.27 % and Sp 100 %). Sodium concentrations of more than 156 mmol/L (Se 83.33 % and Sp 76.19 %) were adverse from perspectives of prediction.

Conclusions. Hypernatremia reflects the severity of traumatic brain damage; its value and stability determine the forecast. Control of intracranial pressure allows quick normalization of sodium metabolism, improves the quality of life, but its positive effects are offset by manifestations of post-traumatic inflammation.

Key words: intracranial pressure; hypernatremia; traumatic brain injury; children.

Information about authors:

Fogel I.A., student of 6th course of pediatric faculty, Novosibirsk State Medical University, Novosibirsk, Russia.

Shmakov A.N., MD, PhD, professor of anesthesiology and critical care medicine of medical department, Novosibirsk State Medical University, chief pediatric anesthesiologist-intensivist of Health Ministry of Administration of Novosibirsk Region, Novosibirsk, Russia.

Budarova K.V., candidate of medical science, docent at department of anesthesiology and critical care medicine of medical department, Novosibirsk State Medical University, Novosibirsk, Russia.

Kokhno V.N., MD, PhD, professor, chief of at department of anesthesiology and critical care medicine of medical department, Novosibirsk State Medical University, Novosibirsk, Russia.

Elizar'eva N.L., MD, PhD, professor of department of anesthesiology and critical care medicine of medical department, Novosibirsk State Medical University, Novosibirsk, Russia.

Address for correspondence:

Budarova K.V., 1905 goda St., 87-45, Novosibirsk, Russia, 630132

E-mail: bcv@yandex.ru

REFERENCES:

Semenova ZhB, Melnikov AV, Savvina IA, Lekmanov AU, Khachatryan VA, Gorelyshev SK. Recommendations for the treatment of children with traumatic brain injury. Russian Herald of Pediatric Surgery, Anesthesiology and Resuscitation. 2016; 6 (2): 112-131. Russian
Lekmanov AU, Petlakh VI. Emergency medical care for children injured in traffic accidents. Russian Herald of Pediatric Surgery, Anesthesiology and Resuscitation. 2012; (4): 79–87. Russian
Dats AV, Dats LS, Khmelnitsky IV. The structure of defects in the provision of medical care for polytrauma in intensive care units and intensive care. Polytrauma. 2017; (3): 23-37. Russian
Dixon R, Nocera M, Zolotor JA, KeenanH. T. Intracranial pressure monitoring in infants and young children with traumatic brain injury. Pediatric Critical Care Medicine. 2016; 17(11): 1064-1072. doi: 10.1097/PCC.0000000000000937
Semenova ZhB, Lukyanov VI, Meshcheryakov SV. A new indicator of the dynamics of intracranial pressure in the prognosis of outcomes in children with severe head injury. Neurosurgery and Neurology of Childhood. 2017; 3(53): 46-57. Russian
Hawthorne C. Monitoring of intracranial pressure in patients with traumatic brain injury. Front Neurol. 2014; 16(5): 121.
Surgery for severe traumatic brain injury. Krylov VV, Talypov AE, Levchenko OV. Moscow, 2019. 859 р. Russian
Kolykhalkina IA, Amcheslavsky VG, Bagaev VG, Ivanova TF, Lukyanov VI. The importance of monitoring ICP and CPD in children with severe trauma. Pediatric Surgery. 2019; 23(1S2): 34. Russian
Rivera-Lara L, Zorrilla-Vaca A, Geocadin R, Ziai W, Healy R, Thompson R et all. Predictors of outcome with cerebral autoregulation monitoring: a systematic review and meta-analysis. Crit Care Med. 2017; 45(4): 695-704. doi: 10.1097/CCM.0000000000002251.
Zeiler FA, Cardim D, Donnelly J, Menon DK, Czosnyka M, Smielewski P. Transcranial doppler systolic flow index and ICP-derived cerebrovascular reactivity indices in traumatic brain injury. J Neurotrauma. 2018; 35(2):314-322. doi: 10.1089/neu.2017.5364.
Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, et al. Recommendations for the diagnosis and treatment of severe traumatic brain injury. Part 2. Intensive care and neuromonitoring. Questions of Neurosurgery named after N.P. Burdenko. 2016; (1): 98-106. doi: 10.17116/neiro201680198-106 Russian
Neuroresuscitation: practical guidance. Krylov VV, Petrikov SS, Ramaanov GR, Solodov AA. 2nd edition, edited and supplemented. Moscow: GEOTAR-Media, 2019. 171 p. Russian

13. Kim H, Lee HJ, Kim YT, Son Y, Smielewski P., Czosnyka M, et all. Novel index for predicting mortality during the first 24 hours after traumatic brain injury. J Neurosurg. 2018; 131(6): 1887-1895. doi: 10.3171/2018.7.JNS18995.

Case history

improvement in treatment of patients with traumatic injuries to soft tissues of the head

Bogdanov S.B., Karakulev A.V., Polyakov A.V., Marchenko D.N., Aladina V.A.

Scientific Research Institute – Ochapovsky Regional Clinic Hospital No.1,

Kuban State Medical University, Krasnodar, Russia

Unsatisfactory results of autodermoplasty on bone structures in the acute period after injury are determined by insufficient vascularization of the wound. The classic approach is staged surgical treatment with maturation of granulation tissue on the skull within 6 months.

Objective − to develop a method for treating extensive head wounds in the acute period after trauma, which will improve the restoration of skin on extensive head wounds, shorten the treatment period, create conditions for the engraftment of a free skin autograft for the bone, ensure uniform tight pressure on the graft during autodermoplasty, and improve functional and cosmetic results.

Materials and methods. A clinical case of surgical treatment of a victim with a large defect in the soft tissues of the head with the exposure of the skull bones of 20 × 30 cm is presented.

Results. The developed technique allows for one operation in the first days after injury to restore the integrity of the skin on extensive head wounds with the exposure of the skull bones; to achieve better functional and cosmetic results of surgical treatment of facial wounds due to plastic grafts of 0.7-1 mm of thickness; to improve cosmetic results on donor sites as a result of the use of the wound coating "Chitopran", which covers the areas of perforated autografts. The vacuum dressing ensures tight contact of skin autografts with the bottom of the wound, which in turn minimizes the likelihood of migration of autografts, as well as the appearance of hematomas under autografts, which can slow their healing.

Conclusion. When performing osteonecrectomy of the external cortical plate of the skull to the bleeding layer, conditions are created for the engraftment of a free skin autograft on the bone.

Key words: head wound; skull; skin plasty; vacuum dressing; wound coating.

Information about authors:

Bogdanov S.B., MD, PhD, chief of burn center, Scientific Research Institute – Ochapovsky Regional Clinic Hospital No.1; professor of department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Karakulev A.V., trauma orthopedist of burn unit, Scientific Research Institute – Ochapovsky Regional Clinic Hospital No.1; postgraduate student of trauma and military field surgery department, Kuban State Medical University, Krasnodar, Russia.

Polyakov A.V., candidate of medical science, surgeon of burn unit, Scientific Research Institute – Ochapovsky Regional Clinic Hospital No.1; docent at general surgery department, Kuban State Medical University, Krasnodar, Russia.

Marchenko D.N., surgeon of burn unit, Scientific Research Institute – Ochapovsky Regional Clinic Hospital No.1; postgraduate student of surgery department, Kuban State Medical University, Krasnodar, Russia.

Aladina V.A., postgraduate student of surgery department, Kuban State Medical University, Krasnodar, Russia.

Address for correspondence:

Bogdanov S.B., Matrosova St., 88, Krasnodar, Russia, 350000

Tel: +7 (918) 650-28-57

E-mail: bogdanovsb@mail.ru

REFERENCES:

1. Bogdanov SB. Etudes of surgery in combustiology. Krasnodar, 2019. 187 p. Russian

2. Bogdanov SB. Surgical aspects of performing facial plastic surgery with a full-layer skin autograft. Annals of Plastic, Reconstructive and Aesthetic surgery. 2016; (1): 12-20. Russian

3. Lin SJ, Hanasono MM, Skoracki RJ. Scalp and calvarial reconstruction. Seminars in Plastic Surgery. 2008; 22(4): 285.

4. The method of osteonecrotic on the flat surfaces of bones. Patent 2209606 Russian Rederation. Zinatullin RM, Hunafin SN, Kuvatov SS, Kuvatov ND. Application from May 4, 2001; published on August 10, 2003. Russian

5. Eyubov YuSh, Startseva OI, Milanov NO. The use of greater omentum with skin autografts in reconstructive microsurgery. State of the problem. Annals of Plastic, Reconstructive and Aesthetic surgery. 2003; (4): 58-64. Russian

6. Lysov AA, Kropotov MA, Brzhezovskiy VZh, Bekyashev AKh, Sobolevskiy VA, Dikov YuYu. Reconstruction of combined defects of the cranial vault in patients with malignant tumors of the scalp. Clinical and Experimental Surgery. Petrovsky Journal. 2015; (4): 57. Russian

7. Korotkova NL. Reconstructive and restorative treatment of patients with the consequences of facial burns. Dr. med. sci. abstracts diss. Nizhniy Novgorod, 2015. 352 p. Russian

8. Method of applying a vacuum bandage to the head. Patent 2651057 Russian Rederation. Bogdanov SB, Kovalenko AL., Dikarev AS., Marchenko DN. Application from October 26, 2016; published on April 18, 2018. Russian

9. Volokh MA, Lesnyakov AF, Kikoriya NG, Romanova ES, Volokh SA. Basic principles of creating models of allocomplexes of facial tissues. Grekov's Bulletin of Surgery. 2016; 3(2): 36-39. Russian

SURGICAL STRATEGIES FOR cervicothoracic injury with penetrating injury to the right common carotid artery, trachea and esophagus
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

Objective − to discuss the features of surgical strategies in a patient with a cervicothoracic stab wound with an injury to the right common carotid artery, trachea and esophagus.

Materials and methods. Results of treatment of the patient: “the stab cervicothoracic wound with the injury to the right common carotid artery, trachea and esophagus. Massive blood loss. Severe ethanol poisoning (3.2 ‰ in the blood)". The features of diagnosis and surgical strategies in the patient with the cervicothoracic injury and unstable hemodynamics are discussed.

Results. The patient was taken from the scene to the anti-shock operating room, St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. Taking into account the unstable hemodynamics and the presence of the injury in the 1st zone of the neck, he received the abbreviated examination protocol, including FAST examination and chest radiography. The cervicothoracic injury with a damage to the great vessels was suspected. Urgent surgery was performed: sternotomy, replantation of the right common carotid artery into the brachiocephalic trunk, suturing wounds of the trachea and esophagus. The postoperative period was uneventful. The patient was discharged on the 7the postoperative day.

Conclusion. The examination of the patient with unstable hemodynamics and the stab injury of the neck in the anti-shock operating room according to abbreviated diagnostic protocol and immediately surgery, including sternotomy, provided a satisfactory treatment result.

Key words: cervicothoracic injury; carotid artery injury; esophageal injury; tracheal injury.

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., Korablestroiteley St., 30-176, Saint Petersburg, Russia, 199397

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

E-mail: babichmed@mail.ru

REFERENCES:

Lee T, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofacial Trauma and Reconstruction. 2014; 7 (3): 175–189.
Schweigert M, Santos Sousa H, Solymosi N, Yankulov A. Spotlight on esophageal perforation: a multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg. 2016; 151(4): 1002–1011.
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
Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series). Emerg. Med. Australas. 2018; 30(6): 754-772.
Pogodina AN, Tatarinova EV, Korovkina EN. Experience in the treatment of cervicothoracic wounds. Medical Alphabet. 2016; (4): 18-23. Russian
Sperry JL, Moore EE, Coimbra R. Western trauma association critical decisions in trauma: penetrating neck trauma. Journal of Trauma and Acute Care Surgery. 2013; 75(6): 936–940.
Savelyev VS, Kirienko AI, Cherkasov MF, Sedov VM, Skvortsov MB, Grigoriev EG. Surgical diseases. Moscow: GEOTAR-Media, 2014. 1400 p. Russian

Rehabilitation

REHABILITATION AFTER TOTAL HIP AND KNEE REPLACEMENT: PROBLEMS AND PERSPECTIVES

Ratmanov M.A., Benyan A.S., Kuznetsova T.V., BorkovskiyA.Yu., Barbasheva S.S.

Samara Regional Clinical Hospital named after V.D. Seredavin,

Samara State Medical University,

Samara, Russia

This article deals with the issue of patient rehabilitation following major joints endoprosthetics.

Objective − to analyze the literature on modern methods of rehabilitation of patients after endoprosthetics, and describe the most promising directions in rehabilitation.

Materials. Review of Russian and foreign literature on the topic.

Results. This paper considers methodological basis of creating a successful rehabilitation system, analyses current rehabilitation platforms and describes the role of telemedicine in rehabilitation process. In addition to this, authors specify requirements for implementing enhanced recovery after surgery, consider its advantages and describe the significance of medical rehabilitation in achieving ultimate results. Moreover, the present paper analyses frequently used rehabilitation effectiveness assessment methods and highlights the important role of International Classification of Functioning (ICF) in creating a unified patient-care approach.

Conclusion. The most perspective direction in rehabilitation is IT-development, creating rehabilitation coordination centres and implementing multidisciplinary approach on all stages.

Key words: endoprosthetics; medical rehabilitation; multidisciplinary team.

Information about authors:

Ratmanov M.A., healthcare minister of Samara region, Healthcare Ministry of Samara region, Samara, Russia.

Benyan A.S., MD, PhD, chief physician, Samara Regional Clinical Hospital named after V.D. Seredavin, Samara, Russia.

Kuznetsova T.V., candidate of medical science, chief of medical rehabilitation unit, Samara Regional Clinical Hospital named after V.D. Seredavin, Samara, Russia.

Borkovskiy A.Yu., candidate of medical science, chief of traumatology unit, Samara Regional Clinical Hospital named after V.D. Seredavin, Samara, Russia.

Barbasheva S.S., candidate of medical science, docent at department of foreign and Latin languages, Samara State Medical University, Samara, Russia.

Address for correspondence:

Kuznetsova T.V., Vladimirskaya St., 23-34, Samara, Russia, 443030

Tel: +7 (917) 150-21-00

E-mail: samara900@yandex.ru

REFERENCES:

1. Belyaev AF, Kantur TA, Khmeleva EV. Rehabilitation of patients after hip replacement. Herald of Restorative Medicine. 2018; (4): 3. Russian

2. Gutenbrunner C, Bickenbach J, Melvin J, Lains J ge, Nugraha B. Strengthening health-related rehabilitation services at national levels. J. Rehabil Med. 2018; 50(4): 317-325. doi: 10.2340/16501977-2217.

3. Snell DL, Dunn JA, Sinnott KA, Hsieh CJ, Jong G, Hooper GJ. Joint replacement rehabilitation and the role of funding source. J. Rehabil Med. 2019; 51(10): 770-778. doi: 10.2340/16501977-2600.

4. Gutenbrunner C, Nugraha B. Principles of assessment of rehabilitation services in health systems: learning from experiences. J. Rehabil Med. 2018; 50(4): 326-332. doi :10.2340/16501977-2246.

5. Ponnusamy KE, Naseer Z, Dafrawy El MH, Okafor L, Alexander C, Sterling RS, et al. Post-discharge care duration, charges, and outcomes among medicare patients after primary total hip and knee arthroplasty. J. Bone Joint Surg Am. 2017; 99(11): e55. doi: 10.2106/jbjs.16.00166.

6. Jansen E, Brienza S, Gierasimowicz-Fontan A, Matos C. Rehabilitation after total knee arthroplasty of hip and knee. Rev Med Brux. 2015; 36(4): 313-320.

7. Larsen JB, Mogensen L, Arendt-Nielsen L, Madeleine P. Intensive, personalized multimodal rehabilitation in patients with primary or revision total knee arthroplasty: a retrospective cohort study. BMC Sports Sci Med Rehabil. 2020; 1: 5. doi: 10.1186/s13102-020-0157-1.

8. Buylova TV, Tsykunov MB, Kareva OV, Kochetova NV. Federal clinical recommendations. Rehabilitation during hip replacement in a specialized department of a hospital. Bulletin of Restorative Medicine. 2016; (5): 94-102. Russian

9. Kim JH, Kim BR, Kim SR, Han EY, Nam KW, Lee SY, et al. Functional outcomes after critical pathway for inpatient rehabilitation of total knee arthroplasty. Ann Rehabil Med. 2019; 43(6): 650-661. doi: 10.5535/arm.2019.43.6.650.

10. Konev ES, Serebryakov AB, Shapovalenko TV, Lyadov KV. Analysis of 5-year experience of a multidisciplinary team with protocol of fast-track therapy after total hip and knee arthroplasty at the clinic "Medical Rehabilitation Center". Physiotherapy, Balneology and Rehabilitation. 2016; 15(4): 175-182. Russian

11. Scott NB, McDonald D, Campbell J. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units-an implementation and follow-up at 1 year, 2010-2011: a report from the Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg. 2013; 133(1): 117-124. doi: 10.1007/s00402-012-1619-z.

12. Berezenko MN, Gubaidullin RR, Onegin MA. Influence of fast-track rehabilitation after total knee replacement on the duration of hospitalization, consumption of analgesics and recovery time of joint function. General Practitioner's Guide. 2015; (8): 25-34. Russian

13. Li K, Liu YW, Feng JH, Zhang W. Clinical study of enhanced recovery after surgery in peri-operative management of total hip arthroplasty. Sichuan Da Xue Xue Bao Yi Xue Ban. 2019; 50(4): 604-608.

14. Zhang C, Xiao J. Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty. J. Int Med Res. 2020; 48(1): 2-13. doi: 10.1177/0300060519889718.

15. Naylor JM, Hart A, Harris IA, Lewin AM. Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: a call for evidence-based guidelines. BMC Musculoskelet Disord. 2019; 20(1): 214. doi 10.1186/s12891-019-2570-8.

16. Ageenko AM, Sadovoy MA, Shelyakina OV, Ovtin MA. The technology of accelerated rehabilitation after joint replacement of the hip and knee joints (literature review). Traumatology and Orthopedics of Russia. 2017; 23(4): 146-155. Russian

17. Goryannaya NA, Ishekova NI, Popov VV. Dynamics of the psychoemotional state of patients at the first stage of rehabilitation after hip replacement. International Journal of Applied and Fundamental Research. 2017; 3-1: 49-52. Russian

18. Soeters R, White PB, Murray-Weir M, Koltsov JCB, Alexiades MM, Ranawat AS. Hip and knee surgeons writing committee. Preoperative physical therapy education reduces time to meet functional milestones after total joint arthroplasty. Clin Orthop Relat Res. 2018; 476(1): 40-48. doi: 10.1007/s11999.0000000000000010.

19. Jansson MM, Harjumaa M, Puhto AP, Pikkarainen M. Patients' satisfaction and experiences during elective primary fast-track total hip and knee arthroplasty journey: a qualitative study. J. Clin Nurs. 2019; 29(3-4): 567-582. doi:10.1111/jocn.15121.

20. Svinøy OE, Bergland A, Risberg MA, Pripp AH, Hilde G. Better before-better after: efficacy of prehabilitation for older patients with osteoarthritis awaiting total hip replacement - a study protocol for a randomised controlled trial in South-Eastern Norway. BMJ Open. 2019; 9(12): e031626. doi: 10.1136/bmjopen-2019-031626.

21. Tanzer D, Smith K, Tanzer M. Changing patient expectations decreases length of stay in an enhanced recovery program for THA. Clin Orthop Relat Res. 2018; 476(2): 372-378. doi: 10.1007/s11999.0000000000000043

22. Sekirin AB. Protocol of early rehabilitation after endoprosthesis replacement of large joints (literature review). Journal of Rehabilitation Medicine. 2019; (2): 51-57. Russian

23. Tsykunov MB. Scales for assessing disorders in the pathology of the musculoskeletal system using categories of the international classification of functioning (discussion). Herald of Restorative Medicine. 2019; 2: 2-12. Russian

24. Panarina IM, Volkova ES, Salnikova EP. Comparative characteristics of methods of physical rehabilitation after total hip replacement. Science and Society in the Era of Change. 2019; 1(5): 2-4. Russian

25. Rud IM, Melnikova EA, Rassulova MA, Razumov AN, Gorelikov AE. Rehabilitation of patients after endoprosthesis of lower limb joints. Questions of Balneology, Physiotherapy and Therapeutic Physical Culture. 2017; (6): 38-44. Russian

26. Nikolayev NS, Petrova RV, Ivanov MI, Fadeeva UG. On the results of the Pilot project "Development of the medical rehabilitation system in the Russian Federation" in providing rehabilitation assistance after hip replacement. Herald of Restorative Medicine. 2017; (4): 2-9. Russian

27. Ivanova GE, Belkin AA, Belyaev AF, Bodrova RA, Buylova TV, Melnikova EV et al. Pilot project "Development of the medical rehabilitation system in the Russian Federation". General principles and Protocol. Bulletin of Ivanovo State Medical Academy. 2016; (1): 7-14. URL: https://cyberleninka.ru/article/n/pilotnyy-proekt-razvitie-sistemy-meditsinskoy-reabilitatsii-v-ross... (дата обращения: 03.03.2020). Russian

28. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008; 79(2): 168-173. doi: 10.1080/17453670710014941.

29. Güler T, Sivas F, Yurdakul FG, Çelen E, Utkan A, Başkan B, et al. Early improvement in physical activity and function after total hip arthroplasty: Predictors of outcomes. Turk J Phys Med Rehabil. 2019; 65(4): 379-388. doi: 10.5606/tftrd.2019.4695.

30. Small SR, Bullock GS, Khalid S, Barker K, Trivella M, Price AJ. Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review. BMJ Open. 2019; 9(12): e033832. doi: 10.1136/bmjopen-2019-033832.

31. Lebleu J, Poilvache H, Mahaudens P. Predicting physical activity recovery after hip and knee arthroplasty: a longitudinal cohort study. Braz J Phys Ther. 2019; Dec 18: pii: S1413-3555(19)30199-6. doi: 10.1016/j.bjpt.2019.12.002.

32. Chughtai М, Kelly JJ, Newman JM. The role of virtual rehabilitation in total and unicompartmental knee arthroplasty. J. Knee Surg. 2019; 32 (1): 105-110. doi: 10.1055/s-0038-1637018.

33. Russell TG, Buttrum P, Wootton R, Jull GA. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J. Bone Joint Surg Am. 2011; 93(2): 113-120. doi: 10.2106/jbjs.i.01375.

34. Jiang S, Xiang J, Gao X, Guo K, Liu B. The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: a systematic review and meta-analysis. J. Telemed Telecare. 2018; 24(4): 257-262. doi: 10.1177/1357633x16686748.

35. Shukla H, Nair SR, Thakker D. Role of telerehabilitation in patients following total knee arthroplasty: Evidence from a systematic literature review and meta-analysis. J. Telemed Telecare. 2017; 23(2): 339-346. doi: 10.1177/1357633x16628996.

36. Fisher C, Biehl E, Titmuss MP, Schwartz R, Gantha CS. Physical therapist-led telehealth care navigation for arthroplasty patients: a retrospective case series. HSS J. 2019; 15(3): 226-233. doi: 10.1007/s11420-019-09714-x.

37. Lyadov KV, Shapovalenko TV, Koneva ES. Experience of using remote rehabilitation of patients after endoprosthesis of lower limb joints: review of literature and results of own research. Herald of Restorative Medicine. 2015; (5): 72-75. Russian

38. Eichler S, Rabe S, Salzwedel A, Müller S, Stoll J, Tilgner N, et al. Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: study protocol for a multicenter, superiority, no-blinded randomized controlled trial. Trials. 2017; 18(1): 438. doi 10.1186/s13063-017-2173-3.

Reviews

C LOSED LIVER INJURIES: THE ALGORITHM OF SURGEON'S

ACTIONS IN A FIRST-LEVEL TRAUMA CENTER

Maskin S.S., Aleksandrov V.V., Matyukhin V.V., Ermolaeva N.K.

Volgograd State Medical University,

Volgograd, Russia

Objective − to summarize the data of Russian and foreign literature to improve the results of treatment of patients with blunt liver trauma.

Materials and methods. The analysis of literary sources of Russian and foreign authors on this issue.

Results. The algorithm of the surgeon's actions for liver injuries of various severity is justified. Indications for conservative management of patients and endovascular methods of hemostasis are described, and a brief description of surgical interventions is given.

Conclusion. Tactics depends on hemodynamic status of a patient. In surgical treatment of severe liver trauma, priority is given to perihepatic packing.

Key words: blunt abdominal injury; liver trauma; non-operative management; operative management; topical hemostatic agents; atriocaval shunting; damage control; perihepatic packing.

Information about authors:

Maskin S.S., MD, PhD, Professor, Head of the Department of Hospital surgery, Volgograd State Medical University, Volgograd, Russia.

Aleksandrov V.V., candidate of medical science, Associate Professor at the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russia.

Matyukhin V.V., candidate of medical science, Associate Professor at the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russia.

Ermolaeva N.K., candidate of medical science, Assistant at the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russia.

Address for correspondence:

Aleksandrov V.V., Pavshikh Bortsov Sq. 1, Volgograd, Russia, 400131

Tel: +7 (917) 830-49-89

E-mail: 79178304989@yandex.ru

REFERENCES:

Aleksandrov VV. Experimental study of local cryohemostasis in liver and spleen trauma. Abstract of the dissertation for the academic degree of candidate of medical sciences. Volgograd, 2013. 21 р. Russian
Chalyk RYu. Clinical rationale for the choice of surgical technique for liver damage. Abstract of the dissertation for the academic degree of candidate of medical sciences. Saratov, 2009. 21 p. Russian
Chernaya NR. Endovascular hemostasis in closed and open liver injuries. Abstract of the dissertation for the academic degree of candidate of medical sciences. Moscow, 2003. 21 р. Russian
Coccolini F, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg. 2016; 11:50. https://doi:10.1186/s13017-016-0105-2
Dyukov AK. Diagnosis and surgical tactics for closed abdominal trauma with liver damage at multi-field hospital. Abstract of the dissertation for the academic degree of candidate of medical sciences. Saint-Petersburg, 2018. 29 p. Russian
Doklestić K, Stefanović B, Gregorić P, Ivančević N, Lončar Z, Jovanović B, et al. Surgical management of AAST grades III–V hepatic trauma by damage control surgery with perihepatic packing and definitive hepatic repair-single centre experience. World J. Emerg. Surg. 2015; 10: 34. https://doi:10.1186/s13017-015-0031-8
Еrmolov AS, Blagovestnov DA, Gulyayev AA, Yartsev PA, Andreyev VG, Smolyar AN, et al. Injuries to parenchymal organs of the abdominal cavity in abdominal trauma: textbook. Moscow: GBOU DPO RMAPO, 2015.138 р. Russian
Еrmolov AS, Khubutiya MSh, Abakumov MM. Abdominal trauma: a guide for doctors. Moscow: Vidar M publishing office, 2010. 504 р. Russian
Ermolov AS, Abakumov MM, Vladimirova ES. Liver injury. Moscow: Medicine, 2003. 191 p. Russian
Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J. Trauma Acute Care Surg. 2016; 80(3): 529–537. https://doi: 10.1097/TA.0000000000000942
Hazelton JP, Choron RL, Dodson GM, Gerritsen JA, Khan S, VanOrdenet KE, et al. Comparison of atriocaval shunting with perihepatic packing versus perihepatic packing alone for retrohepatic vena cava injuries in a swine model. Injury. 2015; 46(9):1759–1764. https://doi:10.1016/j.injury.2015.04.014
Hommes M, Navsaria PH, Schipper IB, Krige JE, Kahn D, Nicol AJ. Management of blunt liver trauma in 134 severely injured patients. Injury. 2015; 46(5):837–842. https://doi:10.1016/j.injury.2014.11.019
Jung K, Kim Y, Heo Y, Lee JC, Youn S, Moon J, et al. Management of severe blunt liver injuries by applying the damage control strategies with packing-oriented surgery: experiences at a single institution in Korea. Hepatogastroenterology. 2015; 62 (138): 410–416.
Kobayashi T, Kubota M, Arai Yu, Ohyama T, Yokota N., Miura K, et al. Staged laparotomies based on the damage control principle to treat hemodynamically unstable grade IV blunt hepatic injury in an eight-year-old girl. Surg. Case Reports. 2016; 2(1):134. https://doi:10.1186/s40792-016-0264-0
Morse DC, Silva E, Bartrom J, Young K, Bass EJ, Potter D, et al. Improved bleeding scores using Gelfoam Powder with incremental concentrations of bovine thrombin in a swine liver lesion model. J Thromb Thrombolysis. 2016; 42(3):352–359. https://doi:10.1007/s11239-016-1388-6
Reva VA, Makhnovskiy AI, Sokhranov MV, Semenov YeA, Samokhvalov IM. Endovascular balloon aortic occlusion in combat injuries: possibilities and prospects of application in the field. Trauma 2017: a multidisciplinary approach. Collection of abstracts of the International conference. Moscow, November 3-4, 2017. Voronezh. Nauchnaya Kniga publishing office, 2017, 102-103. Russian
Ribeiro MA Jr, Medrado MB, Rosa OM, Silva AJ, Fontana MP, Cruvinel-Neto J, et al. Liver transplantation after severe hepatic trauma: current indications and results. Arq Bras Cir Dig. 2015; 28(4): 286–289. https://doi:10.1590/S0102-6720201500040017
Segura-Sampedro JJ, Pineño-Flores C, Craus-Miguel A, Morales-Soriano R, González-Argente FX. New hemostatic device for grade IV-V liver injury in porcine model: a proof of concept. World J Emerg Surg. 2019; 14:58. https://doi:10.1186/s13017-019-0277-7
Shapkin YuG, ChalykYuV, Stekolnikov NYu, Gusev KA. Perihepatic Paking as the First Stage of Damage Control Strategy. (Review) Annals of HPB surgery. 2017; 22(4): 89-95. Russian
Sigua BV, Zemlyanoy VP, Dyukov AK. Closed abdominal injury with liver damage. Grekov's Bulletin of Surgery. 2015; 174(1): 9-15. Russian
Slobozhanin MI. The results of surgical treatment of patients with open and closed injuries of the liver. Health, Demography, Ecology of Finno-Ugric Peoples. 2019; (1): 48-51. Russian
Smolyar AN. Closed abdominal trauma. Liver injuries. Part 1. Pirogov Russian Journal of Surgery. 2015; (12): 5–13. Russian
Tarchouli M, Elabsi M, Njoumi N, Essarghini M, Echarrab M, Chkoff MR. Liver trauma: What current management? Hepatobiliary Pancreat Dis Int. 2018; 17(1): 39–44. https://doi:10.1016/j.hbpd.2018.01.013
Vladimirova ES, Valetova VV. Temporary hemostasis at severe hepatic injury and its influence on vital functions. Medical Alphabet. 2016; 3(20): 14-19. Russian

Annotations journal "Polytrauma" 1/2020

4. Sato T, Vries RG, Snippert HJ, van de Wetering M, Barker N, Stange DE , et al. Single Lgr5 stem cells build crypt-villus structures in vitro without a mesenchymal niche. Nature. 2009; 459( 7244): 262–265.

5. Malkoch AV, Bel’mer SV. Intestinal microflora and the importance of prebiotics for its functioning. Attending Physician. 2006; (4): 60-65. Russian

7. Zhu R, Ma XC. Role of metabolic changes of mucosal layer in the intestinal barrier dysfunction following trauma/hemorrhagic shock. Pathol Res Pract. 2018; 214(11): 1879-1884.

8. Li Z, Li J, Zhang S, Chen G, Chi S, Li X, et al. Metabolomics analysis of gut barrier dysfunction in a trauma-hemorrhagic shock rat model. Biosci Rep. 2019; 39(1): BSR20181215.

9.Armacki M, Trugenberger AK, Ellwanger AK, Eiseler T, Schwerdt C, Bettac L, et al. Thirty-eight-negative kinase 1 mediates trauma-induced intestinal injury and multi-organ failure. J Clin Invest. 2018; 128(11): 5056–5072.

10. Zhou QQ,Verne GN. Intestinal hyperpermeability: a gateway to multi-organ failure? J Clin Invest. 2018; 128(11): 4764–4766.

11. Patel JJ, Rosenthal MD, Miller KR, Martindale RG. The gut in trauma. Curr Opin Crit Care. 2016; 22(4): 339-346.

12. Derikx JP, van Waardenburg DA, Thuijls G, Thuijls G, Willigers HM, Koenraads M, et al. New insight in loss of gut barrier during major non-abdominal surgery. PLoS One. 2008; 3(12): e3954.

13. De Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study. Crit. Care. 2009; 13(3): R86.

14. Osuka A, Kusuki H, Matsuura H, Shimizu K, Ogura H, Ueyama M. Acute intestinal damage following severe burn correlates with the development of multiple organ dysfunction syndrome: a prospective cohort study. Burns. 2017; 43(4): 824-829.

16. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal Failure score in critically ill patients: a prospective observational study. Crit Care. 2008; 12(4): R90.

Rivera-Lara L, Zorrilla-Vaca A, Geocadin R, Ziai W, Healy R, Thompson R et all. Predictors of outcome with cerebral autoregulation monitoring: a systematic review and meta-analysis. Crit Care Med. 2017; 45(4): 695-704. doi: 10.1097/CCM.0000000000002251.

13. Kim H, Lee HJ, Kim YT, Son Y, Smielewski P., Czosnyka M, et all. Novel index for predicting mortality during the first 24 hours after traumatic brain injury. J Neurosurg. 2018; 131(6): 1887-1895. doi: 10.3171/2018.7.JNS18995.