Annotations journal "Polytrauma" 1/2021

Original researches

RISK PREDICTION OF DEVELOPMENT OF CLINICALLY SIGNIFICANT HETEROTOPIC OSSIFICATION AROUND MAJOR JOINTS IN PATIENTS WITH TRAUMATIC SPINAL CORD INJURY

Khokhlova O.I., Barannikov A.A., Filatov E.V., Ovchinnikov O.D.

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

Novokuznetsk, Russia

Heterotopic ossification (HO) around major joints with limitation of motion is a common complication of a traumatic spinal cord injury leading to person’s severe functional disability. Early detection and prophylaxis might prevent or reduce complications of this pathology.

Objective − to determine whether main clinical and demographic indicators may be used to predict risk of development of clinically significant heterotopic ossification around major joints in patients with traumatic spinal cord injury.

Materials and methods. Altogether, 823 cases of patients with traumatic spinal cord injury (TSCI) that underwent rehabilitation program in Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons from 2016 to 2018 were analyzed. HO was diagnosed in presence of clinical signs and with X-ray images.

Binary logistic regression was used to identify significant predictive factors of HO development and build predictive model.

Results. Clinically significant HO around major joints was found in 6.7 % of patients with TSCI, mainly in male with cervical or thoracic spinal cord injury with severe neurological deficit (AIS grade A and B). Most common location of HO was around hip joint (89.1 % of cases).

Major risk factors of development of clinically significant HO around major joints were (in decreasing order of significance): cervical spinal cord injury, male gender, complete impairment of sensory and motor function (AIS grade A).

Conclusion. The resulting prognostic model is a simple system of stratification of persons with spine and spinal cord injury into groups at risk of developing clinically significant HO around major joints. Health specialists can use this model when making clinical decisions regarding prevention of the development of this complication.

Key words: traumatic spinal cord injury; heterotopic ossification; risk factors.

Information about authors:

Khokhlova O.I., MD, PhD, leading researcher at department of medical, social and vocational rehabilitation, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Barannikov A.A., traumatologist-orthopedist, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Filatov E.V., candidate of medical sciences, head of department of neurosurgery, neurosurgeon, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Ovchinnikov O.D., traumatologist-orthopedist, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:

Khokhlova O.I., Malaya street, 7, Novokuznetsk, Kemerovo region, Russia, 654055

Tel: (3843) 36-91-26,

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

REFERENCES:

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3. Krauss H, Maier D, Bühren V, Högel F. Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients. Spinal Cord. 2015; 53 (5): 345–348. DOI: 10.1038 / sc.2014.186.

4. Ohlmeier M, Suero EM, Aach M, Meindl R, Schildhauer TA, Citak M. Muscle localization of heterotopic ossification following spinal cord injury. Spine J. 2017; 17 (10):1519–1522. DOI: 10.1016/j.spinee.2017.04.021.

5. Suero EM, Meindl R, Schildhauer TA, Citak M. Clinical prediction rule for heterotopic ossification of the hip in patients with Spinal Cord Injury. Spine. 2018; 43 (22):1572–1578. DOI: 10.1097/BRS.0000000000002680.

6. Meyers C, Lisiecki J, Miller S, Levin A, Fayad L, Ding C, et al. Heterotopic ossification: a comprehensive review. JBMR Plus. 2019; 3(4): e10172. DOI: 10.1002/jbm4.10172.

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11. Reznik J, Biros E, Marshall R, Jelbart M, Milanese S, Gordon S, Galea MP. Prevalence and risk-factors of neurogenic heterotopic ossification in traumatic spinal cord and traumatic brain injured patients admitted to specialised units in Australia. J Musculoskel Neuron Interac. 2014; 14 (1): 19–28.

12. Ranganathan K, Loder S, Agarwal S, Wong VW, Forsberg J, Davis TA. Heterotopic ossification: basic-science principles and clinical correlates. J Bone Joint Surg Am. 2015; 97 (13): 1101–1111. DOI: 10.2106/JBJS.N.01056.

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Anesthesiology and critical care medicine

CONTRASTING EVALUATION OF BODY TEMPERATURE VARIABILITY OF PATIENTS WITH SEVERE TRAUMATIC SHOCK IN DIAMETRICAL ENVIRONMENTAL LIQUIDUSES

Girsh A.O., Leonov G.V., Stepanov S.S., Stukanov M.M., Leyderman I.N., Chumakov P.A., Yaroshetskiy A.I.

Omsk State Medical University, Omsk, Russia

Objective − implementation of contrasting evaluation of body temperature variance in patients with severe traumatic shock in case of diametrical environmental liquiduses at the stages of emergency medical care and hospital.

Materials and methods. The study included 63 patients with severe traumatic shock which were distributed into 6 groups depending on environment liquidus at the moment of occurrence of commotion. Body temperature was measured in all patients at emergency medical care and hospital stages, followed by synective accounting.

Results. Synective accounting found evident favorable body temperature variability in the victims at all study points. Materialized paired contrast recorded true body temperature variability in the groups I and II, II and III, III and IV, IV and V, V and VI. The implemented multiple comparison demonstrated a steady temperature exponent divergence between the groups throughout the research period.

Conclusions. In victims with severe traumatic shock, thermal regulation imbalance occurs already at the stage of emergency medical care and continues at the hospital stage from 24 to 48 hours, depending on the range of environmental liquidus at the time of commotion.

The degree of thermoregulation disorders in victims with severe traumatic shock also depends on the range of environmental liquidus at the time of commotion. Unheated infused solutions used in the anti-shock treatment program also contribute to the imbalance of thermal regulation in patients with severe shock.

For purposefully and individualized reduction of the degree of thermoregulation disorders in victims with severe traumatic shock, it is rational to use heated infusion solutions in the anti-shock treatment program at both the emergency medical care and hospital stages (taking into account the environment liquidus at the time of commotion).

Key words: body temperature; environmental liquidus.

Information about authors:

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

Leonov G.V., anesthesiologist-intensivist, deputy chief physician of medical assistance, Emergency Medical Care Station, Omsk, Russia.

Stepanov S.S., MD, PhD, professor at department of histology and cytology, Omsk State Medical University, Omsk, Russia.

Stukanov M.M., MD, PhD, chief physician, Emergency Medical Care Station, Omsk, Russia.

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

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

Yaroshetskiy A.I., MD, PhD, chief of department of anesthesiology and critical care medicine, Research Institute of Clinical Surgery, Pirogov Russian National Research Medical University, Moscow, 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

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15. Girsch AO, Stukanov MM, Leonov GV. Timing and frequency of hypothermia development in patients with shockogenic trauma. Ambulance Medical Care. 2018; (2): 46-53. Russian

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RISK FACTORS OF ALLOGENEIC BLOOD TRANSFUSION
IN PRIMARY TOTAL HIP ARTHROPLASTY

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

Irkutsk Scientific Centre of Surgery and Traumatology,

Irkutsk State Medical University,

Irkutsk, Russia

The need for allogeneic blood transfusion limits the possibility of orthopedic surgeries, slows down the rehabilitation of patients, increases resource consumption and the cost of treatment, and therefore remains an urgent problem of modern orthopedic surgery.

Objective − to identify risk factors for allogeneic blood transfusion in patients after primary total hip arthroplasty in the clinic of Irkutsk Scientific Centre of Surgery and Traumatology.

Materials and methods. We used the data of 355 patients who had planned primary total hip arthroplasty in the clinic of Irkutsk Scientific Centre of Surgery and Traumatology. The criterion for dividing the total data set into groups was the fact of carrying out allogeneic blood transfusion. Group 1 (n = 49) included patients who had a transfusion of at least one unit of donor blood components during hospitalization, and group 2 (n = 306) included patients whose treatment didn’t require allogeneic blood transfusion. The first stage of the research was the comparison of groups according to formal characteristics, including age, BMI, gender ratio, preoperative ASA physical status assessment, hip fracture diagnosis, baseline blood hemoglobin level, perioperative blood loss, duration of surgery, and the presence of concomitant somatic pathology: coronary heart disease, arterial hypertension, chronic obstructive pulmonary disease, diabetes mellitus. At the second stage, indicators with statistically significant difference were included in the binary logistic regression equation in order to quantitatively establish their effect on the need for blood transfusion.

Results. The obtained equation of binary logistic regression showed that a patient with diagnosed coronary artery disease had 4.3 times increased relative risk of donor blood transfusion. A doubling of the relative risk of allogeneic blood transfusion is observed with a decrease in the baseline blood hemoglobin concentration by 25.6 g/L, an increase in the duration of surgery by 21 minutes and of external perioperative blood loss − by 3.7 % of the total blood volume.

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

Information about authors:

Lebed M.L., MD, PhD, head of department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, assistant at department of general surgery and anesthesiology, Irkutsk State Medical University, Irkutsk, Russia.

Kirpichenko M.G., candidate of medical sciences, physician, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Shamburova A.S., candidate of medical sciences, anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Sandakova I.N., candidate of medical sciences, anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Bocharova Yu.S., candidate of medical sciences, transfusiologist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Popova V.S., anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Karmanova M.M., anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Fesenko M.A., anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Slobodchikova A.O., anesthesiologist-intensivist, department of anesthesiology and reanimation, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Vilyak E.A., anesthesiologist-intensivist, department of anesthesiology and reanimation, 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 Revolyutsii St, 1, Irkutsk, Russia, 664003

Tel: +7(3952) 290-348

E-mail: swanmax@list.ru

REFERENCES:

1. 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. ScientificWorldJournal. 2014; 2014:623460.

2. 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.

3. Jiang T, Song K, Yao Y, Pan P, Jiang Q. Perioperative allogenic blood transfusion increases the incidence of postoperative deep vein thrombosis in total knee and hip arthroplasty. J OrthopSurg Res. 2019;14(1):235.

4. 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.

5. 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.

6. Newman JM, Webb MR, Klika AK, Murray TG, Barsoum WK, Higuera CA. Quantifying bood loss and transfusion risk after primary vs conversion total hip arthroplasty. J Arthroplasty. 2017; 32(6):1902-1909.

7. 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.

8. Pan P, Song K, Yao Y, Jiang T, Jiang Q. The impact of intraoperative hypothermia on blood loss and allogenic blood transfusion in total knee and hip arthroplasty: a retrospective study. Biomed Res Int. 2020; 2020:1096743.

9. SongK, PanP, YaoY, JiangT, JiangQ. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J OrthopSurg Res. 2019;14(1):273.

10. 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.

11. Chang CH, Chang Y, Chen DW, Ueng SW, Lee MS. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res. 2014; 472(5):1552-1557.

12. Chin J, Blackett J, Kieser DC, Frampton C, Hooper G. The value of routine intravenous tranexamic acid in total hip arthroplasty: a preliminary study. Adv Orthop. 2020; 2020:2943827.

13. Rhee C, Lethbridge L, Richardson G, Dunbar M. Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg. 2018; 61(3):165-176.

14. Slover J, Lavery JA, Schwarzkopf R, Iorio R, Bosco J, Gold HT. Incidence and risk factors for blood transfusion in total joint arthroplasty: analysis of a statewide database. J Arthroplasty. 2017; 32(9):2684-2687.

15. Taneja A, El-Bakoury A, Khong H, Railton P, Sharma R, Johnston KD, et al. Association between allogeneic blood transfusion and wound infection after total hip or knee arthroplasty: a retrospective case-control study. J Bone Jt Infect. 2019;4(2):99-105.

16. Xu H, Xie J, Lei Y, Huang Q, Huang Z, Pei F. Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. J OrthopSurg Res. 2019;14(1):163.

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Clinical aspects of surgery

COMPLEX TREATMENT OF PATIENTS WITH EXTENDED PHLEGMONS OF THE SOFT TISSUES WITH APPLICATION OF CRYOPLASMA-ANTIENZYME THERAPY

Tseymakh E.A., Zinchenko V.Yu., Lavrinenko O.Yu., Chernenko V.V., Kalashnikov A.V., Tseymakh M.E., Shalabod E.A.

Altay State Medical University,

City Hospital No. 8, Barnaul, Russia

Despite of the achievements of modern medicine, the treatment of purulent-inflammatory diseases is still a serious surgical problem, which is determined by the prevalence of this type of pathology, long-term treatment of patients and high mortality. This justifies the need to develop new methods of treatment for these patients. In this regard, in the treatment of extended soft tissue phlegmons, we used a cryoplasma-antienzyme complex (CAC) as the basic therapy, which included transfusions of fresh-frozen (FFP) and cryosupernatant plasma (CSNP) containing fully the components of proteolytic systems, including AT III, coagulation and fibrinolysis factors, as well as heparin and proteinase inhibitors.

Objective − improving the outcomes of complex treatment of patients with extended soft tissue phlegmons by stopping thrombohemorrhagic syndrome.

Materials and methods. The results of treatment of 121 patients with extended phlegmons were analyzed. In the main group, 59 patients (48.8 %) received complex treatment with cryoplasma-antienzyme therapy, and in the comparison group, 62 patients (51.2 %) received conventional treatment for extended soft tissue phlegmons.

Results. Studies of the hemostatic system have shown that patients with extended soft tissue phlegmons develop thrombohemorrhagic syndrome with the consumption of physiological anticoagulants and clotting factors, and microcirculation disorders in the lesion. As the severity of the septic process increases, an increase in the level of thrombinemia according to orthophenanthroline test, a decrease in the plasminogen reserve index, and a slow down in XII-a dependent fibrinolysis were detected.

Conclusion. Use of CAC for the treatment of patients with extended soft tissue phlegmons reduced mortality by 2.3 times. Also, thrombotic and thromboembolic complications were observed less frequently in the main group of patients.

Key words: cryoplasma-antienzyme complex; phlegmon; sepsis; DIC-syndrome.

Information about authors:

Tseymakh E.A., MD, PhD, professor, head of department of general surgery, operative surgery and topographic anatomy, Altay State Medical University, Barnaul, Russia.

Zinchenko V.Yu., assistant at department of general surgery, operative surgery and topographic anatomy, Altay State Medical University, Barnaul, Russia.

Lavrinenko O.Yu., head physician, City Hospital No. 8, Barnaul, Russia.

Chernenko V.V., candidate of medical sciences, docent, head of department of purulent surgery, City Hospital No. 8, Barnaul, Russia.

Kalashnikov A.V., surgeon, department of purulent surgery, City Hospital No. 8, Barnaul, Russia.

Tseymakh M.E., 4th course student of the faculty of medicine, Altay State Medical University, Barnaul, Russia.

Shalabod E.A., head of laboratory, City Hospital No. 8, Barnaul, Russia.

Address for correspondence:

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

Tel: +7(3852) 244-873; +7 (3852) 566-942

E-mail: yea220257@mail.ru

REFERENCES:

1. Surgical infections of the skin and soft tissues. Russian National Recommendations. Second edition. Edited by B.R. Gelfand. Moscow, 2015. 109 p. Russian

2. Gostishchev V.K. Clinical operative purulent surgery. Moscow: GEOTAR-Media, 2016. 448 p. Russian

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

4. Dutkevich IG. Disseminated intravascular coagulation (DIC) syndrome in surgical practice. Grekov Herald of Surgery. 2013; 172(2): 067-073. Russian

5. Kuznik BI. Cellular and molecular mechanisms of hemostasis system regulation in normal and abnormal conditions. Chita: Express-Izdatelstvo, 2010. 823 p. Russian

6. Barkagan ZS, Vorobyev AI. Pathology of platelet hemostasis: the manual for hematology. Moscow: Medicine, 2005. Vol. 3. 416 p. Russian

Clinical aspects of traumatology and orthopedics

AN ADVANCED METHOD OF BONE TISSUE RECONSTRUCTION IN PATIENTS WITH OSTEOREGENERATION DISORDERS

(EXPERIENCE WITH CLINICAL APPLICATION OF SCAFFOLD TECHNOLOGIES)

Davydov D.V., Chirva Yu.V., Brizhan L.K., Babich M.I., Fedulichev P.N., Al-hanih Murad

Academician N.N. Burdenko Main Military Clinical Hospital of Defence Ministry of the Russian Federation, Moscow, Russia

V.I. Vernadsky Crimean Federal University, Simferopol, Russia,

Peoples' Friendship University of Russia, Moscow, Russia

Nonunion and defects of bone tissue are the same complex of comparable pathological processes − impairment of reparative osteoregeneration of the diaphysis of the long bone.

With objective of recovery of bone tissue and improvement in extremity function, the original technique for replacement of a bone defect in combination with internal fixation was offered.

Materials and methods. We studied 119 patients with non-unions and 19 wounded persons with a bone defect in the diaphysis of the long bone. In the main group of patients, the bone defect was plastered with autobone and collagen hydrogel. Internal osteosynthesis was performed. In the control group, the bone tissue defect was restored by the method of G.A. Ilizarov. The result of treatment was assessed clinically, radiographically and by testing.

Results. In the main group of patients with non-unions (61 people), the post-resection bone defect was restored in the mid-physiological terms of the segment bone fusion (mean time − 107.41 ± 41.29 days), which was 1.5 times better than the similar result of the control group (58 patients ) − on average 170.45 ± 7.30 days. In the main group of wounded with post-traumatic bone defect (9 people), restoration of the integrity of the bone tissue was completed on average after 267.57 ± 32.61 days, which was 1.4 times faster than in the control group (10 people). According to the test results in the main group, a good effect of treatment was obtained by 8-24 % more, than in the control group.

Conclusion. Collagen hydrogel is an effective matrix for the construction of a tissue-engineered structure when replacing a bone defect. The proposed algorithm for the treatment of patients with severe disorders of reparative osteoregeneration allows restoring the integrity of the bone and obtaining excellent and good treatment results.

Key words: bone defect; non-union; scaffold; tissue engineered construction; collagen; hydrogel; reparative osteoregeneration.

Information about authors:

Davydov D.V., MD, PhD, professor, chief of hospital, Academician N.N. Burdenko Main Military Clinical Hospital of Defence Ministry of the Russian Federation, Moscow, Russia.

Chirva Yu.V., candidate of medical sciences, senior resident of traumatology (reconstructive and restorative) unit of traumatology and orthopedics center, Academician N.N. Burdenko Main Military Clinical Hospital of Defence Ministry of the Russian Federation, Moscow, Russia.

Brizhan L.K., MD, PhD, professor, chief of traumatology and orthopedics center, Academician N.N. Burdenko Main Military Clinical Hospital of Defence Ministry of the Russian Federation, Moscow, Russia.

Babich M.I., consultative traumatologist, Academician N.N. Burdenko Main Military Clinical Hospital of Defence Ministry of the Russian Federation, Moscow, Russia.

Fedulichev P.N., candidate of medical sciences, docent at department of topographic anatomy and operative surgery, V.I. Vernadsky Crimean Federal University, Simferopol, Russia.

Al-hanih Murad, postgraduate at department of traumatology and orthopedics, Peoples' Friendship University of Russia, Moscow, Russia.

Address for correspondence:

Chirva Yu.V., Hospitalnaya Ploshchad, 3, Moscow, Russia, 106094

Tel: +7 (916) 207-34-92

E-mail: bf-4irva@rambler.ru

REFERENCES:

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5. Sevastyanov VI. Technologies of tissue engineering and regenerative medicine. Bulletin of transplantology and artificial organs. 2014; 16 (3): 93-108. Russian

6. Sevаstyanov VI. Cellular engineering structures in tissue engineering and reparative medicine. Bulletin of transplantology and artificial organs. 2015; 17(2): 127-130. Russian

7. Sheikh FA, Ju HW, Moon BM, Lee OJ, Kim JH, Park HJ, et al. Hybrid scaffolds based on PLGA and silk for bone tissue engineering. Journal of tissue engineering and regenerative medicine. 2016; 10(3): 209-221. DOI: 10.1002/term.1989

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9. Hasany M, Thakur A, Taebnia N, Kadumudi FB, Shahbazi MA, Pierchala MK, et al. Combinatorial screening of nanoclay-reinforced hydrogels: a glimpse of the "Holy Grail" in orthopedic stem cell therapy? ACS Appl Mater Interfaces. 2018; 10(41): 34924-34941. doi: 10.1021/acsami.8b11436.

10. Xin S, Gregory CA, Alge DL. Interplay between degradability and integrin signaling on mesenchymal stem cell function within poly(ethylene glycol) based microporous annealed particle hydrogels. Acta Biomater. 2020; 101: 227-236. doi: 10.1016/j.actbio.2019.11.009.

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OSTEOSYNTHESIS ACCORDING TO ILIZAROV AS A SELF-SUFFICIENT METHOD FOR TREATMENT OF SHIN BONES FRACTURES

Artemyev А.А., Brizan L.К., Davydov D.V., Ivashkin А.N., Grigoryev М.А., Hassan MokhammedKh.Yu., Kashoob A.M., Gyandzhaliev R.А.

Academician N.N. Burdenko Main Military Clinical Hospital,

Medical Institute of Continuous Education of Moscow State University of Food Manufacturing,

V.V. Vinogradov City Clinical Hospital of Moscow Healthcare Department,

Peoples' Friendship University of Russia,

Moscow, Russia

Shin fractures are the most common skeletal injuries. Practically all known types of osteosynthesis are used for treatment. The use of the Ilizarov method is associated with certain difficulties relating to the peculiarities of postoperative observation.

Objective − to generalize the long-term experience of using the Ilizarov method in the treatment of diaphyseal fractures of the shin bones, to optimize the technique, analyze problems and assess the prospects for the development of the method.

Materials and methods. The experience with treating 57 patients with diaphyseal fractures of the shin bones is presented. All patients underwent Ilizarov osteosynthesis using rod and spoke-rod devices. The dynamics of load recovery, the timing of dismantling the apparatus, the number and severity of complications were assessed.

Results. The recovery times for the loads were as follows: 25 % − 5.4 + 1.4 days; 50 % − 34.7 + 11.2 days; 100 % − 76.2 + 17.6 days. The time for dismantling the apparatus is 155 + 37.3 days. The minimum period from osteosynthesis to the dismantling of the apparatus was 95 days, the maximum − 278 days.

During the treatment of the group of patients under consideration, two types of complications were encountered: inflammation of the soft tissues at the points of exit of the wires in 24 (42.1 %) and delayed fusion in 1 (1.8 %) patient.

Conclusion. The use of spoke-rod structures is optimal. The osteosynthesis operation involves performing a preliminary reduction. A feature of the postoperative period is constant monitoring and interaction between the doctor and the patient. Osteosynthesis according to Ilizarov in the treatment of patients with fractures of the shin bones is a self-sufficient method that provides accurate reposition, stable fixation and good anatomical and functional results.

Key words: tibial fractures; closed fracture; Ilizarov technic; Ilizarov method.

Information about authors:

Artemyev A.A., surgeon, Academician N.N. Burdenko Main Military Clinical Hospital, professor at department of surgery of injuries, Medical Institute of Continuous Education of Moscow State University of Food Manufacturing, Moscow, Russia.

Brizhan L.K., chief of traumatology and orthopedics center, Academician N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia.

Davydov D.V., leading surgeon, Academician N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia.

Ivashkin A.N., chief of traumatology department, V.V. Vinogradov City Clinical Hospital of Moscow Healthcare Department, professor at department of surgery of injuries, Medical Institute of Continuous Education of Moscow State University of Food Manufacturing, Moscow, Russia.

Grigoryev M.A., chief of traumatology unit of branch 3 (32 Central Military Navy Clinical Hospital), Academician N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia.

Hassan Mokhammed Kh.Yu., postgraduate at traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Kashoob A.M., postgraduate at traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Gyandzhaliev R.A., postgraduate at traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Address for correspondence:

Kashoob A.M., Miklukho-Maklaya St., 6, Moscow, 117198

Tel: +7 (965) 400-22-66

E-mail: dr.ali.kashoob@gmail.com

REFERENCES:

1. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J. Bone Jt. Surg. 1995; 77(3): 417-421.

2. Weiss RJ, Montgomery SM, Ehlin A, Al Dabbagh Z, Stark A, Jansson KA. Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop. 2008; 79(4):526-33. doi: 10.1080/17453670710015535.

3. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015; 46(4):746-750. doi: 10.1016/j.injury.2014.12.027.

4. Khrupkin VI, Artemiev AA, Popov VV, Ivashkin AN. Ilizarov's method in the treatment of diaphyseal fractures of the leg bones. Moscow: Geotar-med, 2004. 96 p. Russian

5. Mashtalov VD, Mytsykov RYu. Minimally invasive osteosynthesis with intramedullary pins with blocking - the method of choice for fractures of long bones. Chief Physician of the South of Russia. 2008; 4 (16): 19-21. Russian

6. Chelnokov AN, Bekreev DA. Intramedullary osteosynthesis in fractures of the upper third of the tibia - a technique based on transosseous osteosynthesis. Genius of Orthopedics. 2011; (2): 102-106. Russian

7. Gritsanov AI. Substantiation of transosseous osteosynthesis of closed comminuted fractures of the limb bones (experimental study). Military Medical Journal. 1988; (2): 38-42. Russian

8. Shved SI, Sysenko YuM, Shchurov VA, Gorbachev LYu, Sveshnikov AA. Transosseous osteosynthesis according to Ilizarov in the treatment of patients with closed diaphyseal comminuted fractures of the shin bones. Genius of Orthopedics. 1999; (4): 63-66. Russian

9. Bondarenko AV. Early transosseous osteosynthesis according to Ilizarov of open diaphyseal fractures of the shin bones as a factor in the prevention of complications and unfavorable outcomes in patients with polytrauma. Genius of Orthopedics. 2004; (1): 118-122. Russian

10. Lerner A, Fodor L, Soudry M, Peled IJ, Herer D, Ullmann Y. Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities. J Trauma. 2004; 57(3): 603-608. doi: 10.1097/01.ta.0000087888.01738.35.

11. May JD, Paavana T, McGregor-Riley J, Royston S. Closed tibial shaft fractures treated with the Ilizarov method: a ten year case series. Injury. 2017; 48(7):1613-1615. doi: 10.1016/j.injury.2017.05.019.

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

13. Golyakhovsky V, Frenkel V. Guidance on transosseousosteosynthesis by the Ilizarov method. Moscow: BINOM; Saint Petersburg: Nevsky Dialect, 1999. 267 p. Russian

14. Ilizarov GA. A way for bone union in fractures and a device for realization of this way: A.S. No. SU 98471 A1 USSR. No. 44962; application from 09.06.1952; published on 01.01.1954. Russian

15. Trishkin DV, Kryukov EV, Chuprina AP, Khominets VV, Brizhan LK, Davydov DV, et al. Evolution of the concept of medical care for victims with injuries to the musculoskeletal system. Military Medical Journal. 2020; (2): 4-11. Russian

16. Court-Brown CM, Gustilo T, Shaw AD: knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997; 11: 103-105.

17. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006; 88: 576-580.

18. Gayuk VD, Klyushin NM, Burnashov SI. Inflammation of the soft tissues around the transosseous elements and pin osteomyelitis: a literary review, Genius of Orthopedics. 2019; 25(3): 407-412. Russian

19. https://ru.wiktionary.org/wiki/самодостаточный

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Mistakes and COMPLICATIONS OF POSTOPERATIVE MANAGEMENT OF PATIENTS WITH transtrochanteric hip FRACTURES

Yamsрchikov O.N., Emelyanov S.A., Mordovin S.A., Kolobova E.A.

Yamshchikov O.N., Emelyanov S.A., Mordovin S.A., Kolobova E.A.

Derzhavin Tambov State University,

Tambov, Russia

Currently, transversal femoral fractures occupy one of the most significant places in the structure of injuries to the musculoskeletal system in patients older than 60 years. The most efficient method for treatment of this pathology is surgical. DHS-construct is the gold standard for treatment of transtrochanteric fractures in many facilities in Russia. However, despite of wide-spread use, this technique is associated with some complications owing to mistakes in the postsurgical period or unfavorable factors influencing on union process.

Objective − to assess the structure of complications in patients of different age groups who have undergone osteosynthesis of a transtrochanteric fracture.

Materials and methods. Assessment of the frequency and structure of complications in the postoperative period was carried out in 60 patients operated for hip fracture using the DHS design in the trauma department from 2014 to 2018.

Results. When using the DHS construct in patients with transtrochanteric fractures of type 31А1, 31А2 according to the AO/ASIF classification, effective consolidation was observed in 78.3 % of cases, which characterizes this method as quite reliable. However, 32.8 % of all complications are associated with mistakes made in the postoperative period, and are associated with the inadequate application of the load on the operated limb, which in most cases leads to the migration of a metal construct and to the development of post-traumatic osteoporosis. In patients under 75 years of age, complications associated with excessive physical activity, migration and damage to metal structures occurred more often by 21.74 % (X² = 4.728, p = 0.03) than in patients over 75 years old. Conclusion. Thus, the analysis of complications and errors in the management of the postoperative period in patients with transtrochanteric fracture of the femur allows us to conclude that it is necessary to resolve the issue of choosing the optimal way to dose the load on the operated limb.

Key words: transtrochanteric fracture; postoperative complications; osteosynthesis; dynamic femoral screw.

Information about authors:

Yamshchikov O.N., candidate of medical sciences, head of department of hospital surgery with course of traumatology, Derzhavin Tambov State University, Tambov, Russia.

Emelyanov S.A., docent at department of hospital surgery with course of traumatology, Derzhavin Tambov State University, Tambov, Russia.

Mordovin S.A., senior lecturer at department of hospital surgery with course of traumatology, Derzhavin Tambov State University, Tambov, Russia.

Kolobova E.A., intern at department of hospital surgery with course of traumatology, Derzhavin Tambov State University, Tambov, Russia.

Address for correspondence:

Emelyanov S.A., B. Vasilyeva St., 6/55, Tambov, Russia, 392000

Tel: +7 (915) 884-23-63

E-mail: cep_a@mail.ru

REFERENCES:

1. Amraev SA, Abudzhazar UM, Almabaev YA, Abdurazakov UA, Alkhodzhaev SS, Kuandykov EK, et al. Complex treatment of proximal femoral fractures. Modern problems of science and education. 2018; (2): 21. Russian

2. Chapter 52. Fractures and Dislocations of the Hip. In : Campbell`s Operative Orthopaedics. 11^thedition. 2008, Philadelphia. P. 3237-3270.

3. Kristea S. Modern methods of treating trochanter fractures and hip neck fractures (Teaching lecture). Genius of orthopedics. 2014; (2): 99-105 Russian

4. Belinov NV. Evolution of metal osteosynthesis of lateral fractures of the proximal femur. Surgeon. 2015; (4): 3-4. Russian

5. Milyukov AYu, Ustyantsev DD, Gilev YaKh, Mazeev DV. Predictive significance of comorbid status in development of complications in surgical treatment of patients with proximal hip injuries. Polytrauma. 2017; (2): 17-26. Russian

6. Ustyantsev DD. The рredictive model of the risk of postoperative complications in fractures of the proximal femur: abstracts of candidate of medical science: 14.01.15. Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics. Novosibirsk, 2019; 118 p. Russian

7. Voytovich AV, Shubnyakov II, Abolin AB, Parfeev SG. Emergency operative treatment of elderly and senile patients with fractures of the proximal femur. Traumatology and orthopedics of Russia. 1996; (3): 32-33. Russian

8. Amraev SA, Abudzhazar UM, Abdurazakov UA, Alkhodyaev SS, Tezekbayev KM. Treatment of transversal fractures: choosing the optimal metal structure. Herald of Kazakhstan National Medical University. 2018; (2): 138-139. Russian

9. Dudaev AK, Tsed AN, Radysh VE, Bobrin MI, Dzhusoev IG. Features of surgical treatment of patients with the extraarticular hip fractures. Traumatology and orthopedics of Russia. 2010; 4(58): 11-17. Russian

10. Pavlenko SN, Malik VD, Evdoshenko VP. Application of DHS plate in treatment of trochanter fractures of femur. Doctor Practice. 2001; 12(4): 155-157. Russian

11. Slobodskaya AB, Kirsanov VA, Popov A.Yu., Bordukov G.G. Treatment of spit fractures at the modern stage (literature review ). Modern medicine. 2018; 2 (10): 63-67. Russian

Functional, instrumental and laboratory diagnostics

HIGH-SENSITIVE TROPONIN IN DIAGNOSTICS OF MYOCARDIAL INJURY IN HYPERTENSIVE PATIENTS WITH FEMORAL FRACTURES

Klyuchevskiy V.V., Komarov A.S., Sokolov D.A., Ganert A.N.

Yaroslavl State Medical University,

Solovyev Clinical Hospital of Emergency Medical Care,

Yaroslavl, Russia

In the last decade of the 21th century, a concept of perioperative myocardial injury (PMI) in non-cardiac patients was put forward. PMI is considered as the main cause of complications and mortality caused by diseases of the circulatory system. This problem requires particular attention and development in the area of hip fracture surgery due to both lack of work in this area and a number of surgery-related myocardial injury risk factors such as patients over the age of 65, evident arterial damage, hypertension, coronary heart disease and heart failure. Accurate diagnosis of myocardial injury has become possible with the introduction of the high-sensitivity troponin test (hsTnТ) into clinical practice.

Objective − to study the frequency of high-sensitivity troponin increase in patients with hypertension who suffered femoral fracture and the consequences of such an increase within three days after osteosynthesis.

Materials and methods. A study was conducted in 268 patients with hypertensia who underwent intraosseous osteosynthesis of the femoral bone in the period of 24-48 hours from the moment of injury. Spinal anesthesia with levobupivacaine was used. The anesthetic risk was assessed on the ASA scale, the risk of cardiac complications − on the RCRI scale. All patients were monitored for blood pressure, heart rate, ECG, ST segment, glycemia and blood lactate. HsTnТ was determined before surgery, a day later, and then according to indications. Depending on its initial level, all patients were divided into 3 groups: those who did not have an increase in hsTnТ, those who had an increased level in the range of 15 ng/l - 99 ng/l, and patients who had hsTnТ values of 100 ng/l or higher. Statistical methods of results processing were used.

Results. No significant increase in high-sensitivity troponin was observed in 221 patients after surgery. 27 patients showed an increase, but not exceeding 100 ng/l, without clinical and/or ECG symptoms. We considered this increase as a possible result of myocardial injury that required further cardiac monitoring to reduce the risk of 30-day mortality and complications. In 20 patients, a sharp increase in troponin was observed in the range of 147-2,009 ng\l, which indicated myocardial injury. Death in the first three days after surgery was observed in 11 subjects, including due to myocardial infarction in 5 and acute cardiovascular failure in 6 patients.

Conclusion. The study shows a high incidence of both myocardial injury (17.5 %) and associated mortality (4.1 %) in hypertensive patients who had been operated for hip fractures. Therefore, the determination of high-sensitivity troponin in patients with risks of myocardial damage can be an effective strategy to reduce postoperative mortality and improve the results of treatment of trauma patients.

Key words: femoral fracture; intraosseous osteosynthesis; spinal anesthesia; high-sensitivity troponin; perioperative myocardial injury; arterial hypertension.

Information about authors:

Klyuchevskiy V.V., MD, PhD, professor at department of traumatology, orthopedics and military field surgery, Yaroslavl State Medical University, Yaroslavl, Russia.

Komarov A.S., anesthesiologist-intensivist, Solovyev Clinical Hospital of Emergency Medical Care, Yaroslavl, Russia.

Sokolov D.A., candidate of medical science, assistant at department of anesthesiology and critical care medicine, Yaroslavl State Medical University, Yaroslavl, Russia.

Ganert A.N., candidate of medical science, docent at department of anesthesiology and critical care medicine, Yaroslavl State Medical University, Yaroslavl, Russia.

Address for correspondence:

Komarov A.S., Malaya Proletarskaya St., 41-4, Yaroslavl, Russia, 150001

Tel: +7 (910) 663-77-76

E-mail: A.S.Komarov@mail.ru

REFERENCES:

1. Klyuchevskiy VV. Surgery of injuries. Moscow: Geotar-Media, 2013. Chapter 10. P. 373-379. Russian

2. Fractures of proximal femoral bone. Federal clinical recommendations. Ministry of Healthcare of Russia. Moscow, 2019. 79 p. Russian

3. Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in elderly. Clinical Guideline. American Academy of Orthopaedic Surgeons. 2015; 23 (2): 131-137. DOI: 10.5435/JAAOS-D-14-00432

4. Perioperative management of geriatric patients. Clinical guidelines. Federation of Anaesthesiologists and Resuscitators of Russia, Ministry of Health of Russia. Moscow, 2018. 56 p. Russian

5. Hip fracture: management. Clinical Guideline. National Institute of Health and Care Excellence, NICE. 2017; 19 p. https://www.nice.org.uk/guidance/cg124

6. Management of hip fracture in older people. Clinical Guideline. Scottish Intercollegiate Guidelines Network. 2009; 56 p.

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8. Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int. Orthop. 2006; 30 (2): 69-78. DOI: 10.1007/s00264-005-0028-0.

9. Perioperative management of patients with coronary heart disease. Clinical guidelines. Federation of Anaesthesiologists and Resuscitators of Russia, Ministry of Health of Russia. Moscow, 2019. 40 p. Russian

10. Kozlov IA, Ovezov AM, Petrovskaya EL. Perioperative myocardial damage and heart failure in non-cardiac surgery (Review) Part 1. Etiopathogenesis and prognosis of perioperative cardiac complications. General Critical Care Medicine. 2019; 15(2): 53-78. https://doi.org/10.15360/1813-9779-2019-2-53-78. Russian DOI:10.15360/1813-9779-2019-2-53-78

11. Lomivorotov VV, Lomivorotov VN. Peri-operative injury and myocardial infarction. Messenger of Anesthesiology and Resuscitation. 2019; 16(2): 51-56. Russian https://doi.org/10.21292/2078-5658-2019-16-2-51-56

12. Botto M, Alonso P, Xavler D, Villar JC.. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120(3): 564-578. DOI: 10.1097/ALN.0000000000000113

13. Devereaux PJ, Szczeklik W. Myocardial injury after non-cardiac surgery: diagnosis and management. Eur Heart J. 2020; 41(32): 3083-3091. DOI: 10.1093/eurheartj/ehz301.

14. Sabu T, Borges F, Bhandari M, De Beer J, Cuchí GU, Adili A, et al. Association between myocardial injury and cardiovascular outcomes of orthopaedic surgery: a vascular events in non-cardiac surgery patients cohort evaluation (VISION) substudy. J Bone Joint Surg Am. 2020; 2 (Mar). DOI: 10.2106/JBJS.18.01305.

15. Devereaux PJ, Braley D. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing non-cardiac surgery. JAMA. 2017; 317 (16):1642-1651. DOI: 10,1001 / jama.2017.4360

16. Coetzee E, Biccard BM. Myocardial injury after non-cardiac surgery: time to shed the ignorance. S Afr Med J. 2018; 108(6): 464-467. DOI:10.7196/SAMJ.2018.v108i6.13346

17. Hua A, Pattenden H, Leung M, Davies S, George DA, Raubenheimer H, et al. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS). Journal of Thoracic Disease. 2016; 8(5):920-4. DOI: 10.21037/jtd.2016.03.55

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Case history

HIP JOINT REPLACEMENT IN A PATIENT WITH TRANSTROCHANTERIC FRACTURE AT THE BACKGROUND OF BONE ANKYLOSIS

Shevchenko A.V., Polyushkin K.S., Nesterenko A.V., Pyatakov S.N., Bogdanov S.B., Mukhanov M.L.

Research Institute − Ochapovsky Regional Clinical Hospital No. 1,

Kuban State Medical University,

Krasnodar, Russia

An increase in the frequency of fractures of the proximal femur leads to the need to improve the tactics of their treatment. Particular complexity for selection of surgical techniques is associated with fractures against the background of hip ankylosis. The most rational method of treatment is hip replacement with the use of systems with a pair of friction with double mobility, which reduces the risk of dislocations of the components of the hip replacement against the background of ankylosis.

Objective − to determine the indications for primary hip arthroplasty in patients with trochanteric fractures associated with bone ankylosis, to evaluate the results of this method of surgical treatment and to identify disadvantages.

Materials and methods. The results of two cases of total hip arthroplasty for transtrochanteric fractures against the background of bone ankylosis are described. Before the injury, both patients had established bone ankylosis in a functionally disadvantageous position, namely adduction, external rotation, and limb shortening.

Results. The patients were activated on the second day after the operation, and the results were assessed according to the Harris score at discharge on the 9th day. The score was 60 points, two months after surgery − 76 points, after 12 months − 91 points.

The data obtained confirm the validity of the application of this method of treatment of the fractures of the proximal femur against the background of ankylosis, since most iatrogenic arthrodesis procedures for the hip joint eventually become ankylosis in a functionally disadvantageous position − in adduction and external rotation.

This approach will allow not only to reduce the frequency of unsatisfactory functional results of arthroplasty, but also to prevent the development of irreversible degenerative-dystrophic lesions of adjacent segments, thereby reducing the terms of social and household rehabilitation of patients in this category.

Conclusion. When choosing the option of surgical intervention, one should take into account the etiological factor of the ankylosis formation, as well as the individual characteristics of each particular patient, taking into account the limiting factors.

Key words: femoral fracture; peritrochanteric fracture; hip replacement; ankylosis; surgical treatment.

Information about authors:

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 Health Ministry of Krasnodar region, Krasnodar, Russia.

Polyushkin K.S., traumatologist-orthopedist, traumatology and orthopedics unit No. 2, Research Institute − Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.

Nesterenko A.V., traumatologist-orthopedist, traumatology and orthopedics unit No. 2, Research Institute − Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.

Pyatakov S.N., deputy chief physician of medical issues, Sochi City Clinical Hospital No. 4, docent at surgery department No. 1, advanced training and professional retraining faculty, Kuban State Medical University, Krasnodar, Russia.

Bogdanov S.B., professor at department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Mukhanov M.L., docent at surgery department No. 1, advanced training and professional retraining faculty, Kuban State Medical University, Krasnodar, Russia.

Address for correspondence:

Polyushkin K.S., Pervogo Maya St., 167, Krasnodar, Russia, 350073

Tel: +7 (918) 285-76-27

E-mail: kirilldoc@gmail.com

REFERENCES:

1. Solod EI, Lazarev AF, Zagorodniy NV, Kostiv EP, Futryk AB, Dendymarchenko RS, Kostiv RE. Surgical treatment of patients with medial fractures of the femoral neck. Pacific Medical Journal. 2018; 1 (71): 19-25. Russian

2. Tikhilov RM, Shubnyakov II. Hip surgery guide. Saint Petersburg: RNIITO named after R.R. Vreden. 2015. Vol. 2. 104-123. Russian

3. Yu J, Zhang C, Li L, Kwong JS, Xue L, Zeng X, et al. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence. Sci Rep. 2015; 5:18195.

4. Karampinas PK, Kollias G, Vlamis J, Papadelis EA, Pneumaticos SG. Salvage of failed hip osteosynthesis for fractures with modular hip prosthesis. Eur J Orthop Surg Traumatol. 2015; 25(6):1039-1045.

5. Dziadosz D. Considerations with failed intertrochanteric and subtrochanteric femur fractures: how to treat, revise, and replace. J Orthop Trauma. 2015; 29(Suppl 4): S17-S 21.

6. Weiser L, Ruppel AA, Nuchtern JV, Sellenschloh K, Zeichen J, Puschel K, et al. Extra- versus intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg. 2015; 135: 1101–1106.

7. Puram C, Pradhan C, Patil A, Sodhai V, Sancheti P, Shyam A. Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures. Injury. 2017; 48(Suppl 2): S72– S77.

8. Tikhilov RM, Shubnyakov II, Myasoyedov AA, Pliyev DG, Karelkin VV, Berezin GV. Hip joint endoproshetics for bone ankylosis of various etiology, causes and results. Modern problems of science and education. 2018; (2): 12-22. Russian

9. Letov AS, Bakhteyeva NKh, Voskresenskiy OYu, Markov DA, Yamshchikov ON, Yusupov KS, et al. Surgical treatment of patients with ankylosis of the hip joint. Herald of Tambov University. Series: Natural and Technical Sciences. 2010; 15(5): 1511-1514. Russian

10. Barabash YuA, Letov AS, Barabash AP, Korshunova GA. Restoration of limb function after total hip arthroplasty in ankylosis. International Journal of Applied and Fundamental Research. 2016; (4): 690-693. Russian

11. Ryabov MN, Nazarov EA, Zubov AA, Podyablonskaya IA. Total hip repacement in bilateral ankylosis. Eruditio Juvenium. 2017; 5(2): 265-276. Russian

12. Voloshenyuk AN, Serdyuchenko NS, Chaykovskiy AR, Skuratovich NV, Evseev GM. Surgical treatment of hip joint ankylosis. News of National Academy of Sciences of Belorussia. Series of Medical Sciences. 2019; 16(4): 404-409. Russian https://doi.org/10.29235/1814-6023-2019-16-4-404-409).

13. Tikhilov RM, Nikolaev NS, Shubnyakov II, Myasoedov AA, Boyarov AA, Efimov AV, et al. Features of hip arthroplasty in patients with rhizomelic form of ankylosing spondylitis (clinical observation). Traumatology and Orthopedics of Russia. 2016; 22(2): 70-79. Russian

14. Kim YL, Shin SI, Nam KW, Yoo JJ, Kim YM, Kim HJ. Total hip arthroplasty for bilaterally ankylosed hips. J. Arthroplasty. 2007; 22(7): 1037-1041.

15. Yefimov NN, Stafeyev DV, Lasunskiy SA, Mashkov VM, Parfeyev DG, Shubnyakov II, et al. The use of coupled liners and dual mobility systems for the prevention of dislocations during revision hip arthroplasty. Traumatology and Orthopedics of Russia. 2018; (3): 22-33. Russian

A CLINICAL CASE OF SURGICAL TREATMENT OF AN UNSTABLE FRACTURE OF THE CERVICAL SPINE IN COMBINATION WITH AN UNSTABLE-ROTATIONAL FRACTURE OF THE PELVIC BONES

Lobanov G.V., Likholetov A.N., Borovoy I.S.

Gorky Donetsk National Medical University, Republican Traumatology Center,

Donetsk, Donetsk People's Republic

A one-stage violation of the stability of the cervical spine and the support of the pelvic ring with a direct impact are extremely life-threatening displacements, combined with neurological deficits and massive bleeding, which determine high mortality. Treatments for these injuries in isolation are controversial. In combination, they are indefinite due to their extreme rarity and high lethality.

Objective − to estimate the results of treatment with anterior stabilization technique in a patient with the hangman's fracture according to Levine and Edwards and possibilities of apparatus treatment technique for unstable pelvic injury.

Materials and methods. The analysis of successful observation of unstable injuries to the pelvis and cervical spine was performed. Patient S., 33 years old, case history No. 16352, was admitted after an injury as a result of the collapse of a metal structure on 14.07.19. He was delivered to Republican Traumatology Center by relatives in a passenger car without immobilization. Diagnosis: Polytrauma. Closed comminuted fracture of the posterior part of the right iliac bone, rupture of the right sacroiliac joint, rupture of the pubic symphysis with dislocation of the right hemipelvis. Fracture-dislocation of the C2 vertebra anteriorly, fracture of the arches and articular processes of the C2-C3 vertebrae, with severe pain and radicular syndrome.

Results and discussion. Treatment of unstable trauma of the pelvis and cervical spine in the acute period is controversial among clinicians due to the rare opportunity to provide assistance and undeveloped effective tactics and strategies for managing these patients. We are categorically opposed to the installation of the C-frame, with a fracture of the sacrum and posterior parts of the pelvis, which can be diagnosed clinically. The patient underwent combined treatment, stabilization and primary reduction of the pelvis with an external fixation apparatus with the possibility of hardware reduction and after reduction and skeletal traction on the 8th day, submerged stable fixation of the cervical spine.

Conclusion. Treatment outcomes are almost always unfavorable, which determines the relevance of the study of each particular case of injury, the options for their treatment, and the particularities of further assistance − this will subsequently allow developing a unified tactics for managing such severe injuries. Own successful case of treatment of unstable injuries is presented. Timely and high-quality surgical treatment in a victim with unstable fractures of the pelvis and cervical spine (hangman type III), adequately matched for these injuries, ensured a favorable outcome in the near and long term period.

Key words: unstable trauma of the cervical spine and pelvis; traumatic listhesis of C₂ vertebra; hangman's fracture; interbody fusion; external guided fixation; stabilization of the spine and pelvis.

Information about authors:

Lobanov G.V., MD, PhD, professor, chief of department of traumatology, orthopedics and surgery of extreme conditions, Gorky Donetsk National Medical University, Donetsk, Donetsk People's Republic.

Likholetov A.N., candidate of medical sciences, docent at department of tramatology, orthopedics and surgery of extreme conditions, Gorky Donetsk National Medical University, Donetsk, Donetsk People's Republic.

Borovoy I.S., candidate of medical sciences, docent at department of tramatology, orthopedics and surgery of extreme conditions, Gorky Donetsk National Medical University, Donetsk, Donetsk People's Republic.

Address for correspondence:

Lobanov G.V., Ilyicha Prospect, Donetsk, Donetsk People's Republic, 283003

Tel: +38 (071) 324-15-17

E-mail: lgv_don@mail.ru

REFERENCES:

1. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral crews: does posterior injury pattern predict fixation failure. J Orthop. Trauma. 2006; 20 (1 Suppl): S30–S36.

2. Herkowitz HN. The Spine. 6 th Edition. Elsevier Saunders, 2011. 2020 p.

3. Gubin AV, Burtsev AV, Ryabykh SO. Posterior fixation of executioner's fractures. Spine surgery. 2014. (4): 15-19. Russian

4. Lobanov GV. Transosseous osteosynthesis of unstable pelvic injuries: abstracts of PhD in medicine. Kiev, 2001. 30 p. Russian

5. Roerich VV, Zherebtsov SV. Surgical treatment of C2 injuries. Spine Surgery. 2004; (3): 20-25. Russian

6. Shapovalov VM, Dulaev AK, Dydykin AV. Experimental development and clinical application of minimally invasive internal rod fixation of the pelvic ring. Bulletin of Traumatology and Orthopedics named after V.I. N.N. Priorov. 2001; (4): 33-37. Russian

EPIDURAL SPINAL NEUROSTIMULATION IN THE SUBACUTE PERIOD OF POLYTRAUMA WITH SPINAL INJURIES IN A 6-YEAR-OLD CHILD

Timershin A.G., Galimov I.I., Mironov P.I.

Republican Pediatric Clinical Hospital of Health Ministry of Bashkortostan Republic,

Bashkir State Medical University,

Ufa, Russia

Objective − to present a case of using spinal programmed neurostimulation in early neurorehabilitation of children with polytrauma with spinal injury.

Material and methods. The article presents a clinical observation of a successful case of using spinal programmed neurostimulation in combination with traditional methods of early neurorehabilitation

Results. The child was admitted after a traffic accident with severe polytrauma and spinal injury with the presence of tetraparesis and bulbar disorders. 25 days after the injury, taking into account the slight regression of neurological disorders after the measures taken, it was decided to include epidural spinal neurostimulation in the complex of early rehabilitation. This made it possible to improve the recovery of spinal cord functions

Conclusion. The obtained results suggest that the use of spinal programmed neurostimulation in the complex of early rehabilitation measures in the subacute period of spinal injury can improve the recovery of spinal cord functions in children.

Key words: polytrauma; spinal injury; rehabilitation; programmed neurostimulation.

Information about authors:

Timershin A.G., candidate of medical sciences, chief of neurosurgery unit, Republican Pediatric Clinical Hospital of Health Ministry of Bashkortostan Republic, docent at department of neurosurgery with neurorehabilitation, Bashkir State Medical University, Ufa, Russia.

Galimov I.I., MD, PhD, chief of department of pediatric surgery with courses of medical and physical rehabilitation with course of additional professional education, Bashkir State Medical University, Ufa, Russia.

Mironov P.I., MD, PhD, professor at department of anesthesiology and critical care medicine with course of additional professional education, Bashkir State Medical University, Ufa, Russia.

Address for correspondence:

Mironov P.I., Lenina St., 3, Ufa, Russia, 450073

Tel: + 7 (917) 773-58-11

E-mail: mironovpi@mail.ru

REFERENCES:

1. Baindurashvili AG, Kenis VM, Ivanov SV, Ikoeva GA. Rehabilitation of children with neuroorthopedic pathology at the stages of surgical treatment with the use of robotic mechanotherapy. Herald of Rehabilitation Medicine. 2012; (2): 57–60. Russian

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

3. Bodrova RA. Biofeedback mechanotherapy: effective rehabilitation for spinal cord injury Doktor.Ru. 2012; (10): 46–47. Russian

4. Daminov VD, Zimina EV, Kankulova EA, Kuznetsov AN. Recovery of walking by brain stem stimulation during classes on robotic complexes. Herald of Rehabilitation Medicine. 2012; (6): 55–59. Russian

5. Chernikova LA. Robotic systems in neurorehabilitation. Annals of Clinical and Experimental Neurology. 2009; 3(3): 30–36. Russian

6. Kamadey OO, Alekseev GN, Poverennova IE, Krivoshchekov EP. Results of use of chronic epidural neurostimulation for treatment of pain and spastic syndromes. In: Polenovskie Chteniya: materials of XIIth scientific practical conference, Saint Petersburg, 24-27 April, 2013. Saint Petersburg, 2013. 82 p. Russian

7. Shabalov VA, Isagulyan YeD. What to do with "difficult" pain? Electrical stimulation of the spinal cord and brain in the treatment of chronic non-oncological pain. Мoscow, 2008. 96 р. Russian

8. Erokhin AN, Kobyzev AE, Sergeenko OM, Turovinina EF. Stimulation of the phrenic nerve by means of a modified implantable device in a complex of rehabilitation measures after damage to the cervical spinal cord. Genius of Ortopedics. 2020; 26 (1): 89-94. Russian

9. Cioni B, Meglio M, Pentimalli L, Visocchi M. Spinal cord stimulation in the treatment paraplegic pain. J. Neurosurg. 1995; 82 (1): 35-39.

10. Devulder J, De Laat M, Van Bastelaere M, Rolly G. Spinal cord stimulation: a valuable treatment for chronic failed back surgery patients. J. Pain Symptom Manage. 1997; 13 (5): 296-301.

11. Park DS, Kim M, Jung DW, Lee BS. Rowing machine for paraplegic patient. Pub. No.: WO/2012/008664 International Application No.: PCT/KR2010/009182 IPC: A63B 22/20 (2006.01), A61H 39/00 (2006.01), A63B 23/04 (2006.01) Applicants: National Rehabilitation Center [KR/KR]

Experimental investigations

changes in biomechanical properties of clavicular-scapular ligaments

Miziev I.A., Baksanov Kh.D., Akhkubekov R.A., Ivanova Z.O.

Kabardino-Balkarian State University named after Kh.M. Berbekov,

Nalchik, Russia

Objective − to study biomechanical properties of ligaments of clavicular-scapular junction.

Materials and methods. For study of biomechanical properties of tendons of clavicular-scapular junction, we used the pull test machine RT-250 M with automatic recording of a chart of pull load and extension in textile material engineering. Anatomic experimental studies were conducted with 60 non-fixed and non-autopsied bodies of adult persons of both gender.

Results. Our studies showed that an injury to single ligaments caused some non-homogenous changes in dislocation of the distal end of the clavicle. So, after crossing the superior acromioclavicular ligament, upward dislocation was 2/3 of height of articular surface of acromion. After crossing the one of two other ligaments (trapezoid, conoid or inferior acromioclavicular), upward dislocation did not exceed the half of height of articular surface of acromion. Therefore, an injury to one ligament causes a subluxation of the acromial end of the clavicle.

After simultaneous crossing of two ligaments, a different degree of dislocation occurs depending on the fact of which ligaments are crossed. So, after crossing of superior and inferior acromioclavicular ligaments, cranial dislocation of the clavicle was equal to height of articular surface of the acromion. i.e. it corresponded to complete dislocation. After crossing of the lower acromioclavicular and conoid ligaments or acromioclavicular ligament, cranial dislocation of the clavicle corresponded to acromial subluxation.

Simultaneous crossing of three ligaments in various combinations always increases the degree of dislocation of the distal end of the clavicle. So, crossing of both acromioclavicular and conoid ligaments causes higher (3 mm) dislocation than the height of articular surface of the acromion surface.

Crossing of all ligaments of acromioclavicular junction increases dislocation in all directions.

Conclusion. The superior acromioclavicular ligament has the highest strength and the lowest elasticity, the inferior acromioclavicular ligament − the lowest strength and higher elasticity. Both acromioclavicular ligaments have higher strength than clavicular-coronoid ones. Forms of changes in acromioclavicular ligaments and their biomechanical properties determine the various persistence to mechanical impact. For complete supraacromial dislocations, not all tendons can be injured. It influences on abnormal dislocation of the distal end of the clavicle.

Key words: biomechanical properties of clavicuar-scapular junction; restoration of function and anatomic relationships in acromioclavicular joint.

Information about authors:

Miziev I.A., MD, PhD, professor, dean of medical faculty, chief of department of theoretical and endoscopic surgery, Kabardino-Balkarian State University named after Kh.M. Berbekov, Nalchik, Russia.

Akhkubekov R.A., candidate of medical sciences, docent, chief of department of continuous medical education, Kabardino-Balkarian State University named after Kh.M. Berbekov, Nalchik, Russia.

Baksanov Kh.D., candidate of medical sciences, docent at department of theoretical and endoscopic surgery, Kabardino-Balkarian State University named after Kh.M. Berbekov, Nalchik, Russia.

Ivanova Z.O., candidate of medical sciences, lecturer at department of theoretical and endoscopic surgery, Kabardino-Balkarian State University named after Kh.M. Berbekov, Nalchik, Russia.

Address for correspondence:

Ivanova O.Z., Yakhogoeva St., 135, Nalchik, Kabardino-Balkar Republic, Russia, 360004

Tel: + 7 (928) 720-46-51

E-mail: ivanovazalina@icloud.com

REFERENCES:

1. Egiazaryan KA, Lazishvili GD, Shukyur-Zade E. A method for miniinvasive dynamic two-bundle reconstruction of clavicular arcomial junction. In: Materials of 11th All-Russian convention of traumatologist-orthopedists. Saint Petersburg, 11-13 April, 2018. Saint Petersburg, 2018. Vol. 1. 280 p. Russian

2. Pisarev VV, Lvov SE. A way of operative treatment of dislocation of acromial end of clavicle. Traumatology and Orthopedics of Russia. 2008; (3): 54-57. Russian

3. Sirodko VV, Nikolskiy NA, Zheleznyak AV, Podolinskiy SG, Beyner YuF. Migration of a pin into posterior mediastinum after osteosynthesis of acromioclavicular joint. News of Surgery. 2010; 18(2): 133-136. Russian

4. Gulyaev DA, Godanyuk DS, Kaurova TA, Krasnoshlyk PV, Maykov SV. Migration of K-wire into spinal canal after fixation of acromioclavicular joint (literature review and clinical cases). Traumatology and Orthopedics of Russia. 2018; 24(4): 121-128. Russian

5. Kukin GN, Solovyev AN. Textile materials: guidance for institute of textile and consumer industry. Part 2. Moscow: Consumer industry, 1964. P. 148-272. Russian

6. Sabaev SS, Plotnik GL. Final element model of clavicle for estimation of parameters of implants with shape memory. In: Treatment of concomitant injuries and disease of extremities: abstracts of 3rd All-Russian Anniversary Scientific Conference. Moscow, 2003. P. 269-270. Russian

7. Savlaev KF, Shavyrin IA, Petrichenko AV, Ivanova NM, Sharoev TA. Low invasive treatment of dislocation of acromial end of clavicle. In: Forum of orthopedist-traumatologists of Northern Caucasus: collection of materials. Vladikavkaz, 2017. P. 328-331. Russian

8. Henkel T, Oetiker R, Hackenbruch W. Die Behandlung der frischen AC-Luxation Tossy III durch Bandnaht und temporäre Fixation mit Klavikula-Hakenplatte [Treatment of fresh Tossy III acromioclavicular joint dislocation by ligament suture and temporary fixation with the clavicular hooked plate]. Swiss Surg. 1997; 3(4):160-166. German. PMID: 9340131.

9. Urist MR. The treatment of dislocations of the acromioclavicular joint: a survey of the past decade. Am J Surg. 1959; 98:423-31. doi: 10.1016/0002-9610(59)90535-5.

Reviews

PATHOGENESIS AND PREDICTION OF CRITICAL COMPLICATIONS OF POLYTRAUMA FROM THE POSITION OF COMMON PATHOLOGICAL PROCESSES

Gusev E.Yu., Zotova N.V.

Institute of Immunology and Physiology of Ural Department of RAS,

Ural Federal University named after the first president of RF B.N. Eltsin,

Ekaterinburg, Russia

Polytrauma can be determined as a life-threatening multi-trauma, which requires for intensive care. Most patients die within the first 4 hours after polytrauma. In the later period, the main cause of death is systemic inflammation (SI), which should be distinguished from protective manifestations of posttraumatic classic inflammation − the adaptive variant of systemic inflammatory response (SIR).

Objective − to describe the pathogenesis of SI as the general pathologic process and its role in development of critical complications in polytrauma.

Methods. The analytic (deconstruction) review of literature with use of results and own studies.

Results. The core of SI pathogenesis as the general pathologic process is microcirculatory disorders. Clinical manifestation of SI is refractory shock, ongoing signs of multiple organ dysfunction, disseminated intravascular clotting (DIC), secondary acute respiratory distress syndrome, but not the criteria of SIR which are low specific to development of critical complications. For verification and monitoring of SI, it is appropriately to fix some qualitative levels of SIR with several molecular criteria of SIR, for example, blood plasma cytokines. Moreover, it is necessary to systematize some range and other signs of SI, including DIC, intravascular activation of phagocytes and complement system, intensity of systemic tissue injury and organ dysfunction, distress response of neuroendocrine system, signs of tissue perfusion disorders.

Conclusion. Pathogenesis of polytrauma combines various types of inflammation: classic one, which determines adaptation of the body to an injury; systemic inflammation, which is characterized by life-threatening microcirculatory disorders and chronic inflammation of low intensity (parainflammation) which is the basis of many chronic disease of older age and is considered as the risk factor of critical complications of polytrauma.

Key words: polytrauma; systemic inflammation; general pathologic symptoms; cytokines; microcirculatory disorders.

Information about authors:

Gusev E.Yu., MD, PhD, professor, chief of laboratory of inflammation immunology, Institute of Immunology and Physiology of Ural Department of RAS, Ekaterinburg, Russia.

Zotova N.V., candidate of biological sciences, senior researcher at laboratory of inflammation immunology, Institute of Immunology and Physiology of Ural Department of RAS; docent at department of medical biochemistry and biophysics, Ural Federal University named after the first president of RF B.N. Eltsin, Ekaterinburg, Russia.

Address for correspondence:

Zotova N.V., Pervomayskaya St., 106, Ekaterinburg, Russia, 620049

Tel: +7 (902) 873-21-47

E-mail: zotovanat@mail.ru

REFERENCES:

1. Almahmoud K, Abboud A, Namas RA, Zamora R, Sperry J, Peitzman AB, et al. Computational evidence for an early, amplified systemic inflammation program in polytrauma patients with severe extremity injuries. PLoS One. 2019; 14(6): e0217577. DOI: 10.1371/journal.pone.0217577.

2. Astapenko D, Benes J, Pouska J, Lehmann C, Islam S, Cerny V. Endothelial glycocalyx in acute care surgery - what anaesthesiologists need to know for clinical practice. BMC Anesthesiol. 2019; 19(1): 238. DOI: 10.1186/s12871-019-0896-2

3. Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, et al. Polytrauma in the elderly: a review. EFORT open reviews. 2017; 1(5): 146–51. DOI: 10.1302/2058-5241.1.160002.

4. Cabrera CP, Manson J, Shepherd JM, Torrance HD, Watson D, Longhi MP, et al. Signatures of inflammation and impending multiple organ dysfunction in the hyperacute phase of trauma: a prospective cohort study. PLoS Med. 2017; 14(7): e1002352. DOI: 10.1371/journal.pmed.1002352.

5. Chakraborty S, Karasu E, Huber-Lang M. Complement after trauma: suturing innate and adaptive immunity. Front Immunol. 2018; 9: 2050. DOI: 10.3389/fimmu.2018.02050.

6. Charbonney E, Tsang JY, Li Y, Klein D, Duque P, Romaschin A, et al. Endotoxemia following multiple trauma: risk factors and prognostic implications. Crit Care Med. 2016; 44(2): 335-41. DOI: 10.1097/CCM.0000000000001404.

7. Chignalia AZ, Yetimakman F, Christiaans SC, Unal S, Bayrakci B, Wagener BM, et al. The glycocalyx and trauma: a review. Shock. 2016; 45(4): 338-48. DOI: 10.1097/SHK.0000000000000513.

8. Custodero C, Mankowski RT, Lee SA, Chen Z, Wu S, Manini TM, et al. Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: a systematic review and meta-analysis. Ageing Res Rev. 2018; 46: 42-59. DOI: 10.1016/j.arr.2018.05.004.

9. da Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, et al. Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. Clinics (Sao Paulo). 2017; 72(8): 461-68. DOI: 10.6061/clinics/2017(08)02.

10. Dobson GP, Morris JL, Davenport LM, Letson HL. Traumatic-induced coagulopathy as a systems failure: a new window into hemostasis. Semin Thromb Hemost. 2020; 46(2): 199-214. DOI: 10.1055/s-0039-1701018.

11. Domizi R, Damiani E, Scorcella C, Carsetti A, Castagnani R, Vannicola S, et al. Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: a subgroup analysis of a prospective observational study. PLoS One. 2019; 14(3): e0213085. DOI: 10.1371/journal.pone.0213085.

12. Edston E, van Hage-Hamsten M. Mast cell tryptase and hemolysis after trauma. Forensic Sci Int. 2003; 131(1): 8-13. DOI: 10.1016/s0379-0738(02)00383-3

13. Girardot T, Rimmelé T, Venet F, Monneret G. Apoptosis-induced lymphopenia in sepsis and other severe injuries. Apoptosis. 2017; 22(2): 295-305. DOI: 10.1007/s10495-016-1325-3.

14. Gusev EYu, Osipenko AV. Immunology of systemic inflammation. Immunology of Ural. 2001; (1): 4-8. Russian

15. A way for diagnosis and prediction of systemic inflammation with verification of phases and stages: the patent 2335771 FR, MPK G01N 33/53 / E.Yu. Gusev, L.N. Yurchenko, V.A. Chereshnev, N.V. Zotova, A.Yu. Kopalova; applicant and patent owner Institute of Immunology and Physiology of Ural Department of RAS. No. 2006124894/14; application from 20.01.2008; published on 10.10.2008, bulletin No. 28. Russian

16. Gusev EY, Zotova NV. Cellular stress and general pathological processes. Curr Pharm Des. 2019; 25(3): 251-297. DOI: 10.2174/1381612825666190319114641.

17. Gusev EYu, Zotova NV, Sipachev AS. Trauma and the theory of systemic inflammation. Messenger of Anesthesiology and Resuscitation. 2009; 6(2): 2-9. Russian

18. Gusev EYu, Zotova NV, Zhuravleva YA, Chereshnev VA. Physiological and pathogenic role of scavenger receptors in humans. Medical Immunology. 2020; 22(1): 7-48. Russian DOI: 10.15789/1563-0625-PAP-1893.

19. Haider T, Simader E, Glück O, Ankersmit HJ, Heinz T, Hajdu S, et al. Systemic release of heat-shock protein 27 and 70 following severe trauma. Sci Rep. 2019; 9(1): 9595. DOI: 10.1038/s41598-019-46034-w.

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CONCOMITANT CLOSED INJURY TO URINARY SYSTEM ORGANS: AN OPINION BY GENERAL SURGEON

Maskin S.S., Aleksandrov V.V., Matyukhin V.V.

Volgograd State Medical University,

Volgograd, Russia

Objective − standardization of medical and diagnostic approach for concomitant closed injury to the urinary system organs to improve treatment results.

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

Results. A therapeutic and diagnostic algorithm was developed for concomitant closed injury to the urinary system organs based on the severity of patient's condition, and a detailed description of staged surgical treatment was given on the basis of the principles of evidence-based medicine.

Conclusion. The use of minimally invasive interventions in the treatment of injuries to the urinary system, as well as their staged treatment in conditions of severe polytrauma contributes to reducing mortality.

Key words: blunt abdominal trauma; damage control surgery; concomitant injury; blunt renal trauma; blunt ureter injury; urinary bladder rupture; closed urethral injury.

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 Sciences, Associate Professor at the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russia.

Matykhin V.V., Candidate of Medical Sciences, Associate Professor 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

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