The purpose of the study. Is to analyze the medical and social consequences of pelvic fractures in combination with polysegmental injuries, study the health care system for these injuries, predict complications and mortality to assess the quality of life of patients with pelvic fractures and other segments (lower or upper limb). Materials and methods. The examination reports were examined according to the Zaporizhia Regional Trauma expertise commission code ICD-10 codes/manual S32 (Fracture of the lumbar spine and pelvic bones). Results. According to the Zaporizhia Regional Trauma expertise commission, the number of patients after bone fractures in 2014–2018 is 44 people. The analysis of the material revealed the general tendencies of steady growth of the number of patients with pelvic trauma to disability, which confirms the world statistics. During the period 2016–2019 on the basis of «Сity hospital of emergency medical care» and «City Hospital № 9» were operated on 28 patients with fractures of the acetabulum, of which as a result of osteoarthritis of the hip joint surgery was performed in 3 cases (10, 7%). Conclusions. Some methods of trauma care need to be improved, aimed at reducing their trauma, as well as preventive measures for the development of general and local complications in victims with combined pelvic trauma, refusal of surgical treatment entails improper fracture fusion and disability Keywords: polytrauma, disability, temporary disability, polysegmental injuries, quality of life.
Актуальность. Количество неудовлетворительных результатов лечения внутрисуставных переломов пяточной кости достигает 34 %. Поиск оптимальной мини-инвазивной методики лечения, которую можно применить даже в скомпрометированных состояниях, уменьшить травматичность, начать раннюю реабилитацию и оптимизировать процессы репаративной регенерации, является актуальной проблемой. Одним из путей оптимизации процесса репаративной регенерации является применение обогащенной тромбоцитами плазмы. Цель: проанализировать результаты лечения больных с внутрисуставными переломами пяточной кости и оптимизировать репаративную регенерацию костной ткани плазмой с повышенным содержанием тромбоцитов. Материалы и методы. В период 2017–2019 гг. (I полугодие) в отделении травматологии Коммунального некомерческого предприятия «Городская больница № 9» Запорожского городского совета проходили лечение 79 больных с переломами пяточной кости. Двусторонние переломы имели место в 11 случаях (13,9 %). Гендерный состав: мужчины — 71 (89,9 %), женщины — 8 (10,1 %). Механизм травмы: падение с высоты (более 1,5 м) — 47 (59,5 %) человек, бытовые — 32 (40,5 %) человека. Были выполнены следующие оперативные вмешательства: металлоостеосинтез спицами — 62 (74,7 %), винтами — 7 (8,4 %), пластины и аппараты внешней фиксации не применялись. Отказались от оперативного лечения 14 (16,9 %) человек. Результаты. В основной группе пациентов рентгенологическое сращение перелома наступило через 6 недель у 6 больных (85,7 %), у 1 больного (14,3 %) — через 12 недель (случай тяжелого обломочного внутрисуставного перелома). В контрольной группе сращение на 8-й неделе выявлено у 14 пациентов (58,3 %), у 8 (33,3 %) — на 16-й неделе, у 2 пациентов (8,4 %) послеоперационный период осложнился полостью резорбции костной ткани. Выводы. Применение обогащенной тромбоцитами плазмы для регенерации костной ткани имеет значительный клинический потенциал. Предложенная мини-инвазивная методика оперативного лечения в сочетании с введением обогащенной тромбоцитами плазмы позволяет применять ее в осложненных случаях, когда есть противопоказания к оперативному вмешательству.
The purpose of the study. Is to analyze the medical and social consequences of pelvic fractures in combination with polysegmental injuries, study the health care system for these injuries, predict complications and mortality to assess the quality of life of patients with pelvic fractures and other segments (lower or upper limb). Materials and methods. The examination reports were examined according to the Zaporizhia Regional Trauma expertise commission code ICD-10 codes/manual S32 (Fracture of the lumbar spine and pelvic bones). Results. According to the Zaporizhia Regional Trauma expertise commission, the number of patients after bone fractures in 2014–2018 is 44 people. The analysis of the material revealed the general tendencies of steady growth of the number of patients with pelvic trauma to disability, which confirms the world statistics. During the period 2016–2019 on the basis of "Сity hospital of emergency medical care " and "City Hospital № 9" were operated on 28 patients with fractures of the acetabulum, of which as a result of osteoarthritis of the hip joint surgery was performed in 3 cases (10, 7%). Conclusions. Some methods of trauma care need to be improved, aimed at reducing their trauma, as well as preventive measures for the development of general and local complications in victims with combined pelvic trauma, refusal of surgical treatment entails improper fracture fusion and disability. Keywords: polytrauma, disability, temporary disability, polysegmental injuries, quality of life
Summary. Purulent-inflammatory complications of fractures of pelvic bones represent up to currently one of the most difficult and little-studied sections of traumatology. Complexity anatomical structure and topographic relations of the pelvic region, deep location a significant part of the bones under the muscle mass create objective difficulties for surgical treatment of bone damage and later in the diagnosis of purulent processes. Osteomyelitis of the pelvis is accompanied by high mortality and is from 2.5 to 52% as in acute and in the chronic stage of the disease. Purpose: by analyzing clinical mistakes and the possibility of purulent-inflammatory complications during operative treatment and postoperative management of patients with fractures bones of the pelvis, as well as to determine methods of diagnosis, treatment and ways of prevention traumatic sacroiliitis. Materials and methods. In the period from 2017 to 2022 in the bone-purulent surgery department of Zaporizhzhia city clinical hospital №9 treated 9 patients with purulent processes in of the pelvic region, 6 (66.3%) of them were men, and 3 (33.4%) were women. With postoperative osteomyelitis, which occurred after osteosynthesis with plates of multiple pelvic bone fractures, 4 (44.5%) patients were treated. Conservative therapy with sacroiliitis, the cause of which was abortion, received by 2 (22.2%) women, 1 (11.1%) patient suffered from right-sided sacroiliitis since childhood and repeatedly operated, and 2 (22.2%) men were treated with cause of sacroiliitis, which occurred after slaughter of the sacroiliac joint area. Results. All patients who were treated in the bone-purulent surgery department for purulent-inflammatory processes of pelvic bones, recovered and were discharged for outpatient treatment. While treatment in the ward, patients received complex treatment, which included conservative therapy and surgical intervention. Despite the introduction of modern methods of treatment of osteomyelitis of the pelvis, a trend of steady growth in the number is noted exits of patients with disabilities, which is confirmed by world statistics. Conclusions. Lack of hard fixation of bone fragments by implants increases the risk of purulent complications in the postoperative period. Use of additional diagnostic methods and complex treatment, which includes radical purulent sanitation foci, creation of favorable conditions for tissue regeneration, prevention of relapses suppuration, targeted antibacterial therapy, correction of homeostasis indicators and increases the protective forces of the body during purulent processes of the bones and joints of the pelvis achieving positive results in 80.2% of patients.
Purpose of the study. To develop a systematic approach to the treatment of various clinical forms of septic complications after open fractures dislocations in the ankle joint. Materials and methods. 36 patients were treated. Of these, 28 (78, 3%) are men and 8 (21,7%) are women of working age. The basis of surgical treatment was radical sequestrectomy – resection of articular joint surfaces and through bone osteosynthesis according to Ilizarov. In the postoperative period, patients received antibacterial, vascular and detoxification therapy. During dressings, the wound was flushed with antiseptics through drainage tubes. In the presence of significant necrosis of soft tissues, VAKtherapy, laser therapy, prolonged intraosseous blockade were prescribed. Results and discussion. Longterm results were studied in 31 (83,7%) patients. Bone ankylosis occurred in 29 (78,3%) patients, 3 (8,1%) patients in connection with the progression of the inflammatory process in the talus bone performed the second operation astragalectomy. Conclusion. When the inflammation of the articular surface is affected, resection of the joint with subsequent compression of the arthrodesis is necessary. The Ilizarov apparatus provides a stable fixation at the site of resection.
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