The aim: To analyse long-term results of treating patients with open fractures of low-leg bones within a specific time period and to describe concomitant problems. Materials and methods: A retrospective study was carried out to evaluate the results of the final treatment of patients after one year and after five years. Patients were divided into two groups. Group I included 47 (61.84%) patients for whom the treatment method was changed from external fixation to internal fixation. Group II included 29 (38.16%) patients for whom the final treatment of an open fracture was performed with an external fixation device without changing the method. The study exclusion criteria were patients under 18 years old and patients with gunshot fractures of the lower leg bones. Results: Patient treatment included initial surgical debridement and fracture stabilization with external fixation devices. In all patients, wound healing occurred within 30 days (on average, 24 ± 4.5 days). When evaluating the treatment of patients in group I, 32 (68.09%) of them underwent a one-stage removal of an external fixation device and osteosynthesis of fragments during the first 7-10 days. In 3 (20.0%) patients, osteosynthesis was performed with an intramedullary locking nail, in 12 (80.0%) patients – with a plate. The decision to change the fixation method was made taking into account clinical and laboratory parameters. It is noted that the treatment of patients with type III open fractures of the lower leg bones according to the Gustilo-Andersen classification, provided that the method of external fixation is replaced with an internal one, gives better results compared to osteosynthesis with external fixation devices. Conclusions: Treatment of patients with high-energy injuries of the lower leg bones is a long-term process. It is possible to improve the therapy efficiency by changing the fixation method from external to internal one. In this regard, the main evaluative characteristics are such indicators as uncomplicated wound healing combined with the absence of laboratory and clinical signs of inflammation.
областной рады «Киевская областная клиническая больница». Украина 2 Национальная медицинская академия последипломного образования им. П. Л. Шупика, Киев. Украина
Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children. Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median - 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole - in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) - in 34 (33.3%). Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,0±46,2 minutes (median - 120 minutes); in LUPS(LUUS) - 160,1±44,7 minutes (median - 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, Clavien-Dindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%). Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump. What this paper adds For the first time, it has been proven that laparoscopic heminephrectomy in comparison with laparoscopic ipsilateral ureteropyeloanastomosis or ureteroureteroanastomosis is considered to be an unsafe operation, since this can cause kidney failure. It has been established that total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.
1 КУ КОС «Киевская областная клиническая больница». Украина 2 Национальная медицинская академия последипломного образования имени П. Л. Шупика, Киев. Украина © Анкин Н. Л., Петрик Т. М., Ладыка В. А., Дударь С. Л., 2019 Останніми десятиліттями невплинно зростає кількість переломів головки стегнової кістки (ГСК), які обумовлені підвищенням частоти дорожньо-транспортних пригод і виживаності після високошвидкісних травм. Мета: проаналізувати результати хірургічного та консервативного лікування переломів ГСК і обґрунтувати тактику лікування цього ушкодження. Методи: проведено ретроспективний аналіз результатів лікування пацієнтів із переломами ГСК з 2002 по 2017 р. Перед операцією постраждалим виконано рентгенографію і КТ кісток таза. Переломи розподілили за класифікацією Pipkin: тип I -10 (25,6 %) осіб, 9 %), 7 %), 8 %). Консервативне лікування після усунення вивиху виконано 8 (20,5 %) пацієнтам: тип Pipkin I -6 (15,4 %); Pipkin II -2 (5,1 %). Результати: виявлено ускладнення, серед яких гетеротопічна осифікаціяу 1 (3,0 %) пацієнта, асептичний некроз ГСК -7 (23,3 %); 2 -з переломами типу Pipkin II, 5 -Pipkin IV. У період від 12 до 36 міс. після травми у 32 (76,9 %) пацієнтів отримані такі результати лікування за шкалою 1 %),3 %),6 %),0 %). Висновки: у разі переломів типів Pipkin I і II досягнуто кращі функціональні результати порівняно з важчим типом перелому Pipkin IV. Пізнє відкрите вправлення невправлених переломовивихів призвело до розвитку асептичного некрозу ГСК в 66,7 % випадків. Вибір методу лікування переломів ГСК залежить від типу перелому. У разі переломів типу Pipkin I консервативне лікування привело до високого відсотка хороших результатів. За умов переломів типу Pipkin II кращі показники спостерігали після відкритого вправлення й остеосинтезу фрагментів, Pipkin III -ендопротезування, Pipkin IV -остеосинтезу ГСК і перелому кульшової западини. Ключові слова: перелом головки стегнової кістки, переломовивих головки стегнової кістки, кульшовий суглоб, асептичний некроз, остеосинтез.Ключевые слова: перелом головки бедренной кости, переломовывих головки бедренной кости, тазобедренный сустав, асептический некроз, остеосинтез
Among all fractures, pelvic injuries are 5-8 %, and combined trauma-30-58 %. The level of mortality due to unstable pelvic fractures ranges from 10 to 18 %, and in patients with polytrauma-36.5-50 %. Objective: to analyze the organizational problems of treating patients with pelvic injuries in Ukrainian clinics and to propose ways of their solutions. Methods: a retrospective study of surgical treatment results of patients with pelvic fractures was made. Patients of group 1 osteosynthesis of pelvic bone fractures were carried out in the traumatological departments of the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.