В ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУ 3. Лечение больных с острой позвоночноспинномозговой травмой 3.1. Оказание первой медицинской помощи больным с подозрением на травму позвоночника на догоспитальном этапе Для оказания квалифицированной помощи на догоспитальном этапе пострадавшим с подозрением на позвоночно-спинномозговую травму (ПСМТ) обязательно соблюдение следующих условий. 1. Каждой бригаде скорой медицинской помощи (СМП) иметь жесткий головодержатель, метилпреднизолон и жесткие или вакуумные носилки (опция). 2. Любой пациент с подозрением на травму позвоночника, в том числе больные в бессознательном состоянии, после дорожно-транспортного проис

Несмотря на успехи в хирургии повреждений грудного и пояснич-ного отделов позвоночника, вопрос поздних последствий травм грудных и поясничных позвонков остается актуальным. К причинам возникно-вения посттравматических деформа-ций относят неадекватно применен-ный метод консервативного лечения, позднее выявление переломов позво-ночника вследствие тяжести политрав-мы, сочетанной травмы, недиагности-рованные и нелеченные переломы позвонков [17,24].Посттравматические деформации приводят к нарушению сагиттального баланса туловища и возникновению болевых синдромов, функциональной несостоятельности грудного, пояснич-ного отделов позвоночника и космети-чески неприемлемых деформаций [18].

Objective. To perform comparative analysis of osseointegration of bioceramic alumina-based granules, hydroxyapatitebased granules, and granules of deproteinized bone tissue. Material and Methods. The experiment was conducted on 52 adult male Kyoto-Wistar laboratory rats weighing 350 to 520 g. Animals were divided into five matched groups, which differed only in the type of implanted material. Granules were implanted in lumbar vertebral bodies and in distal right femur of each laboratory animal. Two months after surgery animals were euthanized with subsequent tissue sampling for morphological studies. Results. Examination of specimens from groups with implantation of alumina granules revealed the formed trabecular bone with evidence for remodeling. Bone tissue filled the space between granules fitting closely to their surfaces. There was no connective tissue capsule on the border between the bone tissue and alumina granules. Conclusion. Bioceramic alumina-based granules in the form of cylinders with a through inner channel have high strength surpassing that of analogs and ability for osseointegration close to that of hydroxyapatite and deproteinized bone granules.

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To analyze variants of post-traumatic spinal canal narrowing in burst fractures accompanied by fragment displacement of critical values, and to determine the effectiveness of surgical remodeling of the spinal canal. Material and Methods. Medical records of 136 patients with burst fractures of thoracic and lumbar vertebrae involving displacement of fragments into spinal canal on critical values were analyzed. Fragments were classified by their quantity, width, displacement type, and connection with the rest of vertebral body. Results. Three types of fragments displaced into spinal canal were identified: Type I-a large free fragment occupying all interpedicular space in the cranial part of the spinal canal with linear and angular displacement; Type II-a large fragment impacted into the central and posterior parts of the vertebral body and occupying the whole interpedicular space with linear displacement; and Type III-several fragments connected with the central part of the vertebral body and occupying the space less than interpedicular one with linear displacement. Conclusion. Type I fragments are most favorable for application of indirect reduction, while Types II and III fragments are less likely reduced by transpedicular fusion and ligamentotaxis than by anterior spinal canal remodeling. Accounting for a type of fragment displacement into the spinal canal is important in preoperative planning for burst fracture surgery.

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Background: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. Aim: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. Materials and methods: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. Results: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. Conclusion: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.

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