卷 341, 编号 2 (2020)

Over 60% of victims of local military conflicts and emergencies have injuries of the musculoskeletal system, 90% of them need surgical treatment in a specialized medical institution. Mortality at the advanced stages of medical evacuation in case of severe multiple and combined injuries associated with traumatic shock is up to 10-15%; disability is more than 30%, no more than 50% of victims who have suffered severe injuries of the musculoskeletal system are returned to service. More than 30% of these wounded develop purulent-septic complications. The authors have developed a fundamentally new concept for the treatment of victims of injuries of the musculoskeletal system in emergencies and local military conflicts in combination with air medical evacuation using aviation and helicopter medical modules. The concept is based on antishock therapy, primary surgical treatment of wounds, and fixation of fractures of the extremities and pelvis in the early period after injury (the «golden hour»), as close as possible to the focus of sanitary losses. The authors have developed a medical military field mobile complex «Clover», which has no analogs in the world. Using the complex allowed: to reposition (comparison) of bone fragments at the advanced stage of medical evacuation in 95% of cases (2 times higher than when using domestic external fixation devices of previous designs); to reduce the time of surgery by 50%, which reduced the number of repeated operations of remounting the external fixation apparatus by 2.5 times. The implementation of the concept allowed to reduce the treatment time for patients with injuries of the extremities and pelvis by 1.5 times and by 55% the cost of inpatient treatment; reduce the number of complications in injuries of the extremities by more than 15%, with gunshot fractures - by 25%. The use of the medical aviation (helicopter) module and the Clover mobile complex led to a significant reduction in mortality, disability of the wounded, and an increase in the quality of treatment.

One of the issues of interest to investigating authorities and the courts in ordering forensic medical examinations of injuries of internal organs is the possibility of determining the number of traumatic effects. In the specialized scientific literature, there is no data on the determination of the number of traumatic effects on the spleen, as well as the establishment of signs of repeated trauma in the morphology of ruptures of this organ. As a result of the study, it was found that with repeated shock trauma, the morphology of the primary damage to the spleen changes due to the addition of shear deformations to the shock load due to the loss of strength of the organ as a whole during its primary damage. Such morphological changes are characteristic of repeated trauma to the spleen. The obtained data can be used in practice by forensic experts in solving questions about the number of traumatic effects and the presence of signs of repeated trauma to the spleen.

Mortality in pancreatic injuries reaches 60%, which is associated both with the combined nature of trauma to the organs of the abdominal cavity and retroperitoneal space, and with the development of multiple complications, up to destructive traumatic pancreatitis. Even though in the modern period of the war they are local in nature, there is no tendency to reduce the frequency of pancreatic injuries. A special group consists of gunshot wounds of the pancreas. Most scientific publications note that the latter are represented by isolated cases (except for the World War II). The initial serious condition of patients caused by the syndrome of mutual complication causes difficulties in the diagnosis of traumatic damage to the pancreas, poses difficult tasks in terms of choosing a rational method of surgical intervention.

The clinical and laboratory-instrumental manifestations of repeated community-acquired pneumonia, disease risk factors in young people from organized groups were studied and the prognostic capabilities of the data obtained were evaluated. The analysis of the results of the examination of 194 patients aged 18-27 years with repeated community-acquired pneumonia that developed within a year after previously transferred pneumonia of mild course was carried out. The control group consisted of 526 patients with community-acquired pneumonia of patients of a similar age, gender and social status. It was established that repeated community-acquired pneumonia significantly more often had the same localization as the previous one. Most of cases of repeated pneumonia (72.6%) developed during the first 3 months after the first case of the disease. Its clinical course in most cases was not severe and was characterized by a more rapid normalization of clinical and laboratory parameters.

The problem of organizing anti-epidemic measures in the Far North and the Arctic has become urgent in connection with the re-establishment of a permanent grouping of troops and fleet forces here. The formation of risks for their sanitary and epidemiological well-being is influenced by the complex of natural and climatic conditions inherent in this region, environmental features, conditions for the deployment of military personnel, transport, and logistics of military units. These circumstances determine and transform the structure and dynamics of infectious diseases, the implementation of mechanisms and factors of transmission of pathogens, the resistance of the human body, the timing, and the nature of the immune response. The article gives medical and geographical, epizootological, and epidemiological characteristics of the region. Information on factors determining the organization of anti-epidemic measures in the troops (fleet forces) is summarized.

The article presents data on the prevalence and structure of the incidence of chronic diffuse diseases of the liver of non-viral etiology among military personnel. The study included 282 male military personnel aged 19 to 54 years. It was found that the prevalence of non-viral chronic diffuse liver diseases among the examined military personnel was 58.1%, including non-alcoholic fatty liver disease in 33.3, alcoholic liver disease in 7.8%, and fatty liver disease of an alcohol-metabolic etiology in 17% of patients.

The stage-by-stage treatment of military pilots with alimentary-constitutional obesity is developed and introduced into practice. The flight crew of the Armed Forces of the Russian Federation, suffering from alimentary-constitutional obesity, goes to the annual medical and flight commission at the Branch No. 1 of the N.N.Burdenko Main Military Clinical Hospital. In the future, military pilots are transferred to the next stage of treatment in the Branch No. 2 of the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation. Upon arrival, they are assigned a comprehensive treatment and rehabilitation program aimed at weight correction and leveling of concomitant pathology. Upon completion of treatment, the pilots return to Branch No. 1 of the N.N.Burdenko Main Military Clinical Hospital for subsequent submission to the hospital medical flight commission.