卷 3, 编号 1 (1996)

The article deals with upper extremity guided anaesthesia in children in outpatient trauma practice.

The results of surgical treatment of 36 patients with scoliosis, aged 18-29, were presented. Correction by Harrington distractor and posterior spondylosyndesis with allografts was performed. The average deformity correction achieved made up 38,8% of the initial value. Long term results (from 2 to 9 years) were studied in 29 patients. In 2 patients, complete loss of the correction was noted. In the rest of patients, the final correction varied from 9,9 to 49%, average 25,7%, of the initial value. The less is the scoliosis degree and age of a patient, the better is outcome of surgical correction. The preoperative pain syndrome being present in 7 patients was eliminated after operation.

Authors present their experience with 36 cases of spinal canal stenosis due to ossification of posterior longitudinal ligament in cervical spine. Ligament ossification extent was found to be local (1 segment) or segmental (2-3 segments). Clinical examination showed cervical myelopathy of various severity. Diagnosis of cervical spinal canal stenosis was determined mainly by CT and MRT. All patients underwent surgical treatment - anterior transcorporal decompression of spinal cord. Positive results were achieved in 34 patients including 22 patients with complete elimination of myelopathy, 9 patients with partial elimination and 3 patients with stopping of the process progression. In 2 patients, surgical procedure was inefficient.

In transdental injuries of atlantoaxial region the indications for conservative treatment and author’s bipolar Halo-traction method were worked out on the base of spine biomechanical peculiarities (anterior shifting moment and extensor conditionality of the posterior cervical muscles) as well as depending on the mechanism of the development of plane fracture of C2 odontoid process. In flexion fracture of the odontoid process without dislocation as well as in extension fracture with dislocation within the limits of 1/3 of its diameter the successful conservative treatment with plaster thoracocranial bandage was possible. In the rest of cases the author’s method of bipolar Halo-traction was indicated. The experience of treatment of 32 patients was used in the work.

The experience of treatment of 217 patients with primary benign spine tumor (14 nosologic forms) is presented. The importance of axial computer tomography and MRT for diagnosis is outlined. 201 patients have been operated on. In lesion of cervical spine, as rule, the anterior and posterior approaches are used, very seldom combined ones. In operations on thoracic spine the authors prefer the posterolateral extrapleural approach that allows to perform laminectomy, costotransversectomy (sometimes, bilateral) as well as partial or complete spondylectomy. Besides posterolateral approach anterior extraperitoneal one is used for local lesion of lumbar vertebra body. When tumor is localized in the sacrum the posterior approach is used more often, sometimes in combination with uni- or bilateral anterior extraperitoneal ones. Replacement of vertebra body defect is performed by autografts from the upper flaring portion of the ilium, more seldom - by implants. Posterior spondylodesis is carried out using cortical implants with transosseous fixation by metalic wire. In 7 patients, the recurrence has been revealed within 2 years after operation. In the rest of patients there have been no recurrences. The authors make a conclusion that active surgical tactics for primary benign spine tumors is justified and necessary.

With the purpose of the improvement of the x-ray diagnosis of the thoracic vertebral body compression fractures in children the roentgenometry of the thoracic vertebral bodies was performed in children in norm by age aspect. The main criteria, i.e. wedge-shaped index and discoid coefficient, were calculated for the different segments of the thoracic spine in children from 3 to 15 years.

Experimental study on 68 dogs and clinical observation of 28 patients with bone pathologic remodelling showed that the morphologic base of that process was a reparative response to overtension resulting in local thickening of bone (hyperostosis due to overtension). In case of old chronic process, the creeping fracture occured-willow fracture, during the development of hyperostosis due to overtension. The diagnosis, prevention, treatment of bone pathologic remodelling were presented.

The authors present their experience in the application of external fixation devices for the treatment of 96 patients with multiple and combined pelvic bones injuries. It is shown that treatment with use of both pivot and pin devices exerts powerful antishock effect, allows to shorten the duration of bed rest and early activate the patient. Favourable results were achieved in all cases.