Vol 8, No 1 (2001)

Massive bleeding is the main cause of death in patients with extensive severe fractures and dislocations of the pelvic bones in the first minutes and hours after admission to the hospital [7, 45, 63]. In 54~88% of cases, the source of bleeding is damaged pelvic vessels [43, 63, 82]. In particularly severe pelvic injuries with predominant damage to its main blood vessels, mortality reaches 89-100% [43, 79].

In the most general form, the main factors of traumatic disease can be represented as follows (Scheme 1): the traumatic factor acts on organs and tissues, causing their damage. As a result of this, the cells are destroyed and their contents are released into the intercellular environment; other cells are exposed to concussion, as a result of which their metabolism and their inherent functions are disturbed. Primarily (as a result of the action of a traumatic factor) and secondarily (due to a change in the tissue environment), numerous receptors in the wound are irritated, which is subjectively perceived as pain, and objectively characterized by numerous reactions of organs and systems.

Present work is a sequel to the publication presented in № 3, 2000. Projecting of the medical technological process is considered on the example of the hospital treatment of patients with low back degenerative diseases. Technologic chart for diagnosis and treatment of patients with spondylogenous low back pain for the inpatient treatment is given. High efficacy of the proposed technological approach to the treatment of lumbar spine degenerative diseases is proved by clinical results.

Results of examination and treatment of patients with polytrauma complicated by deep vein thrombosis of lower extrimities (DVT) and pulmonary thromboembolism (PTE) are presented. Proximal deep vein thrombosis was confirmed by Doppler. PTE developed on week 2 after trauma in patients with asymptomatic DVT. For timely diagnosis of DVT and prevention of PTE in patients with polytrauma it is necessary to perform Doppler of lower extrimities 1—2 times a week within 2—4 weeks after trauma and for 2—4 weeks after surgical interventions on long bones and pelvic bones. In patients with PTE the implantation cava-filter allowed to avoid lethal outcomes and PTE relapse. The application of low molecular weight heparin allowed to increase the efficacy ofprevention and treatment of thrombotic complications in patients with polytrauma.

The work is based on the analysis of examination and treatment results in traumatic hip dislocation (52 patients). The development of aseptic femoral head necrosis was detected in 11 patients at follow-up from 2 to 5 years. Algorithm of complex examination and treatment in traumatic hip dislocation has been elaborated for early and long-term periods after trauma. The group of high risk for aseptic femoral head necrosis development includes the patients with concomitant trauma, with posterior, obturatory and central dislocation. Rehabilitation is requiered to all patients with traumatic hip dislocation in the period from 2 to 5 years taking into account the peculiarities of hip injury. If the signs of posttraumatic aseptic femoral head necrosis are detected at early stages, then conservative treatment is indicated. In advanced process the operative treatment is indicated. Localization of necrosis area within femoral head, necrosis extension and articular surface congruence are of importance for the choice of adequate operative treatment. Roentgenologic signs of irreversibility of articular tissues destruction are the indication for total hip replacement.

The potentialities of ultrasonography for the imaging of wrist tendons is shown. Normal sonographic appearance of flexor wrist tendons as well as extensor wrist tendons is given in longitudinal and transverse scanning. The causes of artifacts have been analysed and the methods for their elimination are given. Elaborated protocol and technique of ultrasonographic investigation of wrist tendon at rest and in dynamics under real time condition are presented.

Three cases of evulsion tibia fractures at the posterior cruciate ligament attachment are presented. The bone fragment displacement was more than 1 cm. All patients were treated surgically. In 1 patient reduction offracture was completed by bone suture, in 2 patients by fixation with screw inserted retrogradely. Follow up from 6 months to 4 years showed no complications, the joint was stable and full volume of motion was noted.

Results of biomechanic examination of walking in healthy individuals and patients with ICP before and after treatment using dynamic proprioceptive correction are presented. The patients with ICP had different forms of the disease: spastic, hemiplegic, hyperkinetic and atonic-ataxic. The following features of walking were studied: range and volume of flexor-extensor motion in hip, knee and ankle joints as well as time characteristics of step cycle. Data obtained showed common and individual signs of gait disturbance depending on the form of ICP. In author's opinion the possible mechanism of walking disturbance in patients with ICP was pathological change of motion stereotype and that disturbed motion stereotype was normalized using dynamic proprioceptive correction. Biomechanic examination of walking allows to provide the differentiation of various forms of ICP as well as to evaluate the locomotor function changes in the course of treatment.

Introduction of tubular perforated implants of demineralized bone matrix was shown to provide the formation of organ specific bone regenerate and restoration of full value anatomic structure of the injured bone. Shape, material, method of matrix implantation conditioned the development of longitudinally oriented compact bone between free cortical distal and proximal bone fragments as well as the restoration of bone marrow intergrity in the defect site and its intergra-tion with bone marrow of total bone. Implant structure having multilevel widely branched canal system is suggested to provide free microcirculation of tissue liquid and migration of bone cell precursors into osteogenesis area.

In December 2000, Professor Irina Iosifovna Mirzoeva turned 80 years old. She was born on December 6, 1920 in a family of St. Petersburg lawyers. Her father I.A. Mirzoev and his stepfather - a well-known lawyer and writer from the group of "Smenovekhites" A.V. Bobrishev-Pushkin on false charges were arrested and shot. Only many years later, both of them are fully rehabilitated.

May 10, 2001 marks the 60th birthday and 36 years of medical and scientific and pedagogical activity of the Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Professor N.G. Fomichev.