[Optimization of rehabilitation of elderly and senile patients with primary traumatic dislocation of the shoulder.]

Тhe aim of the study is to improve the treatment outcomes of elderly patients with primary traumatic shoulder dislocation by developing an atraumatic rehabilitation method. The study included 56 patients aged over 60 years with primary traumatic dislocation of the shoulder. The patients of the first group (29 patients) after the dislocation of the shoulder was corrected, functional treatment was performed using orthoses and a developed course of physical therapy. Patients of the second group (27 patients) were treated according to the traditional method with the use of plaster immobilization after the dislocation of the shoulder was corrected. Shoulder joint radiography, MRI, determination of potentials in biologically active points (BAT) during the first 2-3 days after dislocation were used to diagnose shoulder dislocation and assess outcomes. To assess the immediate results, the electrical potential in BAHT was studied after 1,3 and 6 months. In 70,3% of group 1 patients, positive outcomes were obtained after 3-6 months on the ASES scale, while in the second group such results were achieved only in 57,3% of patients, and on the UCLA scale 22,8 and 19,2%, respectively. Thus, the use of the proposed tactics of functional treatment makes it possible to significantly (p<0,05) improve outcomes in patients of the older age group.

[Optimization of trauma care to victims of older age groups with fractures of the proximal femur.]

The objective of the study was to improve the treatment outcome of patients of older age groups with fractures of the proximal femur by developing an algorithm for providing medical care while taking into account the nature of a fracture and the comorbid background of a patient. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups with fractures of the proximal femur. 4 491 patients with fractures of the proximal femur who had been treated at the Hospital for War Veterans in Saint Petersburg from 2010 to 2019 were included for analysis. All the patients were divided into two groups depending on the tactics of the treatment used. Group 1 (2 082 patients) were treated in 2010-2014 using traditional methods. Group 2 (2 409 patients) were treated according to the developed algorithm while taking into account the nature of a fracture and the severity of comorbid pathology. The results were evaluated by the Leken's functional index, and the quality of life was assessed by WHO scale. In patients of the 1st group, good outcomes were achieved after a year in 126 (10,5%), after 3 years in 111 (9,1%), while in the second group after a year, excellent outcomes were achieved in 103 (6%) cases, good in 960 (55,7%), and after 3 years excellent in 87 (5,4%), good in 843 (52,3%). Thus, the use of the proposed algorithm for providing care to patients with fractures of the proximal femur significantly (p<0,001) improves the treatment outcomes for this category of patients.

NEW TECHNOLOGIES IN TREATMENT OF FRACTURES OF THE UPPER EXTREMITIES IN PATIENTS WITH SEVERE MULTIPLE AND POLYTRAUMA.

A comparative analysis of treatment results of fractures of long bones of the upper extremities was made in 172 victims with severe polytrauma. The traditional strategy of treatment was used in the first group. The new technologies such as prognostic tactics, method of Damage control orthopedics and low-invasive osteosynthesis developed by the authors were applied in the second group. The application of new technologies allowed doctors to improve the immediate and long-term results of surgery. The rate of lethality decreased in 1,6 times, incidence of complications reduced in 1,4 times. Hospital stay shortened in 2 times: for victims with favorable prognosis ­ on 7 days; for patients with unfavorable prognosis ­ on 13 days. The long-term results were studied in 154 (89,5%) patients. The common duration of treatment reduced on 30 days and the quantity of good results increased on 18,6%. The number of patients with vocational rehabilitation increased from 82,3 to 90,7%.

[Cardiac rhythm variability in patients with coronary heart disease and duodenal ulcer].

Nowadays most medical patients suffer from combined pathology. One of the most frequent examples is a combination of coronary heart disease (CHD) and duodenal ulcer (DL). The pathogenetic interrelations between these diseases have not been fully studied yet. Meanwhile, knowledge of shifts in cardiac rhythm variability (CRV) would widen the concept of the pathogenesis of these diseases, play predictory role, and allow individualization of prophylaxis and treatment. The subjects of this study were 23 patients suffering from CHD and DU. They were compared with 34 DU ulcer patients, and 15 CHD patients. The study revealed that in patients with combined pathology CRV was significantly lower than in those who had either CHD or DU.

[Value of echography in the diagnosis of chronic osteomyelitis]. / Znachenie ekhografii v diagnostike khronicheskogo osteomielita.

The only method of preoperative visualization of spread of the process in the soft tissues (phlegmons, abscesses etc.) is the ultrasonic examination which was used in 32 patients. The diagnostic significance of echography in chronic osteomyelitis was 50%, suppuration in the soft tissues was 92.3%.

[Use of demineralized allogeneic bone transplants for plastic surgery of osteomyelitic cavities]. / Primenenie demineralizovannykh kostnykh allotransplantatov dlia plastiki osteomieliticheskikh polostei.

Plasty of osteomyelitic cavities with demineralized bone transplants was performed in 55 patients. Different methods of the bone cavity plasty were used with regard for the state of soft tissues surrounding the pathological focus, changes in the purulent focus. In most of the patients (41) the cavity was filled up with the demineralized bone transplant formed with special reference to the size of the bone wound. In the other 14 patients with false joints complicated by osteomyelitis the bone allotransplant was put in the area of the defect as a duplicator. Good results were obtained in 53 (96.4%) patients.

[Epidemiological characteristics of postoperative wound infections in a trauma center hospital]. / Epidemiologicheskaia kharakteristika posleoperatsionnykh ranevykh infektsii v travmatologicheskom statsionare.

The occurrence of cross infections in osteomyelitis patients has been proved by clinical, microbiological, and epidemiological methods. The patients are infected mainly in the dressing room for patients with purulent processes; the working conditions in this dressing room do not preclude the possibility of cross infections.

[The causes and prevention of postoperative osteomyelitis]. / Prichiny vozniknoveniia i profilaktika posleoperatsionnogo osteomielita.

An analysis of causes of the appearance of postoperative osteomyelitis in 537 patients treated in the clinic has shown that in 82% they resulted from errors made by surgeons during operations, in 16% from insufficient examination of the patient during the preoperative period and erroneous management of the patients after operation. Strict observation of the requirements during the preoperative period, good organization, supply and performing the operation and postoperative managements, as well as the elevation of immune reactivity of the macroorganism allowed the percentage of postoperative osteomyelitis to be considerably reduced.

[Adipose tissue repair of the bone cavities in treating chronic osteomyelitis]. / Zirovaia plastika kostnykh polostei pri lechenii khronicheskogo osteomielita.

The substitution of osseous cavities by fat pedicle flaps was performed in 29 patients with chronic osteomyelitis after radical surgical treatment of the osteomyelitic focus. Recovery was achieved in 24 patients after a single operation. Five patients were subjected to reoperations. The authors consider the fat tissue to be a reserve plastic material for surgery of chronic osteomyelitis.

[Treatment of suppurative coxitis]. / Lechenie gnoinogo koksita.

An experience with the treatment of purulent coxitis in 56 patients is described. Acute coxitis was treated by arthrotomy, sequestrectomy and antibacterial therapy. Chronic forms of osteoarthritis consisted in the surgical treatment of the purulent focus and filling the cotyloid cavity with a muscular flap or the proximal end of the femoral bone.

[Effect of levamisole on the immunological reactivity of patients with chronic postoperative osteomyelitis]. / Vliianie levamizola na immunologicheskuiu reaktivnost' bol'nykh khronicheskim posleoperatsionnym osteomielitom.

Clinical observations of 31 patients have shown that levamisole promotes the improvement of immunological indices in patients with chronic postoperative osteomyelitis. In a group of patients treated with levamisole good results were obtained in 84%, while in the group of patients treated without levamisole good results were obtained in 63,9%.

[Allogeneic tendoplasty in surgery of the locomotor system]. / Allotendoplastika v khirurgii oporno-dvigatel'nogo apparata.

Allogenic tendotransplants were used in the treatment of different lesions and diseases of the locomotor apparatus in 410 patients. Good anatomical and functional results were obtained in 84% of the patients. Unsatisfactory results were noted in 7% of cases. The method of preservation of allogenic tendons had no influence upon the results.