[Application of intramedullary blocked osteosynthesis for treatment of patients with open fractures of the shin and femur in combined injuries].

Actual problems of using intramedullary blocked osteosynthesis for open fractures of the shinbones and femoral bones in patients with combined injuries are considered. The most optimal terms of operative treatment were established depending on the severity of the injuries by ISS scale and on classification of injuries of the soft tissues by Gastillo-Andersen. The schemes of antibacterial prophylactics of infectious complications are proposed both during operation and at the postoperative period. Under consideration are the questions of intraoperative boring of the bone marrow canal of the shinbones and femoral bones in severe combined injuries.

[The influence of transplanted culture of bone marrow stromal cells on reparative osteohistogenesis in parietal bone defect].

Recently the problem connected with transplantation of bone marrow stromal cells for optimization of reparative osteogenesis is very actively studied. However, the objective methods allowing to observe the behavior of transplanted cells in a bone wound and to estimate character of regenerative osteogenesis after cell transplantation are used in an insufficient measure in both experimental and clinical researches. The aim of this study is to clarify the fate of stromal cells in a bone wound and to investigate the influence of bone marrow stromal cells on the process ofposttraumatic osteogenesis after cell transplantation in parietal bone defect. The experiments were carried out on 38 rabbits with artificially made parietal bone defect (diameter 1.0 cmm). The rabbits were divided into three groups: the first group was a control one; the rabbits of the second group were injected autogenic cultivated bone marrow stromal cells (10(6)); the rabbits of the third group were injected with autogenic cultivated bone marrow stromal cells (10(6)) in collagn gel. The methods of light and fluorescent microscopy, histomorphometry and statistical treatment of the data were used to estimate the results. The obtained data showed that transplanted cells were viable at least during 18 days after transplantation and efficiently took part in the reparative process. The transplantation of cultivated bone marrow stromal cells in collagen gel caused 30% increase in the part of bone tissue in the bone regenerate tissue in comparison with control after 120 days.

[Characteristic of combat trauma and treatment of gunshot fractures of long bones of the limbs]. / Kharakteristika boevoi travmy i lechebnye meropriiatiia pri ognestrel'nykh perelomakh dlinnykh kostei konechnostei.

Treatment of the patients with gunshot fractures of extremity long bones is one of the main problems of field surgery. The complex study of medical records obtained from 718 servicemen with gunshot fractures of extremity long bones who participated in counter-terrorist operation in the Republic of Chechnia (1994-1996) allowed to evaluate character and severity of the injuries, content of the treatment measures conducted at the stages of medical evacuation. The peculiarities of fighting trauma were the following: the high frequency of combined (22.5%) and multiple (25.9%) injuries, the high share of multi-fragmentation and splintered (76.4%), intra-articular fractures (17.3%), the primary defects of bones (7.1%) and soft tissues (4.8%), the injuries of main vessels (12.1%) and nerves (18.5%). Owing to the short periods of evacuation to the stage of specialized medical care (up to 18.2 +/- 5.3 h), high share of preserving variant of primary surgical treatment (82.3%); high quality of medical immobilization at the expense of wide introduction of functionally stable external osteosynthesis (51.2% of the casualties) it was possible to improve the treatment results.

[Effectiveness of nutritional support of elderly and senile of orthopedic traumatological profile]. / Effektivnost' nutritsionnoi podderzhki bol'nykh ortopedotravmatologicheskogo profilia pozhilogo i starcheskogo vozrasta.

An analysis of results of the operative treatment of 36 patients who received and did not receive nutritional support in the pre- and postoperative periods has shown that the nutritional support improves the course of the postoperative period.

[Treatment of servicemen with pelvic injuries at the stage of medical evacuation during local military conflicts (Report II)]. / Lechenie voennosluzhashchikh s povrezhdeniiami taza na étapakh meditsinskoi évakuatsii v sovremennykh lokal'nykh voennykh konfliktakh (Soobshchenie vtoroe).

Basing on the analysis of medical record data obtained from servicemen with pelvic unstable injuries the authors evaluate the results and effectiveness of the used treatment methods and give the recommendations how to improve medical care rendered such category of casualties at the stages of medical evacuation. The analysis of treatment results obtained in the casualties with pelvic unstable injuries shoes high frequency (up to 24.4%) of unsatisfactory results among which not eliminate deformations of pelvic ring (14.3%), disordered walk (20.4%) and painful syndrome (18.8%) prevailed. In the structure of treatment measures during the local armed conflicts in Afghan and Chechnyathe conservative methods of hipbone immobilization (and even in the cases of pelvic unstable injuries) prevailed. Osteosynthesis with external apparatus was used only in 2.1% of the cases. Such treatment tactics resulted in the large number of unsatisfactory anatomical and functional outcomes of medical rehabilitation (46.8%), changes in servicemen fitness category (30.3%) their discharge and disability. To make the treatment of such category of casualties more effective it is necessary to conduct the appropriate surgical stabilization of pelvic fractures at the stage of specialized medical care with the use of modern methods of external and internal osteosynthesis.

[The comprehensive surgical treatment of patients with degenerative lesions of the lumbosacral spine]. / Kompleksnoe khirurgicheskoe lechenie bol'nykh s degenerativnymi porazheniiami poiasnichno-kresttsovogo otdela pozvonochnika.

On the basis of a complex analysis of surgical treatment of 52 patients with degenerative diseases of the lumbosacral part of the spine complicated by the formation of compressive reticulopathies main states were established responsible for the worse quality of life of this category of patients. Different forms of vertebrogenic radiculopathies were determined according to the morphological substrate of compression. The methods of diagnosing the spinal diseases at the lumbosacral level were estimated and the diagnostic algorithms for different variants of degenerative lesions were developed. Rational schemes of surgical correction are proposed according to the established groups of vertebrogenic lumbosacral radiculopathies. Special attention is given to prophylactics of recurrences of the pain syndrome and postoperative instability of the spine.

[Posttraumatic spinal instability and the methods for its surgical correction]. / Posttravmaticheskaia nestabil'nost' pozvonochnika i metody ee khirurgicheskoi korrektsii.

The paper deals with the outcomes of 982 patients with thoracic and lumbar spinal lesions and the data of biomechanical testing (298 studies on 103 specimens from the cervical, thoracic, and lumbar spine). Major types of acute posttraumatic spinal instability (such as axial instability, threatening fractured fragment instability, and threatening segmental instability) are defined and the stabilizing capacities of routine surgical techniques are assessed. The current systems for stabilizing the spine (transpedicular designs and plates for anterior spinal fixation is shown to be effective.

[Surgical treatment of patients with injuries of the spine of the thoracic and lumbar localization]. / Khirurgicheskoe lechenie postradavshikh s povrezhdeniiami pozvonochnika grudnoi i poiasnichnoi lokalizatsii.

Surgical treatment of 276 patients with uncomplicated (71.7%) and complicated (28.3%) injuries of the spine of the thoracic and lumbar localization was taken as the material for the article. The authors propose a rational strategy and tactics of operative treatment of patients with traumas of the spine and also they make an assessment of efficiency of some new surgical technologies. The volume and optimum terms of the decompressive-stabilizing operations on the spine are determined depending on the kind of the vertebral injury and the general state of the patient. The effectiveness of the present-day systems of stabilization of the spine (transpedicular constructions and plates for the frontal fixation of the spine) was demonstrated.

[Experimental substantiation of the mechanism of adaptive disintegration in the pathogenesis of traumatic disease]. / Eksperimental'noe obosnovanie mekhanizma adaptatsionnoi dezintegratsii v patogeneze travmaticheskoi bolezni.

For experimental verification of the authors' hypothesis on the role of the mechanism of adaptative disintegration in pathogenesis of trauma disease the essence of which consists in inadequacy of emergency adaptation of the organism to a critical and middle degree of the injury by the time and amplitude, an investigation on 89 rabbits has been performed with modeling of extensive wound of soft tissues of the femur. The correction of the neuroendocrine response of the organism to trauma by injection of synthetic opiopeptide dalargin++ was made. The use of dalargin changed quantitatively and qualitatively the neuroendocrine reaction to the injury and optimized the wound process and restoration of the homeostasis parameters.