Лечение сочетанной травмы позвоночника и конечностей

Abstract

Мета роботи – вивчення ефективності оперативного лікування хворих з поєднаною травмою хребта в поєднанні з іншими переломами опорно-рухової системи. З 367 потерпілих 210 хворим проведено тільки консервативне лікування, прооперовано 157 постраждалих з травмами хребта в поєднанні з іншими ушкодженнями опорно-рухової системи та внутрішніх органів. З оперованих 157 хворих чоловіків було 106, жінок – 51. Вивчено найближчі й віддалені результати лікування, а також встановлені інвалідності в трьох групах, доведено необхідність проведення реабілітації постраждалих, що впливає на прогноз лікування. Оцінюючи результати лікування пацієнтів з неускладненими нестабільними пошкодженнями хребта з переломами кінцівок у більшості (до 93%) хворих відзначають хороший і сприятливий трудовий прогноз.

Цель работы – изучение эффективности оперативного лечения больных с сочетанной травмой позвоночника в сочетании с другими переломами опорно-двигательной системы. Из 367 пострадавших 210 больным проведено только консервативное лечение, прооперировано 157 пострадавших с травмами позвоночника в сочетании с другими повреждениями опорно-двигательной системы и внутренних органов. Из оперированных 157 больных мужчин было 106, женщин – 51. Изучены ближайшие и отдаленные результаты лечения, а также установлены инвалидности в трех группах, доказана необходимость проведения реабилитации пострадавших, что влияет на прогноз лечения. Оценивая результаты лечения пациентов с неосложненными нестабильными повреждениями позвоночника с переломами конечностей у большинства (до 93%) больных отмечают хороший и благоприятный трудовой прогноз.

Objective: to study the effectiveness of surgical treatment of patients with combined spinal trauma in combination with other fractures of the musculoskeletal system (ODS). Methods. In the period 2000-2017, 367 victims who had a combined spinal injury with fractures of the musculoskeletal system (ODS) were treated in the clinic of traumatology and orthopedics of Azerbaijan Medical University. Of the 367 injured 210 patients, only conservative treatment was carried out, 157 victims were operated on with spinal injuries in combination with other injuries of the musculoskeletal system and internal organs. Of the 157 patients operated on, 106 were men and 51 were women. Among damages of a backbone the predominant lesions were multiple lesions of the vertebrae (77 patients, or 49%). The age of patients varied from 17 to 72 years. Among the injuries of the musculoskeletal system predominant were injuries of the lower extremities (43 patients) and multiple fractures of the musculoskeletal system (40 patients) (27 and 25% – respectively). Results. Upon admission, all patients underwent clinical and x-ray examination, computed tomography. Based on x-ray and topographic studies, spinal injuries were systematized using a universal classification for the thoracic and lumbar: for the lower left; for the upper left. Fractures of the calcaneal bones are systematized according to the Essex – Lopresti classification. Other injuries of the lower extremities were categorized by descriptions of damage. 14 patients had injuries to the abdominal cavity or chest, 8 of them underwent surgical treatment as an emergency. The stage of surgical treatment of spinal injuries in case of revealed indications was delayed, without discharge of the patient from the hospital. All the operated patients were divided into 3 groups. Among the spinal injuries (132), the predominant were damages of type a – 80 (61%), type B-38 (29%), type C-14 (10%). Among the patients of the first group operated only on limbs, examination took place 4, which amounted to 12.5% of the number of operated in this group and 2.5% of the total number of operated patients with spinal injuries in combination (1 patient was determined I-th group, 2 patients-2nd). Among patients of the second group 23 – man that was 26.4%, or 14.6%, respectively, in 20 patients defined by the 2-nd group 2 patients, the 3rd disability group), 10 patients defined by the 2-nd group, 1 patient – the 1st group of disability. To one patient from each group the disability group at primary survey was not defined. Thus, it should be noted that the differential approach in the treatment of spinal cord injuries, carrying out stages of the correction of its deformation and identification in one surgical session, combined with operations on the damaged segment of the limbs, conducted simultaneously in patients with polytrauma, optimize the rehabilitation process. Conclusions. The correct assessment of the functional state of the spine be damaged to focus directional fully functional aftercare of the patient, determining the feasibility of temporary and permanent disability.