[Comparative analysis of blood loss and haemodynamic changes in endoprosthesis replacing of coxofemoral joint in patients with bilateral coxarthrosis].

Comparative analysis of blood loss and haemodynamic changes in endoprosthesis replacing of coxofemoral joint in patients with bilateral coxarthrosis. Endoprosthesis replacement of coxofemoral joint is the method of choice in treatment of bilateral coxarthrosis which can eliminate the pain syndrome and physical restraint of patients. Also this method gives the opportunity for fast return to the labor activity. However, this orthopedic device is related to the different complications, the most dangerous among them is the blood loss. The method of the single-stage bilateral endoprosthesis replacement of coxofemoral joint was developed and introduced in the center of traumatology and orthopedics of the Central Military Clinical Hospital n.a N.N.Burdenko. The offered method let to reduce the total intraoperative blood loss at average to 30% in comparison with the consequential surrogation of two coxofemoral joint.

Experience of treating gunshot wounds of large vessels in Afghanistan.

The problem of treating injuries of large vessels in times of peace has been sufficiently well developed both in theoretical and practical aspects. In times of war, however, due to the large numbers of the wounded, a shortage of expert angiosurgeons, and multiple gunshot wounds, many theoretical tenets lose their academic regularity. The present study is based on the experience of treating 302 patients wounded during the Afghanistan war (1981-1985). Most of the injuries were to the vessels of the extremities. The gunshot wounds were complex. They included extensive destruction of tissue in the damaged segments of the extremities with simultaneous damage of large veins (42.0% of the cases), nerves (45.5%), and bones (47.4%). Multiple-vessel injuries were encountered in 4% of the cases, with combined injuries comprising 17.5%. Most of the wounded (83.7%) were in a state of shock, with 6.4% in a terminal condition. The blood loss amounted to 15% to 65% of the total volume. Ninety percent of the wounded were admitted to hospitals in the first 6 hours. A two-stage method was used to treat 71 of the wounded. The method included temporary bypass of the injured arteries and veins while evacuating the wounded and during surgery. Two hundred ninety-five wounded underwent vessel surgery. Out of the total number of injuries of arteries and veins, vessel sutures were used in 36.9% and 35.9% of the cases, vessel plastics in 41.4% and 7.1% of the cases, and vessel ligation in 21.7% and 60.0% of the cases, respectively. Surgery was completed by fixing the bone fragments externally with the help of special devices using the Ilizarov method. Amputation was performed in 13.9% of the cases. In 7.3% of the cases amputation was performed according to primary indications (no reconstructive surgery attempted on the vessels). In 6.6% of the cases extremities were amputated during the early postoperative period as a result of vessel thrombosis and an increase of tissue ischemia. The mortality rate after vessel surgery was 5.3%. We believe that for patients with gunshot wounds involving vessel injuries, early one-time reconstruction of the destroyed anatomical structures should be performed.

[Cases of complex endoprosthetic surgery of the hip joint]. / Endoprotezirovanie tazobedrennogo sustava v slozhnykh sluchaiakh.

140 complex endoprosthetics of the hip joint were performed in 124 patients treated in the traumatology and arthrology Center of the Buyrdenko Main Military Clinical Hospital during the period from 1988 to 2001. It constituted 14.3% of all patients with diseases and trauma sequelae of such localization treated in the Hospital. There were 6 main patient groups in whom the pathological changes were considerably expressed and required the special approaches to the operation, i.e. the primary simultaneous bilateral hip joint endoprosthetics. The patients' age was 17-65 (the mean age 48.7), while during the conventional primary endoprosthetics the mean age was 68. We have developed the method of hip joint endoprosthetics performed in two stages. (Patent No 2173108 RF). This method was applied in 16 patients (group 1-11 and group 2-5 patients). The post-operative follow-up period lasted 1-6 years. Excellent and good results were obtained in 14 (87.5%) patients that were evaluated according to Harris's method. We think that it is reasonable to consider the primary complex endoprosthetics as the independent type of surgical intervention as it requires the special approaches to planning and performance of the operation, high skill and special up-to-date equipment.

[The treatment of middle-aged and elderly patients suffering from trochanteric fractures of the femur]. / Lechenie postradavshikh pozhilogo i starcheskogo vozrasta s vertel'nymi perelomami bedrennoi kosti.

Treatment of 198 elderly patients with trochanteric fractures included different conservative and operative therapy methods. For the first time in Russia a new approach of extrafocus osteosynthesis was recommended for "decompensated" patients. It is proved, that for this category of the injured, active surgery tactics results in a considerable improvement of treatment outcome.

[The rehabilitation of the wounded with combat injuries to the extremities]. / Reabilitatsiia ranenykh s boevymi povrezhdeniiami konechnostei.

In the article necessity of organization of system of rehabilitation of the wounds in the limbs is emphasized, its main rules, components, problems and methods are opened. Due to early specialized surgical care in combination to modern conservative grant terms of stationary treatment are much reduced, in 2 times quantity of good remote results is increased, in 3 times number of bad outcomes, in 1.5 time--number of retired, on 15.2%--physical inability are reduced. Ways of further perfection of system of complex rehabilitation treatment are planned.

[The treatment of gunshot wounds of the hand]. / K lecheniiu ognestrel'nykh ranenii kisti.

During the war in Afghanistan gunshot hand injuries came to 12% of all wounded among Soviet servicemen. At the stages of specialized medical care the vast wounds, crushes or amputations of hand were 49%, hand injuries accompanied by traumata of other anatomical zones were 42%. The gravity, concomitant and multiorgan character of the injuries required that the conservative and active methods of treatment, as well as the expert appreciation of that category of wounded should be developed and improved. Field surgeons frequently performed primary operations accompanied with the elements of the specialized medical care. The experience shows that the local purulent complications during the primary surgical management of wounds performed without elements of specialized medical care were up to 29,5%, and in primary reconstructive operations--12.4%. Osteomyelitis was correspondingly recorded at 11.1% and 3.2% of cases. The efficiency of treatment was growing when microsurgical technique was used.

[The general and local treatment of wounded patients with gunshot fractures at stages in the medical evacuation]. / Obshchee i mestnoe lechenie ranenykh s ognestrel'nymi perelomami na étapakh meditsinskoi évakuatsii.

The article discusses the pathogenetical approach to an early prophylaxis of local disorders of blood circulation in the cases of gunshot fractures of limbs. The authors emphasize the negative influence of the post-traumatic edema of muscles inside osseous-fascial bursas. On the background of blood losses and centralization of blood circulation edema causes the decompensation ischemia of tissue, which leads to the appearance of centres of secondary necrosis. An early recovery of optimal tissue blood circulation is propounded as one of the goals during the primary surgical management of wounds. A rational sequence of immediate surgery, which was practically tested is proposed. Basic methods of operations on limb segments are enclosed.

[Clinico-experimental study of different types of allotenoplasty]. / Kliniko-eksperimental'noe izuchenie razlichnykh vidov allotendoplastiki

The results of an experimental study carried out on 140 rabbits with the aim to investigate auto- and allotendinoplasty are briefly described. General clinical, morphological, lymphographic and histochemical data allowed a conclusion as to the presence of a decreased lymphoido-plasmocytic reaction as the process of replacement of conserved allogenic grafts by connective tissue proceeded. Clinical utilization of conserved tendinous allografts in 32 patients in restoration of 41 injured digital tendons revealed positive aspects of this kind of tendinoplasty.