5 research outputs found
АНАЛИЗ ОКАЗАНИЯ СПЕЦИАЛИЗИРОВАННОЙ МЕДИЦИНСКОЙ ПОМОЩИ ПОСТРАДАВШИМ С ПОЗВОНОЧНО-СПИННОМОЗГОВОЙ ТРАВМОЙ ГРУДНОЙ И ПОЯСНИЧНОЙ ЛОКАЛИЗАЦИИ В УСЛОВИЯХ ГОРОДСКОГО ЦЕНТРА НЕОТЛОЖНОЙ ХИРУРГИЧЕСКОЙ ВЕРТЕБРОЛОГИИ
Background. Foundation of specialised centres or units of acute spinal surgery in general acute hospitals is to be considered a tendency of much importance in development of metropolitan systems for management of trauma victims with spinal injuries.Objective. To analyse size and structure of the patient inflow, contents and outcomes of treatment of trauma victims with thoracic and lumbar spine injuries in a setting of a specialised centre for acute spinal surgery located in a major city in our country.Material and methods. 1,760 trauma victims with thoracic and lumbar spine injuries admitted to an urban centre for acute spinal surgery of St. Petersburg in 2010 through 2016: 1,204 (68.4%) – isolated neurologically intact, 410 (23.3%) – isolated with spinal cord injury, 146 (8.3%) – spinal injuries in polytraumatised patients. An analysis of health administrative and clinical data was performed using non-parametric statistics.Results. During the period the centre worked, the number of annually admitted trauma victims increased 3.44 times, while notably, in the annual structure of the inflow, of which a fraction of isolated neurologically intact injuries decreased from 75.4% to 64.5%, there was an increase in fractions of persons with isolated spine and cord injuries (from 20.2 to 25.0%; р=0.2878) and with spinal injuries and polytrauma (from 4.4 to 10.5%; р=0.0718). The surgical rate was observed to increase from 69.3% to 81.9% (р = 0.0036), especially in trauma victims with unstable isolated neurologically intact injuries. In the annual structure of surgical work, a fraction of early procedures constantly increased (from 27.8 to 91.6%; р=0.0001), the increase rate appearing most stable in neurologically intact patients with isolated injuries. The treatment outcomes showed high values by all measures.Conclusion. The setting of a specialised secondary care centre for acute spinal surgery of a major city delivers high effectiveness and favourable outcomes of treatment of trauma victims with spinal injuries owing to the centralisation of their inflow, broad use of modern medical technology, and the tactic of early surgery. Введение. Создание специализированных центров или отделений неотложной спинальной хирургии на базе многопрофильных стационаров скорой медицинской помощи считается важнейшей тенденцией развития системы лечения пострадавших с травмами позвоночника в мегаполисах.Цель – проанализировать величину и структуру входящего потока, содержание специализированной медицинской помощи и результаты лечения пострадавших с позвоночно-спинномозговой травмой грудной и поясничной локализации в условиях профильного центра неотложной хирургии крупного города нашей страны.Материал и методы. 1760 пострадавших с позвоночно-спинномозговой травмой грудной и поясничной локализации, госпитализированных в городской центр неотложной хирургии позвоночника Санкт-Петербурга в 2010–2016 гг.: 1204 (68,4 %) – с изолированной неосложненной, 410 (23,3 %) – с изолированной осложненной травмой, 146 (8,3 %) – с повреждениями позвоночника в структуре политравмы. Проведен анализ медико-статистических и клинических показателей с использованием методов непараметрической статистики.Результаты. За период работы центра число ежегодно поступающих пострадавших возросло в 3,44 раза, причем в годовой структуре входящего потока на фоне снижения доли пациентов с изолированными неосложненными повреждениями с 75,4 до 64,5 % возросла доля лиц с изолированной осложненной спинальной травмой (с 20,2 до 25,0 %; р=0,2878) и с пнеотложных операций (рис. 1). При анализе этой ситуации в процентном отношении обращает на себя внимание тот факт, что после небольшого снижения их доли в общей структуре операций на протяжении первых 3 лет работы Центра (с 27,8 % в 2010 г. до 22,0 % в 2012 г.; р=0,435, критерий χ2 ) в 2013 г. она значительно увеличилась (до 68,4 %; р=0,0001, критерий χ2 ) и в последующем также постоянно повышалась, достигнув в 2016 г. величины 91,6 % (р=0,0001, критерий χ2 ). Применительно к каждому из трех вариантов ПСМТ (соответствующих ранее выделенным трем группам пострадавших) динамика изменения числа выполненных хирургических вмешательств и структуры методов лечения в целом была сходной (рис. 2–4). Так, для изолированных неосложненных повреждений доля неотложных операций возросла с 31,4 до 90,7 % (р=0,0001, критерий χ2 ), для аналогичных осложненных травм – с 26,1 до 100,0 % (р=0,0001, критерий χ2 ), для ПСМТ в структуре политравмы – с 0,0 до 75,6 % (р=0,0022, двусторонний точный критерий Фишера). При этом наиболее стабильная динамика ежегодного прироста числа таких операций была характерна именно для пострадавших с изолированными неосложненными повреждениями. Действительно, при изолированной осложненной ПСМТ необходимость оказания хирургического пособия в максимально короткие сроки после травмы является несомненной [7, 8], овреждениями позвоночника, являющимися компонентом политравмы (с 4,4 до 10,5 %; р=0,0718). Имело место повышение уровня хирургической активности с 69,3 до 81,9 % (р=0,0036), особенно в отношении пострадавших с нестабильными изолированными неосложненными повреждениями. В годовой структуре хирургических вмешательств происходило постоянное увеличение доли неотложных операций (с 27,8 до 91,6 %; р=0,0001), при этом наиболее стабильная динамика этого прироста была характерна для пациентов с изолированными неосложненными повреждениями. Результаты лечения пострадавших характеризовались высокими значениями всех показателей.Выводы. Условия профильного специализированного центра неотложной спинальной хирургии крупного города обеспечивают высокую эффективность и благоприятные результаты лечения пострадавших с травмой позвоночника за счет централизации их потока, широкого применения современных медицинских технологий и тактики раннего хирургического лечения.
Surgical complications after ankle-joint arthrodesis
Currently, for a number of cases of grade III-IV osteoarthritis of the ankle, the only possible intervention which helps to relieve pain, pathological condition of the limb and restores its support ability is arthrodesis of the joint [1]. Arthroplasty and prosthetics of the ankle, largely having purely cognitive and historical value, are not practically applied [2]
Development of management of emergency surgical care for patients with acute traumatic and nontraumatic spinal pathologies in conditions of megapolis
OBJECTIVE. The authors developed the management strategy of emergency care for patients with acute spinal surgical pathology in conditions of megapolis. MATERIAL AND METHODS. A comparative statistical analysis was made in 2627 patients. The patients (n =777) underwent treatment in multicenter hospitals of emergency care of the spine (decentralized system). The other patients (n = 1850) were treated in Municipal Center of Emergency Surgery of the Spine (centralized system). RESULTS. It is appropriate to establish departments of emergency surgery of the spine on the base of separate multicenter hospitals in megapolis. These hospitals should be properly equipped and they should have specially trained doctors and nurses, stable financing, effective management on admission to hospital. CONCLUSIONS. The efficacy of proposed measures allowed authors to recommend them to wide practical application
ANALYSIS OF SECONDARY CARE PROVIDED TO TRAUMA VICTIMS WITH THORACIC AND LUMBAR SPINE INJURIES IN A SETTING OF AN URBAN CENTRE FOR ACUTE SPINAL SURGERY
Background. Foundation of specialised centres or units of acute spinal surgery in general acute hospitals is to be considered a tendency of much importance in development of metropolitan systems for management of trauma victims with spinal injuries.Objective. To analyse size and structure of the patient inflow, contents and outcomes of treatment of trauma victims with thoracic and lumbar spine injuries in a setting of a specialised centre for acute spinal surgery located in a major city in our country.Material and methods. 1,760 trauma victims with thoracic and lumbar spine injuries admitted to an urban centre for acute spinal surgery of St. Petersburg in 2010 through 2016: 1,204 (68.4%) – isolated neurologically intact, 410 (23.3%) – isolated with spinal cord injury, 146 (8.3%) – spinal injuries in polytraumatised patients. An analysis of health administrative and clinical data was performed using non-parametric statistics.Results. During the period the centre worked, the number of annually admitted trauma victims increased 3.44 times, while notably, in the annual structure of the inflow, of which a fraction of isolated neurologically intact injuries decreased from 75.4% to 64.5%, there was an increase in fractions of persons with isolated spine and cord injuries (from 20.2 to 25.0%; р=0.2878) and with spinal injuries and polytrauma (from 4.4 to 10.5%; р=0.0718). The surgical rate was observed to increase from 69.3% to 81.9% (р = 0.0036), especially in trauma victims with unstable isolated neurologically intact injuries. In the annual structure of surgical work, a fraction of early procedures constantly increased (from 27.8 to 91.6%; р=0.0001), the increase rate appearing most stable in neurologically intact patients with isolated injuries. The treatment outcomes showed high values by all measures.Conclusion. The setting of a specialised secondary care centre for acute spinal surgery of a major city delivers high effectiveness and favourable outcomes of treatment of trauma victims with spinal injuries owing to the centralisation of their inflow, broad use of modern medical technology, and the tactic of early surgery
ISSLEDOVANIE EFFEKTIVNOSTII BEZOPASNOSTI TERAPII TERIPARATIDOM(FORSTEO) V TEChENIE 1 GODA PRI POSTMENOPAUZAL'NOMOSTEOPOROZE
The aims of the reported multinational open study were to estimate the influence of subcutaneous injections of 20 mkg daily Teriparatide on bone mineral density (BMD) at the lumbar spine and proximal femur, the markers of bone metabolism, the quality of life as well as the safety of treatment. Duration of the treatment period was one year.
Fifty postmenopausal women with osteoporosis (L1-L4 T-score mean -3,2±0,6 SD) were enrolled in the study. 70,8% of patients had fragility fractures. Forty four patients (78%) remained until the end of the study. BMD was detected by dual energy X-ray absorptiometry (DXA) («Prodigy», Lunar and «Hologic» 4500 W) at the lumbar spine (L1-L4) and proximal femur with converting to the standardized BMD. Bone alkaline phosphatase (BAP) and osteocalcin (OC) were measured as markers of bone formation and C-terminal cross-linking telopeptide (CTX) were measured in serum as a marker of bone resorption.
The significant increase in BMD was found at the lumbar spine (L1-L412,5±6,6%), whereas BMD at the proximal femur did not change significantly. The levels of markers of bone metabolism were increased after 3 months of the treatment and to the end of the study were 192,2%; 385%; 526,3% higher versus the baseline levels for BAP, OC., CTX consequently. There was also found a significant improvement in the quality of life of the patients which was estimated by EQ-5D inquirer at the baseline visit and at the end of the study. The adverse effects, which were related to the teriparatide injections, were observed in 44% of the patients. Due to the adverse effects Tereiparatide was cancelled for 6 (12%) patients. In other cases the adverse effects were slight and the cancellation of treatment was not required.
Conclusions: The daily injections of Teriparatide (20 mkg) during 1 year provide the significant increase in BMD at the lumbar spine for postmenopausal women with osteoporosis as well as the early increase in the bone turnover rate. Treatment with Teriparatide improves the quality of life for women with postmenopausal osteoporosis. The daily injections of Teriparatide during 1 year are well tolerated and safe