1 research outputs found
ΠΠ½ΡΡΡΠΈΠΊΠΎΡΡΠ½Π°Ρ ΡΠΈΠΊΡΠ°ΡΠΈΡ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ ΡΡΠΈΡΡΠΎΠΌ Ρ Π±Π»ΠΎΠΊΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ: ΠΏΠ΅ΡΠ²ΡΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΎΠΏΡΡ
Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16Β±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1Β±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8Β±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91Β±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients β 93.8Β±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.Β Β Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΈΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΡΠΈΠ½ΡΠΈΠΏΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π½ΠΎΠ²ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΡΠΈΠΊΡΠ°ΡΠΈΠΈ Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ°ΠΌΠΈ ΠΊΠΎΡΡΠ΅ΠΉ ΡΠ°Π·Π°. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΎΠΏΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ 18 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π°Π²ΡΠΎΡΡ Π²ΡΡΠΎΠ»Π½ΠΈΠ»ΠΈ 25 ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΠΎΡΡΠ΅ΠΎΡΠΈΠ½ΡΠ΅Π·Π° ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΠΎΠ³ΠΎ ΡΠΎΠ»ΠΈΠ΄Π½ΠΎΠ³ΠΎ ΡΠΈΡΠ°Π½ΠΎΠ²ΠΎΠ³ΠΎ ΡΡΠΈΡΡΠ°. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡΡΠ°Π²ΠΈΠ» 40,16Β±10,35 Π»Π΅Ρ. ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½Π°Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅Ρ ΠΎΠ±ΡΠ·Π°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΠΎ-ΠΎΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°ΡΠ΅Π»Ρ Π½Π° Π²ΡΠ΅Ρ
ΡΡΠ°ΠΏΠ°Ρ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. Π ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π° ΡΠΏΠΈΠ½Π΅ ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ ΠΎΡΡΠ΅ΠΎΡΠΈΠ½ΡΠ΅Π· ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ ΡΡΠΈΡΡΠΎΠΌ ΡΠ΅ΡΡΠΎΠ³ΡΠ°Π΄Π½ΠΎ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΡΡΠΊΠΈ-Π½Π°Π²ΠΈΠ³Π°ΡΠΎΡΠ° ΡΠ΅ΡΠ΅Π· ΠΊΠΎΠΆΠ½ΡΠΉ ΡΠ°Π·ΡΠ΅Π· 1 ΡΠΌ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΡΠΈΠΌΡΠΈΠ·Π°. ΠΠΎΡΠ»Π΅ ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ³ΡΡΠΆΠ΅Π½ΠΈΡ ΡΡΠΈΡΡΠ° Π² ΠΊΠΎΡΡΡ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ Π΅Π³ΠΎ Π±Π»ΠΎΠΊΠΈΡΠΎΠ²ΠΊΡ Π² ΠΏΡΠΎΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ°ΡΡΠΈ Π΄Π²ΡΠΌΡ ΠΊΠΎΡΡΠΈΠΊΠ°Π»ΡΠ½ΡΠΌΠΈ Π²ΠΈΠ½ΡΠ°ΠΌΠΈ Π΄ΠΈΠ°ΠΌΠ΅ΡΡΠΎΠΌ 3,5 ΠΌΠΌ ΡΠ΅ΡΠ΅Π· Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΊΠΎΠΆΠ½ΡΠΉ ΡΠ°Π·ΡΠ΅Π· 1,0 ΡΠΌ ΠΏΡΠΈ ΠΏΠΎΠΌΠΎΡΠΈ ΡΡΡΠΊΠΈ-Π½Π°Π²ΠΈΠ³Π°ΡΠΎΡΠ° ΠΈ Π½Π°ΠΏΡΠ°Π²Π»ΡΡΡΠΈΡ
Π²ΡΡΠ»ΠΎΠΊ. ΠΡΠ΅ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΡ ΡΠ°Π·ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΠΎΠ»ΡΡΠ° ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΠΠ/ΠΠ’Π, ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΡ Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Nakatani. Π€ΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Majeed. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΈΠ»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΡΠ΅ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΡ Π±ΡΠ»ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Ρ Ρ 7 (38,8%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (ΡΠ»ΠΎΡΠΈΡΡΡΡΠΈΠΉ ΡΠΈΠΌΡΠΈΠ·). Π£13 (72,2%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»Π° ΠΌΠ΅ΡΡΠΎ ΡΠΎΡΠ΅ΡΠ°Π½Π½Π°Ρ ΡΡΠ°Π²ΠΌΠ° β ΡΡΠ΅Π΄Π½ΠΈΠΉ Π±Π°Π»Π» ΠΏΠΎ ISS ΡΠΎΡΡΠ°Π²ΠΈΠ» 25,1Β±7,8. Π£ 2 (11,1%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Ρ ΠΎΡΠΊΡΡΡΡΠ΅ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΡ ΡΠ°Π·Π°, Ρ 3 (16,6%) ΠΈΠΌΠ΅Π»ΡΡ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΠΉ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌ Π²Π΅ΡΡΠ»ΡΠΆΠ½ΠΎΠΉ Π²ΠΏΠ°Π΄ΠΈΠ½Ρ. ΠΠ²ΡΠΌ (11,1%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΡΠΏΠΈΡΠΈΡΡΠΎΡΡΠΎΠΌΠΈΡ, 5 (27,8%) β Π»Π°ΠΏΠ°ΡΠΎΡΠΎΠΌΠΈΡ Ρ Π²ΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ Π΄ΡΠ΅Π½Π°ΠΆΠ΅ΠΉ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ ΡΡΠΎΠΊ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΡΠΎΡΡΠ°Π²ΠΈΠ» 7,8Β±6,2 ΠΌΠ΅ΡΡΡΠ΅Π². Π£ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΄Π°Π»ΠΎΡΡ Π΄ΠΎΠ±ΠΈΡΡΡΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΡΠΈΠΊΡΠ°ΡΠΈΠΈ ΠΎΡΠ»ΠΎΠΌΠΊΠΎΠ² Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ. Π ΠΌΠΎΠΌΠ΅Π½ΡΡ ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΡΠ°ΡΠ΅Π½ΠΈΠ΅ Π»ΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Π² 16 (64%) ΡΠ»ΡΡΠ°ΡΡ
, Π² ΠΎΡΡΠ°Π»ΡΠ½ΡΡ
9 (36%) ΡΠ»ΡΡΠ°ΡΡ
ΡΡΠΎΠΊ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π±ΡΠ» ΠΌΠ΅Π½ΡΡΠ΅ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ ΡΡΠΎΠΊΠ° ΡΡΠ°ΡΠ΅Π½ΠΈΡ (2 ΠΌΠ΅Ρ.). Π£ Π (68,8%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ Π² ΡΡΠΎΠΊ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 6 ΠΌΠ΅Ρ. ΡΠΎΡΡΠ°Π²ΠΈΠ» Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 91Β±3,9 Π±Π°Π»Π»Π° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Majeed, Ρ 8 (50%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΅ΡΠ΅Π· 12 ΠΌΠ΅ΡΡΡΠ΅Π² ΠΈ Π±ΠΎΠ»ΡΡΠ΅ ΡΡΠ΅Π΄Π½ΠΈΠΉ Π±Π°Π»Π» ΠΏΠΎ Majeed ΡΠΎΡΡΠ°Π²ΠΈΠ» 93,8Β±2,9 Π±Π°Π»Π»Π°. ΠΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π² Π²ΠΈΠ΄Π΅ Π½Π΅ΠΊΡΠΎΠ·Π° ΠΊΠΎΠΆΠΈ, Π²ΡΠΎΡΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΌΠ΅ΡΠ΅Π½ΠΈΡ ΠΎΡΠ»ΠΎΠΌΠΊΠΎΠ² ΡΠ»ΡΡΠ°Π΅Π² ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΎΡΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠ΅Π΄Π²Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ ΡΠ°Π½ ΠΈ Π½Π°Π΄Π΅ΠΆΠ½ΡΡ ΡΠΈΠΊΡΠ°ΡΠΈΡ ΠΎΡΠ»ΠΎΠΌΠΊΠΎΠ² Π½Π°ΡΡΠ΄Ρ Ρ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΠΌΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ ΠΎΡΡΠ΅ΠΎΡΠΈΠ½ΡΠ΅Π·Π°. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, ΡΠΈΠΊΡΠ°ΡΠΈΡ ΠΌΠΎΠΆΠ΅Ρ Π²ΡΠΏΠΎΠ»Π½ΡΡΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌ ΡΡΠΎΠΌ ΠΈ Π΄ΡΠ΅Π½Π°ΠΆΠ΅ΠΉ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΠΏΠ΅ΡΠ΅Π΄Π½Π΅ΠΉ Π±ΡΡΡΠ½ΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ, ΡΡΠΎ ΡΠ°ΡΡΠΈΡΡΠ΅Ρ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡ Π΄Π»Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΠ΅Π΄Π½Π΅Π³ΠΎ ΠΏΠΎΠ»ΡΠΊΠΎΠ»ΡΡΠ° ΡΠ°Π·Π°. ΠΠ°Π½Π½Π°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ, Π±Π»Π°Π³ΠΎΠ΄Π°ΡΡ Π½Π°Π΄Π΅ΠΆΠ½ΠΎΠΉ ΡΠΈΠΊΡΠ°ΡΠΈΠΈ ΠΎΡΠ»ΠΎΠΌΠΊΠΎΠ², ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ ΡΡΠ°Π·Ρ ΠΊΡΠΏΠΈΡΠΎΠ²Π°ΡΡ Π±ΠΎΠ»Π΅Π²ΠΎΠΉ ΡΠΈΠ½Π΄ΡΠΎΠΌ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ° Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ ΠΈ Π°ΠΊΡΠΈΠ²ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΊΠΎΡΠΎΡΠΊΠΈΠ΅ ΡΡΠΎΠΊΠΈ