Double fractures of the bones of the crus and their treatment

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.     

复方当归提取物对皮肤抗氧化作用实验研究

目的:观察含复方当归提取物的护肤品对皮肤的抗氧化作用。方法:测定含复方当归提取物护肤品对D-半乳糖衰老模型小鼠皮肤超氧化物歧化酶(SOD)、羟脯氨酸(Hyp)及皮肤含水量的影响。结果:含复方当归提取物护肤品具有使D-半乳糖衰老模型小鼠皮肤SOD、Hyp含量增高的作用(P<0.05),对小鼠皮肤含水量有增高趋势,但无统计学意义。结论:含复方当归提取物的护肤品对皮肤的抗氧化作用与提高皮肤SOD活性、增加Hyp含量有关。     

In Vitro Assessment of the Hemocompatible Properties of Polymers

Summary: Based on the available data in the literature and personal results, a system of in vitro tests, consisting of two levels of selection, was proposed for assessment of hemocompatible properties of polymers. The first level consists of rapid methods for preliminary assessment (clotting time, hemolytic activity of the sample, and number of adhesive platelets). The second level involves methods for final selection and consists of measurement of the kinetics of the initial stages of adsorption of albumin, the degree of activation of the complement system, the intensity of radical oxidation of the lipid fraction of the blood, and the degree of platelet spreading. Comparative experimental assessment of these methods was conducted with a number of polymers and revealed the confidence limits for the application of each test and suggested quantitative criteria for selection.     

四肢长骨骨折内固定的合并症

从１９７５年８月－１９９３年１２月，我院共共收治因内固定不当所致的合并症的１７７例，１２种类型，计骨不连４５例，感染２３例，肪肪栓塞１２例，神经损伤１１例，血管损伤４例，关节僵直２１例，髓外钉８例，髓内钉进退困难１４例，髓内钉、钢板弯曲、折断１２例，钉尾过长１５例，髓内钉进入关节１０例，肌腿损伤２例。本文对上述合并症发生的原因及预防进行了简要探讨。     

Clinical and morphological substantiation of the surgical treatment of post-traumatic neurogenic deformations of the limbs in children

The authors have analysed and determined the role of such clinical factors as the age of the patients, the level of the nerve lesion, the period of time since the moment of the injury, the lesions of the arterial vessels and the individual regenerative capacity of various nerves with the aim of defining the optimal period of time for surgical correction of neurogenic deformations of the extremities in children in cases of the peripheral nerve lesions. Morphological investigation of the paralysed muscles of 56 patients with lesions of the peripheral nerves was carried out. Characteristic structural and functional changes in the denervated muscles were established and the terms of appearance of irreversible changes were determined.A conclusion about the necessity of surgical treatment within the period of 1 year and more since the time of the nerve injury has been made on the basis of the investigation. Positive results of the treatment of 180 patients confirmed the correctness of the authors' conclusions.     

Acute insufficiency of the gastrointestinal tract in patients with severe gunshot injury

Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.     

Cost-based evaluations of the treatment of back pain: a primer for health-care professionals.

BACKGROUND CONTEXT: There is an extensive literature on the costs of back pain and on cost-based evaluations of the effectiveness of alternative modes of care for back pain. An understanding of the adequacy of a study often requires information that is not part of the experience or training of health-care professionals. The article seeks to provide clinicians with some criteria by which to judge the validity of cost-based evaluations of the treatment and consequences of back pain. PURPOSE: This article is not a comprehensive, critical review of the research literature on the costs of back pain or the relative cost-effectiveness of different methods of care for back pain. It presents, instead, a discussion of some important characteristics of cost-related studies of back pain and some criteria that can be used to evaluate the validity of cost estimates and cost-effectiveness analyses related to back pain. STUDY DESIGN: A guide for the evaluation of cost-based studies of back pain. METHODS: A summary of criteria for the evaluation of the validity of cost-based studies of back pain. RESULTS: Three sets of criteria for evaluation, ranked from most important to least important. CONCLUSIONS: Application of the suggested criteria can enhance the ability of health-care professionals to better understand the limits and relative adequacy of cost-based studies of back pain.     

A new method of surgical treatment of vasculogenic impotence

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.     

The use of external fixation apparatus in injuries to the hand bones]

An analysis of experimental studying the stability of osteosynthesis and clinical application of apparatuses of external fixation in 282 patients with fractures and sequellae of traumas of the bones and joints of the hand is presented. Main conditions influencing stability of fixation of the hand bones were determined. A universal complex of details is recommended which allows to make the optimum construction of the device as applied to the specific kind of trauma. It was proved that choice of the individual construction of the apparatus considerably widened the scope of using the method of external fixation and improved results of the treatment.     

Diet regimes in acute pancreatitis]

A method of determination of the duration of curative fasting in acute pancreatitis, depending on the degree of severity of patients' condition is described. The dependence between the probability of exacerbation of the process after resumption of feeding, the degree of severity of the condition at admittance, the duration of the fast vs degree of the severity of the condition in which the feeding was resumed was studied, for this purpose the method for calculation of so called coefficient of the degree of severity of acute pancreatitis was developed. 130 patients with acute pancreatitis underwent the treatment according to this method.     

Frontal resection as a means of decision for surgical treatment of rectum cancer

The work has been devoted to the improvement of methods of surgical treatment of cancer of the rectum. The possibilities to perform organ-saving operations in treatment of cancer of the rectum are discussed. An analysis of treatment of 351 patients with cancer of the rectum has shown that frontal resection of the rectum is possible in more than 40% of such patients since such interventions save the function of the rectum more completely. New methods of preoperative preparation of the patients are described as well as the application of the improved methods of surgical interventions.     

Predicting surgical risk in acute cholecystitis

From mathematical treatment of the results of operative treatment of 163 patients with acute cholecystitis on a computer with the use of program complexes on the basis of the mathematical theory of image recognition the authors obtained a decisive rule which allowed calculation of the prognostic index reflecting the severity of the patient's condition and the prognosis of the surgical treatment according to the initial values of total protein, leucocytosis, AlAT, and the patient's age. Besides, the efficacy of the preoperative management can be judged from the dynamics of changes of the index. Development of the tactics of treatment of patients with acute cholecystitis on the basis of the prognostic index improved the results of operative treatment considerably.     

Comparative study of electric excitability and metabolism in the assessment of vitality of the ischemized muscles of the amputated limb before replantation

The authors have studied the dynamic changes of metabolic processes and the functional and the structural preservation of the muscles under the influence of heat ischemia (18-21 degrees C) on 29 amputated posterior extremities of 21 adult dogs of the both sexes. It has been shown that direct muscle excitability disappears 5 hours after the influence of heat ischemia, although after 6 hours of observation the values of the metabolic processes in the muscles made 35-40% of the basic level. The character of the changes in the muscle excitability gives an idea of the duration of action of heat ischemia and the preservation of vitality of the amputated extremity only up to the moment of its complete disappearance. The final irreversible ultrastructural lesions of the overwhelming majority of the myocytes appear during the period of 6 to 8 hours of action of heat ischemia.     

经寰椎后弓侧块螺钉固定治疗上颈椎损伤

目的 评估经寰椎后弓侧块螺钉固定应用于上颈椎损伤的价值和作用。方法 对13例上颈椎损伤患者进行后路经寰椎后弓侧块行钉棒系统复位内固定,植骨融合,重建上颈椎的稳定性。结果 13例获2~18个月随访,无术中、术后并发症,头部前曲、后伸活动好,左右旋转活动有受限,未见螺钉松动及钉棒断裂现象。结论经寰椎后弓侧块螺钉固定可使固定节段获得高度的内在稳定性,同时保留枕颈间的运动功能,并发症少,适用于上颈椎损伤需重建稳定性的治疗。     

Metabolic disorders and functional properties of erythrocytes in acute arterial obstruction of the extremities

On the basis of experimental studies (in 43 rabbits) of the model of acute arterial obstruction and examination of 19 patients with various kinds of acute ischemia of the extremity it was established that the development of the ischemic lesions of the extremity can result in significant changes in the metabolism of adenyl nucleotides and deformability of erythrocytes. The value of the erythrocytes deformability gradient can show the degree of reversibility of ischemia of the diseased extremity.     

Experimental-clinical reasons for application of endoprostheses of reperen for plasty of the abdominal wall

The work presents results of a morphological investigation of tissues in the zone of implantation of synthetic material in creation of experimental model of ventral hernia. A comparative characteristic of a reaction of tissues on reperen and polypropylene is given. A number of principal advantages of reperen as compared with polypropylene were detected in plasty of hernial hilus. An analysis of the first experience of operative treatment of hernias by nonstrain methods using reperen in clinic is made.     

游离皮瓣移植修复手部及前臂皮肤缺损407例分析

目的 探讨游离皮瓣移植修复手部及前臂皮肤缺损的疗效。方法 1990年5月—2005年9月，选用18种游离皮瓣移植修复手部及前臂皮肤缺损407例。其中躅趾腓侧趾腹皮瓣39例，躅趾或第二趾趾甲瓣11例，躅甲瓣或第二趾趾甲皮瓣60例，躅趾腓侧半月形皮瓣6例，躅趾腓侧或第二趾胫侧半侧甲瓣7例，足背三叶或二叶皮瓣6例，带足背皮瓣的足趾移植144例，第一趾蹼皮瓣12例，足底内侧皮瓣4例，足背皮瓣10例，足外侧皮瓣8例，小腿内侧皮瓣21例，小腿外侧腓骨皮瓣2例，肩胛皮瓣2例，股前外侧皮瓣9例，胸脐皮瓣27例，背阔肌皮瓣5例，桡动脉皮瓣5例，跗甲瓣或第二趾与游离皮瓣组合移植29例。结果术后成功401例，成功率为98．5％。术后经6个月～8年（平均3．5年）的随访，皮瓣血运、质地、弹性良好。不同类型的足趾组织瓣或足部皮瓣移植修复后的拇、手指外形良好，指腹两点分辨觉为5至8mm。结论 游离皮瓣移植是修复手部及前臂皮肤缺损的理想方法之一。尤其对拇手指皮肤缺损，选用不同类型的足部游离皮瓣移植修复，功能与外形优于其他方法。     

Activity of the actomyosin complex of the esophageal muscles in patients with functional cardial obstruction

The results of studying ATP-ase activity of the actomyosin complex of the esophageal smooth muscles in functional cardiac obstruction (FCO) are discussed. It was established that in advancement of the diseases the ATP-ase activity of the actomyosin complex of the esophageal muscular coat diminishes steadily. Analysis of surgical treatment of 63 patients with FCO showed that in 12 patients with neglected stages of the disease (stages III and IV) its results were poor due to marked reduction of the esophageal tonus, which was linked with diminished activity of the actomyosin complex of the esophageal muscles in stages III and IV of the disease. The study provides evidence of the importance of determining ATP-ase activity of actomyosin in FCO in choice of the methods of nonoperative treatment and the time of surgical management of this pathological condition.     

The early identification and classification of growth disturbances of the proximal end of the femur

An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.     

Damper osteosynthesis using an external perosseous fixation device

The authors substantiate the expediency of improving osteosynthesis with apparatuses of perosseous external fixation on the basis of electromechanical principles making use of statistically reliable results of 58 chronic experiments on animals, 27 stand studies on the tibia of cadavers and 207 dynamic clinical observations employing quantitative results of clinical, roentgenomorphometric, electrophysiologic, biomechanical and histomorphological studies. Optimal parameters of the rigidity of fixation for early restoration of the properties of elasticity and strength of the injured bone are determined. Dampered external osteosynthesis in the treatment of open comminuted fractures of the bones of the crus reduced the mean periods of in-patient treatment and consolidation of the fractures by 27-34. 5% and the frequency of complications and unsatisfactory outcomes by 75%.