28

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2.

, .

1. / . . , . . , . . , . . // . . . . . 2004. . 163, 6. . 8992.

2. / . . ,. . , . . [ .] // . ., 2006. . 17. . 136146.

3. : / [ . ., . ., . ., . .]. ,2008. 112 .

4. . . : a. . . . . : . 14.01.21 / . . . .,2005. 19 .

5. Practice management guidelines for the optimal timing of longbone fracture stabilization in polytrauma patients: the EAST Practice Management Guidelines Work Group / C. M. Dunham, M. J. Bosse,T. V. Clancy [et al.] // J.of Trauma. 2001. 50 (5). P. 958967.

6. Lipinski J. Modern approach to management of patients following major trauma / J. Lipinski,J. Lasek // Przeglad lekarski. 2000. T. 56, 5. P. 120123.

7. Quality management in early clinical multiple trauma care. Documentation of treatment andevaluation of critical care quality / B. Zintl, S. Ruchholtz, D. NastKolb [et al.] // Unfallchirurg. 1997. Oct. V. 100 (10).

8. Risk Analysis / [ed. by J. L. Rubio, C. A. Brebbiaj]. London, 1998. 250 p.9. . . / . . . . : .

1996. 192 .

.. , .. , .. , .. & ( )

. , .

: , , .

S.O. Guryev, M.I. Berezka, O.S. Solovjov, S.P. SatsykPOLYTRAUMA AS THE MEDICAL AND SOCIAL PROBLEM (RISK MAKER ASPECT)

The article devoted to problem of the medical and social aspects of the polytrauma. It is studied bymeans of risk based point of viev on natural model the epidemiological characteristics of the polytrauma and risks dependented on these risk factors.

Key words: olytrauma, medical and social aspects, risks.

32

. 2012. 1 (54)

616.718.16001.506089.168.1

.. , ..

. 98 , 20022008 . , 14 , (23 ) . : , , .

14,3 %, .

15 (15,3 %) . 7 , 6 . 4 2 ( 4 ). .

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33

. 2012. 1 (54)

, 15 30 . . (63,3 %). , (

34

. 2012. 1 (54)

(16 %). 10 60 %. .

1.

, , 14 .

2. (23 ) .

1. . . : . . . . : . 14.01.21 / . . . , 2005. 34 .

2. . . / . . ,. . , . . // . . . 2003. . 3, 2. . 113114.

3. Letournel E. Fractures of the acetabulum / E. Letournel, R. Judet. Berlin : Springer Verlag. 1981. 832 p.

4. Beaule P. E. Letournel lassification for cetabular fractures: assessment of interobserver andintraobserver reliability hip / P. E. Beaule, F. J. Dorey, J. M. Matta // J. Bone Jt. Surg. 2003. V. 85A, 4. P. 17041709.

5. Liebergall M. Acetabulum fractures: clinical outcome of surgical treatment / M. Liebergall,R. Mosheiff, J. Zow // Clin. Orthop. 1999. 366. P. 205216.

6. Longterm results in surgically treated acetabular fractures through the posterior approaches /P. G. Triantaphillopoulos, E. C. Panagiotopuolos, C. Mousafaris [et al.] // J. Trauma. 2007. V. 62, 2. P. 378382.

.. , ..

. 98 , 20022008 . , 14 , (23 ) .

: , , .

N.L. Ankin, T.M. PetrykLONG&TERM RESULTS OF SURGICAL TREATMENT OF COTYLOID CAVITY FRACTURES

Cotyloid cavity fractures being among the most severe and complex locomotor system injuriesare an actual problem of diagnosis and treatment in traumatology and orthopedics. Longterm results of surgical treatment of 98 patients with cotyloid cavity fractures treated in orthopedic trauma center of Kyiv Regional Clinical Hospital during 20022008, are analyzed. Excellent results havebeen observed in cases with surgery performed during the first 14 days after injury and in patientswith anatomical and inaccurate (23 mm) reduction while restoration the cotyloid cavity anatomy.

Key words: cotyloid cavity, surgical treatment, longterm results.

35

. 2012. 1 (54)

616.72007.248089.843:618.29

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1. /. . , . . , . . [ .] // , . 2006. 1. . 8487.

39

. 2012. 1 (54)

2. Karnezis I. A. Biomechanical consideration in biological femoral osteosynthesis: an experimental study of the bridging and wave plating techniques / I. A. Karnezis // Archives of Orthopaedic and Trauma Surgery Springer Verlag. 2000. V. 120 (56). P. 272275.

3. . . / . . , . . , . . //, . 2007. 2. . 8286.

4. . : / . . , . . ,. . // . 2008. . 9, 1. . 1922.

5. . . () / . . . . : . . . , 2007. 123 .

6. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fracturesof the distal femur / M. Arazi, R. Memik, . Ogun, M. Yel // The J. of Bone and Joint Surgery. 2001. V. 83B, 5. P. 663667.

7. . . /. . , . . , . . . : , 2002. 342 .

8. Sckalea T. M. External fixations as bridge to intramedullary nailing for patients with multipleinjuries and with femur fractures: damage control orthopedics / T. M. Sckalea, S. A. Boswell, I. Scott //J. Trauma. 2000. V. 48, 4. P. 613624.

9. / . . , . . , . . [ .] // . 2003. 4. . 107114.

10. / . . , . . , . . [ .] //, . 2001. 3. . 2729.

11. . . /. . . . : , 2008. 376 .

12. . . / . . , . . , . . // , . 2002. 4. . 9092.

13. . . / . . . : ,1975. 324 .

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.

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M.I. Berezka, V.A. Litovchenko, V.V. Grigoruk, N.S. GrimajloMATHEMATICAL SIMULATION OF DISTRIBUTION OF PRESSURE IN A BONE FRACTURE DEPENDINGON LOCALIZATION OF CRISIS AND A FIXATION METHOD AT AN OSTEOSYNTHESIS OF ADJACENTAND COUNTERLATERAL FRACTURES OF BONES OF THE LOWER EXTREMITIES

Authors by means of mathematical simulation prove application of certain fixators at adjacent and counterlateral fractures of the lower extremity.

Key words: mathematical simulation, locking nailing, plates, external fixation, adjacentand counterlateral fractures.

40

. 2012. 1 (54)

616.381001001.3108+615.281

.. , .. , .. ,.. , .. , ..

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41

. 2012. 1 (54)

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1 2

1. : , , : / [ . . . , . . ]. . : , 2006. 170 c.

2. . . , , : , 012400 / . , 2005. 76 .

3. . . / . . . . : , 1999. 496 .

4. : , , : / [ . ., . ., . . .]. . :, 2006. 166 .

5. : (., 1617 2000 .).

6. Absence of crossreactivity between sulfonamide antibiotics and sulfonamide nonantibiotics /B. Strom, R Schinnar, A. Apter [et al.] // N. Engl. J. Med. 2003. V. 349. P. 16281635.

7. Principles of appropriate antibiotic use for acute pharyngitis in adults / V. Show, C. MotturPilson, R. J. Cooper, J. R. Hoffman // Ann. Intern. Med. 2001. V. 37. P. 711719.

.. , .. , .. , .. , .. , .. ,

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42

. 2012. 1 (54)

V.V. Bojko, P.N. Zamyatin, I.Z. Yakovtsov, Ye.N. Krutko, V.N. Lychman, D.P. ZamyatinANTIBACTERIAL THERAPY IN VICTIMS WITH OPEN AND CLOSED ABDOMINAL INJURIESCOMPLICATED TRAUMATIC DISEASE

The new ways of antibacterial therapy affected with open or closed abdominal injuries complicated traumatic disease are presented. During study of procalcitonine and the neutrophils / lymphocytes coefficient at this category of victims are proved the validity of the use of the scheme of theantibacterial therapy.

Key words: traumatic disease, combined antibacterial therapy, victims.

43

. 2012. 1 (54)

616.7001083,98:614.86

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44

. 2012. 1 (54)

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, 2007 . 20,4 100 000 , 2 . 1290 05.11.07 2010 . , . : 2002 . 224 613 (465,1 10 ), 2006 . 228 917 (489,6 10 ). , 3 . 370 01.06.09 . , , , , [6].

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, : , , . , , 2007, 2008, 2009 . 584, 514 434 . 109, 112 80 . , , .

46

. 2012. 1 (54)

: ,, .

. () (, ). , . .

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, . , 3 3 , 3 (, ). 14 .

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1. . . / . . // . . . . 2003. . 4, 2. . 8085.

2. Murray C. Y. L. Alternative projections of mortality and disability by cones 19902020; cylobal burden of disease study / C. Y. L. Murray, A. D. Lopes // Lancet. 1997. V. 349, 9064. . 14951544.

3. ( ) / . . ,. . , . . [ .] // . 2009. . 40, 4. . 363366.

4. / . . , . . , . . [ .] // . 2007. . 32. . 6062.

5. . . / . . // V . , 2010. . 322.

6. . / . . ,. . , . . [ .] // : . ., 2010. . 28. . 5056.

7. / . . , . . ,. . [ .] // : . ., 2006. . 315.

8. / . . , . . , . . , . . / : . ., 2006. . 167172.

9. / . . , . . , . . , . . // : . .,2006. . 8792.

10. . . / . . // . . . . 2005. 4. . 8184.

47

. 2012. 1 (54)

.. , .. , .. , .. , .. , ..

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: , , .

V.V. Boyko, A.V. Kozachenko, V.G. Ryndenko, V.I. Scherbakov, S.V. Ryndenko, A.E. FeskovEXPERIENCE IN MEDICAL AID TO VICTIMS WITH MULTIPLE AND COMBINED INJURIES INKHARKOV

The data about organizational questions of rendering of medical aid to victims with multiple injures in specialized polytrauma department are cited. Experience of the basic directions of work isgeneralized, rationally of regular structure of specialized polytrauma department is proved.

Key words: polytrauma, medical aid, organization.

48

. 2012. 1 (54)

616.728.20.07.17036

.. , .. , .

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. 2012. 1 (54)

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. 380 IV J.H. Kellgren J.S. Lavrence [16] . ( , , ), ( D); ( ), , .

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. 2012. 1 (54)

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1. . . : , , / . . , . . . . : , 2009. 208 .

2. . . / . . ,. . // . 2008. 12. . 157160.

3. . . : / . . , . . . . : , 2003. 448 .

4. . . : / . . , . . , . . . :, 2007. 320 .

5. . . / . . , . . ,. . // , . 2005. 2. . 511.

6. . . (, , ) / . . , . . . . : , 1999. 112 .

7. Elders M. J. Age is the most powerful risk factor for osteoarthritis (OA) in the United States. Theincreasing impact of arthritis on public health / M. J. Elders // J. Rheumatol. 2000. V. 60. P. 68.

%

52

. 2012. 1 (54)

8. : ( ) / . . ,. . , . . [ .] // . . . . 2001. 2. . 9699.

9. . . , . / . . , . . , . . // , . 2004. 3. . 95100.

10. Schilt M. Optimal age for hip sonography screenining / M. Schilt // Ultrashall Med. 2001. Bd. 22, 1. S. 3947.

11. , , / . . , . . , . . [ .] // : , . 1990 . : . , 1990. . 35.

12. . . / . . . . : , 2000. 155 .

13. . . : / . . , . . , . . . : , 2007. 424 .

14. Spector T. D. How serious is knee osteoarthritis? / T. D. Spector, D. J. Hart // Ann. Rheum.Dis. 1992. 51. . 11051106.

15. Bock G. W. Rapidly destructive hip disease: clinical and imaging abnormalities / G. W. Bock,A. Garcia, M. H. Weisman // Radiology. 1993. 186. . 461466.

16. Kellgren J. Radiological assessment of osteoarthritis / J. Kellgren, J. Lawrence // Ann. Rheum.Dis. 1957. V. 16. P. 494501.

17. . . D3, , /

. . , . . , . . // . . . 1991. . 63, 5. . 8994.

18. Reriew of the concept vitamin D Sufficiency and insufficiency / A. S. Gomez, D. M. Nares,G. M. Rodriguez [et al.] // Nefrologia. 2003. V. 23, 2. . 7377.

19. . . / . . . . : , 1992. 423 .20. Jensen B. Iridology. The scince and practice in the healing, 1990 / B. Jensen. 580 .21. Accurace of body mass index in diagnosing obesity in the adult general population / A. Rome

roCorral, V. K. Somers, J. SierraJohnson [et al.] // Internat. J. of Obesity. 2008. V. 32, 6. . 959956.

22. . . / . . . . : , 2001. 448 .

.. , ..

180 IV J.H. Kellgren J.S. Lavrence . : () IIIII , D

3 .

.

: , , .

G.V. Gajko, A.V. KalashnikovIDENTIFICATION OF THE RISK FACTORS FOR RAPID PROGRESSION OF THE OSTEOARTHROSISOF THE HIP JOINT

A complex study of 180 patients with osteoarthrosis of the hip joint stage IV J.H. Kellgren andJ.S. Lavrence of various etiologies. It is identified risk factors for rapid progression of this disease:the presence of hidden (undifferentiated) dysplasia of the connective tissue IIIII degree in patientswith idiopathic and dysplastic coxarthrosis, the body mass index increase and the active metaboliteof vitamin D

3 decrease in patients with idiopathic coxarthrosis. Allocation of the risk factors for

rapid progression of coxarthrosis will allow effective preventive and therapeutic measures in patients with complex orthopedic pathology.

Key words: coxarthrosis, progression, risk factors.

53

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616.72007.248089.843:618.29

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. 2012. 1 (54)

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56

. 2012. 1 (54)

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1. / . . , . . , . . , . . // . . . . 2004. 1. . 20.

2. / . . C, . . , . . , . . // , . 2008. 3. . 1923.

3. Distal femoral fixation: a biomechanical comparison of trigen retrograde intramedullary (i.m.)nail, dynamic condylar screw (DCS), and locking compression plate (LCP) condylar plate / J. P. Heiney,M. D. Barnett, G. A. Vrabec [et al.] // J. Trauma. 2009. Feb. 66 (2). P. 443449.

4. . . / . . , . . // . 2008. . 9, 2. . 711.

5. Valles J. F. Distal femur fractures. Comparative analysis of two different surgical treatments /J. F. Valles, F. R. Rodriguez, J. M. Gomez // Acta Ortop. Mex. 2010. 24 (5). P. 324330.

6. / . . , . . , . . , . . // . 2011. . 12, 2. . 4447.

7. . . / . . , . . , . . //. 2010. . 11, 5. C. 7276.

.. , .. , .. , .. , ..

41 , , . . . , .

: , .

G.G. Golka, V.A. Litovchenko, N.S. Grimajlo, M.I. Berezka, V.V. GrigorukRETROGRADE LOCKING INTRAMEDULLAR OSTEOSYNTHESIS AT TREATMENT OF DISTALFEMUR LOW FRACTURES AT PATIENTS WITH POLYTRAUMA

The experience of treatment of 41 patients with distal femur low fractures is shown. Half fromwhich were treated by retrograde locking intramedullar osteosynthesis, second half treated by platesand the devices of external fixing. The remote results of treatment are studied and analysed. Therewere no significant difference revealed in results of treatment by those techniques. Retrograde locking intramedullar osteosynthesis is an effective lessinvasive method in treatment not only diaphisial, but also pery and intraarticular distal femur fractures.

Key words: retrograde locking intramedullar osteosynthesis, distal femur low fractures.

58

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616.711001089.84

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1. / . . , . . , . . , . . // , . 1987. 8. . 3944.

2. . . / . . ,. . // : . ., . 70 . . . : . , 1991. . 5961.

3. / . . , . . , . . ,. . // . , 1996. . 129130.

4. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults /L. Y. Carreon, R. M. Puno, J. R. Dimar [et al.] // J. Bone Joint Surg. 2003. V. 85A. P. 20892092.

5. Touliatos A. S. Postdiscectomy perineural fibrosis: Comparison of conventional versus microsurgical techniques / A. S. Touliatos, P. N. Soucacos, A. E. Beris // Microsurgery. 1992. V. 13. P. 192194.

6. Volvo ward winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with andwithout spinal instrumentation / J. S. Fischgrund, M. Mackay, H. N. Herkowitz [et al.] // Spine. 1997. V. 22. P. 28072812.

7. Chapman J. R. Thoracolumbar spine fractures with neurologic deficict / J. R. Chapman,P. A. Anderson // Orthop. Clin. N. Amer. 1994. V. 25, 4. P. 595612.

8. Lumbar diskectomy for recurrent disk herniation / H. R. Silvers, P. J. Lewis, H. L. Asch,D. E. Clabeaux // J. Spinal Disord. 1994. 7. P. 408419.

9. Hanakita J. Surgical treatment of lumbar canal stenosis in the elderly / J. Hanakita, H. Suwa,M. Mizuno // Neurol. Med. Chir. (Tokyo). 1999. V. 39. P. 519522; discussion 522523.

10. Kruls Hein J. A. The BWM spinal fixator system / J. A. Kruls Hein, F. A. van Beurden //Instrumented fusion of the degenerative lumbar spine / ed. by M. Szpalski, R. Gunzburg, M. Sprengle, A. Nachemson. Philadelphia : LippincottRaven Publishers, 1996. P. 221232.

11. Lugue E. Interpedicular segmental fixation / E. Lugue // Clin. Orthop. 1986. V. 203. P. 5457.

12. RoyCamille R. Internal fixation of the lumbar spine with pedickle serew peasing / R. RoyCamille, I. Saillont //Clin. Orthop. 1986. V. 203. P. 717.

13. / . . , . . ,. . [ .] // , . 2001. 1. . 8589.

14. . . /. . , . . . : , 2004. 160 .

15. . . : / . . . : , 2001. 25 .

.. , .. , .. , .. & MEDTRONIC SOFAMOR DANE

MEDTRONIC SOFAMORDANE . CDH Legacy 5,5. , .

: , , .

G.G. Golka, O.V. Ryabov, M.A. Garkusha, D.A. IstominADDITIONAL OPERATIVE TREATMENT IN DYSTROPHIC DEGENERATIVE DISEASES OF THE LUMBARAND TRAUMAS OF THE THORACOLUMBAR SPINE REGIONS WITH APPLICATIONOF TRANSPEDICULAR FIXATION SYSTEMS MEDTRONIC SOFAMOR DANEK

Application of transpedicular fixation systems MEDTRONIC SOFAMOR DANEK in additionaloperative treatment on the lumbar spine region in different forms of dystrophic degenerative diseasesand traumas of the thoracolumbar spine region is described. Preference was given to the spine stabilization system CDH Legacy 5.5. As opposed to other types of fixation this system is preferable in case ofdevelopment of instability. It is also used to prevent instability at the stabilizing stage of additionaloperative treatment.

Key words: spine, polytrauma, transpedicular spinal fixation.

63

. 2012. 1 (54)

616.711001089.84

.. , .. , .. , ..

36 , 8 % . , . : , , .

.

. 2009 36 , 8 % . , 75 % , 15 % 10 %. 2 % , 12 %, 16 %, 7 %, 12 % . , , 1 2 .

( ) . () [7].

.. , .. , .. , .. , 2012

, , [13].

. , , .

( ) , , , [46].

,

64

. 2012. 1 (54)

AO/ASIF .

24 , 12.

. , (). , . , , , .

.

, . , . ; . . , ,: ; ; , .

.

, . , .

(). , .

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65

. 2012. 1 (54)

.

I. , . . , .

II. , , .

III. .

IV. .

: , , , , . , .

:

, , 30 % ;

;

;

;

;

, ( , );

, .

. , , .

, , , , , , , , , , [816]. , , , , , .

, : , . , . , .

. 1. .,25 . , . : . L1 , , , , L1L2

66

. 2012. 1 (54)

; (. 1). : , L1, , , CDH Legacy 5,5 MEDTRONIC SOFAMOR DANEK Th11L3 .

2. . ., 24 . , . : , L2, , (. 2, ). , 7 , MEDTRONIC SOFAMOR DANEK L1L3 (. 2, ).

. 2. ., (); , ()

. 1. ., (); , ()

67

. 2012. 1 (54)

, .

1. , , .

2. , , . , , , . , . . .

3. , , , .

4. . , , .

5. .

, , , ,, .

1. . . / . . , . . , . . // . ., 1991. . 8793.

2. / . . , . . , . . ,. . // . , 1996. . 129130.

3. Neurological recovery, mortality and length of stay after spinal cord ingury associated withchanges in management / C. H. Tator, E. G. Duncan, V. E. Edmonds [et al.] // Paraplegia. 1995. V. 33. P. 254262.

4. . . (, , , ) / . . , . . , . . . . : , 2001. 388 .

5. . . . / . . , . . , . . ;[. .]. ., 2003. 432 .

6. . / . , . ; [. .]. . : , 2008. 124 .

7. . . : /. . , . . . . : , 2006. 196 .

8. RoyCamille R. Internal fixation of the lumbar spine with pedickle serew peasing / R. RoyCamille, I. Saillont // Clin. Orthop. 1986. V. 203. P. 717.

9. Meyer P. R. Surgery of the spine trauma / P. R. Meyer. N.Y. : Churchill Livingstone, 1989. 867 p.

10. Chapman J. R. Thoracolumbar spine fractures with neurologic deficict / J. R. Chapman,P. A. Anderson // Orthop. Clin. N. Amer. 1994. V. 25, 4. P. 595612.

11. . . . / . . , . . . . : , 2000. 231 c.

12. / . . , . . ,. . [ .] // , . 2001. 1. . 8589.

13. . . : / . . . : , 2001. 73 .

14. / . . , . . , . . [ .] // . 2004. 3. . 4045.

15. . . / . . , . . , . . // . 2005. 2. . 812.

16. . . : 2 . / . . . 1. . M., 2002. 126 .

68

. 2012. 1 (54)

.. , .. , .. , ..

36 , 8 % . , .

: , , .

G.G. Golka, O.V. Ryabov, Ye.V. Garyachiy, O.G. FadeevDIAGNOSIS AND SURGICAL TREATMENT OF SPINAL INJURIES IN POLYTRAUMA

The experience of treating 36 patients in the department of polytrauma with injuries of the spinewith combined and multiple injuries, which accounted for 8 % of all victims are presented. We describe the stages and methods of diagnosis, are ostentatious sequence of surgical care for patientswith combined and multiple trauma with injuries at the hospital stage.

Key words: spine, polytrauma, transpedicular spinal fixation.

69

. 2012. 1 (54)

61600107:614.21

.. , .. , .. , ..

, .

,

, , , . : , , , .

, 73,51 %, 2,77 , . , , , , , , , .

. (clinical risk management) (clinical result risk) [7].

( ) , .

. ,

, , . , , , , [14].

, , , , 17,6 80,0 % [24].

, [1, 2, 5, 6], .

. 385 , . . . .

.. , .. , .. , .. , 2012

70

. 2012. 1 (54)

, , , (0,47) 1,68 (0,28), .

.

40 , 75 , 3 .

, , 0,60; 0,59 0,58,

, , , 0,29 1,13, .

, 0,42. . , , (1,13). 0,72 0,61, , 0,42, . 0,26, . ,

0,40.

( ), 23 ( 0,290,47), 3 .

( ) . ( 2,40).

71

. 2012. 1 (54)

( 0,65), (0,58), (0,60), (0,56). (0,38), (0,31), (0,27), (0,27), (0,18), (0,22) (0,20).

, .

, .

, , 2,33 ; , . , : ; ; .

, 1 (0,26), 12 ( 0,76), 2 ( 1,0 26 2,5 6 ).

, , , .

1.

.

2. , , , , , , .

3. , , 0,42, , 0,18 2,40, .

4. .

1. / . . , . . , . . [ .] //, . 2002. 3. . 8287.

2. . . : / . . , . . // . 2004. 4 (84). . 46.

72

. 2012. 1 (54)

3. . . : , / . . , . . // . 2004. 4 (84). . 4243.

4. General issues of medical care in multiple trauma / A. S. Ermolov, M. M. Abakumov, V. A. Sokolov [et al.] // Khirurgiia (Mosk). 2003. V. 12. P. 711.

5. / . . , . . , . . [ .] // . 2004. 4(84). . 3638.

6. . . / . . ,. . , . . // . 2004. 4 (84). . 4849.

7. Rubio J. L. Risk nalysis / J. L. Rubio, C. A. Brebbiaj. London, 1998. 250 p.

.. , .. , .. , .. ,

, , , .

: , , , .

S.O. Guryev, G.V. Bondarchuk, S.P. Satsyk, P.V. TanasienkoRISK ORIENTED APPROACH IN ESTIMATION PATIENTS WITH POLYSYSTEMIC TRAUMATICINJURIES WHO RECEIVE MEDICAL CARE IN CONDITIONS CITY HOSPITAL

It is analysed clinical efficient risk of arising fatal traumatic process in patients with polytraumawho provided medical care in the city hospital for clinicoepidemiological and cliniconosologicalrisk creating factors, which should be considered when forming schemes and protocols for care ofthe victims.

Key words: trauma, polysystemic injuries, risk, risk creating factors.

73

. 2012. 1 (54)

616001:614.86]022.036.22

.. , .. , ..

, .

. . , , , , . , . : , ,.

, . , .

.

. 386 , 20082010 . , , , . : 272 , , 114 , . .

, , 5070 % (), , . , , 40 . 810 , , , 70 % . , 180 , 225 34 [1]. 30 %, 1990 135,5 100 , 2003 184,9 100 [2].

, , , , , , , , , [35].

.. , .. , .. , 2012

74

. 2012. 1 (54)

. 275 (71,24 %) 111 (28,76 %). 193 (70,95 %), 79 (29,05 %). 82 (71,92 %),32 (29,08 %). , 2,5 , . .

. 1.

5160 . , , . 6170 , . 6170, 71 20 . 2130 , . 71 20, .

2.

1.

. 1, , 2130 3140 . , 3140 5160 . , . 4150

, (1860 ) 83,08 %, 75,43 %, 81,08 %.

. 2.

. 2,

75

. 2012. 1 (54)

2130 , 71 . , , 3140 . , 20 . 5160 , 3140 . 4150 , , . 6170 , . , , , .

, , . ,

, , . , . 2130 3140 70 20 .

1.

.

2. , , .

3. .

1. /. . , . . , . . , . . // : : 2 . .. ., . ,2021 2007 .: . , 2007. . 4041.

2. . . / . . , . . , . . // . 2005. 1112. . 104.

3. . . / . . , . . , . . // . 2009. . 10, 3. . 259262.

4. New Orleans Charity Hospital your trauma center at work / Z. T. Stockinger, V. L. Holloway,N. E. Jr. McSwain [et al.] // J. La State Med. Soc. 2004. MayJun. V. 156 (3). P. 9138.

5. Infection and local treatment in orthopedic surgery / Meani E., Romano C., Crosby L., Hofmann G. Berlin, Heidelberg, 2007. 396 .

.. , .. , .. &

. . . , .

: , ,.

76

. 2012. 1 (54)

S.O. Gurjev, P.V. Tanasenko, S.P. SatsikCLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS WITH INFECTIOUSCOMPLICATIONS OF POLYTRAUMA IN ROAD ACCIDENTS

The features of clinical and epidemiological characteristics in patients with infectious complications of polytrauma in road accidents are studied. The agesex characteristics of the victims are established. The structure and distribution of infectious complications among survivors and deceasedvictims are different. Mostly victims with infectious complications during polytrauma are people ofworking age, which underlines the importance of further research this problem.

Key words: infectious complication, clinical and epidemiological characteristics, polytrauma.

77

. 2012. 1 (54)

617.57706:616.74018.38]00107089

.. , .. .

46 . 13 % , 15,2 % . 89,1 %, 10,9 %. 47,8 % , 34,8 % , 17,4 , . : , .

8 2008 2011 . 18 50 (91,3 %). 11,5:1. 28,3 % ( , .). IIIII . 15,2 %, 84,8 %. 1 . 2 76,1 % , 26 21,7 % , 6 2,2 %. 28,3 %.

. . 89,1 %, 10,9 %. .

.

. , 30,8 57 % [1,2]. , , . 32,7 % [3].

, , (27,2 %), (18,8 %). , , , , [410].

. 46 ,

.. , .. , 2012

78

. 2012. 1 (54)

, , ,, . 30,4 % . 84,8 % , 15,2 % , , , . 13 % . . . . . (, ). . . 34,8 % . . , , , . . . , , . , . .

.

. . . , . , . 13 % 2 , . , , . . . 3.04.0. . , . . . , . 4 . 16 . 5 . 39 , 5 2 . .

79

. 2012. 1 (54)

, , .

. . . 78,3 % . 21,7 % , . 1,5 . . 4 ,

, . 3 , . crossfinger flap.

28,2 % .

47,8 % , 34,8 % , 17,4 % , .

1. , / . . , . . , . . [ .] // . 2010. . 11, 2. . 133141.

2. . . : / . . // . 2006. 2. . 307308.

3. . . / . . // . 2010. . 15, 4. . 7378.

4. ( ) /. . , . . , . . , . . // , . 2004. 4. . 1115.

5. . . / . . // , . 2004. 2. . 2632.

6. / . . , . . , . . , . . // , . 2003. 1. . 132134.

7. . . / . . , . . //. 2010. 1. . 3435.

8. . . / . . ,. . , . . // : ... . , , 1718 2007 . : . ., 2007. . 1516.

9. . . / . . , . . // . 2006. . 7, 4. . 340343.

10. / . . , . . , . . , . . // . 2011. . 12, 4. . 4345.

.. , ..

46 . 13 % , 15,2 %

80

. 2012. 1 (54)

. 89,1 %, 10,9 %. 47,8 % , 34,8 % , 17,4 % , .

: , .

I.Yu. Dutka, I.P. TrutjakDIAGNOSTICS AND TREATMENT OF COMBINED INJURIES OF FLEXOR TENDONS AND FRACTUREOF THE BONES OF FINGERS IN THE HAND

The peculiarities of diagnostics and treatment of combined injuries of flexor tendons and fracture of the bones of fingers in the hand were described at 46 patients. Preoperational diagnostics offlexor tendon injuries was not informative in 13 %, and in 15,2 % intraoperational findings werenot equal to roentgenological data. Repairs were performed in 89,1 %, reconstructions in 10,9 %.In 47,8 % of patients were achieved satisfactory results, in 34,8 % good and excellent results andin 17,4 % injured structures were repaired with poor results that required staged operations.

Key words: injuries of flexor tendons, fracture of the bones of fingers in the hand.

81

. 2012. 1 (54)

616.71001.5908

.. , .. , .. ,.. , ..

, .

, . : , , .

[7]. . , .

, .

. . 88 , 64 :40 10 14, 21, 28 56 ( 58285 ), 24 .

.

48 180200 (12 ).

.. , .. , .. ., 2012

25 % , 33 %, 2 , [14].

. , : , , , , , [5, 6].

, , , , ,

82

. 2012. 1 (54)

. , . (. 1). 3,7, 14, 21

.

119 17 71 (30 ,89 ). : (35 ) (84). . (. 2, 3).

( 62096 ).

. : 37 , , 1421

1.

2.

3.

83

. 2012. 1 (54)

, . . .

3 , , 714. , , , , , . 721 , 21 , . .

, . 21 3 .

37 , , , , 1421 , .

3 , , ,

.

7 , , . , . . , .

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14 , , , . , . , , . . . , .

21

84

. 2012. 1 (54)

. , . , , . , .

28 , , 28 , , .

, , .

3 , , , 7 . . 14 , . , .

28 , . , , .

. ., 1953 , . : , . 1 2 . , . : , (. 1).

. 1. . ,

(. 2).

. 2. . , ,

85

. 2012. 1 (54)

. 10 . 1,5 , (. 3).

, , , , , . , .

. , . , , , , , . . , , .

. 1,5 .

.. (1983) . 95 % , 5 % , .

1.

.2.

.

3. ,, .

. 3. . ,

, , , , ; , , .

, , . 3 , .

86

. 2012. 1 (54)

1. . . / . . . . : , 1995. 204 .2. . . /

. . // , . 1989. 3. . 7174.3. . . /

. . , . . , . . // , . 2004. 2. . 4045.

4. . . / . . //, . 2001. 2. . 134139.

5. . . , / . . , . . // III : . .. ., : , 2001. . 297299.

6. . . / . . , . . // , . 2002. 3. . 3540.

7. . 58285 . / . ., . ., . ., . ., . . ; . . 15.17.03, . 7.

.. , .. , .. , .. , .. &

, .

: , , .

A.N. Ivanov, V.A. Litovchenko, N.I. Berezka, V.V. Grigoruk, V.G. VlasenkoCLINICAL&EXPERIMENTAL SUBSTANTIATION OF CURATIVE TACTICS FOR PATIENTSWITH BONE FRACTURES DISREGENERATIONS

On the basis of electronic and light microscopy, and also on the given clinical researches the effectiveness of using chorial covers for osteoreparation stimulation at patients with bone fracture disregeneration is reasonable.

Key words: disregeneration, light microscopy, electronic microscopy.

87

. 2012. 1 (54)

616:718.4001.508

.. , .. * , .

* , .

. 123 . : HARFIX, (LCP), (DCS). , . : , , , .

, [6]. [2, 3].

, , [7, 8]. .

. 123 . 68 (55,2 %) 55 (44,7 %) . 82 (67,4 %) 60 , 2049 40,2 % . , , 34,8 %.

615 % . 2045 . [1, 2]. , , . , , , , , [3, 4]. , 25 % , [5].

.

.. , .. , 2012

88

. 2012. 1 (54)

75,5 % , 20,7 % . 36 (51,1 %). 84,8 % , 15,2 % , 2 .

1. , 1 69 , 2 16, 3 38.

(56,5 %). (13,0 %) (9,8 %) .

: 63 HARFIX, hM (), 29 (LCP), 31 (DCS).

. &. .

:

( 5 5 );

;

( , );

.

:

;

;

L; L, DCS; L, DCS.

.

18 . 3 4 . .

, 8 , .

(DCS) .

, .

1 .

: , 6,5 , 4,5 .

LISS LCP , . .

, . .

, . . 30 %

89

. 2012. 1 (54)

2 , 50 % 1 , 75 % 3 . 2 50 % , 75 % .

2 4 .

. 12 (19 %) 7 (24,1 %) .

, 5. 3 .

1 5 2 .

1 90,6 % , 9,4 % 18 .

.

.

.

1. 20082010 . / . ., . ., . . [ .]. . : ,2010. 132

2. , / . . , . . , . . [ .] // ., . 2008. 2. . 6873.

3. / . . , . . , . . , . . // . . . . 2004. 1. C. 5860.

4. Saw A. Supracondylar nailing for difficult distal femur fractures / A. Saw, C. P. Lau // J. ofOrthopaedic Surgery. 2003. 11 (2). P. 144147.

5. / . . , . . , . . [ .] // : .. . : . : , 2008. . 2324.

6. Wagner M. General principles for the clinical use of the LCP / M. Wagner // Injury. 2003. V. 34, suppl. 2.

7. Kumar A. Management of distal femoral fracture in the elderly patients using retrograde titanium supracondylar nails / A. Kumar, V. Jasani, M. S. Butt // Injury. 2000. 31. P. 169173.

8. Ruedi N. P. AO principles of fracture management / N. P. Ruedi, R. E. Buckley. Thieme,2007. 947 p.

.. , ..

. 123 . : I CHARFIX, (L), (DCS). , .

: , , , .

90

. 2012. 1 (54)

A.V. Kalashnikov, Yu.V. LazarenkoTHE EXPERIENCE OF THE PATIENTS WITH FRACTURES OF DISTAL FEMURS TREATMENT

The data of the treatment of 123 patients with the distal femur fractures are analysed. All patients were operated with using osteosynthesis by BIOS blocked intramedullary rod, a plate withangle stability, dynamic condular screw. The developed algorithm managed to achieve good resultsin treatment of all patients with fractures of distal femur, to activate patients in earlier terms, thusavoid of complications and hasten social adaptation.

Key words: fractures of distal femur, intramedullary osteosynthesis, plate with angle stability,alogorithm of the treatment.

91

. 2012. 1 (54)

616089.873

..

. .

, , . , , (5,449,6 %) (7,729 %) . 6,8 %. : , , .

.

, , . .

.

. 255 , .. . 4,4 (208; 81,6 %), (47; 18,4 %). 180 (70,6 %) . 34,9 % (89) 27,5 % (70). , , , 17,6 % (45) 20 % (51).

. , , [14].

. . (1852), , : , . , . .

, , 1,4 15,3 % [57]. , 8,557,6 % [8, 9]. 5,4 49,6 % [10].

50 . , .

.. , 2012

92

. 2012. 1 (54)

, (72; 12 %). . . (66,3 %) 274 (45,7 %) . . (325;54,3 %) . 16,4 %(98) .

196 (76,9 %) . 147 (75,0 %) IIIII . , , , , . : (62,1 %), (35,1 %), (32 % ).

: , , , , , , , , .

: , , .

. . . , . , 400 , 200 , 1000 , 500 , , 200 , ,500 , 200 , 100 , , , (77 %) (90,1 %). , , , , 2 , , , .

, , , . , , , . , , , , , , 66,7 % , 44 % .

, , . .

93

. 2012. 1 (54)

, .. , .. (1984) .

. . . . , 27 , , . . .

.

. , , , , .

. . .

714 . , 14 , .

, . , . . , , .

,, , , . , , , , , , , . . .

. .

. , () , . , ,

94

. 2012. 1 (54)

. , ,

, , .

1. . . / . . ,. . // . . 90 . ., 1989. . 4445.

2. . . / . . //. . . ., 1986. . 67.

3. / . . , . . , . . ,. . // . 2001. 2. . 510.

4. . . , / . . // : . . . ., 1992. . 1719.

5. . . / . . , . . , . . // . 2001. 3. . 138142.

6. . . // . 2000. 2. . 8384.

7. . . /. . // : I ; , 1617 2002 . : . ., 2002. . 128.

8. . . / . . // , . 1989. 6. . 6164.

9. . . / . . . . : , 1970. 236 .

10. . . / . . , . . // . 1975. 5. . 7582.

..

, , . , , (5,449,6 %) (7,729 %) . 6,8 %.

: , , .

S.N. KrivenkoTREATMENT OF THE VICTIMS WITH MULTIPLE FRACTURES OF OSSA IN MEMBRI INFERIORISACUTE PERIOD OF THE TRAUMATIC DISEASE

To present time the questions of methods, terms, volume of grant of help a victims with the multiple trauma of extremities did not get necessary illumination. This type of damages is accompaniedby deep disorders of the system of gomeostasis, weight of which exceeds adaptation possibilities ofhuman organism, that stitulates the high level of lethality (5,449,6 %) and disability (7,729 %)among victims. Application at patients with the multiple fractures of diafizal long bones of extremities of the combined tactics of treatment in an early term after a trauma allowed to reduce the percent of complications to 6,8 %.

Key words: multiply skeletal breaks, urgent treatment, traumatic disease.

95

. 2012. 1 (54)

61.831005073.432.19:612.13

.. , .. , .. ,.. , .. , ..

. . , , . . : , , .

. 25(78,1 %) , 21,9 %. : 16 ; 15 , 1 . 28 , 17 . 14 . 6 26 (81,2 %), 6 12 5 (15,6 %), 1 (3,2 %) 24 , .

, ,, , , .

: , , , , ,

() , , , , 0,2 10 % [13].

, . (16,670 %, ) [1, 4, 5].

, [1].

.

. 2000 2011 . 32

.. , .. , .. ., 2012

96

. 2012. 1 (54)

, . 2 .

E. Moore . (1991), .

I , .

II 50 % .

III 5075 % 50100 % , , .

IV 75 % .

V .

:

, ;

, ;

.

. . , , , .

0,5 . . 14 (53,8 %) , 8 (30,8) %, 4 (15,4 %). 15 % . 10 (38,5 %), 9 (34,6 %) 7 (26,9 %) .

IIII 6 , , .

IVV 6 , . 22,2 %. . .

, , , . 35,7 %.

. .

. 28 %. ; ; ( , ); 6 ; .

.

, , .

97

. 2012. 1 (54)

.

1. . . / . . ,. . , . . // . 2006. 1. . 1314.

2. / . . , . . , . . , . . // . 2003. 12. . 3943.

3. / . . , . . , . . [ .] // . 2000. 5. . 5257.

4. / . . ,. . , . . , . . // . .. . 2004. . 163, 2. . 9293.

5. . . / . . , . . // . 2007. 2. . 128.

.. , .. , .. , .. , .. ,..

. . , , . .

: , , .

I.. Kryvoruchko, S.N. Teslenko, V.P. Kolesnik, A.V. Sivogelezov, M.S. Povelichenko, A.I. KovrigaSURGICAL TACTICS PECULIARITIES DURING TRAUMATIC DAMAGES OF THE DUODENUM

The results of surgical treatment of patients with a trauma of the duodenum are analysed. Thechoice of a method of operative intervention is made individually during operation for each patient.For adequate sanitation carry out drainage of abdominal cavity, decompression bilious tree, intubation of duodenum by double tube. In the postoperative period necessarily medicamentous suppressionof secretion of a stomach and a prescription of antibiotics combined infusionaltransfusional therapy.

Key words: a trauma, duodenum, surgical treatment.

98

. 2012. 1 (54)

616.71001.59089.22:617.58:615.48

.. , .. , .. , .. , .

40 . , . : , .

:

( , , );

( , , );

() ( a 0

99

. 2012. 1 (54)

V ).

, . V V , [1].

, ( ) , , , , [1, 2].

, [3, 4].

.

. 40 , 20 .

, . , /3 /3 /3 . .

, . , /3 /3. .

(. 1). 6 .

( ), . 2. . , 45 .

( 3500 ) 2 ,

. 2. (), ()

. 1. (), : ;

100

. 2012. 1 (54)

.

2 .

. 45 . 4 , 6 .

( ) ( ), 8 .

23 .

3 , 4 .

. 46 . 45 , 68 .

.

1. . . . . / . . . . : , 2005. 580 .

2. . . / . . . . : Ad Marginem, 1996. 747 .

3. . . / . . , . . . : STT, 2001. 480 .

4. /. . , . . , . . , . . // . . . . 1999. 1. . 144145.

.. , .. , .. , ..

40 , . , .

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.. Kostrub, V.B. Zaec, I.A. Zasadnjuk, R.I. BlonskiyAPPLICATION OF EXTERNAL FIXATION DEVICE AT MULTISPLINTERED BREAKS OF LOWEREXTREMITY

40 patients which had a multisplintered breaks of femur or bones of the crus were inspected.Application of external fixation device at the complicated breaks of bones of lower extremityallowed to shorten time of operative interference and decreased the risk of origin of complications ina postoperaitve period and to attain rapid consolidation of break at minimum trauma of bone andsoft tissues.

Key words: vehicle of the external fixation, myltifracture breaks.

101

. 2012. 1 (54)

616.71.45.001.1/3.008

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. 2012. 1 (54)

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103

. 2012. 1 (54)

, , 1,5 %. . , .

. 3 . 98,8 % . 1,2 % : , , ,

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. 43 %. , . 98,8 % .

1. . . /. . , . . , . . // . , 2001. . 6971.

2. . . / . . , . . , . . // . ,2001. . 117.

3. / . . , . . , . . , . . // . , 2001. . 3840.

4. . . / . . , . . , . . // . ., 2005. . 6669.

5. / . . , . . , . . , . . // . ., 2009. . 1112.

6. . . / . . , . . // , , : .. . . ., 2008. . 912.

7. . . / . . , . . . .,2006. . 3. . 189190, 446450.

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. , . : , , , , , , . . 98,8 % , .

: , , , .

Ya.S. Lezvinsky, V.V. Veklich, S.M. Verchovez, K.S. LisitskayaMODERN TREATMENT OF MULTIPLE AND COMBINED INJURES OF LOCOMOTOR SYSTEMIN CHILDREN AND ADOLESCENTS

Clinical essay of trauma victim children and adolescents with multiple and combined injuries oflocomotor system was carried out. Osteosynthesis was performed with wires, pins, screws, plates,ring fixation, metallicpolymeric nails. In the pastoperative period complex prevention of posttraumatic osteomyelitis developed by the authors, was applied. Good results in 98,8 % cases are the evidence of rational osteosynthesis method choice.

Key words: multiple, combined trauma, children, adolescents.

104

. 2012. 1 (54)

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107

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4. . . / . . , . . , . . // . 2004. 1. . 178180.

5. / . . , . . ,. . [ .] // . 2004. . 2, 1. . 6470.

6. . . ( ) / . . ,. . , . . // . 2004. . 7, 2. .123126.

7. . 64931 , 6117/56. / . ., . ., . . 2003021659 ; . 25.02.03 ; . 15.03.04, . 3.

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V.A. Litovchenko, G.V. Bondarchuk, Ye.V. Garyachiy, V.V. Suhovetsky, M.I. Berezka, A.S. KravchenkoTREATMENT OF FRACTURES OF THE PROXIMAL PART OF THE FEMUR IN ELDERY PATIENTSWITH POLYTRAUMA

One of the complex and not completely solved problems are fractures of the proximal femur, whichhave affected elderly patients on the background of the combined injury creates further difficultiesfor treatment. In our opinion priority should be given to less traumatic, minimally invasive methods,easy to implement and brief in time. The developed method of osteosynthesis of fragments of the femur with trochanteric fractures with a rod apparatus is well proven in the treatment of elderly patients with multiple injuries. The use of the proposed method has shown its benefits and has improvedthe outcomes of these patients.

Key words: polytrauma, trochanteric area, rod apparatus.

108

. 2012. 1 (54)

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1. . . / . . // . 2011. . 12, 4. . 9497.

2. . . /. . // . 2007. . 8, 3. . 317321.

3. : / . . , . . , . . [ .] // . . . . 2005. 2. . 4045.

4. . . / . . . . : , 1978. 519 .

5. : . . . . / [. . . ]. . : , 1988. 311 .

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.. , .. , .. , .. , ..

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V.A. Litovchenko, D.V. Vlasenko, M.I. Berezka, V.G. Vlasenko, E.V. GaryachiyBIOMECHANICAL GROUNDS OSTEOSYNTHESIS OF POLIFRATUR FEMUR

The research is based on the analysis of biomechanical observations of fractures of the diaphysisof the femur combined with fractures of the proximal femur. Based on these data the indications forthe use of locking intramedullary nailing for fractures of the femur in different anatomical andfunctional areas were determined.

Key words: intramedullary locking osteosynthesis, multiple fractures, anatomical and functional zones.

113

. 2012. 1 (54)

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114

. 2012. 1 (54)

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. 2012. 1 (54)

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118

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1. . . / . . // . 1995. 1. . 810.

2. ( , , ) / . . , . . , . . [ .] // . 2005. . 6, 2. . 134139.

3. / . . ,. . , . . [ .] // , . 2002. 4. . 101103.

4. . . : // . . // . . 1, 2. . 166171.

5. . . / . . , . . , . . // , . 2004. 1. . 2124.

6. / . . , . . , . . [ .] // , . 2010. 2. . 510.

7. / . . , . . , . . [ .] // . . . . 2006. 4. . 38.

8. / . . , . . , . . [ .] // , . 2008. 2. . 57.

9. / . . ,. . , . . [ .] // . 2007. . 8, 3. . 253256.

10. /. . , . . , . . [ .] // . 2010. . 11, 2. . 152155.

11. . . /. . // . 2007. . 8, 3. . 317321.

12. , / . . , . . , . . [.] // , . 2008. 2. . 5662.

13. , , / . . , . . , . . [ .] // . 2011. . 12, 4. . 2023.

14. . . / . . // . 2005. 1 (34). . 1316.

15. / . . , . . , . . [ .] // . 2009. . 5, 4. . 594596.

16. . . / . . , . . // . 2002. 2. . 1518.

17. / . . , . . , . . [ .] // , . 2007. 1. . 2633.

119

. 2012. 1 (54)

18. / . . , . . , . . [ .] // , . 2006. 4. . 513.

19. . . / . . , . . // . 2010. . 11, 3. . 348352.

20. / . . , . . , . . [ .] // . 2009. . 10, 3. . 243246.

.. , .. , .. , .. : ,

327 , . , . , .

: , .

V.A. Litovchenko, E.V. Garyachiy, M.I. Berezka, I.I. SpesiviyINTRAMEDULLARY LOCKING OSTEOSYNTHESIS: ERRORS WHICH SHOULD NOT BE

The experience of treating of 327 patients with fractures of the extremities, which undergoneintramedullary blocking osteosynthesis, is summarized. In the research we studied and analysed themajor mistakes that surgeons have made performing intramedullary locking osteosynthesis. Themain causes of errors are a violation of the foundations of this method of tactical and technical disadvantages among which the most important is the lack of preoperative planning.

Key words: locking intramedullary osteosynthesis, errors.

120

. 2012. 1 (54)

617089.844059:616089.881

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121

. 2012. 1 (54)

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122

. 2012. 1 (54)

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2. , ( 2 ).

3. . ( 0,3 ).

1. . . 20032004 / . . , . . , . . . . : . . , 2005. 134 .

2. Burch J. M. New consepts in trauma / J. M. Burch // Amer. J. Surg. 1997. V. 173, 1. P. 4446.

3. / [ . . . , . . ]. . : ,1996. 414 .

4. . . / . . , . . , . . . . :, 1993. 464 .

5. . . / . . . . :, 1995. 428 .

6. Flotating fracture of the ribs as the index of the hard trauma / D. L. Ciraulo, D. Elliott,K. A. Mitchell [et al.] // J. Am. Coil. Surg. 1994. V. 178, 5. P. 466470.

7. . . : . . . . : . 14.00.27 / . . . ., 2009. 173 .

8. . . (, , ,). / . . . X : , 1998. 504 .

9. Armstrong B. W. Pressurecontrolled, inverse ratioventilation that avoid sair trapping in theadult respiratory distress syndrome / B. W. Armstrong, N. R. Macintyre // Crit. Care Med. 1995. V. 23, 2. P. 279285.

10. Changes in the inflammatory response of the lung during acute respiratory distress syndrome:prognostic indicators / R. P. Baugham, K. L. Gunter, M. C. Rashkin [et al.] // Amer. J. Resp. Crit.Care Med. 1994. V. 154, 1. P. 7581.

11. . . / . . // . . 1998. 7. . 4144.

12. . . / . . // .. . 1998. 3. . 6973.

123

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13. . . / . . ,. . // : /[ . . . . ]. ., 2002. . 616621.

14. / [ . . . ]. . : LOGOS, 1995. 312 .15. Charash W. E. Delayed fixation on fumurs fracturing is risk factor of development of the

lung failure in the case of breasts trauma / W. E. Charash, T. C. Fabian, M. A. Croce // J. Trauma. 1994. V. 37, 4. P. 667672.

.. , .. , .. , .. , .. , ..

. .

: , , , , .

V.A. Litovchenko, O.A. Kipa, E.V. Gariachiy, V.V. Grigoruk, N.S. Grimajlo, A.V. LitovchenkoBIOMECHANICAL SUBSTANTIATION OF A CHOICE OF A FIXATION METHOD OF A CLAVICLEDIAPHISIS FRACTURE AT PATIENTS WITH ACUTE THORACIC TRAUMA

Authors by means of mathematical modeling prove application of plates and external fixationdevices of a clavicle diaphisis fracture at patients with acute thoracic trauma. The analysis shows thenecessity of using the apparatus of external fixation and plate owter table provided considering scoring severity of injury and degree of traumatizm of the surgery.

Key words: the mathematical modeling, fixator, clavicle diaphisis fracture, acute thoracic trauma.

124

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616001.5003.089.11/.1507

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125

. 2012. 1 (54)

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126

. 2012. 1 (54)

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4. , , .

1. Treatment of open fractures of the shaft of the tibia / M. Bhandari, G. H. Guatt, M. F. Swiontkowski, E. H. Schemitsch // J. Bone Joint Surg. Br. 2001. V. 83. P. 6268.

2. Giannoudis P. V. Temperature rise during reamed tibial nailing / P. V. Giannoudis, S. Snowden,S. J. Matthews // Clin. Orthop. 2002. Feb. V. 395. P. 255261.

3. Giannoudis P. V. Improved results in treatment of femoral shaft fractures with the unreamedfemoral nail? A multicenter experience / E. R. Hammacher, M. C. Van Meeteren, C. Van der Werken //J. Trauma. 1998. Sep. V. 45 (3). P. 517521.

4. Giannoudis P. V. Reamed against undreamed nailing of the femoral diaphysis: a retrospectivestudy of healing time / P. V. Giannoudis, A. J. Furlong, D. A. Macdonald, R. M. Smith // Injury. 1997. Jan. V. 28 (1). P. 1518.

5. Prospective comparison of retrograde and antegrade femoral intramedullary nailing /R. F. Ostrum, A. Agarwal, R. Lakatos, A. Paka // J. Orthop. Trauma. 2000. Sep.Oct. V. 14(7). P. 496501.

6. Hontzsch D. Distal femoral fracture technical possibilities / D. Hontzsch // Kongrassbd.Dtsch. Ges Chir. Kong. 2001. V. 118. P. 371374.

7. . . / . . . . : , 2004. 544 .

8. . . : : / . . , . . // , . 2006. 1. . 7784.

.. , .. , .. , .. , .. ,.. : ?

. .

: , , .

V.A. Litovchenko, S.V. Mushnyov, Ye.V. Miroshnichenko, Ye.V. Garyachiy, A.V. Litovchenko,V.G. VlasenkoREAMING OF THE BONE CHANNEL AT THE LOCKED NAILING: IS IT NECESSARY?

The expediency of locked nailing without reaming the bone channel is proved. The reaming procedure of the bone channel reduces potential reparative possibilities of a bone tissue.

Key words: locked nailing, osteosynthesis, osteogenesis, reaming.

127

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617.54001.4089

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. 20022010 ., , 2,19 % 202 , (27,01,4) ( 17 68 ), 95,2 % .

(62,2 %), 58 (28,8 %) . (33,7 %), (32,4 %) (26,4 %). . (80,6 %) (19,4 %). , 75% .

II 39,9 %, I III 22,0 22,7 % . 15,4 % . 52,9 % , 27,1 % ( 15,1 %, 6,5 %, 5,5 %), 6,0 8,7 % .

210 % . 21,062,2 % [14]. [57]. , 1832 % , 6,5 % [1, 810].

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, [4, 7].

, , [5, 6, 12]. , , , 34 %.

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128

. 2012. 1 (54)

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. [6] . 58,7 %, 34,6 %. II . 11 %, 4 %.

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14 ( .., 1996) 95 % (=0,58;

129

. 2012. 1 (54)

I /III , . . .

. 4,2 , . 32 % , 20 % . (30 %, , , ).

, , , , .

36 79 %. (67 %) , , (36 %). (35 %) .

13,4 %. 34 % . 1,7 %, 19,5 %. (40 %), (22,7 %) (19,5 %). 76% , 72 % . 18 13,5 % 38 26,8 %.

, , , , .

1. . . (damage control) / . . // . . . 2008. 4. . 1924.

2. . . / . . ,. . , . . // . . . 1996. 6. . 4859.

3. Penetrating injuries of the neck: review of 16 operated cases / F. Colombo, F. Sansonna,F. Baticci [et al.] // Ann. Ital. Chir. 2003. V. 74, 2. P. 141148.

4. Thyroid storm after blunt thyroid injury: a case report / A. Hagiwara, A. Murata, T. Matsuda[et al.] // J. Trauma. 2007. V. 63, 3. P. 8587.

5. . . / . . , . . //. 1998. 8. . 1013.

6. / . . , . . , . . [ .] // : . . . , 1985. . 1. . 1819.

7. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury:a note of caution / A. K. Malhotra, M. Camacho, R. R. Ivatury [et al.] // Ann. Surg. 2007. V. 246, 4. P. 632642.

8. . . / . . . . : , 2000. 512 .

9. . . : , / . . , . . , . . // . 1997. 3. . 8897.

130

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10. / . . , . . , . . ,. . // . 2004. 3. . 193194.

11. / . . , . . , . . , . . // . 1985. . 134, 5. . 7680.

12. Firoozmand E. Extending damagecontrol principles to the neck / E. Firoozmand,G. Velmahos // J. Trauma. 2000. V. 48, 3. P. 541543.

13. Rathlev N. K. Evaluation and management of neck trauma / N. K. Rathlev, R. Medzon,M. E. Bracken // Emerg. Med. Clin. North Am. 2007. V. 25, 3. P. 679694.

.. , ..

202 , 20022010 . . 17 68 . 95,2 % . .

: , , .

M.Yu. Sizuj, P.N. ZamyatinPROVIDING SURGICAL SERVICES IN THE NECK WOUNDS

The results of surgical treatment of 202 patients with wounds to the neck. They were treated during20022010 y. in Institute of common and urgent surgery AMS of Ukraine. Age 1768 years. 95,2 %of victims are men. Medical and diagnostic algorithms of provide skilled and specialized surgical carein these patients are developed.

Key words: neck injury, associated injuries, skilled and specialized surgical care.

131

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616.414089.87036.8

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174 (96,7 %) , 6 (3,3 %) . . 129 (71,6 %), 18 16; 1820 14; 2130 40; 3140 30; 4150 15; 50 14 . 51 (28,4 %), 18 16; 1820 6; 2130 8; 3140 10; 4150 6, 50 5 . 1 78 . 18 32 (17,7 %).

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132

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120 (66,7 %) : 21 60 . 162 (90 %) . 100 (55,5 %) , 6 57 (31,6 %) , 6 23 (12,7 %). 36 (20 %) . 68(37,7 %) .

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59(37,8 %) . . 51(28,3 %) ; 15 (8,33 %) . 53 (29,4 %) . 4 (2,2 %) , 25(13,8 %) , , , . 24 (13,