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следуют одинаковые цели.
Главной целью является предотвращение поражения тканей головного мозга, и как следствие поддержание нормального внутричерепного давления и защита коры головного мозга от гипоксии. В некоторых случаях для этого выполняются трепанации с целью дренирования внутричерепных гематом. При отсутствии кровотечения в полость черепа больные ведутся как правило на консервативной терапии.
Прогноз заболевания во многом зависит от характера и тяжести травмы. При легких травмах прогноз условно благоприятный, в некоторых случаях происходит полное выздоровление без медицинской помощи. При тяжелых повреждениях прогноз неблагоприятный, без немедленной адекватной медицинской помощи больной умирает.
Существуют случаи, когда даже при серьезных черепно-мозговых травмах врачам удавалось спасти пациентов. Большое значение имеет помощь и лечение на догоспитальном этапе. Все больные с ЧМТ доставляются в стационар.
Тужырым
З. У.Доспанбетова
К,К,К,К МЖЖС №4 цосалцы станциясы, БИТ бригада дэргер:
Бас сYйек-ми зацымы (БСЗ) - деген/м/'з бас сYйек немесе жумсац тiндердiн зацымдалуы. Эдетте БСЗ-нын жец'л, орташа жэне ауыр ауыртпалыц денгейiн ажыратады. Сондай-ацжекеленген, Yйлестiрiлген формалары ажыратылады (взге де мYшелердiн зацымдалуы байцалады). БСЗ жабыцжэне ашыц формалы деп бвл/'нед/' (тер, апоневроз, сYйек т/'ндер/' мен терен орналасцан тiндердiн жарацаты).
Клиникалыц тургыдан БЗС:
Бас ми шайцалуы: жYрек айнушылыц, цусу, бас ауруы, тер цуцылдыгы, естен тану сектд/' белглер бас ми шайцалуына тэн белг лер болып табылады.
Бас ми мYшесiн согып алу;
Бас миынын цысылуы;
Мидын диффузиялыц-аксоналды жарацаты деп бвл/'нед/'
Естiн бYлiнуi - дыбыс цатандануы, естен айырылып
;алушылы;, элазд/'к, кома барлыгы да БСЗ ауыртпалыгына мецзейд/'.
Нау;ас стационарга mYCKeH кезде келесдей тексеруден emedi:
Клиникалы;;
Бас сYйектi рентген сэулеа ар;ылы суретке mYcipy (рентгенография жасау)
Компьтерл1к томография.
Емн/'ц басты ма;саты: нау;асты бас cYйек ;ысымынан, гипоксиядан са;тау.
Болжам жара;ат сипаты мен ауыртпалыгына байланы-сты.
Summary
Z.U.Dospanbetova
SSMO EMSS sub-centre No. 4 TIT team doctor.
Craniocerebral trauma (CT) - affection of skull bones or soft tissues. It is distinguished mild, medium and heavy CT severity. Also there are isolated and concomitant injuries (other organs are affected also).
CT is divided into close and open form (affection of skin integument, aponeurosis, bony tissue and deep-seated tissues).
Clinically CT is divided into:
Concussion of the brain: nausea, vomit, headache, skin pallor, faintness are specific symptoms.
Brain contusion.
Brain compression.
Diffuse axonal injury.
Impairment of consciousness - stupefaction, sopor, coma show CT severity.
Admitting conducted following examinations:
Clinical;
Craniography;
Computerized tomography.
The treatment come to:
intracranial pressure and hypoxia protection. Prognosis depends on injury characteristics and severity.
YRK 616-001.31
O.S. Seyidbeyov, G.F. Hasanova
Azerbayjan state advanced training institute for doctors Named after
Aziz Aliyev Clinical And Expertise Assessment Of Mandibular Fractures As A Result Of Blunt Object Impact
Conclusions:
Based on the research we had made following conclusions:
Knowing the mechanisms of mandibular fractures significantly simplify the choice of tactics and treatment methods, as well as helps during forensic-medical examination.
Clinically grounded description of the general and local condition of the patients at the moment of admission with mandibular fracture help to have and objective view on the gravity of health damage.
The length of the the hospital treatment of mandibular fracture depends less on the mechanism of the blunt trauma and rather more on fracture itself and its complications.
The maximum required duration of the hospital treatment is during multiple mandibular fractures, specifically one's coupled with combined trauma especially with complications.
The assessment of mandibular fractures is performed on the basis of morphologic and functional peculiarities of fractures, the study of establishment mechanisms and the character of damaging factor, location and the direction of the impacting force, as well as the intermediary and final outcomes of fractures [1,4,5,8]. it was determined in the clinical and forensic-medical practice that
mandibular fractures mostly appear as a result of the impact of blunt objects. This is determined by the factor that blunt objects cause different mechanical lesions: excoriasions, scratches, hematomas, wounds, injuries, tensions, lacerations, dislocations, cracks, fractures, etc. [6,7]. as it is known, one of the most complicated forms of lesions in stomotological and forensic-medical practive is the facial skeleton fractures, including mandibular — the only mobile bone of th facial skeleton. The peculiarities of the facial skeleton structure, as well as the wide range of blunt object impact mechanisms lead to the great variety of lesions.
According to our observations mandibular fractures form 65.4% of total facial bone fractures. Of all facial bones mandible is the least protected from external impact and, given its mobility, the mechanism of mandibular fracture formation to a greater extend is determined by the peculiarities of anatomic structure.
Over last several years the number of forensic-medical assessments of impact of mandibular fractures on to the level of damage to the health had increased.
Undoubtedly introduction to the medical pratice of modern diagnostics and treatment methods for mandibular damages, significantly impact the duration of temporary loss of ability to work and the results of rehabilitation. All of above suggest the elaboration
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Вестник хирургии Казахстана №4, 2012
of new approaches to the assessment of expert criteria of the level of damage to the health, as well as of late outcomes.
These factors determined the main direction of our reaserach, aimed at improving the criteria of forensic assessment of the level of damage to the health during mandibular fractures based on the analysis of modern clinical and instrumental methods of examination of patients with focus on to early and late outcomes of the trauma.
We had reviewed cases of 214 patients with facial fractures.
Mandibular fractures 140 65.4%
Single 65 46.4%
Double 51 23.8%
Triple and multiple 14 10%
Combined 10 4.67%
The goal of our study is to perform an integrated analysis of mandibular fractures using clinical stomatologic and forensic-medical observations,.
During the review, mandibular fractures were combined in to two groups of direct and indirect fractures. Given the point that mandibular fractures were quite divers in their mechanisms and peculiarities of blunt trauma, this definition caused certain difficulties in determining trauma mechanisms. This is the reasons of having cases (20%, 28) with unidentified mechanism of a mandibular fracture.
Out of 214 injured 12 (5.6%) had complications during treatment. The dislocation of fracture segments had led to hematoma and edema of soft facial tissues (37) (26.4%). However, along with that, in 4 persons (2.85%) there were purulent complication, nerve damage in 40 (18,7%) and lacerations of soft tissues 120 (56.7%).
The forensic-medical examination of the cause to the health is performed by the forensic-medical expert through medical examination of victims. The forensic-medical examination of victims (as was said above) is performed in forensic-medical out-patient facilities (in big cities), out-patient clinics and hospitals, in relevant departments of investigation and court authorities, as well as, at home of the victim in case if unable to come to relevant facilities. In any case the identity of the person should be identified based on passport or any other equivalent document (military ID, etc) with the indication of such submitted document in the "Expert's Notes" («The Certificate»). This is followed by the investigation of circumstances of the case (preliminary information).
The source of preliminary information on the circumstances of the case is the appointment of forensic examination, referral to the forensic expert or any other document from investigative bodies or court. It contains ID information of the examination subject, short information on the event, as well as, the objective of the examination — questions to be answered by forensic-medical expert. In most cases the circumstances of the case are determined based in information provided y the victim who answers questions of the expert.
The interview should give information on: a) when (day, hour) and where (at home, in the street, at work, etc.) damages were caused; 6) who caused them (surname, name, farther's name, sex, age and physical status); b) using which object and method (punches, injuring by knife, burns, etc.); r) which part of the body was injured (head, chest, hands, etc.).
Along with that, it is expedient to find out the status of general condition of the victim during the first period after the trauma, namely, if the victim was conscious shortly after the trauma, vomiting, nausea, dizziness, whether applied to medical care and to which medical facility, etc.
At that, during the interview, no direct suggestive questions shall be asked to the victim as this may lead to intentional aggravation and even simulation. Besides, often trauma is the culmination of a quarrel, family drama, etc., accompanied with psychological trauma aggravating the general condition and leading to the point when the victim, even without any intention, can exaggerate trauma symptoms.
One shall not forget about pathologic simulation (for example,
during hysteria), when simulation is one of the symptoms of the condition.
That is why, suggestive questions of a doctor may lead to a significant exaggeration of subjective symptoms by the victim.
All of above, certainly, doesn't mean that forensic-medical examination experts shall not take in to account the historical data. The expert must analyze them with scrutiny, comparing with the results of objective examination and forming opinion based on the later [3,7,9,10,11].
While doing the subjective examination of the victim one shall always remember that forensic-medical examination is medical, scientific-practical examination and it shall be performed based on the rules of modern medical science. Along with that we believe that forensic-medical examination is not a purely clinical examination and that is why one shall not be aimed at comprehensive description of the general condition, rather detailed description of the condition of those organs and systems that have or may have any value in term of forensic-medical assessment.
Analysis of the forensic-medical examinations during mandibular fractures showed that in most cases during the assessment health burder of the mechanism and the remoteness of the trauma doesn't cover the details of medical documents, laboratory and instrumental examinations, which impedes the objectiveness of the outcomes of such assessment and often lead to false conclussions.
It is important during the assessment to determine the gravity of health damage in case of mandibular fractures, accurate identification of the type of the fracture, its location, duration of healing, which help to determined the duration of loss of ability to work.
As it is known, the treatment and their results in case of mandibular fractures depend on a number of reasons: correct first aid, time of transportation to medical facility, appropriate tactics and performed medical interventions, individual peculiarities of a person, condition of the mandible of the victim (the degree of atrophy in alveolar bone of mandible, infection before trauma, related to tooth conditions), type of the fracture: single, double, triple and multiple, combines, the level of damage of soft tissues, local nerves and vessels. While choosing the tactics and methods of treatment in case of mandibular fractures, we also used the assessment of trauma mechanisms. The review of the duration of time spent in the clinic for treatment of mandibular fractures showed average duration from 4 to 23 days: in case of single non-complicated fracture - from 4 to 12 days; single fracture with complications - 5 to 16 days, double non-complication fracture - from 4 to 26 days, double fracture with compliations - 12 to 28 days, triple and multiple non-complicated - 7 to 23 days and finally, triple and multiple fractures with complications - 10 to 28 days. These days for combined fractures without and with complications are 6 to 14 and 10 to 19 days respectively.
During the research we used the description of morphology of mandibular fractures, reviewing the X-ray status of mandible and qualitative and quantitative assessment of mandibular fractures.
As our observations showed, the majority of complications of mandibular fractures during blunt trauma happen at later stages. That is why, in connections with this point, it is important to do repeated assessment of patients in one month time after the lesion.
Thus, during the assessment of gravity of health impact, the mechanism and remoteness of mandibular fractures during blunt trauma it is expedient to engage a specialist - the oral and maxillofacial surgeon both for the individual assessment of such patients and for cooperation with the forensic-medical examination expert.
Conclusions:
Based on the research we had made following conclusions:
knowing the mechanisms of mandibular fractures significantly simplify the choice of tactics and treatment methods, as well as helps during forensic-medical examination.
Clinically grounded description of the general and local condition of the patients at the moment of admission with mandibular fracture help to have and objective view on the gravity of health damage.
The length of the the hospital treatment of mandibular fracture depends less on the mechanism of the blunt trauma and rather more
on fracture itself and its complications.
The maximum required duration of the hospital treatment is during multiple mandibular fractures, specifically one's coupled with combined trauma especially with complications.
References - Литература:
1 Аникеева, Елена Александровна. Судебно-медицинская оценка переломов костей лицевого и прилежащих отделов мозгового черепа при его сдавливании: автореф. дисс. ...канд. мед. наук. - Барнаул. 2004. - 16 с.
2 Васильев М.А.Об экспертной оценке телесных повреждений, нанесенных в особых условиях. Вопросы судебной травматологии.
- Киев. 1971. - с.109-112.
3 Гоомов А.П. Биомеханика травмы (повреждения головы, позвоночника и грудной клетки). - М.: Медицина. 1979. - 28 с.
4 Кабаков Б.Д., Малышев В.А. Переломы челюстей. М.: Медицина. 1981. - 176 с.
5 Коляда И.В. Определение степени тяжести при повреждениях зубов и челюстей: автореф. дисс...канд. мед. наук: 00.24 - Киев. 1972 - 23 с.
6. Лкунин С.А. 2002. СМЭ. Судебно-медицинская оценка повреждений головы при ударах тупыми предметами. - М. 2002. - С.36-40
7 Поздеев И.С., Рочкустов Ю.И. Анализ повреждения зубоче-люстной системы. Судебно-медицинская стоматология, сборник научныхработ. - М. 973. - С. 75-76.
8 Проздоровский В.И. Судебно-медицинские аспекты в стоматологии. Судебная стоматология, сборник научных трудов. - М. 1973. - С.10-13.
9 Робустова Т.Г. Хирургическая стоматология. // Медицина. Москва. 1990. - С. 398-402.
10 Assael L, Tucker M. Management of facial fractures // Contemporary oral and Maxillofacial Surgery. - 2nd ed. - St. Louis. - 1993.
- P. 557.
11 Ellis E. Condylar process fractures of the mandible //Facial. Plast. Surg. - 2000. - Vol. 16, №2. - P. 193-205.
Тужырым
О.С. Сеидбеуов, Г.Ф. Насанова Эзрбайжан дэргерлер бл/'м/'н жеmiлдiру институты Жа;тын сынуларын клиникалы; жэне сараптамалы; багалау
Клиникалы; жэне сот-медициналы; практикасында аныкталгандай, твменг жа;тын сынулары негзнде догал
заттардын эсерлернен пайда болады.
Ягни осындай догал заттар тYрлi механикалыц зацымдануларды келт/рет/нд/'г/' шартталган: жаралар, сы-заттар, цанталау, жарацаттар, жараланган жерлер, а'н/р созылу, жарылулар, буын таю, жарыцшац, сыныцтар тагы сол сиякты(6,7).
Эдебиеттег1 мэл1метер бойынша твменг1 жацтын сыныцтары 65,4% (пайызды) цурайды, жалпы бет цанцасындагы жац сынулары арасындагы кврсеткш. Бзге 214 бет цанцасы сыныгымен жэб1рленуш1лер болганы белг/'л/'. Онын ¡ш/'нде 140(65,4%) твменг жац сыныгымен жэб/'рленушлер, (65-46, 4% жалан сынулар, 51-36, 4% цосарлы, 14-10% Yш есе жэне квп, 10-7,14% цурамдастырылган сынулар).
Зерттеу жасай келе, бз твменг жацтын зацымдануларынын сипаттасын пайдалана, твменг жацтын сынуларына сандыц жэне сапалыц бага бер/'п, цорытындыларга статистикалыц жэне математикалыц анализ берлд/ (вариациялыц, корреляция, регрессивт1г1).
Резюме
В клинической и судебно-медицинской практике установлено, что переломы нижней челюсти в основном возникают от воздействия тупыми предметами. Это обусловлено тем, что тупые предметы причиняют разнообразные механические повреждения: ссадины, царапины, кровоподтеки, раны, ушибы, растяжения, разрывы, вывихи, трещины, переломы и. п. (6,7). По данным литературы переломы нижней челюсти составляют 65,4%, среди общего количества переломов костей лицевого скелета.
Нами было изучены 214 пострадавших с переломами лицевого скелета. Из них 140(65,4%) пострадавших с переломами нижней челюсти (65 - 46,4% одиночных переломов, 51-36,4% двойных, 14-10% тройных и множественных,10-7,14% комбинированных переломов, т.е. в сочетании с переломами других костей лицевого скелета).
При проведении исследований, мы использовали описание морфологии повреждения нижней челюсти, количественную и качественную оценку переломов нижней челюсти, статистический и математический анализ результатов ( вариационный, корреляционный, регрессивный).
УДК 616-003.85 Б.У. Бозабаев
Центральная клиническая больница МЦ УДП РК, г. Алматы
Эффективность комбинированного лечения остеоартроза коленных суставов
Аннотация
В статье приводятся результаты комбинированного метода лечения 32 пациентов с остеоартрозами, которым проводили санационную артроскопию в сочетании с внутрисуставным введением гиалуроната с компонентом Эуфлекс. У всех пациентов получен положительный эффект применения как в интраоперационном, так и в послеоперационном периоде.
Ключевые слова: остеоартроз, санационная артроскопия, внутрисуставное введение гиалуроната с компонентом эуфлекс.
Введение
Остеоартроз (ОА) является проблемой здравоохранения в связи с возрастающей распространенностью. Рост в обществе прослойки населения пожилого возраста, количества больных
с очевидной симптоматикой болезни, среди которой боль в пораженных суставах и нарушение их функции, приводящие к ухудшению качества жизни больных, требуют постоянно растущих расходов из бюджета на здравоохранение, в том числе на консервативное и хирургическое лечение. ОА страдает около 20% населения. Заболевание чаще всего встречается у женщин в возрасте старше 50 лет [1].
В основе патологического процесса при остеоартрозе лежит быстрое старение суставного хряща. При этом он теряет свою природную эластичность и гладкость, начинает растрескиваться и истончаться, вплоть до полного исчезновения, обнажая кость. Затем к этому процессу присоединяется воспаление, вследствие которого начинает происходить разрастание костной ткани, вызывающее деформацию сустава и боль [2].
Современное лечение ОА должно быть направлено на основные звенья патогенеза заболевания, не только способ-
