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Complex aspects of diagnosis and treatment associated trauma in the acute phase
Kuldashev Kahramon Abduhalilovich, The chair of the department Traumatology, orthopedics, neurosurgery and of military field surgery, candidate of medical science Potapov Alexander Alexandrovich, National research Institute of Neurosurgery of Academy N. N. Burdenko, Academic, Institute Director, Moscow, Russia Xudayberdiev Kabul Tursunovich, Head of the department Traumatology, orthopedics, neurosurgery and of military field surgery, Doctor of Medicine, Professor Narmatova Diloramxon Maktubjanovna, Assistant of the Department Traumatology, orthopedics, neurosurgery and military field of Surgery Kuldasheva GulmiraoyKahramonjon kizi, Student Pediatric fakulty 4 E-mail: kuldashev-23@mail.ru
Complex aspects of diagnosis and treatment associated trauma in the acute phase
Abstract: These studies are based on an analysis of 315 patients after a comprehensive examination and treatment in the wards Neurotraumatology and neyroreanimations Andijan branch of the Republican scientific center for emergency medical services. The patients' age from 16 to 76 years in the groups studied male majority. Catamnesis patients from 2010 to 2016 In our center set up special reception department for patients with combined injuries. This complex includes a one-time skilled care of a neurosurgeon, trauma, ophthalmologist, lorvracha, neurologist, gynecologist, surgeon, urologist, followed by clinical and paraclinical methods of investigation. This factor is allowed to carry out timely complete clinical diagnosis and emergency care in targeted combined injuries
Keywords: Combined injury, traumatic brain injury, diagnosis, treatment and injuries of the musculoskeletal system.
Introduction
The problem of treatment of combined injuries in the last quarter of the twentieth century has occupied a leading position, due to its great social significance. Combined injuries are one of the three major causes of death, and the population under the age of40 years, the reason comes out on top.
Combined injuries are the most severe type of injury, characterized by high and has no tendency to excess of 10 times that of isolated lesions with reduction in mortality component of 23.3-85 %, long-term disability and a high level of disability (25-80 %) [1; 2; 3]. According to many authors, the poor results of treatment of patients related to the lack of a unified doctrine of surgical relief of severe concomitant injury, with treatment most of the victims in general surgical hospitals and surgeons with insufficient representation about the features of surgical tactics in combined injuries [2; 4; 5; 6].
Мaterial and methods
Our research is based on an analysis of 315 patients who had a complete examination and treatment in offices and neurotraumatology neuroreanimation Andijan branch RSCEMH (Andijan Regional Emergency Medical Hospital). The patients' age from 16 to 76 years, studied a group of men made up the majority (132). Catamnesis patients from 2010 to 2016 years.
In our RSCEMH created special reception office for patients with combined injuries. This complex includes a one-time assistance to qualified neurosurgeon, traumatologist, ophthalmologist,
ENT doctor, neurologist, gynecologist, surgeon, urologist, followed by clinical and paraclinical methods. This factor has allowed to carry out timely complete clinical diagnosis and emergency care in targeted associated trauma.
Depending on the severity of injuries of traumatic brain injury (TBI), spinal column, spinal cord (SM) and the musculoskeletal system (ODA), we used the classification of Hanover combined injury and classification of combined traumatic brain injury neurosurgery institute them. Acad. N. N. Burdenko, Academy of Medical Sciences. On this basis, we have developed and proposed a classification of associated injuries.
Combined injury — ST:
• ST Grade I — non-severe TBI and extracranial not heavy damage;
• ST Grade II — non-severe head trauma and severe extra-cranial lesions.
• ST Grade III — severe TBI and extracranial not heavy damage.
• ST IV degree — severe head trauma and severe extracranial lesions.
For serious injury ODA and CM attributed fractures of the hip, pelvis, tibia, shoulder, multiple bone fractures of extremities, stable and unstable fractures and dislocations of the vertebrae, damaged SM without him, its roots. For a mild injury and ODA CM assigned closed fractures of facial bones, hand, foot, forearm, the fibula, the nose, the unilateral fractures of the ribs have 1-3 without pleural damage, injuries of the trunk and limbs.
Section 6. Medical science
Results
To perform complex neyrotravmatologicheskogo examination and treatment, if needed emergency surgery on the brain and spinal cord of patients with I-II Group, III Group and partly to immobilize fractures impose a plaster splint, external fixation devices. This made it possible in the future to turn patients, puncture, which contributed to the prevention of pneumonia, bedsores, etc. Treatment of patients with serious violations of the functions of vital organs caused by head injury, was carried out in 3 stages.
The first was carried out resuscitation and antishock measures.
The second provided emergency assistance, depending on the severity of the brain damage (dents removal of bone fragments, intracranial hematomas, crushing parts of the brain, etc.) or limbs (debridement, fracture reduction and fixation of plaster bandage, skeletal traction and external fixation devices).
The third step is performed sequentially systematic treatment of patients. When lighter damage the brain, spinal cord and limbs were treated in two steps of — for lack of need for resuscitation and antishock measures.
When combined injuries occur more significant than in isolated brain injury changes the liquor, which is correlated with the degree of severity of the condition, which may provide some prognostic sign. Often this is manifested in the form of xanthosis or hemorrhage (82 cases).
Among the observed patients about traumatic brain injury were operated 30.7 %, limb fractures — 29.3 %, spinal injuries and spinal cord — 11.6 %.
Our experience convinces us that there is no single, universal operation. Everything is determined by the specific situation. When the prevailing traumatic brain injury, unless contraindicated by the general condition of the patient is the most reasonable conduct osteoplastic trepanation.
Resection trepanation method is applicable in cases of violations of vital (51 operated). Extension Method Milling holes hematoma removal is justified only in the elderly. When you remove intracerebral hematoma, especially localized in the motor area of the brain, sometimes there is a need in the introduction of supply and ottochnoy systems and solutions aimed at thinning the blood clots.
To prevent the increasing edema of the brain during surgery further punctured the lateral ventricles and established special outdoor adjustable drainage for 3-5 days.
Thus, diagnosis and treatment of associated injuries are certain difficulties. Caused by a trauma, and extracranial injuries. Analysis of the results allowed the following conclusions.
Conclusion
Timely, qualified to the extent necessary to provide medical assistance at the scene, combined with the correct and rapid transportation ofvictims to specialized medical institution contributes to a reduction in mortality and reduction of disability and reduces the rehabilitation period in patients with combined injuries.
Traumatic shock with concomitant serious injury observed more than half of the victims. Shock may occur against the background ofimpaired consciousness. Respiratory failure, disorders of the central regulation of cardiovascular activity as cerebral and spinal level that causes the severity, atypical and duration of treatment, tolerance to activities conducted antishoked treat.
Puncture and drainage of the cerebral ventricles with rising swelling warn brain compression and development of dislocation syndrome with combined injuries.
Timely comprehensive drug treatment reduces the length of stay in hospital, and the use of regional lymphotropic therapy allows to obtain economic effect because it reduces hospital stay and rehabilitation period is reduced.
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