CC BY
22
Rehabilitation methods of treatment of acetabulum damage
Table 3. - Difference between PANSS scale indicators during the compulsory treatment of schizophrenics (one year after they committed socially dangerous acts) and at the time of committing the offence
Psychopatholog ical mechanism
Unconditional-psychotic (n = 41) Conditio chotic 1 rnal-psy-n = 55) Negative- personality (n = 61) Kruska ANOVA l-Wallis jy Ranks Intergroup comparison
Average M Average M Average M H p
Scale of positive syndromes -11.35 5.86 -10.02 4.56 -6.13 4.99 24.21 < 0.001 1,2 < 3
Scale of negative syndromes -4.30 7.56 -0.65 4.59 -1.08 4.98 6.81 0.033 1 < 2
General psychopathological scale -19.20 11.94 -14.31 9.70 -9.89 8.42 16.43 < 0.001 1,2 < 3
Total points -34.85 21.65 -24.54 15.46 -17.10 14.69 18.07 < 0.001 1 < 3
Bipolar composite index (±) -7.05 7.82 -9.36 5.56 -5.21 6.39 12.03 0.002 2 < 3
Conclusions
By analyzing mental state dynamics, we found the greatest difference between the offence-time and treatmenttime values on all three scales for schizophrenics whose offences were based on unconditional-psychotic mechanism. The smallest difference on the scale of positive syndromes and on the general psychopathological scale was obtained for schizophrenics whose offences were based on negative-personality mechanism. The smallest difference on the scale
of negative syndromes were obtained for schizophrenics whose offences were based on conditional-psychotic mechanism; these patients’ difference for the other scales were between the ones obtained for schizophrenics whose offences were based on the unconditional-psychotic and negative-personality mechanisms. These differences allow one to detect the psychopathological mechanism of socially dangerous acts using the PANSS scale when no follow-up data are available.
References:
1. Monahan J., Steadman H.J., Appelbaum P. S., Robbins P. C., Mulvey E. P., Silver E., Roth L. H., Grisso T. Developing a clinically useful actuarial tool for assessing violence risk.//The British Journal of Psychiatry. - 2000. - vol. 176. - Р. 312-319.
2. Steadman H., Mulvey E., Monahan J., Robbins P., Appelbaum P., Grisso T., Roth L. and Silver E. Violence by people discharged from acute psychiatric impatient facilities and by other in the same neighborhood.//Archives of General Psychiatry. - 1998. - vol. 41. - Р 395-401.
3. Wallace C., Mullen P., Burgess P., Palmer S., Ruschena D. and Browne C. Serious criminal offending and mental disorder. Care linkage study.//British Journal of Psychiatry. - 1998. - vol. 172. - Р. 477-484.
4. World report on violence and health: summary. - Geneva, World Health Organization, 2002.
5. Мальцева М. М., Котов В. П. Опасные действия психически больных. - М., 1995. - 256 с.
6. Шостакович Б. В. Психические расстройства и преступность.//Механизмы человеческой агрессии. - М., 2000. -С. 150-160.
Shorustamov Mukhammad Todjalievich, Branch manager clinic of Tashkent Medical Academy,
Republic Uzbekistan E-mail: [email protected]
Rehabilitation methods of treatment of acetabulum damage
Abstract: The article is devoted to solving improvement of rehabilitation treatment methods in acetabular injuries. Offered algorithm enables to improve rehabilitation treatment methods of acetabular injuries and to introduce its usage widely in traumatology-orthopedics practice.
Keywords: rehabilitation methods, acetabulum damage, innovation algorithm.
Rehabilitation treatment is a main stage of restoration of functioning hip joint in patients with acetabulum damage. How shows our experience, inopportune started or inadequate rehabilitation methods of treatment may threaten even
high qualitatively performed surgical interventions. At present a great number of recommendations are worked out aimed at rehabilitation of this group of patients. But majority of them went out of date and require revision taking into account
115
Section 8. Medical science
a stable renewal and perfection of arsenal of implants and surgical techniques [1; 3]. Therefore novel innovation methods of rehabilitation treatment undoubtedly help practical physician to reach maximum number of positive medium-dated and remote results in treatment of this cohort of patients [2].
Purpose ofresearch was aimed at working out innovation methods of rehabilitation treatment of acetabulum damage.
Material and methods: Within the last 15 years in the Republican Specialized Center of Joint & Hand Surgery as well as in the Second Clinic of the Tashkent Medical Academy since 1997 till now surgical methods of treatment are preferred in fractures of socket of hip. During this period clinical rentgenologic analysis of histories of the cases of 180 patients with acetabulum fractures was conducted, of them were 147 males and 33 females, their age varied
from 16 to 78. It was established that to the most typical mechanisms of arising acetabulum fractures belong as follows: direction of blow towards greater trochanter — 87, knee joint — 77, on foot — 11 and fractures occurred in 6 patients due to unknown causes.
Diagnosis of acetabulum damage presents definite difficulty because cup-like cavity locates in not easily accessible for examination area and clinical symptoms in the given area (painfulness, labored motion in cotyloid cavity, shortening, forced attitude of extremity) are not pathognomonic, they can be noted in other fractures of hypsiloid bones. Besides, careful clinical examination is not always possible due to severity of common state of the injured person — mental blankness, shock. Final diagnosis may be established based on poly-position rentgenography and multi-spiral tomography.
Fig.1. Scheme of algorithm of rehabilitation treatment of acetabulum damage
116
Estimation a condition of blood cytokine profile at performing a conservative myomectomy
Results and discussion: Innovation aspects of rehabilitation methods of treatment of acetabulum damage (AD) is, first of all, in fixation of fragments with screws in 46 cases and additively in applying apparatus of dynamic unloading on joint in 22 cases. All that gave a possibility to load an extremity on the second day after operation with preservation of motion in joint in three planes: flexion — deflexion, adduction — abduction and rotation motions. The method of applying apparatus of dynamical unloading is based on innovation construction worked out by us. For this construction we received a positive decision of the Agency of Intellectual Property of the Republic of Uzbekistan.
Apparatus of dynamical unloading allowed sufficiently reduce a stay of patients in hospital. If skeletal traction through femoral epicondyles was put after osteosynthesis patients with acetabulum damage for 4-6 weeks, then after using of the worked out by us apparatus patients were activated on the second day after surgical treatment that permitted to load the injured extremity and accomplish functional motions in joint.
Summarizing it may be noted that a possibility of an early activation and reduction of a number of stay days in hospital occurred in 22 patients that additively were underwent applying of authors’ apparatus of dynamical unloading. An early static loading on extremity resulted in prevention of osteoporosis and increased a level of quality of life of patient.
How is given on Figure 1, algorithm of rehabilitation includes blocks of conservative (including blocks ambulatory, treatment at a health resort, medicamentous) and other methods of treatment of acetabulum damage as well as control
block. Block of endo-prosthetics of coxofemoral joint is also provided for in case of detection of signs of coxarthrosis.
According to algorithm elaborated by us, after surgical rehabilitation treatment we provided for block with using of innovation apparatus and block without its application. Algorithm of rehabilitation also includes block of detection of coxarthrosis signs that provides for analysis of results of rehabilitation treatment of injuries of cotyloid cavity. Medicamentous methods of treatment with optimization of dosage, multiplication factor and prolongation of application of preparation aimed at prevention of thromboembolic complications in accordance with generally conventional international standards were also used by us in accomplishment of innovation rehabilitation methods of AD treatment. With that end of view the physiotherapeutic methods in postoperative period of rehabilitation starting from the third day have been used in our Center. Therapeutic physical training in regime of forced loading optimizing an intensity of loading in dependence on type of acetabulum damage aimed at improvement of rehabilitation methods of treatment of AD was used. All that allowed shorten terms of unloading of extremity, perfect self-help service and recurrence of patients to functional motor activity.
Innovation algorithm of perfecting rehabilitation methods of treatment of AD contributes to expansion of an implementation sphere in traumatic surgery and orthopedics practice. It allows practical physicians to build a clear algorithm of postoperative rehabilitation for this complicated cohort of patients with AD.
References:
1. Rakhimzhanova R. I., Abdrakhmanov J. S., Spichak L. V. Radiological diagnosis of aseptic necrosis of the femoral head.//Consilium. - 2010. - № 6. - S. 26-28.
2. Berry D. J., Halasy M. Uncementedacetabular components for arthritis after acetabular fracture.//Clin Orthop Relat Res. -2002. - P. 164-167.
3. Gary J. L., Van Hal M., Gibbons S. D., Reinert C. M., Starr A. J. Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation.//J Orthop Trauma. - 2012. - P. 278-83.
Yuldashev Sanjar Keldiyarovich, Republican specialized scientific-practice medical centre of obstetrics and gynecology Uzbekistan, junior scientific employee E-mail: [email protected]
Estimation a condition of blood cytokine profile at performing a conservative myomectomy
Abstract: In purpose on to studying of influence of operative techniques of conservative method of myomectomy at women of reproductive age on a cytokine state of blood profile in aspect of reduction of intraoperation surgical trauma of the tissue there have been made conservative myomectomy (CME) by laparatomy at 46 women with a uterine myoma on developed by us technique. Efficiency of a technique on the 3rd and 5th days of the postoperative period estimated with definition in dynamics of Interleukin 1, 6 and TNF-a level in blood. For 3rd days after the operational period in group ofwomen with which it has been made conservative myomectomy
117
