首页 > 最新文献

Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko最新文献

英文 中文
Nomogram M validity assessment for predicting multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass 预测选择性心脏手术合并体外循环后多器官功能衰竭和急性肾损伤的Nomogram M效度评估
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-3-30-37
L. Berikashvili, A. V. Smirnova, E. A. Laricheva, Nadezhda D. Gracheva, Kristina K. Kadanceva, Mihail Ya. Yadgarov, A. Grechko
Purpose. To evaluate the predictive value of nomogram M for multiple organ failure (MOF) and acute kidney injury (AKI) after elective cardiac surgery with cardiopulmonary bypass. Materials and methods. This was a retrospective cohort study. The predictive value of nomogram M for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass was evaluated using ROC-analysis. Results. The sample size was 158 patients. The incidence of AKI was 5.7% (9 of 158 patients). The incidence of MOF was 3.8% (6 of 158 patients). AUC nomogram M for AKI was 0.714 [95% CI: 0.555–0.874] (p=0.031); the cut-off value was 12,5 points; the sensitivity was 66.67% and specificity was 82.55%; the odds ratio was 9.46 (95% CI: 2.22–40.30) (p<0.001). AUC nomogram M for MOF was 0.770 [95% CI: 0.594–0.946] (p=0.025); the cut-off value was 12,5 points; the sensitivity was 83.33% and specificity was 82.24%; the odds ratio was 23.15 (95% CI: 2.60–206.20) (p<0.001). Conclusion. Nomogram M has an acceptable predictive value for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass based on the results of the ROC-analysis.
目的。探讨M图对择期心脏手术合并体外循环术后多器官功能衰竭(MOF)和急性肾损伤(AKI)的预测价值。材料和方法。这是一项回顾性队列研究。采用roc分析评价M图对择期心脏手术合并体外循环术后多器官功能衰竭和急性肾损伤的预测价值。结果。样本量为158例。AKI发生率为5.7%(158例患者中有9例)。MOF的发生率为3.8%(6 / 158)。AKI的AUC图M为0.714 [95% CI: 0.555-0.874] (p=0.031);临界值为12.5点;敏感性为66.67%,特异性为82.55%;优势比为9.46 (95% CI: 2.22 ~ 40.30) (p<0.001)。MOF的AUC图M为0.770 [95% CI: 0.594-0.946] (p=0.025);临界值为12.5点;敏感性为83.33%,特异性为82.24%;优势比为23.15 (95% CI: 2.60 ~ 206.20) (p<0.001)。结论。根据roc分析结果,Nomogram M对于选择性心脏手术合并体外循环后多器官功能衰竭和急性肾损伤具有可接受的预测价值。
{"title":"Nomogram M validity assessment for predicting multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass","authors":"L. Berikashvili, A. V. Smirnova, E. A. Laricheva, Nadezhda D. Gracheva, Kristina K. Kadanceva, Mihail Ya. Yadgarov, A. Grechko","doi":"10.53652/2782-1730-2022-3-3-30-37","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-3-30-37","url":null,"abstract":"Purpose. To evaluate the predictive value of nomogram M for multiple organ failure (MOF) and acute kidney injury (AKI) after elective cardiac surgery with cardiopulmonary bypass. Materials and methods. This was a retrospective cohort study. The predictive value of nomogram M for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass was evaluated using ROC-analysis. Results. The sample size was 158 patients. The incidence of AKI was 5.7% (9 of 158 patients). The incidence of MOF was 3.8% (6 of 158 patients). AUC nomogram M for AKI was 0.714 [95% CI: 0.555–0.874] (p=0.031); the cut-off value was 12,5 points; the sensitivity was 66.67% and specificity was 82.55%; the odds ratio was 9.46 (95% CI: 2.22–40.30) (p<0.001). AUC nomogram M for MOF was 0.770 [95% CI: 0.594–0.946] (p=0.025); the cut-off value was 12,5 points; the sensitivity was 83.33% and specificity was 82.24%; the odds ratio was 23.15 (95% CI: 2.60–206.20) (p<0.001). Conclusion. Nomogram M has an acceptable predictive value for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass based on the results of the ROC-analysis.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"165 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133318694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of non-small cell lung cancer using radiation therapy 非小细胞肺癌的放射治疗
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-2-18-24
A. R. Gevorkian, Aleksej V. Smolin
The article is devoted to the use of a combination of systemic and radiation therapy in patients with locally advanced non-small cell lung cancer (NSCLC). The high risk of latent metastasis in this category of patients sets the prerequisites for active research of the combination of radiation therapy and systemic treatment worldwide. The article presents the results of clinical studies aimed to find the most optimal ratio of efficacy and safety of the chemotherapeutic component of chemoradiotherapy (CRT). According to the results of the research, the authors prefer the use of schemes based on platinum doublets. The article discusses the evaluation of the effectiveness of chemoradiotherapy with escalation of the radiation dose to the tumor within the framework of the concept of a personalized approach to therapy of patients with NSCLC. The article also pays attention to the description of new possibilities for RT intensification and the introduction of new RT methods, the use of which became possible with the introduction of innovative linear accelerators. The results of comparing the effectiveness of combined chemoradiotherapy with immunotherapy and chemo radiotherapy alone in patients with lung NSCLC are presented.
本文致力于在局部晚期非小细胞肺癌(NSCLC)患者中使用全身和放射联合治疗。这类患者潜在转移的高风险为全球积极研究放射治疗与全身治疗相结合奠定了前提条件。本文介绍了临床研究的结果,旨在找到放化疗(CRT)中化疗成分的疗效和安全性的最佳比例。根据研究结果,作者更倾向于使用基于铂重态的方案。本文讨论了在非小细胞肺癌患者个性化治疗的概念框架下,随着肿瘤放射剂量的增加,放化疗的有效性评估。本文还关注了RT强化的新可能性的描述和新的RT方法的引入,这些方法的使用随着创新线性加速器的引入而成为可能。本文报道了肺非小细胞肺癌患者联合放化疗与单独免疫治疗和放化疗疗效的比较结果。
{"title":"Treatment of non-small cell lung cancer using radiation therapy","authors":"A. R. Gevorkian, Aleksej V. Smolin","doi":"10.53652/2782-1730-2022-3-2-18-24","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-2-18-24","url":null,"abstract":"The article is devoted to the use of a combination of systemic and radiation therapy in patients with locally advanced non-small cell lung cancer (NSCLC). The high risk of latent metastasis in this category of patients sets the prerequisites for active research of the combination of radiation therapy and systemic treatment worldwide. The article presents the results of clinical studies aimed to find the most optimal ratio of efficacy and safety of the chemotherapeutic component of chemoradiotherapy (CRT). According to the results of the research, the authors prefer the use of schemes based on platinum doublets. The article discusses the evaluation of the effectiveness of chemoradiotherapy with escalation of the radiation dose to the tumor within the framework of the concept of a personalized approach to therapy of patients with NSCLC. The article also pays attention to the description of new possibilities for RT intensification and the introduction of new RT methods, the use of which became possible with the introduction of innovative linear accelerators. The results of comparing the effectiveness of combined chemoradiotherapy with immunotherapy and chemo radiotherapy alone in patients with lung NSCLC are presented.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128563190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of calculated glomerular filtration rate before and after endovascular correction of renal artery stenosis against the background of resistant vasorenal arterial hypertension 抵抗性血管肾动脉高血压背景下肾动脉狭窄血管内矫正前后计算肾小球滤过率的评价
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2023-4-1-7-11
A. Fursov, Nikolaj P. Potekhin, Elena G. Zakharova, T. G. Makeeva, A. V. Gaydukov, Konstanin Yu. Gorodnichev
Atherosclerotic stenosis of the renal arteries is the most common cause of renovascular hypertension (RVHT) among middle-aged and elderly people. In this survey a comparative analysis of the calculated glomerular filtration rate (cGFR) in a patient with resistant renovascular hypertension (RVHT) before and after endovascular correction of atherosclerotic renal artery stenosis is given. The medical records (medical history) of 44 patients (34 men, 10 women) with RVHT were analyzed. The criterion for inclusion in the study was renal artery stenosis of more than 75% of the vessel diameter. The mean age of the patients was 50.7±7.2 years. All patients had unilateral lesion of the renal arteries. Patients were divided into three groups according to the initial level of cGFR. The patients were divided into three groups according to initial cGFR value: Group 1 included 12 patients with cGFR over 90 ml/min/1.73 m2, Group 2 — 19 patients with cGFR from 89 to 60 ml/min/1.73 m2, Group 3 — 13 patients with cGFR from 59 to 45 ml/min/1.73 m2. It was revealed that the level of blood pressure after endovascular correction of stenosis decreased significantly among all patients. At the same time, among the patients with initially preserved cGFR (from 90 ml/min/1.73 m2 and more), there was an improvement in the functional state of the kidneys, a decrease in the number of antihypertensive drugs from 3–5 to a 3-component regimen. Among the patients with initially minimally reduced cGFR (less than 90 ml/min/1.73 m2), the functional state of the kidneys did not change, and among the patients with cGFR less than 60 ml/min/1.73 m2, this state continued to worsen progressively; antihypertensive therapy did not change. During the 2-year follow-up period, restenosis of the renal arteries according to duplex scanning was not observed. When deciding whether to perform endovascular interventions for atherosclerotic stenosis of the renal arteries, it is advisable to take into account the calculated GFR data.
肾动脉粥样硬化性狭窄是中老年人肾血管性高血压(RVHT)最常见的原因。本文对顽固性肾血管性高血压(RVHT)患者行动脉粥样硬化性肾动脉狭窄血管内矫正术前后计算的肾小球滤过率(cGFR)进行了比较分析。分析44例RVHT患者(男34例,女10例)的病历(病史)。纳入研究的标准是肾动脉狭窄超过血管直径的75%。患者平均年龄50.7±7.2岁。所有患者均有单侧肾动脉病变。根据初始cfr水平将患者分为三组。根据初始cGFR值将患者分为3组:1组cGFR≥90ml /min/1.73 m2 12例,2组cGFR≥89 ~ 60ml /min/1.73 m2 19例,3组cGFR≥59 ~ 45ml /min/1.73 m2 13例。结果显示,所有患者血管内狭窄矫正术后血压水平均明显下降。同时,在初始保存cGFR(从90 ml/min/1.73 m2及以上)的患者中,肾脏功能状态有所改善,降压药的数量从3-5种减少到3种。在初始cGFR最低降低(小于90 ml/min/1.73 m2)的患者中,肾脏功能状态未发生改变,而在cGFR小于60 ml/min/1.73 m2的患者中,肾脏功能状态继续进行性恶化;抗高血压治疗没有改变。2年随访期间,双相扫描未见肾动脉再狭窄。在决定是否对肾动脉粥样硬化性狭窄进行血管内介入治疗时,建议考虑计算出的GFR数据。
{"title":"Evaluation of calculated glomerular filtration rate before and after endovascular correction of renal artery stenosis against the background of resistant vasorenal arterial hypertension","authors":"A. Fursov, Nikolaj P. Potekhin, Elena G. Zakharova, T. G. Makeeva, A. V. Gaydukov, Konstanin Yu. Gorodnichev","doi":"10.53652/2782-1730-2023-4-1-7-11","DOIUrl":"https://doi.org/10.53652/2782-1730-2023-4-1-7-11","url":null,"abstract":"Atherosclerotic stenosis of the renal arteries is the most common cause of renovascular hypertension (RVHT) among middle-aged and elderly people. In this survey a comparative analysis of the calculated glomerular filtration rate (cGFR) in a patient with resistant renovascular hypertension (RVHT) before and after endovascular correction of atherosclerotic renal artery stenosis is given. The medical records (medical history) of 44 patients (34 men, 10 women) with RVHT were analyzed. The criterion for inclusion in the study was renal artery stenosis of more than 75% of the vessel diameter. The mean age of the patients was 50.7±7.2 years. All patients had unilateral lesion of the renal arteries. Patients were divided into three groups according to the initial level of cGFR. The patients were divided into three groups according to initial cGFR value: Group 1 included 12 patients with cGFR over 90 ml/min/1.73 m2, Group 2 — 19 patients with cGFR from 89 to 60 ml/min/1.73 m2, Group 3 — 13 patients with cGFR from 59 to 45 ml/min/1.73 m2. It was revealed that the level of blood pressure after endovascular correction of stenosis decreased significantly among all patients. At the same time, among the patients with initially preserved cGFR (from 90 ml/min/1.73 m2 and more), there was an improvement in the functional state of the kidneys, a decrease in the number of antihypertensive drugs from 3–5 to a 3-component regimen. Among the patients with initially minimally reduced cGFR (less than 90 ml/min/1.73 m2), the functional state of the kidneys did not change, and among the patients with cGFR less than 60 ml/min/1.73 m2, this state continued to worsen progressively; antihypertensive therapy did not change. During the 2-year follow-up period, restenosis of the renal arteries according to duplex scanning was not observed. When deciding whether to perform endovascular interventions for atherosclerotic stenosis of the renal arteries, it is advisable to take into account the calculated GFR data.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124933743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sequential external osteosynthesis of gunshot fractures of limb bones at the stages of medical evacuation 医疗后送阶段枪炮性肢体骨折的顺序外植骨
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2023-4-1-22-31
Aleksandr A. Artemev, A. A. Kerimov, Sergej N. Perehodov, Maksim A. Grigoriev, Maksim N. Nelin, S. V. Torshina
Staged treatment of the patients with gunshot fractures of long bones implies a differentiated approach to the choice of different methods and means of extremity immobilization taking into account their peculiarities and functional capabilities. The frequency of different types of osteosynthesis in specialized care of 212 wounded patients with 276 gunshot fractures of long bones who were immobilized with external fixation devices (EFD) at the stage of advanced care was analyzed. It was revealed that when performing sequential osteosynthesis, preference for internal constructions was given — 122 (44.2%) observations. External osteosynthesis with Ilizarov apparatus (IA) was second most frequently used — 87 (31.5%). EFD was used as the definitive method of treatment in 67 (24.3%) cases. We studied and compared the constructive and functional capabilities of EFD and IA. The main advantage of the Ilizarov apparatus is the ability to control the position of the fragments and influence the process of regeneration by creating compression and distraction forces. The advantage of the EFD is the simplicity of use and, accordingly, the possibility of rapid fixation of the limb in resource-poor conditions with the simultaneous admission of a considerable number of wounded patients. Application of IA implies complex reconstructive interventions with prolonged subsequent treatment and rehabilitation. It should be taken into account when organizing staged treatment and use the type of osteosynthesis that corresponds to a particular stage. When providing qualified care, the use of EFD is absolutely indicated; when performing complex reconstructive operations of specialized trauma care, it is advisable to use the capabilities of the Ilizarov method.
对长骨枪击骨折患者进行分期治疗,需要根据患者的特点和功能选择不同的固定方法和手段。分析了212例276例长骨枪弹骨折患者在晚期护理阶段采用外固定装置(EFD)固定的专科护理中不同类型的植骨频率。结果显示,在进行顺序骨固定时,有122(44.2%)的观察结果显示,优先选择内部结构。使用Ilizarov体外植骨器(IA)的次之,为87例(31.5%)。67例(24.3%)采用EFD作为最终治疗方法。我们研究并比较了EFD和IA的构建能力和功能。Ilizarov装置的主要优点是能够控制碎片的位置,并通过产生压缩和分散力来影响再生过程。EFD的优点是使用简单,因此,在资源贫乏的情况下,在同时收治大量受伤患者的情况下,可以快速固定肢体。IA的应用意味着复杂的重建干预和长期的后续治疗和康复。在组织分阶段治疗时应考虑到这一点,并使用与特定阶段相对应的骨固定类型。在提供合格的护理时,绝对需要使用EFD;在进行复杂的创伤专科重建手术时,建议使用Ilizarov方法的功能。
{"title":"Sequential external osteosynthesis of gunshot fractures of limb bones at the stages of medical evacuation","authors":"Aleksandr A. Artemev, A. A. Kerimov, Sergej N. Perehodov, Maksim A. Grigoriev, Maksim N. Nelin, S. V. Torshina","doi":"10.53652/2782-1730-2023-4-1-22-31","DOIUrl":"https://doi.org/10.53652/2782-1730-2023-4-1-22-31","url":null,"abstract":"Staged treatment of the patients with gunshot fractures of long bones implies a differentiated approach to the choice of different methods and means of extremity immobilization taking into account their peculiarities and functional capabilities. The frequency of different types of osteosynthesis in specialized care of 212 wounded patients with 276 gunshot fractures of long bones who were immobilized with external fixation devices (EFD) at the stage of advanced care was analyzed. It was revealed that when performing sequential osteosynthesis, preference for internal constructions was given — 122 (44.2%) observations. External osteosynthesis with Ilizarov apparatus (IA) was second most frequently used — 87 (31.5%). EFD was used as the definitive method of treatment in 67 (24.3%) cases. We studied and compared the constructive and functional capabilities of EFD and IA. The main advantage of the Ilizarov apparatus is the ability to control the position of the fragments and influence the process of regeneration by creating compression and distraction forces. The advantage of the EFD is the simplicity of use and, accordingly, the possibility of rapid fixation of the limb in resource-poor conditions with the simultaneous admission of a considerable number of wounded patients. Application of IA implies complex reconstructive interventions with prolonged subsequent treatment and rehabilitation. It should be taken into account when organizing staged treatment and use the type of osteosynthesis that corresponds to a particular stage. When providing qualified care, the use of EFD is absolutely indicated; when performing complex reconstructive operations of specialized trauma care, it is advisable to use the capabilities of the Ilizarov method.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114484029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of a combined gunshot wound with a defect of the humerus and radial nerve (clinical observation) 一例肱骨桡神经缺损合并枪伤的治疗(临床观察)
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-57-64
V. Sukharev, I.V. Khominets, E.A. Kukushko, Denis I. Vaskul
Treatment of patients with gunshot bone and soft tissue defects of the extremities requires non-standard approaches and the participation of doctors of various specialties. The application of additive and microsurgical technologies allows one-stage restoration of bone defects and functionally important soft tissue formations. Objective: To demonstrate the possibilities of modern reconstructive-plastic surgery in combination with additive 3D-technology in the treatment of patients with severe gunshot wounds of the extremities. Clinical case: a patient with a combined wound of the chest and upper limb with a primary defect of the humerus and radial nerve. Treatment was based on damage control surgery (DCS) and damage control orthopedic (DCO) tactics. X-ray, computed tomography, and angiography were used for diagnostics and preoperative planning. Based on the CT data, a 3D model of the autograft, resection templates, and a metal structure for osteosynthesis were made. After stabilization of the general condition of the wounded man and elimination of the risk of infectious complications, a one-stage replacement of the radial nerve defect at the level of the middle third of the shoulder with a gastrocnemius nerve autograft was performed; the upper and middle third humeral bone defect was replaced with a free blood-supplied fibula autograft with osteosynthesis using an individual 3D plate with bacteriostatic hydroxyapatite spraying in combination with zinc. А positive anatomical and functional outcome was achieved in the treatment of a patient with a gunshot defect of the humerus and radial nerve. An individual complex approach combined with innovative technologies makes it possible to achieve good anatomical and functional results in the treatment of patients with primary combined limb gunshot defects.
四肢枪弹性骨软组织缺损患者的治疗方法不规范,需要各专科医生的参与。添加剂和显微外科技术的应用使得骨缺损和功能重要的软组织形成的一期修复成为可能。目的:探讨现代重建整形手术结合3d打印技术治疗四肢严重枪伤的可能性。临床病例:1例胸上肢合并创面,肱骨及桡神经缺损为主。治疗基于损伤控制手术(DCS)和损伤控制矫形术(DCO)策略。x线,计算机断层扫描和血管造影用于诊断和术前计划。根据CT数据,制作了自体移植物的三维模型,切除模板和用于骨固定的金属结构。在稳定了受伤者的一般情况并消除了感染并发症的风险后,采用自体腓肠肌神经一期置换肩部中三分之一处的桡神经缺损;肱骨上、中第三节骨缺损采用游离供血的自体腓骨移植物置换,并使用单独的3D钢板与抑菌羟基磷灰石喷射结合锌进行植骨。А在治疗肱骨和桡神经枪弹缺损患者中取得了积极的解剖和功能结果。个体复杂的方法与创新技术相结合,可以在治疗原发性合并肢体枪击缺陷患者中获得良好的解剖和功能结果。
{"title":"Treatment of a combined gunshot wound with a defect of the humerus and radial nerve (clinical observation)","authors":"V. Sukharev, I.V. Khominets, E.A. Kukushko, Denis I. Vaskul","doi":"10.53652/2782-1730-2022-3-4-57-64","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-57-64","url":null,"abstract":"Treatment of patients with gunshot bone and soft tissue defects of the extremities requires non-standard approaches and the participation of doctors of various specialties. The application of additive and microsurgical technologies allows one-stage restoration of bone defects and functionally important soft tissue formations. Objective: To demonstrate the possibilities of modern reconstructive-plastic surgery in combination with additive 3D-technology in the treatment of patients with severe gunshot wounds of the extremities. Clinical case: a patient with a combined wound of the chest and upper limb with a primary defect of the humerus and radial nerve. Treatment was based on damage control surgery (DCS) and damage control orthopedic (DCO) tactics. X-ray, computed tomography, and angiography were used for diagnostics and preoperative planning. Based on the CT data, a 3D model of the autograft, resection templates, and a metal structure for osteosynthesis were made. After stabilization of the general condition of the wounded man and elimination of the risk of infectious complications, a one-stage replacement of the radial nerve defect at the level of the middle third of the shoulder with a gastrocnemius nerve autograft was performed; the upper and middle third humeral bone defect was replaced with a free blood-supplied fibula autograft with osteosynthesis using an individual 3D plate with bacteriostatic hydroxyapatite spraying in combination with zinc. А positive anatomical and functional outcome was achieved in the treatment of a patient with a gunshot defect of the humerus and radial nerve. An individual complex approach combined with innovative technologies makes it possible to achieve good anatomical and functional results in the treatment of patients with primary combined limb gunshot defects.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124176528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Application of activated conditioned plasma in patients with macular rupture 活化条件血浆在黄斑破裂患者中的应用
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-2-26-34
V. A. Pavlov, V. E. Kurnosov, Sergey A. Zinovyev, Aleksandr A. Kapatsina, E. Utkina
Objective. To evaluate and summarize the results, as well as to conduct a comparative analysis of the treatment of patients with macular rupture with autoplasm, using a Rotofix 32A Centrifuge and Arthrex ACP systems to obtain autologous conditioned plasma (АСР) with previously used surgical methods. Material and methods. The study conducted a comparative analysis of the results of treatment of patients with macular rupture, with a corrected visual acuity of more than 0.08 (according to the Golovin–Sivtsev table). Group 1 (prospective analysis) included the results of treatment using peeling of the inner boundary membrane with a gas/air tamponade in combination with the application of AСР (4 eyes, 4 patients). In the 2nd group (retrospective analysis of the medical history), surgical treatment was limited to the peeling of the inner boundary membrane with a gas/air tamponade (8 eyes, 8 patients). The parameters were analyzed after 3.0±0.5 and 6.0±0.5 months with assessment of maximum corrected visual acuity (MCOZ), optical coherence tomography (OCT), color photography. Closure of the macular gap was assessed at 6 months of follow-up when comparing the groups. Results. No complications were detected in both groups during the observation period. According to visometry and OCT data, the best functional results were obtained in group 1. The average visual acuity after 6 months was 0.4±0.1. Conclusion. The study found that the use of the peeling of the inner boundary membrane with gas/air tamponade and the use of platelet-derived mass increased the probability of rupture closure.
目标。为了评估和总结结果,并对黄斑破裂伴自体浆患者的治疗进行比较分析,使用Rotofix 32A离心机和Arthrex ACP系统获得自体条件血浆(АСР)与先前使用的手术方法。材料和方法。本研究对黄斑破裂患者的治疗结果进行了对比分析,矫正视力在0.08以上(根据Golovin-Sivtsev表)。第1组(前瞻性分析)包括使用气体/空气填塞去除内边界膜并应用AСР治疗的结果(4眼,4例)。在第二组(回顾性病史分析)中,手术治疗仅限于用气体/空气填塞剥离内边界膜(8眼,8例)。术后3.0±0.5、6.0±0.5个月分别进行最大矫正视力(MCOZ)、光学相干断层扫描(OCT)、彩色摄影等指标分析。在6个月的随访中评估各组的黄斑间隙闭合情况。结果。两组患者观察期间均未发生并发症。根据粘度测定和OCT数据,1组的功能效果最好。6个月后平均视力为0.4±0.1。结论。研究发现,使用气体/空气填塞去除内边界膜和使用血小板来源的肿块增加了破裂闭合的可能性。
{"title":"Application of activated conditioned plasma in patients with macular rupture","authors":"V. A. Pavlov, V. E. Kurnosov, Sergey A. Zinovyev, Aleksandr A. Kapatsina, E. Utkina","doi":"10.53652/2782-1730-2022-3-2-26-34","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-2-26-34","url":null,"abstract":"Objective. To evaluate and summarize the results, as well as to conduct a comparative analysis of the treatment of patients with macular rupture with autoplasm, using a Rotofix 32A Centrifuge and Arthrex ACP systems to obtain autologous conditioned plasma (АСР) with previously used surgical methods. Material and methods. The study conducted a comparative analysis of the results of treatment of patients with macular rupture, with a corrected visual acuity of more than 0.08 (according to the Golovin–Sivtsev table). Group 1 (prospective analysis) included the results of treatment using peeling of the inner boundary membrane with a gas/air tamponade in combination with the application of AСР (4 eyes, 4 patients). In the 2nd group (retrospective analysis of the medical history), surgical treatment was limited to the peeling of the inner boundary membrane with a gas/air tamponade (8 eyes, 8 patients). The parameters were analyzed after 3.0±0.5 and 6.0±0.5 months with assessment of maximum corrected visual acuity (MCOZ), optical coherence tomography (OCT), color photography. Closure of the macular gap was assessed at 6 months of follow-up when comparing the groups. Results. No complications were detected in both groups during the observation period. According to visometry and OCT data, the best functional results were obtained in group 1. The average visual acuity after 6 months was 0.4±0.1. Conclusion. The study found that the use of the peeling of the inner boundary membrane with gas/air tamponade and the use of platelet-derived mass increased the probability of rupture closure.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129904862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of gunshot wounds of extremities using physical and orthobiological methods 肢体枪伤的物理与骨科治疗
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-5-15
D. Davydov, A. A. Kerimov, V.D. Besedin, Dar'ya A. Naida, Georgij G. Ivanov, M. A. Shchedrina
Currently, despite the wide possibilities in the treatment of wounds, patients with gunshot wounds of the extremities present a complex surgical task. The study included 60 patients with gunshot wounds of the extremities who underwent inpatient examination and treatment at the Center of Traumatology and Orthopedics of the Main Military Clinical Hospital named after academician N.N. Burdenko of Ministry of Defence of the Russian Federation. The patients were divided into groups. In group I, physical methods of treatment were used, such as vacuum therapy (35 people), of which 19 patients underwent combined vacuum therapy with laser irradiation of the wound (group IA), 16 patients underwent vacuum therapy in combination with high-intensity pulsed optical irradiation (group IB). Group II included patients in whom orthobiological techniques were used in the complex treatment of wounds (25 patients), including platelet-enriched fibrin glue — in 13 patients (group IIA) and a composition of heterogeneous implantable gel SpheroGEL® in the LONG version (hereinafter SpheroGEL®) — in 12 patients (group IIB). Results. Comparison of the results of the treatment revealed a significant improvement in the regenerative process according to the histological method in group IA: the maturation of mature granulation tissue was observed on the 9th day after the application of local treatment methods. Positive adhesive and wound healing effects were observed in group IIA. According to the "AnalyRan" program, there was a significant reduction in the time of wound healing in all groups under study. According to the results of the study, all techniques showed positive dynamics of wound healing and reduction of the inflammatory process.
目前,尽管伤口治疗的可能性很大,但四肢枪伤患者的手术任务很复杂。该研究包括60名四肢枪伤患者,他们在以俄罗斯联邦国防部n·n·布尔登科院士命名的主要军事临床医院创伤和骨科中心接受住院检查和治疗。病人被分成几组。I组采用物理治疗方法,如真空治疗(35人),其中真空治疗联合激光照射创面19例(IA组),真空治疗联合高强度脉冲光照射16例(IB组)。II组包括使用骨科技术进行伤口复杂治疗的患者(25例),其中13例患者(IIA组)使用富含血小板的纤维蛋白胶,12例患者(IIB组)使用异质植入凝胶SpheroGEL®in LONG版本(以下简称SpheroGEL®)。结果。经组织学方法比较,IA组再生过程明显改善:局部处理方法应用后第9天观察成熟肉芽组织成熟。IIA组有良好的粘附和创面愈合效果。根据“AnalyRan”程序,在所研究的所有组中,伤口愈合时间均显着减少。根据研究结果,所有技术都显示出伤口愈合和炎症过程减少的积极动态。
{"title":"Treatment of gunshot wounds of extremities using physical and orthobiological methods","authors":"D. Davydov, A. A. Kerimov, V.D. Besedin, Dar'ya A. Naida, Georgij G. Ivanov, M. A. Shchedrina","doi":"10.53652/2782-1730-2022-3-4-5-15","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-5-15","url":null,"abstract":"Currently, despite the wide possibilities in the treatment of wounds, patients with gunshot wounds of the extremities present a complex surgical task. The study included 60 patients with gunshot wounds of the extremities who underwent inpatient examination and treatment at the Center of Traumatology and Orthopedics of the Main Military Clinical Hospital named after academician N.N. Burdenko of Ministry of Defence of the Russian Federation. The patients were divided into groups. In group I, physical methods of treatment were used, such as vacuum therapy (35 people), of which 19 patients underwent combined vacuum therapy with laser irradiation of the wound (group IA), 16 patients underwent vacuum therapy in combination with high-intensity pulsed optical irradiation (group IB). Group II included patients in whom orthobiological techniques were used in the complex treatment of wounds (25 patients), including platelet-enriched fibrin glue — in 13 patients (group IIA) and a composition of heterogeneous implantable gel SpheroGEL® in the LONG version (hereinafter SpheroGEL®) — in 12 patients (group IIB). Results. Comparison of the results of the treatment revealed a significant improvement in the regenerative process according to the histological method in group IA: the maturation of mature granulation tissue was observed on the 9th day after the application of local treatment methods. Positive adhesive and wound healing effects were observed in group IIA. According to the \"AnalyRan\" program, there was a significant reduction in the time of wound healing in all groups under study. According to the results of the study, all techniques showed positive dynamics of wound healing and reduction of the inflammatory process.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"11 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124616143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical tactics in cases with large wounds of soft tissue of limbs and pelvis 四肢及骨盆软组织大创伤的手术策略
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-16-23
V. Badalov, I.M. Samohvalov, Valerij S. Koskin, Aleksandr N. Petrov, Aleksandr A. Rud’, M. Borisov
In modern armed conflicts the incidence of multiple and combined limb wounds with extensive wound defects of the limbs and pelvis remains high and tends to increase [1]. Such wounds are accompanied by prolonged treatment period, high frequency of wound infection development (up to 35–80%), impossibility of early internal osteosynthesis and early rehabilitation, and rather high incidence of disability [2–4]. The closure of extensive defects in combination with the wound management algorithm in the early posttraumatic period reduces blood and plasma loss, the development of endotoxicosis and wound infection, significantly improves the results and outcomes of treatment, increasing the efficiency of wound healing and reducing the duration of patient treatment.
在现代武装冲突中,四肢和骨盆广泛创面缺损的多发和合并肢体创伤的发生率仍然很高,并有增加的趋势[1]。这类创面治疗时间长,创面感染发生频率高(可达35-80%),无法早期内固定和早期康复,致残率较高[2-4]。创伤后早期广泛缺损的闭合结合伤口管理算法,减少了血液和血浆的流失,减少了内毒素中毒和伤口感染的发生,显著改善了治疗的效果和结局,提高了伤口愈合的效率,缩短了患者的治疗时间。
{"title":"Surgical tactics in cases with large wounds of soft tissue of limbs and pelvis","authors":"V. Badalov, I.M. Samohvalov, Valerij S. Koskin, Aleksandr N. Petrov, Aleksandr A. Rud’, M. Borisov","doi":"10.53652/2782-1730-2022-3-4-16-23","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-16-23","url":null,"abstract":"In modern armed conflicts the incidence of multiple and combined limb wounds with extensive wound defects of the limbs and pelvis remains high and tends to increase [1]. Such wounds are accompanied by prolonged treatment period, high frequency of wound infection development (up to 35–80%), impossibility of early internal osteosynthesis and early rehabilitation, and rather high incidence of disability [2–4]. The closure of extensive defects in combination with the wound management algorithm in the early posttraumatic period reduces blood and plasma loss, the development of endotoxicosis and wound infection, significantly improves the results and outcomes of treatment, increasing the efficiency of wound healing and reducing the duration of patient treatment.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121215531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Significance of microvascular reconstruction in treatment of gunshot wounds of the face 微血管重建在面部枪伤治疗中的意义
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-50-56
Sergei V. Tereshchuk, Evgenij A. Vasil'yev
Efficient Combat Casualty Care System aims at saving lives of the wounded as well as regaining their quality of life at the highest possible level. This article provides the data on using revascularized grafts to repair gunshot defects, presents data on the proportion, cause, severity and nature of facial wounds. We also give here recommendations on treatment modalities in these patients. In between the 1 March and the 1 November 2022 in the Center of maxillofacial surgery and dentistry of Main Military Hospital named after N.N. Burdenko we performed 54 reconstructions, 47 of which were microvascular utilizing 49 free flaps. Despite good vasculature in the face, it lacks soft tissues for closing vast gunshot defects. Damaged with high energy projectiles the tissue of the face gives poor bedding to the alloplastic implants, resulting in their exposure. Contemporary level of microvascular technique gives the plastic surgeon an efficient instrument for closing the gunshot defects in early wound healing period. We do not recommend using regional tissues to treat gunshot defects in the first place, because they are usually insufficient to fully resolve the defect, and at the same time it leads to a violation of the anatomy and even greater deformation of the soft tissues surrounding the defect. Titanium re constructive and mesh plates are associated with high rate of exposure in the bone defects and are not to be recommended for the reconstruction either.
有效的战斗伤亡护理系统旨在挽救伤员的生命,并在尽可能高的水平上恢复他们的生活质量。本文介绍了用带血管的移植物修复面部枪弹缺损的情况,介绍了面部创伤的比例、原因、严重程度和性质。我们也在这里给出了这些患者的治疗方式的建议。在2022年3月1日至11月1日期间,在以N.N. Burdenko命名的主要军队医院颌面外科和牙科中心,我们进行了54次重建,其中47次是微血管,使用49个自由皮瓣。尽管脸部有良好的血管系统,但缺乏软组织来修补大面积的枪伤缺陷。在高能弹丸的破坏下,面部组织为同种异体植入物提供了不良的垫层,导致其暴露。当代微血管技术水平为整形外科医生在伤口愈合早期闭合枪伤缺损提供了一种有效的工具。我们不建议首先使用局部组织来治疗枪弹缺损,因为它们通常不足以完全解决缺损,同时它会导致违反解剖结构,甚至导致缺损周围软组织更大的变形。钛重建板和网状板与骨缺损的高暴露率有关,也不建议用于重建。
{"title":"Significance of microvascular reconstruction in treatment of gunshot wounds of the face","authors":"Sergei V. Tereshchuk, Evgenij A. Vasil'yev","doi":"10.53652/2782-1730-2022-3-4-50-56","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-50-56","url":null,"abstract":"Efficient Combat Casualty Care System aims at saving lives of the wounded as well as regaining their quality of life at the highest possible level. This article provides the data on using revascularized grafts to repair gunshot defects, presents data on the proportion, cause, severity and nature of facial wounds. We also give here recommendations on treatment modalities in these patients. In between the 1 March and the 1 November 2022 in the Center of maxillofacial surgery and dentistry of Main Military Hospital named after N.N. Burdenko we performed 54 reconstructions, 47 of which were microvascular utilizing 49 free flaps. Despite good vasculature in the face, it lacks soft tissues for closing vast gunshot defects. Damaged with high energy projectiles the tissue of the face gives poor bedding to the alloplastic implants, resulting in their exposure. Contemporary level of microvascular technique gives the plastic surgeon an efficient instrument for closing the gunshot defects in early wound healing period. We do not recommend using regional tissues to treat gunshot defects in the first place, because they are usually insufficient to fully resolve the defect, and at the same time it leads to a violation of the anatomy and even greater deformation of the soft tissues surrounding the defect. Titanium re constructive and mesh plates are associated with high rate of exposure in the bone defects and are not to be recommended for the reconstruction either.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122987227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic treatment of degenerative spinal canal stenosis 退变性椎管狭窄的内镜治疗
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-1-33-42
D. N. Abukov, V. Cherebillo, A. K. Dulaev, D. V. Goranchuk, Z. Y. Alikov, Ramis A. Aslanov
Microsurgical decompression technique has been regarded as the standard surgical method in degenerative spinal diseases to date. The conventional method may lead to instability and lead to chronic lower back pain due to injury of facet joints, posterior ligamentous complex, as well as paraspinal muscles. To avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article. The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic. Study design: retrospective study. One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients were divided into 3 groups according to the clinical condition: 1st group — patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2nd group — patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3rd group — patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in accordance with modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), also postoperative complications were analyzed. There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm and did not require further treatment. No cases of infectious complications were identified. Biportal endoscopic surgery can be considered an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technique can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.
显微外科减压技术一直被认为是治疗脊柱退行性疾病的标准手术方法。传统的方法可能会导致关节突关节、后韧带复合体和棘旁肌损伤,导致不稳定和慢性腰痛。为了避免这些并发症,我们在临床实践中引入了新的双门静脉内窥镜技术。自2019年以来,我们一直在广泛使用这种技术,并首次在俄罗斯积累了独特的经验,使我们能够完成这篇文章。本研究的目的是证明一种新的双门静脉内窥镜脊柱手术技术在治疗退行性腰椎疾病中的可能性,并报告在我们的临床应用该技术的结果。研究设计:回顾性研究。研究纳入了102例腰椎退行性疾病引起的神经系统症状患者。所有患者根据临床情况分为3组:第一组为退行性中枢性椎管狭窄患者,采用单侧入路行双门静脉内窥镜双侧减压;第二组为椎间孔椎管狭窄患者,采用椎间孔外入路行双门静脉内窥镜椎间孔切开术;第三组为退行性单节段不稳、退行性或峡部滑脱患者,采用双门静脉内窥镜腰椎体间融合术。按照改良macnab标准、Oswestry残疾指数(ODI)、数字评定量表(NRS)分析临床结果,并分析术后并发症。三组患者疼痛综合征动态、ODI评分均有显著改善。根据McNab量表,各组均无不良结果。硬膜切开4例。在所有病例中,硬膜切开不超过3毫米,不需要进一步治疗。未发现感染性并发症病例。双门静脉内窥镜手术可以被认为是传统的腰椎减压和脊柱融合显微手术技术的替代方法。使用该技术可以显著减少肌肉创伤,达到充分的减压,减少感染并发症的发生频率。
{"title":"Endoscopic treatment of degenerative spinal canal stenosis","authors":"D. N. Abukov, V. Cherebillo, A. K. Dulaev, D. V. Goranchuk, Z. Y. Alikov, Ramis A. Aslanov","doi":"10.53652/2782-1730-2022-3-1-33-42","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-1-33-42","url":null,"abstract":"Microsurgical decompression technique has been regarded as the standard surgical method in degenerative spinal diseases to date. The conventional method may lead to instability and lead to chronic lower back pain due to injury of facet joints, posterior ligamentous complex, as well as paraspinal muscles. To avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article. The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic. Study design: retrospective study. One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients were divided into 3 groups according to the clinical condition: 1st group — patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2nd group — patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3rd group — patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in accordance with modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), also postoperative complications were analyzed. There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm and did not require further treatment. No cases of infectious complications were identified. Biportal endoscopic surgery can be considered an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technique can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"79 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120874451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1