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

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Surgical mini-Scarf osteotomy in hallux valgus with biodegradable headless screws fixation 生物可降解无头螺钉固定术治疗拇外翻的微创截骨术
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-3-11-19
D. Davydov, A. A. Kerimov, I.V. Khominets, D. Grechukhin
The use of biodegradable implants is becoming increasingly popular, especially in operations on small bones of the skeleton, including operations on the anterior part of the foot. 23 surgical interventions were performed to correct the first metatarsal using the mini-Scarf technique and fixation of fragments with a biodegradable implant. All the operated patients did not have a severe radiological stage of osteoarthritis of the first metatarsophalangeal joint and stiffness. The results of treatment were evaluated using AOFAS and Groulier questionnaires. Out of 23 patients, it was possible to track and obtain data according to the questionnaires in 18 patients (78.3% (16 had grade III deformity (88.9%)). Six months after surgical treatment, the proportion of excellent and good results was 77.8% (14) according to the AOFAS questionnaire and 83.3% (15) according to the Groulier questionnaire. The achieved results suggest a favorable prognosis for the widespread use of magnesium oxide implants, however, further research and comparison of the results of treatment in patients with hallux valgus who underwent surgery with the use of standard titanium screws are needed.
生物可降解植入物的使用正变得越来越流行,特别是在骨骼小骨的手术中,包括脚前部的手术。采用mini-Scarf技术和可生物降解植入物固定碎片,对第一跖骨进行了23次手术干预。所有手术患者均无严重的第一跖趾关节骨关节炎的影像学分期和僵硬。采用AOFAS和Groulier问卷对治疗结果进行评价。在23例患者中,有18例(78.3%)患者(16例为III级畸形(88.9%))可以通过问卷跟踪和获取数据。术后6个月,根据AOFAS问卷,优良率为77.8%(14),根据Groulier问卷,优良率为83.3%(15)。所取得的结果表明氧化镁植入物的广泛应用预后良好,然而,需要进一步研究和比较使用标准钛螺钉的拇外翻手术患者的治疗结果。
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引用次数: 0
Selection criteria for patients with hepatocellular carcinoma for liver transplantation 肝癌患者肝移植的选择标准
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-1-50-56
M. Pitkevich, V. Breder, V. Kosyrev, I. Dzhanyan
The paper considers the selection criteria for liver transplantation for patients with hepatocellular carcinoma (HCC). Liver resection is an effective method of radical treatment in the early stages of HCC. However, severe liver cirrhosis precludes this method of therapy. For these patients, liver transplantation is a good alternative. The article discusses the problem of correct selection of patients for liver transplantation. Best practices in assessing various criteria for liver transplantation are described. Statistical data are provided. There are also examples of studies that analyze additional factors used as extended criteria for liver transplantation: AFP, PIVKA, the effectiveness of locoregional therapy. The article focuses on neoadjuvant therapy, presents the results of global research on neoadjuvant therapy, and emphasizes their importance.
探讨肝细胞癌(HCC)患者肝移植的选择标准。肝切除术是肝癌早期根治性治疗的有效方法。然而,严重的肝硬化排除了这种治疗方法。对于这些患者,肝移植是一个很好的选择。本文就肝移植患者的正确选择问题进行探讨。描述了评估各种肝移植标准的最佳实践。提供了统计数据。也有一些研究分析了用作肝移植扩展标准的其他因素:AFP、PIVKA、局部治疗的有效性。本文以新辅助治疗为重点,介绍了全球新辅助治疗的研究成果,并强调了其重要性。
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引用次数: 0
Effectiveness of endoscopic operations in vertebrology. Literature review 椎骨内窥镜手术的有效性。文献综述
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-1-57-62
S. V. Kolesov, Dmitrij S Gorbatyuk, Arkadij I Kazmin, Nataliya S Morozova , Samir B. Bagirov
In this literature review, an attempt was made to describe the main possibilities and limitations of arthroscopic spine surgery. The description is organized according to topographic principle, for each region of the spine (cervical, thoracic, lumbar). Arthroscopic interventions in vertebrology are a set of methods that are promising and gaining popularity. At present, the main scope of their application (and indication for treatment as well) is degenerative diseases of the spine that are associated with nerve structures’ compression. Arthroscopic methods allow, according to present data, to achieve better functional results than conventional ‘open’ surgical methods, including lower pain level at the postoperative period. The main issues for development of the methods are as follows: minimizing the working parts of the endoscope to be used for interventions at the cervical spine; avoidance of anatomic restrictions for operations on the thoracic spine; expanding the possibilities and indications for the method.
在这篇文献综述中,我们试图描述关节镜脊柱手术的主要可能性和局限性。描述是根据地形原则组织的,针对脊柱的每个区域(颈椎、胸椎、腰椎)。关节镜介入椎体学是一套很有前途和越来越受欢迎的方法。目前,它们的主要应用范围(以及治疗指征)是与神经结构压迫相关的脊柱退行性疾病。根据目前的数据,关节镜方法可以比传统的“开放”手术方法获得更好的功能结果,包括术后疼痛水平更低。该方法发展的主要问题如下:尽量减少内窥镜用于颈椎干预的工作部分;胸椎手术避免解剖限制;扩展了该方法的可能性和适应症。
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引用次数: 0
Trigger electromyography in endoscopic transnasal surgery of the skull base tumors 触发肌电图在内镜下经鼻颅底肿瘤手术中的应用
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2021-2-4(6)-12-18
A. Shkarubo, I. Chernov, A. Ogurtsova, V. Chernov
Preserving anatomical integrity and functions of cranial nerves when removing skull base tumors is one of the significant problems of endoscopic endonasal surgery. For this purpose, it is possible to use intraoperative mapping and cranial nerves identification. The aim of the study was to evaluatе the effectiveness of trigger electromyography (T-EMG) used to prevent iatrogenic damage to the cranial nerves intraoperatively. Twenty-one patients with different skull base tumors were included in the study. Mapping and identification of cranial nerves were carried out during tumor excision, using endoscopic endonasal access. Surgeries were performed on large skull-based chordomas, neuromas of the trigeminal nerve in the cavernous sinus region, pituitary adenomas, meningiomas in the clivus and a skull-based cholesteatoma. Mapping and identification of cranial nerves were carried out using electromyography in trigger mode using bipolar and monopolar electrodes. Functional activity of cranial nerves was evaluated both before and after the operation. The effectiveness of the technique was compared with that of the control group (41 patients). In the course of surgical interventions using T-EMG in the main group of patients, 40 nerves were analyzed. In the course of the study, III, V, VI, VII, XII cranial nerves were identified intraoperatively. In 4 patients in the main group and in 13 patients in the control group, a postoperative deficit of cranial nerves was observed. We did not receive statistically reliable data that the intraoperative identification of cranial nerves using T-EMG reduces the frequency of postoperative complications in the form of a deficiency of cranial nerves (p=0.11), but the ratio of chances (0.26) testifies in favor of rarely occurring complications in main group. Trigger electromyography allows us to estimate the functional state of the cranial nerves during endoscopic endonasal operations. The method of using T-EMG is promising and requires further research.
颅底肿瘤切除时如何保留脑神经的解剖完整性和功能是鼻内窥镜手术的重要问题之一。为此目的,可以使用术中绘图和颅神经识别。该研究的目的是评估触发肌电图(T-EMG)用于预防术中脑神经医源性损伤的有效性。21例不同颅底肿瘤患者纳入研究。在肿瘤切除过程中,使用内镜鼻内通道对脑神经进行定位和鉴定。手术治疗的病例包括:颅底大脊索瘤、海绵窦区三叉神经神经瘤、垂体腺瘤、斜坡脑膜瘤和颅底胆脂瘤。在触发模式下使用双极和单极电极进行肌电图绘制和识别脑神经。术前、术后观察脑神经功能活动。并与对照组(41例)进行比较。主组患者在手术干预过程中应用t -肌电图对40条神经进行分析。在研究过程中,术中对III、V、VI、VII、XII脑神经进行了识别。主组4例,对照组13例,术后出现颅神经缺损。术中使用T-EMG识别颅神经可以减少颅神经缺失的术后并发症发生的频率(p=0.11),我们没有得到统计学上可靠的数据,但机会比(0.26)证明主组很少发生并发症。触发肌电图使我们能够估计内窥镜鼻内手术时脑神经的功能状态。使用t -肌电图的方法是有前途的,需要进一步的研究。
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引用次数: 0
Principles of intensive therapy for gunshot wounds of the skull and brain 颅脑枪伤强化治疗原则
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-42-49
I. E. Onnicev, Valery V. Stets, E. G. Kolobaeva, Vladimir P. Antohov
With the modern development of battlefield medicine and air ambulance evacuation, the quality of medical care is undergoing changes. As for neurosurgical combat trauma, the provision of medical care for this patient population requires more specialization, closer to the front line and reduction of stages. The article summarizes the results of experience in the treatment of gunshot wounds to the head. The severity of injuries to the skull and brain on admission was assessed using the Injury Severity Score. The condition of 67% of those admitted was considered severe, the mortality rate was 0.8%, and the length of stay in the intensive care unit was 12 days. Extremely severe were 33% of the wounded, the mortality rate in this group was 2.2%, and the length of stay in the intensive care unit (ICU) was 31 days. When assessing the level of consciousness at our stage on the Glasgow coma scale, most of the wounded had a score of 6–8, which corresponds to a deep coma. Direct evacuation of the wounded to the specialized stage of care, computed tomography (CT), availability of a qualified neurosurgeon, the earliest possible decompressive craniotomy if indicated are the components of success in dealing with intracranial hypertension, the development of subsequent neurological deficit and reducing mortality. Nutritional support and antibiotic therapy are important components of intensive care in neuroresuscitation.
随着现代战场医学和空中救护后送的发展,医疗服务质量正在发生变化。至于神经外科战斗创伤,为这类患者提供医疗护理需要更加专业化,更接近前线,并缩短阶段。本文总结了头部枪伤的治疗经验。入院时颅骨和脑部损伤的严重程度使用损伤严重程度评分进行评估。入院患者中病情严重的占67%,死亡率为0.8%,重症监护病房住院时间为12天。重症患者占33%,死亡率2.2%,重症监护病房(ICU)住院时间31天。当在格拉斯哥昏迷量表上评估我们这个阶段的意识水平时,大多数伤者的得分为6-8分,这相当于深度昏迷。直接将伤员转移到专门的护理阶段,计算机断层扫描(CT),有资格的神经外科医生的可用性,如果有指征,尽早进行减压开颅手术是成功处理颅内高压的组成部分,随后的神经功能缺损的发展和降低死亡率。营养支持和抗生素治疗是神经复苏重症监护的重要组成部分。
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引用次数: 0
Clinical efficacy of nephroprotective effects of therapeutic plasmapheresis in angiosurgical interventions 治疗性血浆置换在血管外科干预中肾保护作用的临床疗效
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2023-4-2-19-24
O. Demchuk, Igor' V. Gumenyuk, Natal'ja D. Ushakova, S. Gladkaya, Vladislav O. Demchuk
The use of therapeutic plasmapheresis in the early postoperative period after angiosurgical interventions has a nephroprotective effect, which reduces the frequency and severity of acute postoperative reperfusion injury to the kidneys, improves the results of treatment of this category of patients.
血管外科术后早期应用治疗性血浆置换具有肾保护作用,降低了术后急性肾再灌注损伤的发生频率和严重程度,提高了该类患者的治疗效果。
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引用次数: 0
Non transfusion dependent thalassaemia: conventional and novel therapy 非输血依赖性地中海贫血:传统和新疗法
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-2-48-59
C. Asadov
This literature review attempts to describe modern approaches to the diagnosis and therapy of non transfusion dependent thalassaemia (NTDT). NTDT has a wide clinical spectrum. The clinical polymorphism of the disease is due to genetic heterogeneity. There are three major factors, which are responsible for the clinical manifestations of NTDT: ineffective erythropoiesis, chronic anemia, and iron overload. Untreated NTDT is the cause of various complications: splenomegaly, gallstones, extramedullary erythropoiesis, kidney stones, lower limbs trophic ulcers, thrombophilia, pulmonary hypertension, endocrine complications, iron overload, bone abnormalities, osteoporosis. Traditional therapy for NTDT include splenectomy, transfusion therapy, stimulation of fetal hemoglobin (HbF) synthesis, and bone marrow transplantation. However, due to the limitations and challenges associated with available conventional therapies, novel methods are currently being developed. These include: JAK2 inhibition, hepcidin modulation, TMPRSS6 inhibition, apo-transferrin, HIF2 inhibition, Activin receptor-II trap ligands, ferroportin inhibitors.
这篇文献综述试图描述现代方法的诊断和治疗非输血依赖性地中海贫血(NTDT)。NTDT具有广泛的临床范围。该疾病的临床多态性是由于遗传异质性。造成NTDT临床表现的主要因素有三个:红细胞生成无效、慢性贫血和铁超载。未经治疗的NTDT是各种并发症的原因:脾肿大,胆结石,髓外红细胞生成,肾结石,下肢营养性溃疡,血栓形成,肺动脉高压,内分泌并发症,铁超载,骨异常,骨质疏松症。NTDT的传统治疗包括脾切除术、输血治疗、刺激胎儿血红蛋白(HbF)合成和骨髓移植。然而,由于现有常规疗法的局限性和挑战,目前正在开发新的方法。这些包括:JAK2抑制,hepcidin调节,TMPRSS6抑制,载铁转铁蛋白,HIF2抑制,激活素受体- ii陷阱配体,铁转运蛋白抑制剂。
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引用次数: 0
70 years of the neurosurgical clinic of the Hospital named after N.N. Burdenko. Accumulated experience in the treatment of gunshot wounds of the central and peripheral nervous systems 以n·n·布登科命名的医院的神经外科诊所已有70年的历史。积累了治疗中枢和周围神经系统枪伤的经验
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-4-32-41
S. Gizatullin, I.N. Isengaliev, M. Ovchinnikova
The article highlights the historical aspects of the origin of neurosurgery as a specialty within the walls of the Main Military Clinical Hospital named after Academician N.N. Burdenko. Based on the clinical experience of the neurosurgical center, the principles of diagnosis and surgical treatment of gunshot wounds of the central and peripheral nervous systems are described.
这篇文章强调了神经外科作为主要军事临床医院内以院士n·n·布登科命名的专业起源的历史方面。根据神经外科中心的临床经验,阐述了中枢和周围神经系统枪伤的诊断和手术治疗原则。
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引用次数: 0
Correlations of CT signs of COVID-19 viral pneumonia with phases of diffuse alveolar damage COVID-19病毒性肺炎CT征象与弥漫性肺泡损伤分期的相关性
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-3-38-44
Vasilij V. Parshin, D. A. Lezhnev, El'vira E. Berezhnaya, A. V. Mishina
A computed tomography (CT) is the leading diagnostic technique in identifying detailed and specific signs of coronavirus infection (CI). The objective of the work is to correlate between the typical set of signs that occur during CI and the phases of diffuse alveolar damage (DAD). The volume of lung lesions in 78 patients was retrospectively evaluated. All the patients had lung CT from 1 to 3 day before death. 14 patients had a targeted comparison of 3 signs «ground-glass, crazy paving pattern and consolidation» with the phases of DAD. It was found that the «ground glass» feature is most characterized by the exudative phase (lasting up to 8 days), the «crazy paving pattern» by the exudative-proliferative phase (up to 10 days), the consolidation by the proliferative phase (lasting from 8 to 20 days). According to these scientific data, CT-lung can be a prognostic factor of histological phases of DAD and their duration, which in turn may be one of the predictors of a negative prognosis and the onset of death in pneumonia caused by SARS-CoV-2 (COVID-19).
计算机断层扫描(CT)是识别冠状病毒感染(CI)详细和特定症状的主要诊断技术。这项工作的目的是在CI期间发生的典型体征与弥漫性肺泡损伤(DAD)的阶段之间建立关联。回顾性评估78例患者的肺病变体积。所有患者死前1 ~ 3天均行肺部CT检查。14例患者有针对性地比较了3个征象“磨玻璃,疯狂铺路模式和巩固”与DAD的阶段。研究发现,“磨砂玻璃”特征以渗出期(持续时间长达8天)、渗出-增殖期(持续时间长达10天)的“疯狂铺装模式”和增殖期的固结(持续时间为8 ~ 20天)为特征。根据这些科学数据,CT-lung可能是DAD的组织学分期及其持续时间的预后因素,而组织学分期及其持续时间可能是SARS-CoV-2 (COVID-19)引起的肺炎的阴性预后和死亡发病的预测因素之一。
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引用次数: 0
Hemodynamic monitoring in liver transplantation 肝移植血流动力学监测
Pub Date : 1900-01-01 DOI: 10.53652/2782-1730-2022-3-2-36-43
Sergej V. Zhuravel, Natal'ya K. Kuznecova, Viktoriya E. Stacura, P. V. Gavrilov, I. I. Goncharova
Hemodynamic monitoring is an important part of the anesthetic management in liver transplantation. Currently, there is no unified algorithm for the assessment of the cardiovascular system parameters. The article describes the criteria for the presence or absence of the necessity of using routine or additional invasive monitoring methods.
血流动力学监测是肝移植麻醉管理的重要组成部分。目前,心血管系统参数的评估还没有统一的算法。本文描述了是否有必要使用常规或额外的侵入性监测方法的标准。
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引用次数: 0
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Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko
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