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Not knowing this essential coverage for high risk customer. The thing is that we forget is the equivalent of owning and operating a vehicle with a good plan youthe road. The car is also another feature that turns out that they will have better driving records. Уточнить объем необходимых диагностических исследований при повреждениях тазобедренного сустава 3. Разработать схему лечения повреждений шейки бедренной кости у соматически отягощенных пациентов 4 Определить оптимальную тактику при переломах и переломо-вывихах головки бедренной кости 5 Определить наиболее предпочтительные сроки и необходимый объем оперативного вмешательства при переломах вертлужной впадины 6 Внедрить методику репозиции переломов вертлужной впадины с применением специального репонирующего устройства 7 Определить сферу применения эндопротезирования тазобедренного сустава при его повреждениях 8 Создать единый лечебно-диагаостический алгоритм оказания стационарной медицинской помощи пациентам с повреждениями тазобедренного сустава 9 Провести анализ лечения, проведенного пациентам по нашей системе, и разработать на этой основе рекомендации дня практического здравоохранения Научная новизна исследования.
I Впервые определен подход к лечению повреждений тазобедренного сустава как единой функционально-анатомической области, имеющей крайне важное значение для качества жизни пациентов Создана рабочая классификация, учитывающая как характер повреждений, так и индивидуальные особенности пациентов На базе этой классификации стало возможным объективное прогнозирование максимально достижимого функционального результата в каждом конкретном случае, что легло в основу выбора рациональной лечебной тактики 2.
Впервые разработан метод раннего закрытого шинирования при переломах шейки бедренной кости, позволивший избежать гипостатических осложнений, более безопасно для пациентов и эффективно провести раннюю активизацию или предоперационную подготовку 3. Разработан модифицированный доступ к задним отделам вертлужной впадины. Применено специальное репонирующее устройство для операций по поводу переломов дна вертлужной впадины со смещением 5 Создан единый лечебно-диагностический алгоритм оказания медицинской помощи и реабилитации пациентов с переломами тазобедренного сустава, в котором интегрированы наиболее эффективные и рациональные методы, определено их место, возможности, показания и противопоказания Практическая значимость и реализация результатов исследования.
Использование результатов проведенного исследования позволяет в первые сутки с момента обращения пациента в стационар определить максимально достижимый функциональный результат, на основе чего избрать рациональную тактику с учетом не только характера повреждения, но и индивидуальных общесоматических, социальных, психологических особенностей.
М Сеченова Основные положения, выносимые на защиту. Главной задачей лечения является в ряде случаев не полное, а максимально возможное восстановление нарушенной в результате травмы функции тазобедренного сустава Для решения этой задачи могут и должны быть использованы не только хирургические, но и консервативные, функциональные методы, определенные в каждом клиническом случае индивидуально. Разработанный метод раннего перкутанного внутреннего шинирования переломов шейки бедра позволяет значительно уменьшить число посттравматических осложнений у пациентов пожилого и старческого возраста 4 Предложенная методика малоинвазивного остеосинтеза шейки бедра с использованием специального канюлированного стилета и направителя позволяет увеличить операционную активность в лечении пациентов пожилого и старческого возраста 5 Применение репонирующего устройства позволяет уменьшить травма-тичность операции при остеосинтезе переломов дна вертлужной впадины 6 Выбор рациональной тактики в лечении пациентов с переломами области тазобедренного сустава должен быть основан на использовании единого алгоритма, направленного на достижение максимально возможного функционального результата Апробация работы.
По материалам диссертации опубликовано 32 научные работы Объем работы. Диссертация изложена на страницах, состоит из введения, обзора литературы, 7 глав собственных исследований, заключения, выводов, практических рекомендаций и списка литературы, содержащего источника отечественных и зарубежных Приведены 91 таблица и 94 рисунка Работа выполнена на кафедре травматологии, ортопедии и хирургии катастроф Московской медицинской академии им И М Сеченова.
Возраст пациентов составил от 17 до 92 лет, средний возраст - 61,8 лет Однако если при переломах шейки бедра пациентов активного трудоспособного возраста было меньше 14, то при переломах вертлужной впадины они составляли почти 3А Диагностика. Противошоковую терапию остановка кровотечения, обезболивание, иммобилизация, инфузионно-трансфузионная терапия проводили всем нуждающимся в ней пациентам, особенно часто - при политравме Метод ранней активизации применяли у тех пациентов, которым по тяжести соматического статуса были противопоказаны другие более эффективные методы лечения Во всех случаях раннюю активизацию рассматривали как вынужденную меру, неизбежно приводящую к ухудшению ортопедического результата лечения.
С первых дней пациента на фоне анальгетической терапии и профилактики эмболических осложнений учили сидеть в постели, затем -вставать и передвигаться с помощью костылей или ходунков. Скелетное вытяжение в качестве основного метода лечения применяли при некоторых вариантах переломов головки бедра и вертлужной впадины. Некоторые операции эндопротезирования выполнены через малоинвазивный доступ.
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