Keywords
інтрамедулярний блоковий остеосинтез, тактичні помилки, перелом, довга кістка, розсвердлювання
интрамедуллярный блокирующий остеосинтез, тактические ошибки, перелом, длинная кость, рассверливание
How to Cite
Abstract
COMPLICATIONS IN BLOCKING INTRAMEDULLARY OSTEOSYNTHESIS (review)
Mansyrov A.B. Ogly, Lytovchenko V., Berezka M., Garyachiy Ye., Rami A.F. Almasri
Treatment of diaphyseal bone fractures is a complicated, controversial and ambiguous task. Blocking intramedullary osteosynthesis, which became the standard of treatment, is also not perfect and accompanied by a number of complications. The reasons for their occurrence are connected both with defects in the organization of treatment of patients, and with tactical mistakes, the definition, generalization and prevention of which became the purpose of our study. It was found that typical tactical mistakes were: use of the method against the indications, non-compliance with the technology of blocking intramedullary osteosynthesis and the use of unsubstantiated and inadequate "proprietary methods", making their own "modifications" during the surgery and changing the course of operative intervention, excessive drilling of the bone marrow canal, significant intraoperative traumatism of bone fragments and surrounding soft tissues, incorrect type of lock or timely unfulfilled dynamization, lack of consistency and restorative and rehabilitative treatment. But the most negative effect on the anatomical recovery of the bone and functional recovery of the extremity was the bone marrow canal drilling, performed without the corresponding indications and technical disadvantages. It is obvious that the violation of the endostosis of the endostal negative effect on the reparative capabilities of bone tissue, inhibits the process of bone grafting and delay recovery. Therefore, there is no doubt that the further study of the effect of bone marrow duct penetration in the course of reparative osteogenesis is relevant and appropriate.
Key words: blocking intramedullary osteosynthesis, tactical mistakes, fracture, long bones, drilling.
Резюме.
УСКЛАДНЕННЯ ІНТРАМЕДУЛЯРНОГО БЛОКУЮЧОГО ОСТЕОСИНТЕЗУ (огляд)
Мансиров А.Б. Огли, Литовченко В.О., Березка М.І., Гарячий Є.В., Рами A.Ф. Аль-масри
Лікування діафізарних переломів кісток кінцівок є складним, спірним та неоднозначним завданням. Інтрамедулярний блокуючий остеосинтез, який став стандартом їх лікування, також не позбавлений недоліків і супроводжується низкою ускладнень. Причини їх виникнення пов'язані як з дефектами організації лікування хворих, так і з тактичними помилками, визначення, узагальнення та попередження яких і стали метою нашого дослідження. Виявлено, що типовими тактичними помилками є використання методу проти показань, недотримання технології інтрамедулярного блокуючого остеосинтезу та використання необгрунтованих та неадекватних «авторських» методик, внесення власних «поправок» під час виконання операції та зміна ходу оперативного втручання, надлишкове розсвердлювання кістково-мозкового каналу, значна інтраопераційна травматизація кісткових уламків та оточуючих м'яких тканин, невірний тип блокування або вчасно невиконана динамізація, відсутність послідовності у відновному та реабілітаційному лікуванні. Але найбільш негативний вплив на анатомічне відновлення кістки та функціональне відновлення кінцівки мало розсвердлювання кістково-мозкового каналу, виконане без відповідних на те показань і з технічними недоліками. Очевидно, що порушення цілосності ендосту негативно впливає на репаративні можливості кісткової тканини, гальмує процес кісткового зрощення та відтерміновує одужання. Тому не викликає сумнівів, що подальше вивчення впливу розсвердлювання кістково-мозкового каналу на перебіг репаративного остеогенезу є актуальним та доцільним.
Ключові слова: інтрамедулярний блоковий остеосинтез, тактичні помилки, перелом, довга кістка, розсвердлювання.
Резюме.
ОСЛОЖНЕНИЯ ИНТРАМЕДУЛЛЯРНОГО БЛОКИРУЮЩЕГО ОСТЕОСИНТЕЗА (огляд)
Мансыров А.Б. Оглы, Литовченко В.А., Березка Н.И., Гарячий Е.В., Рами A.Ф. Аль-масри
Лечение диафизарных переломов костей конечностей является сложной, спорной и неоднозначной задачей. Интрамедуллярный блокирующий остеосинтез, который стал стандартом их лечения, также имеет недостатки и сопровождается рядом осложнений. Причины их возникновения связаны как с дефектами в организации лечения больных, так и с тактическими ошибками. Поэтому целью исследования было их определение, обобщение и пути предупреждения. Установлено, что типичными тактическими ошибками были: применение метода без показаний, нарушение его технологии и применение необоснованных и неадекватных «авторских» методик, внесение собственных «поправок» во время выполнения операции и изменение хода оперативного вмешательства, избыточное рассверливание костно-мозгового канала, значительная интраоперационная травматизация костных отломков и окружающих мягких тканей, неправильно выбранный тип блокирования или не вовремя выполненная динамизация, отсутствие преемственности в восстановительном и реабилитационном лечении. Однако наиболее негативное влияние на анатомическое восстановление кости и функциональное восстановление конечности имело рассверливание костно-мозгового канала, выполненное без соответствующих показаний и с техническими огрехами. Очевидно, что нарушение целостности эндоста негативно влияет на репаративные возможности костной ткани, тормозит процесс костного сращения и отдаляет выздоровление.Поэтому не вызывает сомнений, что дальнейшее изучение влияния рассверливания костно-мозгового канала на течение репаративного остеогенеза является актуальным и целесообразным.
Ключевые слова: интрамедуллярный блокирующий остеосинтез, тактические ошибки, перелом, длинная кость, рассверливание.
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