Клінічний досвід лікування та реабілітації пацієнтів з гетеротопічною осифікацією ампутаційних кукс внаслідок мінно-вибухового поранення

Abstract

SummaryPurpose – to study the peculiarities of the clinical course and treatment ofservicemen (anti-terroristic operation/Joint Forces operation participants) withheterotopic ossification (HO) of amputation stumps as a result of a mine-explosivewound by clinical case reports.Materials and methods. Retrospectively, for the period from 26.12.2016 to12.05.2020, an analysis of clinical cases (n=2) of HO of amputation stumps after mineexplosive wounds was carried out in military personnel who were treated in theDepartment of rehabilitation of patients with amputated limbs of the Military MedicalClinical Treatment and Rehabilitation Center.Results. In the first clinical case, there was a HO of the amputation stump at thelevel of the middle third of the hip. In the second case, the HO of the amputation stumpat the level of the middle third of the shin was observed. The diagnosis of HO wasconfirmed by X-ray and histology. Both patients had a history of traumatic amputationdue to a mine blast wound. The period from the moment of injury to the onset of clinicalsymptoms (pain syndrome and induration) ranged from 1 to 8 months. In both cases,successful surgical removal of HO was performed. In order to prevent the re-formationof HO, a course of non-steroid anti-inflammatiry drugs (NSAIDs) was carried out for 10days. Management of patients with HO in amputation stumps included a multiprofessional approach and development of an individual rehabilitation program.Conclusion. Considering the mine-explosive nature of contemporary combattrauma, the peculiarities of clinical manifestations (pain syndrome, soft tissuecompaction, limitation of the use of the culprit) as well as additional X-ray examinationmethods, are obligatory to exclude the diagnosis of amputation stump HO. Presentedclinical cases indicate that the formation of HO can vary from 1 to 8 months. The goldstandard of diagnostics is X-ray, and for early diagnosis – multispiral computedtomography and magnetic resonance imaging. Surgical removal of HO is the mainmethod of treatment followed by a postoperative course of NSAIDs in order to preventthe re-formation of HO.