Abstract
Results of surgical treatment of 35 victims who had received serious blunt open and closed injuries of hand were analyzed. All injuries of hand were divided into three types, depending on mechanism and circumstances of trauma. On the basis of the data received at direct measurement of compartment pressure, indirect signs of a menacing ischemia of intrinsic muscles have been defined, and the technique of preventive maintenance of an ischemic lesion of own hand muscles were developed. High efficiency of the offered medical approaches at the expense of the maximum restoration of function of the injured extremity was proved.
Highlights
ÎÐÈÃÈÍÀËÜÍÛÅ ÑÒÀÒÜÈÏÐÎÔÈËÀÊÒÈÊÀ ÏÎÑÒÒÐÀÂÌÀÒÈ×ÅÑÊÈÕ ÈØÅÌÈ×ÅÑÊÈÕ ÊÎÍÒÐÀÊÒÓÐ Ó ÏÎÑÒÐÀÄÀÂØÈÕ Ñ ÒßÆÅËÛÌÈ ÏÎÂÐÅÆÄÅÍÈßÌÈ ÊÈÑÒÈ.
Äàííîå îáñòîÿòåëüñòâî ÿâëÿåòñÿ âàæíåéøèì ïóñêîâûì çâåíîì â ðàçâèòèè èøåìè÷åñêèõ êîíòðàêòóð êèñòè, ïîñêîëüêó ïðèâîäèò ê âîçíèêíîâåíèþ èøåìèè åå ñîáñòâåííûõ ìûøö è ïîñëåäóþùåé èõ ãèáåëè â òå÷åíèå ïåðâûõ 46 ÷àñîâ ïîñëå òðàâìû [6].
Íåäîîöåíêà çíà÷èìîñòè äàííîé ïðîáëåìû ïðèâîäèò ê òîìó, ÷òî îáúåì íåîòëîæíûõ ìåðîïðèÿòèé ñïåöèàëèçèðîâàííîé òðàâìàòîëîãè÷åñêîé ïîìîùè ïîñòðàäàâøèì ñ òÿæåëûìè òðàâìàìè êèñòè, âîçíèêøèìè â ðåçóëüòàòå âîçäåéñòâèÿ òóïîé òðàâìèðóþùåé ñèëû, çà÷àñòóþ îãðàíè÷èâàåòñÿ ëèøü âîññòàíîâëåíèåì ïîâðåæäåííûõ îáðàçîâàíèé, à ïðè çàêðûòîé òðàâìå ãèïñîâîé èììîáèëèçàöèåé ñåãìåíòà áåç âûïîëíåíèÿ åãî äåêîìïðåññèè.
Summary
ÏÐÎÔÈËÀÊÒÈÊÀ ÏÎÑÒÒÐÀÂÌÀÒÈ×ÅÑÊÈÕ ÈØÅÌÈ×ÅÑÊÈÕ ÊÎÍÒÐÀÊÒÓÐ Ó ÏÎÑÒÐÀÄÀÂØÈÕ Ñ ÒßÆÅËÛÌÈ ÏÎÂÐÅÆÄÅÍÈßÌÈ ÊÈÑÒÈ. Äàííîå îáñòîÿòåëüñòâî ÿâëÿåòñÿ âàæíåéøèì ïóñêîâûì çâåíîì â ðàçâèòèè èøåìè÷åñêèõ êîíòðàêòóð êèñòè, ïîñêîëüêó ïðèâîäèò ê âîçíèêíîâåíèþ èøåìèè åå ñîáñòâåííûõ ìûøö è ïîñëåäóþùåé èõ ãèáåëè â òå÷åíèå ïåðâûõ 46 ÷àñîâ ïîñëå òðàâìû [6]. Íåäîîöåíêà çíà÷èìîñòè äàííîé ïðîáëåìû ïðèâîäèò ê òîìó, ÷òî îáúåì íåîòëîæíûõ ìåðîïðèÿòèé ñïåöèàëèçèðîâàííîé òðàâìàòîëîãè÷åñêîé ïîìîùè ïîñòðàäàâøèì ñ òÿæåëûìè òðàâìàìè êèñòè, âîçíèêøèìè â ðåçóëüòàòå âîçäåéñòâèÿ òóïîé òðàâìèðóþùåé ñèëû, çà÷àñòóþ îãðàíè÷èâàåòñÿ ëèøü âîññòàíîâëåíèåì ïîâðåæäåííûõ îáðàçîâàíèé, à ïðè çàêðûòîé òðàâìå ãèïñîâîé èììîáèëèçàöèåé ñåãìåíòà áåç âûïîëíåíèÿ åãî äåêîìïðåññèè. Â-òðåòüèõ, ñóùåñòâóþùèå èíñòóìåíòàëüíûå ìåòîäèêè ïðÿìîãî èçìåðåíèÿ äàâëåíèÿ â ôàñöèàëüíûõ ôóòëÿðàõ êèñòè äîñòàòî÷íî ñëîæíû äëÿ ïðèìåíåíèÿ â óñëîâèÿõ ïðèåìíûõ îòäåëåíèé ìåäèöèíñêèõ ó÷ðåæäåíèé, à îñîáåííî äëÿ ìîíèòîðèíãà åãî êîëåáàíèé â ïåðèîä ñòàöèîíàðíîãî ëå÷åíèÿ òàêèõ ïîñòðàäàâøèõ. Ÿâèëàñü ðàçðàáîòêà íàó÷íî îáîñíîâàííûõ óñîâåðøåíñòâîâàííûõ ëå÷åáíî-òàêòè÷åñêèõ ïîäõîäîâ, íàïðàâëåííûõ íà ïðîôèëàêòèêó ïîñòòðàâìàòè÷åñêèõ èøåìè÷åñêèõ êîíòðàêòóð ó ïîñòðàäàâøèõ ñ òÿæåëûìè ïîâðåæäåíèÿìè êèñòè Ó ñïåöèàëèñòîâ äî ñèõ ïîð íå ñóùåñòâóåò åäèíûõ âçãëÿäîâ, êàñàþùèõñÿ îïðåäåëåíèÿ îïòèìàëüíîãî îáúåìà ëå÷åáíûõ ìåðîïðèÿòèé íåîòëîæíîé ñïåöèàëèçèðîâàííîé ïîìîùè, íàïðàâëåííûõ íà ïðîôèëàêòèêó ðàçâèòèÿ èøÖåìåèë÷üåþñêäèàõííêîîãíîòðèàñêñòëóåðäîêâèàñíòèèÿ. ÿâèëàñü ðàçðàáîòêà íàó÷íî îáîñíîâàííûõ óñîâåðøåíñòâîâàííûõ ëå÷åáíî-òàêòè÷åñêèõ ïîäõîäîâ, íàïðàâëåííûõ íà ïðîôèëàêòèêó ïîñòòðàâìàòè÷åñêèõ èøåìè÷åñêèõ êîíòðàêòóð ó ïîñòðàäàâøèõ ñ òÿæåëûìè ïîâðåæäåíèÿìè êèñòè
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