Results Of Surgical Treatment Research Articles

Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children.

Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial. The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis. Retrospective single-center cohort study. A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information. There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493). The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.

Effect of preoperative body mass index on the outcomes of growth-friendly surgical treatment in patients with early-onset scoliosis

Effect of preoperative body mass index on the outcomes of growth-friendly surgical treatment in patients with early-onset scoliosis

Exercise therapy results of postoperativ treated critical iliac artery stenosis (TASC II A and B) patients who were infected with the Covid 19

Introduction: Adequate individual physical activity after COVID 19 infection as a inevitable part of postoperative therapy of surgically treated vascular and endovascular patients witch still remains a scientific unexplored international neglected secret. General post-covid symptomatology is increasingly present in patients with surgical or endovascular procedures on the iliac segment in the form of a manifestation of various complaints that can affect the very accessibility of the choice of treatment according to the TASC II guidelines, but also affect physical activity and quality of life. Besides the medicament treatment, the management of moderate intensity exercise therapy and future consistency of self-controlled exercise after surgical and endovascular after treatment in iliac critic stenosis with other asymptomatic systemic atherosclerosis can be important factor to support and improve benefits of surgical and endovascular treatment outcome in variable symptomatology of POSTCOVID 19 patients treated classical surgical and endovascular. Goals: The focus is on priority of investigation of remodeling the pattern of cultural smoking behavior and increasing the dynamic of physical activity trying to prevent and avoid potential risk of sudden death, myocardial infarction, stroke graft (stent) occlusion, and cardiovascular mortality in patients with POSTCOVID 19 symptomatology in which is besides other asymptomatic systemic atherosclerosis is the main disease critical iliac artery stenosis (TASC II A and B). Scientifically unproven that sometimes can be associated with poor outcome of surgical intervention the which are in deficit with scientific studies to confirm these scientific observations. Second goals are to investigate the potential possibility of POST COVID 19 symptomatology associated with the success of classic surgical bypass or endovascular intervention and the possibility of reflection on physical activity after vascular intervention. Also the improving and secure the quality of life after successful surgical bypass and endovascular revascularization treatment with influence on primary iliac (TASC II A and B) vascular intervention potency one of main goals as well suppress permanent or permanent consequences of the Covid 19 virus during therapeutic surgical or endovascular procedures of the iliac segment (TASC II A and B) Traditional food as well wrong choice of diet and continuous fight with nicotinism is still remains generally main health threat. Subjects and Methods: 266 Symptomatic post COVID 19 Patients with were observed during 3 years (134 patients with surgical dacron reconstruction and 132 with endovascular treatmant of short segment critical iliac artery stenosis) Moderate interval Intensity Training with Short Interval Repetitions on standard treadmill procedure. Results: The connection of the outcome of surgical and endovascular treatment with post and long covid 19 symptomatology is possible and has a significant impact on the quality of the continuation of physical medication therapy. Difference between the surgical and endovascular groups was observed after the implementation of the treatment as well as factors affecting the outcome of therapy. the outcome is devastating with the prevention of the risk factor of nicotism as well as with the lack of physical activity in some groups. Conclusion: Primary potency after Three years of Endovascular procedure and Dacron bypass Revascularization, has shown as successful with support of supervised exercise training in POSTCOVID 19 patients. Nicotiism still remains highly potency outcome threat when supporting exercise therapy. Also, future and recent studies on this topic should expand their understanding of the effect of the COVID 19 virus on the body in this patients, as well as improving the quality of life in order to improve the patency of bypass or endovascular intervention on the arterial iliac segment.

Diagnostic challenges in low-grade central osteosarcoma.

Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder's grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome. Based on imaging, 35 of 49 patients (71.4%) exhibited malignant features. Overall, 40 of 49 patients (81.6%) had undergone a biopsy before en-bloc resection: 27 of 40 patients (67.5%) were diagnosed on the first biopsy, which was more accurate when carried out by open rather than needle biopsy (91.3% vs 35.3% diagnostic accuracy, respectively; p < 0.001). Of the 40 patients treated by en-bloc resection, surgical margins were wide in 38 (95.0%) and marginal in two (5.0%). Furthermore, nine of 49 patients (18.4%) underwent curettage (intralesional margin) without previous biopsy. All patients with a positive margin developed local recurrence. Distant metastases occurred in five of 49 patients (10.2%). The mean five-year overall survival (OS) and distant relapse-free survival (D-RFS) were 89.3% (SD 5.1%) and 85.7% (SD 5.5%), respectively. Univariate analysis showed that the occurrence of distant metastasis was a poor prognostic factor for OS (hazard ratio 11.54, 95% confidence interval (CI) 1.92 to 69.17; p < 0.001). Local recurrence was a poor prognostic factor for D-RFS (HR 8.72, 95% CI 1.69 to 45.0; p = 0.002). The diagnosis of LGCOS can be challenging because it may present with non-malignant features and has a low diagnostic accuracy on biopsy. If precisely diagnosed, LGCOS can be successfully treated by surgical excision with wide margins.

Clinical outcomes of surgical treatment of degenerative cervical myelopathy; A long-term follow up study

Clinical outcomes of surgical treatment of degenerative cervical myelopathy; A long-term follow up study

Transscleral fixation of intraocular lens in the treatment of lens subluxation in children

This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation. The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated. All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors. The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.

Cardiopulmonary resuscitation at operating room entry in acute aortic dissection type A patients: is surgery contraindicated?

This study aimed to compare the short-term outcomes of surgical treatment for acute type A aortic dissection between patients undergoing cardiopulmonary arrest at the time of entry into the operating room and patients who received successful preoperative cardiopulmonary resuscitation before entering the operating room or patients who had cardiopulmonary arrest on the operating room table after entering the operating room without cardiopulmonary arrest. In the present study, we focused on the circulatory status at the time of entering the operating room because it is economically and emotionally difficult to cease intervention once the patient has entered the operating room, where surgeons, anesthesiologists, nurses, and perfusionists are already present, all necessary materials are packed off and cardiopulmonary bypass have already been primed. Twenty (5.5%) of 362 patients who underwent surgical treatment for acute type A aortic dissection between January 2016 and March 2022 had preoperative cardiopulmonary arrest. To compare the early operative outcomes, the patients were divided into the spontaneous circulation group (n = 14, 70.0%) and the non-spontaneous circulation group (n = 6, 30.0%) based on the presence or absence of spontaneous circulation upon entering the operating room. The primary endpoint was postoperative 30-day mortality. The secondary endpoints included in-hospital complications and persistent neurological disorders. Thirty-day mortality was 65% (n = 13/20) in the entire cohort; 50% (n = 7/14) in the spontaneous circulation group and 100% (n = 6/6) in the non-spontaneous circulation group. The major cardiopulmonary arrest causes were aortic rupture and cardiac tamponade (n = 16; 80.0%), followed by coronary malperfusion (n = 4; 20.0%). Seven patients (50.0%) survived in the spontaneous circulation group, and none survived in the non-spontaneous circulation group (P = .044). Five survivors walked unaided and were discharged home; the remaining two were comatose and paraplegic. The outcomes were extremely poor in patients with acute type A aortic dissection who had preoperative cardiopulmonary arrest and received ongoing cardiopulmonary resuscitation at entry into the operating room. Therefore, surgical treatment might be contraindicated in such patients.

Хирургический лазер 450 нм в лечении заболеваний верхних дыхательных путей

The use of modern laser systems has contributed to the enhancement of the quality and immediate outcomes of surgical treatment for patients with chronic laryngeal diseases. The benefits of laser surgery, such as asepsis, bloodlessness, and rapid onset of clinical effects, are ensured by the device technical characteristics and the physical properties of the generated waves. In laryngological practice, laser radiation with a wavelength of 450±10 nm is actively employed, and its efficacy continues to be studied. We present our experience with the surgical treatment of 10 patients with various pharynx and larynx disorders. All patients underwent surgical interventions using a domestically produced high-energy laser device with a wavelength of 450±10 nm and a maximum average power of 10 W. Subsequently, therapy results were compared with those using similar devices. The high efficacy of the domestic high-energy laser device with a wavelength of 450±10 nm and maximum average power of 10 W was demonstrated in key technical characteristics relative to its counterparts. We successfully performed surgical interventions on ENT organs, confirming the high resection and photoangiolytic properties of the laser device, which, with the specified physical characteristics, is in demand for the surgical treatment of laryngeal diseases, competitive, and easy to use. Additionally, due to its configuration with interchangeable fiber-optic tips, the domestic device offers greater versatility. Its distinguishing features include the simplicity and ease of performing surgical interventions characterized by minimal trauma and the absence of intraoperative bleeding. In the postoperative period, less significant inflammatory phenomena and earlier healing of surgical wounds were observed. FOR CITATION: Krivopalov A.A., Shamkina P.A., Korkmazov M.Yu., Panchenko P.I., Glushchenko A.I., Zhurba V.M., Chuchin V.Yu. 450 nm diode laser in the treatment of upper respiratory tract diseases. Russian Medical Inquiry. 2024;8(8):484–492 (in Russ.). DOI: 10.32364/2587-6821-2024-8-8-7.

ОДНОЭТАПНАЯ КОРРЕКЦИЯ ПОСЛЕДСТВИЙ ПОВРЕЖДЕНИЯ ЛОКТЕВОГО НЕРВА

Objective: : To enhance the outcomes of surgical treatment for chronic ulnar nerve injuries by performing one-stage correction. Methods: From 2015 to 2023, 11 patients with chronic ulnar neurovascular bundle (NVB) injuries underwent one-stage reconstruction to restore hand function. The operations were performed on 8 men and 3 women aged 16 to 23. The duration of treatment for patients from the time of injury varied from 1.2 years to 5 years Results: In cases where there was a diastasis between the neural ends of no more than 3 cm in the upper third of the forearm due to nerve damage, restoration of the nerve with epineural suture was performed in 2 patients, while in two other cases with more significant gaps of 3.5 and 5 cm, epineural repair was carried out after anterior transposition of the nerve trunk. In one case of nerve damage in the middle third of the forearm, epineural sutures were applied to a 2.5 cm gap. Among 6 patients with damage to the ulnar NVB in the lower third of the forearm, 4 received epineural restoration of the ulnar nerve, and autologous neuroplasty was performed in gaps exceeding 3 cm in 2 patients. In cases of damage to the ulnar artery, 3 patients received autologous vein grafting, while in 3 other cases, there were no indications for vascular reconstruction. No infectious or inflammatory complications were observed in the immediate postoperative period, and there were no cases of thrombosis of autologous vein grafts of the ulnar artery. After evaluating all patients for 6 months to 2 years, it was found that 9 cases showed favorable and satisfactory long-term functional outcomes, while 2 cases exhibited unsatisfactory results. Conclusion: Restoring hand function after damage to the ulnar nerve is greatly influenced by the location, extent, and type of the damage, as well as the choice of an appropriate reconstruction method. Breaking the procedure into multiple stages can prolong patient recovery and negatively impact treatment outcomes. Conversely, performing the operation in a single stage within a relatively short timeframe can restore hand function and significantly reduce overall treatment and rehabilitation time Keywords: Ulnar nerve, neurovascular bundle, injury, tendon-muscular transfer, epineural suture

Impact of osteopenia and osteosarcopenia on the outcomes after surgery of hepatobiliary-pancreatic cancers.

The purpose of this study is to investigate potential associations between osteopenia, osteosarcopenia, and postoperative outcomes in patients with hepatobiliary-pancreatic cancer (HBPC). Three online databases, including Embase, PubMed, and the Cochrane Library, were thoroughly searched for literature describing the relationship between osteopenia, osteosarcopenia, and outcomes of surgical treatment of HBPC patients from the start of each database to September 29, 2023. The Newcastle-Ottawa Scale was used to rate the quality of the studies. This analysis included a total of 16 articles with a combined patient cohort of 2,599 individuals. The results demonstrated that HBPC patients with osteopenia had significantly inferior OS (HR: 2.27, 95% CI: 1.70-3.03, p < 0.001) and RFS (HR: 1.96, 95% CI: 1.42-2.71, p < 0.001) compared to those without osteopenia. Subgroup analysis demonstrated that these findings were consistent across univariate and multivariate analyses, as well as hepatocellular carcinoma, biliary tract cancer, and pancreatic cancer. The risk of postoperative major complications was significantly higher in patients with osteopenia compared to those without osteopenia (OR: 1.66, 95% CI: 1.19-2.33, p < 0.001). Besides, we also found that the presence of osteosarcopenia in HBPC patients was significantly related to poorer OS (HR: 3.31, 95% CI: 2.00-5.48, p < 0.001) and PFS (HR: 2.50, 95% CI: 1.62-3.84, p < 0.001) in comparison to those without osteosarcopenia. Preoperative osteopenia and osteosarcopenia can predict poorer OS and RFS with HBPC after surgery.

Outcomes of Surgical Treatment of Acetabular Fractures with a Minimum of 1-Year Follow-up

Outcomes of Surgical Treatment of Acetabular Fractures with a Minimum of 1-Year Follow-up

The Use of Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio and Platelets-to-Lymphocyte Ratio in the Assessment of the Risk of Conversion and Complications After Cholecystectomy Performed Due to Symptomatic Cholelithiasis.

Laparoscopic cholecystectomy is quite a safe procedure, as only about 2% of cases result in clinically significant postoperative complications. The occurrence of conversion and postoperative complications is associated with prolonged hospitalization and higher perioperative mortality. Some parameters assessed in preoperative laboratory tests are used to predict the risk of conversion and clinically significant postoperative complications. The aim of this study was to evaluate the usefulness of preoperative neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelets-to-lymphocyte ratio (PLR) values in predicting the risk of conversion and complications in laparoscopic cholecystectomy performed due to symptomatic cholelithiasis. A retrospective analysis of patients operated on for symptomatic cholelithiasis was performed. The Results of preoperative laboratory tests were assessed - NLR, MLR and PLR. Their impact on early outcomes of surgical treatment was analyzed in the study population. The analysis concerned 227 patients operated on for symptomatic cholelithiasis. The study group included 61 (26.9%) men and 166 (73.1%) women. As the NLR, MLR and PLR values increase, the length of hospitalization increases (rS 0.226, 0.247 and 0.181, respectively), as well as the risk of converting the procedure to an open method (p<0.05). Moreover, with increasing NLR and MLR values, the grade of postoperative complications according to the Clavien-Dindo scale increases (p 0.0001 and 0.008, respectively). The grade of postoperative complications does not depend on the PLR value. The risk of conversion can be assessed based on preoperative NLR, MLR and PLR values in patients undergoing surgery for symptomatic cholelithiasis. Elevated preoperative NLR and MLR values are associated with a higher grade of postoperative complications in the Clavien-Dindo scale.

The effect of surgical technique on the long-term results of treatment of brain aneurysms

To study the long-term outcomes of surgical treatment of cerebral aneurysms (CA) after using different methods of excluding the aneurysm from the bloodstream. We analyzed the long-term results of surgical treatment of 311 patients for CA (on average after 3.5 years). Two hundred and one patients were operated after CA rupture, 110 for an unruptured aneurysm. Microsurgical or endovascular methods were used to isolate the aneurysm from the bloodstream. Upon admission to the hospital for surgical treatment, a clinical diagnostic examination was performed to confirm the diagnosis and determine the timing and type of intervention. In the long-term period, a clinical neurological study, including an assessment of disability with the Barthel index and the modified Rankin scale, cognitive functions (MoCA test) and the psycho-emotional sphere (HADS) was carried out. In the long-term period of aneurysm surgery, symptoms of disability were identified in 49 patients (16%), severe and complete limitation of self-care in 17 (8%), and cognitive impairment in 212 (68%). Endovascular embolization performance of an aneurysm was associated with a higher proportion of favorable functional outcomes compared with the use of a microsurgical method (10% versus 17%), as well as preservation of cognitive functions (9% and 17%, respectively). Blood clots fibrinolysis was associated with severe disability and dependence in the long-term period (p=0.04). Patients treated with extra-intracranial shunting (EICS) demonstrated better cognitive functions; fibrinolysis, on the contrary, was a predictor of dementia (p=0.02). There was no relationship between symptoms of anxiety and depression in the long-term period and surgical treatment method. Disability, dependence and disturbance of cognitive functions in the long-term period of CA surgical treatment are higher in patients after microsurgical clipping compared to endovascular embolization. Performance of blood clots fibrinolysis is associated with severe disability and dementia in patients with massive basal aneurysmal subarachnoid hemorrhage. Performing EICS is associated with a favorable prognosis for the recovery of cognitive functions.

Changing paradigm and clinical outcomes of surgical treatment of hepatocellular carcinoma in the era of new targeted agents

Changing paradigm and clinical outcomes of surgical treatment of hepatocellular carcinoma in the era of new targeted agents

ОПЕРАТИВНОЕ ЛЕЧЕНИЕ ДЕТСКИХ ЦЕРЕБРАЛЬНЫХ ПАРАЛИЧЕЙ

Objective: To improve surgical treatment outcomes of spastic cerebral palsy (SCP) with lower extremities involvement. Methods: The results of surgical treatment of 208 children aged 3 to 14 years with SCP affecting the lower extremities were analyzed. Depending on the treatment tactics, the patients were divided into two groups. The main group included 105 (50.5%) patients who underwent surgery in addition to continuous complex conservative treatment. The control group included 103 (49.5%) children who were operated against the background of unsystematic and incomplete course of conservative therapy with unsystematic drug administration. Results: The surgical treatment tactics were optimized by considering the patient's age, types and combinations of contractures and deformities, enhanced surgical indications, muscle spasticity, and gait disturbances. Improvements have been made in identifying the need to correct particular contractures and deformities. Alongside the commonly used techniques, several enhanced approaches for surgical correction of contractures and deformities have been suggested. In creating efficient surgical strategies, the focus was initially on conducting surgeries on soft tissues. Bone surgeries were carried out only if soft tissue surgeries were unsuccessful. Considering the factors mentioned above, there have been enhancements in the guidelines for multilevel surgical procedures, which may be implemented in single or multiple stages, considering secondary deformities. The scale proposed during the study was used to evaluate long-term treatment outcomes. Implementing the above approach contributed to a statistically significant improvement in long-term outcomes in the main group compared to the control group (72.5±4.7 and 61.2±3.6 points, respectively; p &lt; 0.001). Based on objective data, it was found that the rates of positive outcomes (scoring above 70 points) were significantly higher in the main group compared to the control group (64.4% and 11.8%, respectively, p&lt;0.001). Conversely, the control group showed a predominance of satisfactory outcomes (scoring 61 to 70 points) in comparison to the main group (27.7% versus 65.6%, p&lt;0.001). The main group had a statistically significantly lower rate of unsatisfactory results than the control group (7.9% and 22.6%, respectively, p&lt;0.01).Conclusion: The study's findings demonstrated a statistically significant improvement in the long-term outcomes of treating SCP by implementing enhanced treatment strategies. Performing surgical procedures based on optimized indications leads to favorable outcomes in 92.1% of patients. Keywords: Cerebral palsy, spastic form, surgical treatment, Lorenz-Stoffel neurotomy, Sturm-Zatsepin method, long-term outcomes, long-term outcomes assessment scale.

Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study

Background: Carpal Tunnel Syndrome (CTS) is a common condition that significantly impacts patients' quality of life and work productivity. While both non-surgical and surgical treatments are employed, there is a lack of consensus regarding the most effective management strategy.&#x0D; Objective: This study aims to compare the outcomes of non-surgical and surgical treatments for CTS, focusing on symptom severity, functional status, and patient satisfaction.&#x0D; Methods: This observational cohort study included 74 participants, with 37 in each treatment group (non-surgical and surgical). Demographic data, including age, gender, occupation, and hand dominance, were recorded. Clinical parameters assessed were duration and severity of CTS symptoms, previous treatments, and comorbid conditions. The non-surgical group underwent treatments like wrist splinting, NSAIDs, and physical therapy, while the surgical group underwent decompression surgery. Outcomes measured included frequency and severity of symptoms, impact on daily activities, and satisfaction with treatment outcomes. Data were analysed using descriptive statistics to compare between groups.&#x0D; Results: The average age was 50 ± 9 years in the non-surgical group and 52 ± 8 years in the surgical group, with a predominance of females in both. The non-surgical group showed higher frequency and severity of symptoms, with daily symptoms reported by 76.1% of patients, compared to 44.4% in the surgical group. Severity of pain was higher in the non-surgical group (5.8 out of 10) than in the surgical group (2.8 out of 10). Satisfaction with surgical outcomes was high, with all patients in the surgical group reporting satisfaction despite a 100% rate of postoperative complications.&#x0D; Conclusion: The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non-surgical methods. However, the high rate of postoperative complications in the surgical group necessitates careful consideration and patient counselling regarding treatment choices.&#x0D; Keywords: Carpal Tunnel Syndrome, Non-surgical Treatment, Surgical Treatment, Patient Outcomes, Symptom Severity, Treatment Satisfaction

Surgical tactics for chest trauma accombined by flail chest

Thoracic trauma, often characterised as closed, comprises 23% to 56.9% of polytrauma cases.According to our research, flail chest in thoracic trauma occurs in approximately 7.9—8.9% of cases. The primary factors contributing to this instability are car accidents or falls from a height. Objective — to enhance the outcomes of surgical treatment for patients with flail chest by applying novel techniques for assessing the severity of injuries and implementing improved surgical tactics. Materials and methods. The study included a total sample of 123 patients who had flail chest. The participants were divided into 2 groups: the control group (n=56) and the comparison group (n=67). The ATS scale was used to assess the severity of the condition in the groups. The injury severity score was determined using a point‑based system and categorised as minor, severe, or extremely severe. The control group was additionally evaluated using the AdTS scale, while the perfusion index was measured. Results. The injury severity score determined using the AdTS scale and the perfusion index formed the basis of an algorithm for differential diagnosis that influenced the indication area and scope of diagnostic procedures. The choice of surgical tactics was based on the results of an additional examination and the injury severity score. For a minor injury, the full range of medical procedures was carried out. For a severe injury, a shortened list of procedures was prescribed. In the case of an extremely severe injury, care was provided using the principles of DCS technology. The chest stabilisation procedure was conducted using the suggested approach for assessing the severity of the injury: less traumatic operations were performed for severe injuries, while full‑scale operations were carried out for minor injuries. The selection of the method for stabilising floating segments was based on the established classification of chest instability. The stabilisation of flail chest was carried out either during the first or third phase of the DCS technology or after the patient had been brought out of a state of shock, in accordance with delayed indications. Conclusions. The application of the AdTS anatomical and functional scale and the determination of the perfusion index allowed for a rapid and objective evaluation of the injury severity score (minor, severe, and extremely severe). Additionally, these tools helped in identifying the appropriate diagnostic procedures and deciding on the method for stabilising the flail chest. The differential diagnostic programme implemented in the control group made it possible to reduce the examination time for patients with an extremely severe injury by 9.8±1.1 minutes. Implementing the proposed injury severity assessment and stabilisation tactics decreased the number of late purulent‑septic complications by 19.8% and mortality by 17.4% (from 38.8% to 21.4%).

Comparative Assessment of Surgical Treatment Outcomes in Patients with Sacroiliac Joint Injury

stract The aim of the study is to evaluate the results of surgical treatment in patients with sacroiliac joint injury. Methods. An analysis of the results of surgical treatment of 60 patients with sacroiliac joint injury was conducted at the Center of polytrauma and orthopedic surgery of the State Public Healthcare Institution “Emergency Hospital” in Abai Region, the Trauma and Endoprosthetics Department of the State Public Healthcare Institution “Multispecialty City Hospital No. 1” in the city of Astana, and the “Shymkent City Clinical Hospital No. 1” from June 2019 to August 2022. Patients were divided into two groups. Patients in the control group underwent surgery using the standard technique, while patients in the experimental group underwent surgery using a device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries. The study was a randomized controlled trial by design. Results. The use of the device for minimally invasive locking osteosynthesis of sacroiliac joint injuries leads to a significant reduction in the length of hospitalization for all types of sacroiliac joint injuries regardless of the patient’s initial condition (p=0.001). Correlation analysis revealed a correlation between the observation group and patient pain assessment at 12 months (p=0.001). According to the Majeed Pelvic Score at 12 months, the maximum score in the experimental group was 98 points, while in the control group, it was 70 points. A satisfactory assessment on the Majeed Pelvic Score at 12 months was observed in 3 (10%) of patients in the control group and none in the experimental group. There were no unsatisfactory responses in both groups (significant differences were found, p=0.001). Conclusions. The use of the device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries reduces the length of hospitalization and the time to return to work (12 months in the control group and 8 months in the experimental group). The absence of pain in patients after 12 months in the experimental group was 26 (86.7%) and 20 (66.6%) in the control group. According to the Majeed Pelvic Score in the long term (3, 6, and 12 months), the frequency of excellent results increases from 13.3% to 90.0% in the experimental group and from 10% to 73.4% in the control group.

Outcomes of Treatment of Pectoralis Major Muscle Injury

Background. The incidence of injuries to the pectoralis major muscle (PMM) is steadily increasing, necessitating an assessment of outcomes of surgical treatment.&#x0D; Objective: to analyze the outcomes of surgical treatment for PMM injuries.&#x0D; Material and Methods. The study is based on the analysis of surgical treatment outcomes of 84 patients with PMM injuries who were hospitalized in the Department of Microsurgery and Reconstructive Surgery of the Upper Extremity at the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" from 2003 to 2023. The patients underwent a rehabilitation program and staged observation for up to 12 months after surgical intervention. The age of the patients ranged from 16 to 62 years; they were divided by age into three groups: up to 25 years, 25-40 years, and 41 years and older. Functional assessment of the PMM was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), The Score and Subjective Evaluation by Patients with a Pectoral Major Tear (SEPPMT), and the American Shoulder and Elbow Surgeons (ASES) scales at the time of admission, at 6 months, and at 12 months after the surgery.&#x0D; Results. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT and ASES scales preoperatively, patients with acute injuries had worse results than those with chronic injuries (p &lt; 0.001). At 6 months after surgical treatment, the group of patients with acute injuries showed significantly lower scores compared to the group with chronic injuries. At 12 months after surgical treatment, the group with acute injuries had significantly higher scores compared to the group with chronic injuries (p &lt; 0.001), though still corresponding to excellent and good results.&#x0D; Conclusions. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT, and ASES scales preoperatively and at 6 and 12 months after surgical treatment, patients who underwent surgery within two weeks after the trauma demonstrated better results. In cases of chronic injuries, the results were slightly worse, but still were close to good results.

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p&lt;=0.01) functional outcomes of elbow joint mobility.