The improved system of surgical treatment of the injured persons with damages of pelvis and pelvic organs in polytrauma
Objective. To estimate the efficacy of the improved system of surgical treatment in patients, suffering the pelvis and the pelvic organs injuries in polytrauma.
Materials and methods. The investigation background consisted of clinical observations of 406 damaged persons, suffering nonstable pelvic injuries (NPI) in polytrauma (estimation of severity in accordance to the ISS scale 17 points and higher). NPI in 98 (24.1%) wounded persons with polytrauma were combined with the pelvic organs injuries. Two clinical groups were formed: the main – 137 (33.7%) injured persons, of them in 37 (27.0%) NPI was combined with the pelvic organs injuries, and a control one – 269 (66.3%) injured persons, of them in 61 (22.7%) the injured persons NPI were combined with the pelvic organs damages.
In the wounded persons of the main group a differentiated surgical tactic of treatment, which was based on estimation of the trauma severity, prognosis of the traumatic disease course, depending on its periods, and on the proposed modern methods of diagnosis and treatment of pelvic and other anatomical parts injuries. For treatment of a control group patients surgical tactic was applied in accordance to temporary branch unified standards of medical technologies of the diagnostic–treatment process of stationary help to adult population in the treatment–prophylactic institutions of Ukraine, approved by The Order of MH of Ukraine №226 from July 27 1998 yr.
Results. In the bladder trauma in 47 (83.9%) injured persons its transmural rupture was sutured with epicystostomy and catheterization of bladder using Foley catheter. In urethral trauma epicystostomy was combined with urethral splinting using catheter in 27 (81.8%) patients. In 3 patients of the main group the primary urethral suturing was applied in an acute period of traumatic disease. In all the patients, suffering injuries of rectum, two–barrel sygmostomy was conducted. Operations on internal genital organs were performed in 3 (3.2%) injured persons. In total in acute period of traumatic disease 94 operative interventions of various complexity were performed.
Conclusion. In polytrauma the pelvic bones fractures were combined with the pelvic organs trauma in 24.1% injured persons. Combined injuries of pelvic organs (excluding rectal injuries) do not constitute contraindication for performance of internal and combined melalosteosynthesis of nonstable pelvic ring in the injured persons with polytrauma in early and late periods of traumatic disease.
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