ЗНАЧЕНИЕ ВЫБОРА КОНФИГУРАЦИИ АППАРАТА НАРУЖНОЙ ФИКСАЦИИ ПРИ КОНВЕРСИОННОМ ОСТЕОСИНТЕЗЕ У ПАЦИЕНТОВ С ПОЛИТРАВМОЙ

Polytrauma is socially difficult and severe problem in medical aspect, since the number of patients with polytrauma is steadily increasing and the total number of patients in trauma departments constitute 14-24 %. Traditional tactics of immediate suturing of the damaged parenchymal organs (liver, spleen, etc.), restoration of the integrity of hollow organs (bladder, intestines, etc.) and the final stabilization of bone fragments in bone fractures may correspond to the anatomy, the consequences of which will lead to a fatal outcome due to the excessiveness of the primary immediate «curative» care to the victim (ETC - early total care), with severe traumatic shock and serious postoperative hemodynamic and regenerative disorders. In this regard, many colleagues adhere to the tactics of gradual assistance with damage control, in which the subsequent stages of surgical treatment, in particular, the dismantling of the external fixation device and internal osteosynthesis is performed to stabilize the general condition of the victim. In recent years, this methodology of transition from one (temporary) type of osteosynthesis to the final one has been designated as conversion osteosynthesis. To obtain good results and prevent the risk of complications in the treatment of patients with polytrauma by the method of conversion osteosynthesis, it is necessary to choose the configuration and nature of the arrangement of the external fixing device. It is logical to assume the advantages of rigid fixation of fragments with a single-plane device in comparison with a multi-plane; however, the significance of the choice of the external fixing device configuration and its effect on the risk of complications remains insufficiently studied, which requires a longer study of the problem. In this regard, we investigated the influence of different types of external fixing device configuration on the risk of complications and treatment results in the immediate postoperative period. Objective - to study the effect of different types of external fixing device configuration during the primary stabilization of long bone fragments in patients with polytrauma on the risk of complications in the immediate postoperative period and to evaluate the results of treatment when using conversion osteosynthesis. Materials and methods. A promising analysis of the use of conversion osteosynthesis in the treatment of 120 patients with fractures of the long bones of the extremities using various types of external fixing device at the first stage of treatment in a multidisciplinary hospital has been carried out. To analyze the results of treatment, we divided the patients into two groups: The first group consisted of 44 patients with long bone fractures in polytrauma according to the ISS > 40. The second group included 76 patients with polytrauma according to the ISS 40 increases the risk of early complications. It indicates the insufficiency of uniplanar fixation in these situations. For ISS > 40, it is necessary to use a two- multi-plane uniplanar external fixing device. When analyzing the incidence of early complications in patients of group 2, there were no significant differences in the incidence of these complications depending on the type of external fixing device configuration at the first stage of treatment (p > 0.05), and the use of a single-plane external fixing device at ISS 40 различимо возрастал риск ранних осложнений, что свидетельствовало о недостаточности одноплоскостной фиксации у этой категории пострадавших. При ISS > 40 лучшие результаты достигли при использовании двухплоскостного и даже многоплоскостного аппарата наружной фиксации. При анализе частоты развития ранних осложнений у пациентов 2-й группы существенных различий в зависимости от конфигурации первично наложенного АНФ (одноплоскостной или двухплоскостной) не было выявлено (р > 0,05). Наложение одноплоскостной АНФ при ISS < 40 не превышало риска ранних осложнений, что свидетельствовало о достаточности одноплоскостной фиксации у пострадавших с тяжестью травмы ISS < 40. Заключение. Проведенное исследование подтвердило значение выбора конфигурации и характера компоновки АНФ для получения хороших результатов и профилактики риска осложнений при лечении больных с политравмой при конверсионном остеосинтезе