ksmaКубанский научный медицинский вестникKuban Scientific Medical Bulletin1608-62282541-9544Kuban State Medical University10.25207/1608-6228-2017-24-6-168-176ksma-942Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФАКТОРЫ РИСКА НЕСРАСТАНИЯ ПЕРЕЛОМОВ КОСТЕЙ ПРИ ПОЛИТРАВМЕRISK FACTORS OF FRACTURE NONUNION IN POLYTRAUMAШАПКИНЮ. Г.SHAPKINYU. G.seliwerstov.pl@yandex.ruСЕЛИВЕРСТОВП. А.SELIVERSTOVP. A.seliwerstov.pl@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Саратовский государственный медицинский университет имени В.И. Разумовского» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education Saratov State Medical University named after V.I. Razumovsky of the Ministry of Healthcare of the Russian FederationRussian Federation20172512201706168176Copyright © ШАПКИН Ю.Г., СЕЛИВЕРСТОВ П.А., 20172017ШАПКИН Ю.Г., СЕЛИВЕРСТОВ П.А.SHAPKIN Y.G., SELIVERSTOV P.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://ksma.elpub.ru/jour/article/view/942Цель

Цель. Провести анализ литературы, посвященной патологическим механизмам замедленной консолидации и несрастания переломов костей конечностей и влиянию различных стратегий остеосинтеза на костную репарацию при поли- травме. Риск несрастания переломов костей при политравме увеличивается при высокоэнергетических сложных оскольчатых и открытых переломах с тяжелыми повреждениями мягких тканей и кости, наличии ушиба лёгких, шока и острой массивной кровопотери. Развитие системного воспалительного ответа влияет на местные иммунные реакции в зоне перелома в раннюю воспалительную фазу репарации кости и нарушает последующие процессы остеогенеза и ангиогенеза. Ранний стабильно-функциональный остеосинтез с применением малоинвазивных методик создает оптимальные условия для репарации кости. При следовании тактике этапного лечения Damage Control Orthopedics риск инфекционных осложнений и несрастания перелома повышается с увеличением продолжительности лечения в аппарате внешней фиксации. Заключение. При политравме более часто, чем при изолированной травме происходит нарушение консолидации переломов костей конечностей. Факторами риска несрастания переломов костей при политравме становится тяжесть повреждения кости и мягких тканей, шок, острая кровопотеря и системная воспалительная реакция, а также неоправданная отсрочка окончательной стабильной фиксации отломков длинных костей или применение травматичных методов их раннего остеосинтеза без учета тяжести состояния пострадавшего.

 

 

Aim

Aim. To carry out literature analysis devoted to pathological mechanisms of delayed union and nonunion of limb fractures and the influence of various osteosynthesis strategies on bone healing in polytrauma. The risk of bone fractures nonunion in polytrauma increases with high-energy complex comminuted and open fractures with severe injuries of soft tissues and bones, bruised lung, shock and severe massive blood loss. The development of a systemic inflammatory response affects local immune responses in the fracture zone to the early inflammatory phase of bone healing and disrupts subsequent osteogenesis and angiogenesis processes. Early stable-functional osteosynthesis using minimally invasive techniques creates optimal conditions for bone healing. When following the tactics of the stepwise treatment of Damage Control Orthopedics, the risk of infectious complications and fracture nonunion increases with the duration of treatment in the apparatus of external fixation. Conclusion. In polytrauma a violation of consolidation of bone fractures of the extremities occurs more often than in isolated trauma. Risk factors of fracture nonunion in polytrauma are the severity of bone and soft tissue damage, shock, acute blood loss and systemic inflammatory response, as well as unjustified delay in the final stable fixation of long bones fragments or using traumatic methods of their early osteosynthesis without taking into account the severity of the condition of the injured.

 

 

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The authors declare that there are no conflicts of interest present.