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4.5.3. Results of treatment of patients of 11th investigated group

According to the anamnesis the painful syndrome of various degree of expression was observed at 11 patients (25,6 %) P-j investigated group. From them 2 patients (4,6 %) complained of pains in foot and ankle joint area on a mowing, pains after long walking disturbed 9 sick (20,9 %).

Average term of bracing of an extremity apparatus Ilizarova has made 69,4±4,98 day at unilateral damages and 87,5±7,12 day at fractures of both calcaneuses. To 3 patients after the preschedule dismantle of the apparatus of external bracing bound to development of a purulent inflammation of soft tissues in the field of spokes (2 patients) and spitsevogo a calcaneus osteomyelitis (1 patsiyoent), the immobilisation was spent by a plaster bandage before consolidation pereloyoma, come within average term that in group.

The slowed down consolidation of fracture was observed at 2 sick N-j issleyoduemoj groups (4,6 %), not grown together fractures or nearthroses pjatochyonoj bones is not taped.

Depression of size of angle Bellera in the remote period till 11-20 ° vyjavyoleno only at 1 patient (2,3 %), at 1 patient the angle size - was less than 10 °. At the same 2 patients took place posttraumatic uploshchenie proyodolnogo a foot crest by results podometrii and plantographies.

At 33 sick I-j investigated group (76,7 %) it is reached full vosyostanovlenie movements in an ankle joint. It was not possible to restore function golenostopnoju a joint in full at 10 patients (23,3 %). From them restriction of a back flexion to 70-74°зарсгистрировано at 7 sick (16,3 %), till 75-90 ° - at 3 (7,0 %). At 9 patients (20,9 %) was оіраничсно and poyodoshvennoe a flexion in an ankle joint - to 121-130 ° at 7 sick (16,3 %), to 90-120 ° at 2 patients (4,6 %).

At anthopometrical research signs of an atrophy of muscles of an anticnemion are taped at 5 patients (11,6 %). From them an atrophy of muscles of an anticnemion to 2 sm - at 3 sick (7,0 %), more than 2 sm — at 2 (4,6 %).

By results of a dynamometry depression of force of muscles injured koyonechnosti is registered at 6 patients N-j of investigated group (13,9 %). From their number depression of force of muscles of an anticnemion on 10-29 % is taped at 4 sick (9,3 %), on 30 % and more - at 2 patients (4,6 %).

Local vascular disturbances are taped at 7 sick I-j investigated group (16,3 %). From them an edema of an extremity after long walking 6 patients (13,9 %) noted, a constant edema and trophic disturbances - 1 patient (2,3 %).

Disturbances regionarnoj hemodynamics according to ultrasonic dopyoplerografii and reovazografii took place at 8 patients. Depression of linear rate of a blood flow and indicators of a volume blood flow on 10-29 % is taped at 6 patients (13,9 %), on 30 % and more - at 2 sick (4,6 %).

At 8 patients N-j of investigated group (18,6 %) it is taped posttravmaticheyosky an arthrosis podtarannogo and-or a calcaneocuboid joint. From their number at 6 sick (13,9 %) it is diagnosed posttraumatic arthrosis I-Н of a stage, arthrosis III-IV of a stage was available for 2 patients (4,6 %).

Proof disability has come at 1 patient (2,3 %) - priyoznan a mediko-social commission of experts the invalid of II group.

Good results of treatment at 31 patients (72,1±6,01 %) are reached. As satisfactory results of treatment are estimated at 11 sick (25,6±2,33 %). An unsatisfactory outcome of treatment at 1 patient (2,3±0,16 %) N-j issledueyomoj groups (r < 0,05).

Average term of hospitalisation of patients N-j of investigated group has made 21,2±1,67 day, average duration of an out-patient treatment - 97,1±3,52 day. Average term of a temporary invalidity has made - 118,3£4,58 day (r < 0,05).Приводим клинические примеры лечения больных Н-й исследуемой группы с использованием метода чрескостного остеосинтеза аппа­ратом Илизарова ио разработанным нами способам: «Способ лечения оскольча­тых переломов пяточной кости» (заявка на изобретение № 2003133047/20(035390), приоритет от 17.11.03) и «Способ лечения оскольчатых внутрисуставных переломов пяточной кости» (заявка на изобретение № 2004131078/17(033825), приоритет от 25.10.04).

the Clinical example. Patient P-in. 27 years, a case history № 790/02, it is hospitalised in traumatologic unit of 20.05.2002 with the diagnosis: the Closed splintered fracture of both calcaneuses with shift. The trauma is received at a jump from a lorry body. Roentgenograms pjatochyonyh bones of the patient at entering are presented P Th on fig. 31-34.

Fig. 31 and 32. Roentgenograms of the right calcaneus of the patient to P Th before operation.

Fig. 33 and 34. Roentgenograms of the left calcaneus of the patient to P Th before operation.

23.05.2002 under periduralnoj anaesthesia operation - chreyoskostnyj an osteosynthesis of both calcaneuses by apparatus Ilizarova on razraboyotannomu us to a way of treatment of splintered fractures of a calcaneus (the demand for invention He 2003133047/20 (035390), a priority from 17.11.03) is made. RentgenoYOgrammy calcaneuses of the patient to P Th after operation are presented on fig. 35-38.

Fig. 35 and 36. Roentgenograms of the left calcaneus of the patient to P Th after CHKOS.

Fig. 37 and 38. Roentgenograms of the right calcaneus of the patient to P Th after CHKOS.

Appearance of extremities of the patient in apparatus of external bracing is presented P Th on fig. 39.

Current of the postoperative period without complications. After kupirovayonija a painful syndrome and reduction of an edema of an extremity of 16.06.2002 it is written out on an out-patient treatment in a satisfactory condition.

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Fig. 39. Appearance of extremities of the patient to P Th in apparatus of external bracing.

Fracture consolidation is reached. Roentgenograms of calcaneuses of the patient after dismantle of apparatus of external bracing are presented P Th on fig. 40-41.

Fig. 40. Roentgenograms of the right calcaneus of the patient to P Th after consolidation perelo mA and dismantle of the apparatus of external bracing.

The policy of rehabilitational treatment under the program developed by us is followed. Function of extremities is restored in full. PristuYOpil to physical work in 4 months and 2 days from the moment of a trauma. Appearance and function of extremities of the patient to P Th after treatment end predyostavleny on fig. 42-43.

Fig. 41. Roentgenograms of the left calcaneus of the patient to P Th after consolidation of fracture and dismantle of the apparatus of external bracing.

Fig. 42. Appearance of extremities of the patient to P Th after treatment end.

The remote result of treatment in 3 years - at survey of the patient zhayolob does not show, function of extremities in full. Continues rayobotat the loader. The result is regarded as good.

Fig. 43. Function of extremities of the patient to P Th after treatment end.

Clinical example. The patient I, 41 years, a case history № 901/02, it is hospitalised in traumatologic unit of 8.06.2002 with the diagnosis: For covered splintered fracture of the right calcaneus with shift.

Fig. 44. Roentgenograms of the right calcaneus of the patient I-VA before operation.

The trauma is received as a result of road accident. Roentgenograms right pjatochyonoj I-VA at entering are presented a bone of the patient on fig. 44. 13.06.2002 under periduralnoj anaesthesia operation - CHKOS the right calcaneus by apparatus Ilizarova on a way of treatment of splintered intraarticulate fractures of a calcaneus (the demand on izoyobretenie №2004131078/17 (033825), a priority from 25.10.04) is made. RentgenoYOgrammy to the right calcaneus of the patient I-VA after operation are presented on fig. 45.

Fig. 45. Roentgenograms of the right calcaneus of the patient I-VA after CHKOS apparayotom external bracing.

Current of the postoperative period without complications. After kupirovayonija a painful syndrome and falling off of an edema of an extremity of 24.06.2002 it is written out on an out-patient treatment in a satisfactory condition.

Appearance of an extremity of the patient I-VA in the apparatus of external bracing is presented on fig. 46. Fracture consolidation is reached. Roentgenograms of the right calcaneus of the patient I-VA after dismantle of apparatus of external bracing are presented on fig. 48.

Fig. 46. Appearance of an extremity of the patient I-VA in the apparatus of external bracing.

Fig. 47. External vtsd extremities of the patient I-VA after treatment end.

The policy of rehabilitational treatment under the program developed by us is followed. Extremity function is restored in full. Has started physical work in 3 months and 11 days from the moment of a trauma.

Appearance and function of an extremity of the patient I-VA after treatment end are presented on fig. 47.

Fig. 48. Roentgenograms of the right calcaneus of the patient I-VA after consolidation psrslo -

Fig. 49. Appearance of the patient I-VA and function in an ankle joint after zaveryoshenija aftertreatments.

The remote result is tracked in 3 years. At control survey of the patient of complaints does not show, function of extremities in full. proyodolzhaet to work as the car mechanician. The result is regarded as good (fig. 49).

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Scientific source Ivanov PETER VALENTINOVICH. OPTIMIZATION of TACTICS of SURGICAL TREATMENT And POSTOPERATIVE AFTERTREATMENT of PATIENTS With CALCANEUS FRACTURES. The dissertation on competition of a scientific degree of the candidate of medical sciences. Kazan -.

Other medical related information 4.5.3. Results of treatment of patients of 11th investigated group:

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  16. CHAPTER 1. The ROLE of ULTRASONIC RESEARCHES In DIAGNOSTICS And the SUBSTANTIATION of TACTICS of OPERATIVE TREATMENT of PATIENTS With TUMOURS And OPUHOLEPODOBNYMI FORMATIONS of SOFT TISSUES In OUT-PATIENT CONDITIONS (the literature review)
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