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INTRODUCTION

Theme urgency

Treatment of fractures of a calcaneus is one of actual proyoblem modern traumatology. Calcaneus fractures concern to odyonim from most often meeting kinds of damages of foot and make 0,7 - 4,0 % in structure of all fractures of bones of a skeleton and 12 - 40 % of fractures of bones of foot [73, 103, 109].

Thus 36,6 - 92,9 % of all it povrezhyodeny make intraarticulate compression fractures calcaneal kosyoti [13, 115, 122]. Distinctive feature calcaneus damage is the variety of types of fractures that does impossible use for treatment any one of set of the methods offered for this purpose. Even at use of modern methods of a reposition and bracing pjayotochnoj bones vary bad outcomes of treatment of serious compression fractures from 13 % to 80,5 % [51, 73, 103, 107, 109]. It puts before traumatologists-orthopedists a problem of search of more effective metoyodov treatment and ways of a reposition and bracings of various types of fractures of a calcaneus [4, 19, 21,40, 69, 113].

At the same time, the ubiquitous addicting of traumatologists-orthopedists for new ways of operative treatment leads to importance underestimation reabilitayotsionnyh the actions referred on restoration of function travmiroyovannoj an extremity in the postoperative period. The situation is aggravated with absence of the complex methodological approach to the given problem. Long terms of postoperative treatment testify to it and otnoyositelno high percent unsatisfactory functional rezultayotov [16, 31,74, 95, 101].

Thus, it is necessary to define objective criteria of a choice of an optimum way of a reposition and an osteosynthesis of fractures of a calcaneus, and

Also to develop проірамму complex aftertreatment of patients with such damages.

Research objective - improvement of results of treatment of patients with pereloyomami a calcaneus by working out of original tactics of surgical and postoperative aftertreatment.

Research problems:

1. To study a condition regionarnoj hemodynamics of the bottom extremities at vibratory influences.

2. To develop ways of treatment of fractures of a calcaneus a method chreskosg - nogo an osteosynthesis and to carry out the analysis of their efficiency in comparison with nakoyostnym an osteosynthesis on system LO.

3. To develop tactics) ' complex postoperative aftertreatment bolyonyh after an osteosynthesis of fractures of a calcaneus and to estimate it effektivyonost.

4. To carry out the analysis of errors and complications at use various spoyosobov a calcaneus osteosynthesis, to develop methods of their preventive maintenance and treatment.

Scientific novelty of work

The differentiated approach to treatment of fractures of a calcaneus taking into account biomechanical features of various kinds of damages, with use new, biomehanicheski proved, ways chreskostno - go an osteosynthesis on Ilizarovu is developed: «the Way of treatment of splintered fractures pjayotochnoj bones» (the demand for the invention ³2003133047/20 (035390), a priority from

17.11.2003) and «the Way of treatment of splintered intraarticulate fractures of a calcaneus» (the demand for the invention

³2004131078/17 (033825), a priority from 25.10.2004).

The comparative estimation of efficiency of operative treatment of fractures of a calcaneus is spent at use of methods nakostnogo an osteosynthesis of joint-stock company and chreskostnogo an osteosynthesis by apparatus of external bracing.

For the first time clinicodiagnostic research effektivnoyosti vibratory st imuljatsii circulations of the bottom extremities at zdoroyovyh examinees is carried out.

For the first time the program of complex aftertreatment of patients with calcaneus fractures is developed. From a considerable quantity of various ways and aftertreatment agents the most effective are selected and systematised. «The way of therapy of contractures of joints of extremities» (zayojavka on the invention №2003135902/038638, a priority from 10.02.2003) is offered new.

The practical importance of work

The differentiated approach to a choice of a way of a reposition and osteosinteyoza with use new, biomehanicheski proved, ways chreskoyostnogo an osteosynthesis on Ilizarovu and methods nakostnogo a joint-stock company osteosynthesis allows to restore an anatomic structure and to optimise term konsoyolidatsii calcaneus fracture.

The improvement of indicators taped by us regionarnogo a blood flow not only exposed to vibratory influence, but also kontralateralnoj extremities, allows to recommend vibratory therapy intact koyonechnosti for the purpose of reflex stimulation of a circulation of the injured extremity in clinical practice.

Introduction in clinical practice developed by us about і'раммм komyopleksnoj aftertreatments with use of a new way of therapy of contractures of joints of extremities has allowed to improve results of treatment and to raise kayochestvo lives of patients with calcaneus fractures.

The positions which are taken out on protection

1. Vibratory influence «the Device for a seismotherapy» privoyodit to authentic improvement of indicators regionarnogo a blood flow konechnoyosti not only подверітівшсйся to such influence, but also kontralateralnoj.

2. Developed «the Way of treatment of splintered fractures calcaneal kosyoti» (the demand for the invention №2003133047/20 (035390), a priority from November, 17th, 2003), «the Way of treatment of splintered intraarticulate fractures of a calcaneus» (the demand for the invention №2004131078/17 (033825), a priority from 25 okyotjabrja 2004) allow to restore an anatomic structure and optimiziroyovat term of consolidation of fracture of a calcaneus.

3. The developed program of complex aftertreatment of patients with peyorelomami a calcaneus allows to improve essentially results, sokrayotit terms of treatment and a temporary invalidity of patients with such damages.

Introduction of results of research

Developed by us «the Way of treatment of splintered fractures of a calcaneus» (the demand for the invention № 2003133047/20 (035390), a priority from

17.11.2003) and «the Way of treatment of splintered intraarticulate fractures pjayotochnoj bones» (the demand for the invention № 2004131078/17 (033825), a priority from

25.10.2004), a technique of vibratory stimulation regionarnogo krovoobrashcheyonija the injured extremity by means of influence on kontrlateralnuju an extremity «for a seismotherapy» and the program complex reayobilitatsii patients with calcaneus fractures are approved and introduced by the Device in clinical practice in treatment-and-prophylactic and scientific institutions of a city of Volgograd, the Volgograd area and Republic Tatarstan: MunitsiYOpalnogo public health services establishments «the Hospital №12» the cities of Volt_rada, Open joint-stock company «12th city clinical

Hospital, the city of Kazan »; Hospital of the first help, the city of Kazan; public health services Municipal authority« Elabuzhsky central rajonyonaja hospital », the city of Elabuga.

Materials of dissertational research are used in uchebnoyometodicheskoj to work of chair of traumatology, orthopedy and surgery ekstreyomalnyh conditions G'OU VPO «Kazan state medical uniyoversitet DEWS is sensible».

Volume and work structure

The dissertation is stated on 119 pages of typewriting, includes 49 riyosunkov, 8 tables and 4 charts. Work consists of introduction, 4 heads, obsuzhdeyonija results, conclusions and practical references. The literature index includes 164 sources, including 42 foreign.

The dissertation is performed on the plan of research work GOU VPO «Kazan state medical university ROSZDRAVA» (number of the state registration 01.20.00 09896).

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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 -.

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