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Results of treatment of patients of 1st investigated group

From among patients of 1st investigated group the painful syndrome to some extent expressions was observed at 10 sick (25,6 %). Complaints to pains in stop and ankle joint area in rest showed 2 patients (5,1 %), pains after long walking otmstili 8 sick (20,5 %).

Average term of a constant immobilisation of an extremity plaster longetoj has made 80,54 day, the general term of an immobilisation - 29,72,31 day. Average term of consolidation has made 72,8^5,32 days at unilateral damages and 91,67,19 day at fractures of both calcaneuses. Slowed down konsolidayotsija fracture it was observed at 3 patients (7,7 %) - term of an adnation of fractures at them has exceeded average term on group in 1,5-1,7 times. Not grown together fractures or nearthroses of a calcaneus of nanosecond was.

At the majority of patients it was possible to restore normal anatomicheyoskoe a calcaneus structure. Depression of size of angle Bellera in the remote period took place only at 2 sick (5,1 %). At the same 2 patients vyjavyoleno posttraumatic uploshchenie a longitudinal crest of foot by results podometrii and plantographies.

Full restoration of movements in an ankle joint is reached at 27 sick (69,2 %) 1st investigated group. It was not possible to restore ankle joint function in full at 12 patients (30,8 %). From them ograyonichenie a back flexion to 70-74зарегистрировано at 9 sick (23,1 %), till 75-90 - at 3 (7,7 %). At 11 patients (28,2 %) the plantar flexion in an ankle joint - to 121-130 at 8 sick (20,5 %) and to 90 120 - at 3 patients (7,7 %) has been limited also.

Signs of an atrophy of muscles of an anticnemion at anthopometrical research are taped at 6 sick 1st investigated groups (15,4 %). From them an atrophy of muscles of an anticnemion to 2 sm - at 4 patients (10,3 %), more than 2 sm - at 2 (5,1 %).

By results of a dynamometry depression of force of muscles injured koyonechnosti is registered at 8 patients (20,5 %). Depression of force of muscles goleyoni on 10-29 % is taped at 5 sick (12,8 %), on 30 % and more - at 3 patients (7,7 %).

Local vascular disturbances took place at 8 sick 1st issledueyomoj groups (20,5 %). From them the constant edema and trophic disturbances - 2 persons (5,1 %) would swell extremities after long walking otmechayoli patients (15,4 %).

At the same 8 sick 1st investigated groups disturbances regionarnoj hemodynamics are fixed. Depression of linear rate of a blood flow on danyonym ultrasonic dopplerografii and indicators obemnoju a blood flow by data reovazografii on 10-29 % is taped at 6 patients (15,4 %), on 30 % and more - at 2 sick (5,1 %).

The Poeggravmatichssky arthrosis podtarannoju and-or a calcaneocuboid joint is diagnosed for 6 patients (15,4 %) 1st investigated group. From their number at 5 sick (12,8 %) the posttraumatic arthrosis 1-Й stages, artyoroz Ш-IV stages - at 1 patient (2,6 %) is taped.

By the invalid ІП groups one patient (2,6 %) is recognised by a mediko-social commission of experts.

Results of treatment of a larger part of patients of 1st investigated group authentically (r < 0,05) оценены как хорошие - у 26 больных (66,75,87%).

Удовлетворительные результаты достигнуты у 12 больных (30,72,74%). Неудовлетворительный исход лечения у 1 пациента (2,60,18%).

Average term of hospitalisation of patients has made 23,6 ^. 1,85 days, and average duration of an out-patient treatment - 92,83,36 day. Average term of a temporary invalidity at patients of 1st investigated іруппьі sostayovil - 116,44,61 day (r < 0,05).

We result clinical examples of treatment of patients with fractures pjatochyonoj bones with method use nakostnogo an osteosynthesis plates of joint-stock company and

Screws.

Clinical example. The patient S it, 48 years, a case history № 2973/577, it is hospitalised in traumatologic unit of 2.06.1999 with the diagnosis: ZaYOkrytyj splintered fracture of the right calcaneus with shift. A trauma household - falling from height of 2,5 metres on feet. Roentgenograms right pjatochyonoj in lateral and axial projections of the patient S-VA at entering are presented a bone on fig. 24.

Fig. 24. Roentgenograms of the right calcaneus of the patient S-VA before operation.

8.06.1999 under periduralnoj anaesthesia operation - nakostnyj an osteosynthesis of the right calcaneus by a plate of joint-stock company and screws from external dosyotupa is made. Roentgenograms of the right calcaneus of the patient S-VA after osteosinteyoza are presented on fig. 25 and 26. A current of the postoperative period without complications. After healing of an operational wound of 24.06.1999 it is written out on an out-patient treatment in a satisfactory condition. It is reached konsoliyodatsija fracture.

Fig. 25 and 26. Roentgenograms right calcaneal kostja the patient S-VA after an osteosynthesis playostinoj joint-stock company in screws.

Fig. 27. Roentgenograms of the right calcaneus of the patient S-VA after excision metallokonyostruktsy

The policy of rehabilitational treatment on developed by us proyogramme is followed. Walking with a full load on an extremity is begun 1.09.1999 DostignuYOto full restoration of function of an extremity. Working capacity was completely restored in 3 months and 16 days from the date of a trauma, works as the mechanic.

metallokonstruktsii are removed in 6 months after fracture consolidation. Roentgenograms of the right calcaneus of the patient S-VA after excision metalyolokonstruktsy are presented on fig. 27.

The remote result is tracked in 5 years. At control survey of the patient of complaints does not show, extremity function in full. prodolyozhaet to work as the mechanic. The result is regarded as good.

Clinical example. Patient K-in, 49 years, a case history № 4118/934, gosyopitalizirovan in traumatologic unit of 29.07.2000 with the diagnosis: ZaYOkrytyj splintered fracture of the left calcaneus with shift. A trauma household - falling from height of 2nd floor on feet. Roentgenograms left pjatochyonoj in lateral and axial projections of the patient to K Th at entering are presented a bone on fig. 28.

Fig. 28. Roentgenograms of the left calcaneus of the patient to K Th before operation.

1.08.2000 under periduralnoj anaesthesia operation - nakoyo is made

stnyj an osteosynthesis of the right left bone a plate of joint-stock company and screws from medialnoyogo access. Roentgenograms of the left calcaneus of the patient after an osteosynthesis are presented K Th on fig. 29.

Fig. 29. Roentgenograms left calcaneal kostja the patient to K Th after an osteosynthesis a plate of joint-stock company and screws.

Current of the postoperative period without complications. After healing opeyoratsionnoj wounds of 18.08.2000 it is written out on an out-patient treatment in

Fracture consolidation is reached.

Roentgenograms of the left calcaneus of the patient after konsolidayotsii fracture are presented K Th on fig. 30.

Rehabilitational treatment under the program developed by us. Extremity function is restored in full. Has started physical work in 3 months and 22 days from the moment of a trauma, works as the carpenter-concreter.

metallokonstruktsii are removed in 7 months after consolidation pereyoloma.

The remote result is tracked in 4 years. At control osyomotre the patient of complaints does not show, extremity function in full. Continues to work as the concreter. The result is regarded as good.

Fig. ZO. The roentgenogram calcaneal pave the patient to K Th after fracture consolidation.

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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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