The dissertation on the topic "Surgical tactics of treatment of open fractures
of the bones lower leg with significant damage to soft tissues" is devoted to the
topical issue of surgical treatment of patients with III degree open tibia fractures
according to the Gustilo-Anderson classification. The relevance of this topic is due
to: the heterogeneity of this group of damages; unpredictability of the results surgical
treatment; the lack of studies in which the relationship between the concentration of
interleukin-6 and open fractures of the lower leg bones of III degree according to the
Gustilo-Anderson classification would be established; the lack of a differentiated
approach to the choice of tactics for surgical treatment of open fractures the leg
bones of the III degree according to the Gustilo-Anderson classification; a
significant level of complications and unsatisfactory results in the surgical treatment
of such fractures; lack of rehabilitation programs after surgical treatment of the open
tibial fractures with significant soft tissue damage.
To solve the research problem, a prospective and retrospective study was
conducted to study the dynamics of inflammatory process markers (leukocytes,
erythrocyte sedimentation rate, C-reactive protein, interleukin-6) in patients with
open fractures of the lower leg bones with significant soft tissue damage.
The first group of patients, which consisted of 38 victims who underwent
replacement of the fixation method, was divided into two subgroups: in subgroup 1,
21 (55.26%) patients had indicators of the inflammatory process evaluated, such as
leukocytes, erythrocyte sedimentation rate, C-reactive protein and IL-6. In the 2nd
subgroup, 17 (44.74%) patients also had the indicators of the inflammatory process
evaluated, as in the first subgroup, except for IL-6.
The second group included 41 patients (primary and final treatment in the
external fixation device), all of them were also divided into two subgroups. The third
subgroup consisted of 18 (43.90%) patients who were evaluated for indicators of the
inflammatory process, including interleukin-6. Subgroup 4 included 23 (56.10%)
patients with open fractures of the tibia, who were examined for indicators of the
inflammatory process, except for IL-6. All studied patients were divided into
subgroups according to age, sex, and degree of open fracture according to the
Gustilo-Anderson classification.
As a result of the research, it was proven that the use of indicators, markers of
the inflammatory process, such as C-reactive protein and interleukin-6 on the 3rd,
7th and 14th day after the injury objectifies the detection of the early local
inflammatory process and makes it possible to optimize the surgical tactics of
treatment patients with open tibial fractures with significant soft tissue damage.
It was established that the differences in IL-6 indicators during repeated
studies are statistically reliable with a probability of more than 95% and are the most
sensitive indicator of the early development of infectious complications in patients
with open tibia fractures of the III degree according to the Gustilo-Anderson
classification.
Our analysis of the results of surgical treatment of patients with open tibia
fractures of the III degree according to the Gustilo-Anderson classification using the
proposed tactics of surgical treatment and laboratory examination with the
determination of markers of the inflammatory process showed significant
advantages: an increase in the number of good results by 15.7%, a decrease in
unsatisfactory results - by 7.9%, reduction of postoperative wound suppuration by
9.0%, tibial non-unions - by 4.3%, chronic osteomyelitis - by 6.6%, contractures in
the knee and tibiocalcaneal joints - by 8, 6%.
