Zhuravlov V. Medical rehabilitation of patients with the consequences of pelvic injuries

The incidence of pelvic ring injuries is about 1 % of all injuries of the musculoskeletal system, however, the number of years lived with disability due to the adverse consequences of pelvic injury is the second indicator among bone fractures of other locations. Such patients note decreased mobility, chronic pelvic pain, impaired standing and walking, decreased or lost ability to work, and decreased quality of life. The difficulty of restoring the functional capabilities of the musculoskeletal system after injuries to the pelvic ring is due to the anatomical and biomechanical features of the lower extremity girdle. The postural stability of the pelvic ring is ensured by the self-stabilization mechanism of the sacroiliac joints, the implementation of which involves compression forces created by the pelvic floor muscles, periarticular muscles, and articular ligaments, which prevent displacement of the articular surfaces relative to each other. In a damaged sacroiliac joint, the self-stabilization mechanism is disrupted due to post-traumatic insufficiency of muscles and ligaments, unresolved displacement of articular surfaces, which, in turn, additionally negatively affects muscle strength and endurance. Thus, restoration of the functional properties of the muscular-ligamentous complex of the sacroiliac joints is one of the important tasks of the rehabilitation period. The scientific basis for the developed rehabilitation program for patients with polytrauma in the early postoperative period after surgical fixation of pelvic ring fractures included patients' awareness of their injury, the extent of surgical treatment, the effectiveness and safety of the kinesiotherapy program; early active mobilization of the muscles of the lumbopelvic region and lower extremities, taking into account concomitant injuries of the musculoskeletal system; dosed load of the lower extremities based on a comprehensive quantitative assessment of demographic, clinical and radiological indicators affecting the fracture healing process. In the immediate postoperative period (10–12 days after surgery), the rehabilitation program was aimed at preventing postoperative complications, activating patients, and improving reparative processes. We conducted educational conversations, used isometric exercises for the paravertebral, sciatic muscles, flexor and extensor muscles of the hip, lower leg, and gentle manual therapy techniques aimed at relaxing spasmodic muscles and preventing postoperative adhesions. After the patient was transferred to an upright position, learning to walk began with the help of crutches with a dosed load on the operated limb, depending on the results of a quantitative assessment of the functional state of the musculoskeletal system. Scientific novelty of the obtained results. For the first time, on the basis of a complex quantitative assessment of the functional state of the locomotor system, a scientifically substantiated method of medical rehabilitation of patients with polytrauma in the early postoperative period after surgical treatment of unstable injuries of the pelvic ring. For the first time, calculations of the distribution of the stress-strain state of the biomechanical system "lumbar spine – sacroiliac joint – pelvis" using a mathematical finite element model showed an insignificant increase in the level of stress in the arthrodesis zone under unilateral vertical loading. For the first time, the results of the application of the kinesitherapy program with educational talks, soft techniques of manual therapy and the permissible load of the pelvic girdle and lower limbs in the early postoperative period showed a significant decrease in the intensity of pain, the level of kinesiophobia, the level of anxiety and restlessness associated with the expectation of pain, an increase the degree of patient participation in the rehabilitation process, a significant increase (p < 0.05) in the frequency of excellent treatment results and a significant decrease (p < 0.05) in the negative consequences of pelvic injuries. For the first time, it was shown that the developed "Questionnaire for determination of permissible load during early rehabilitation of patients with pelvic bone fractures" allows for quantitative assessment of demographic, clinical and radiological indicators that can affect the fracture healing process. For the first time, it was proved based on the results of experimental bench studies on preparations of pig pelvic bones that with cyclic loads of alternating signs of threaded connections "rod – pelvic bone", significantly greater stability of pelvic fixation occurs when using rods with multidirectional threads.