Pobiel I. Violation of the structural-functional state of bone fabric for patients after the breaks of long bones: prophylaxis and treatment (experimentally-clinical research)

Object: structural and functional state of bone tissue after diaphyseal fractures of long bones. Objective: to improve the effectiveness of the prevention and treatment of patients after the fracture of long bones based on a determination of disorders mechanisms of the structural and functional state of the bone tissue. Methods: clinical, radiographic, experimental, morphological, two-photon densitometry of skeleton, algorithmic FRAX system, biochemical, cell culture method, a statistical. On the basis of clinical and experimental studies, the correlation analysis between the severity of traumatic injuries, repair process, loss of bone mineral density in different parts of the skeleton, the specificity of bone metabolism and organism reparative potency the mechanisms of osteopenic and osteoporotic skeletal disorders have been identified. A high percentage of systemic osteopenia and osteoporosis in patients with some fractures in a medical history (60.4% men and 74.4% women) were identified. Using FRAX algorithmic system it was proved that the risk of subsequent fracture increases by 3-5 times in women of different ages with a fracture in medical history compared with the control group. It was shown, that reducing of vitamin D level in the blood serum of patients after fracture plays a significant role among the mechanisms of structural and functional disorders of bone quality. This leads to a decrease in bone mass, imbalance process "resorption - bone formation" in the direction of еру resorption increasing. The leading role of osteotrophic therapy in the prevention of post-traumatic osteopenia and refracture that occur on this background was identified. The method of surgical treatment of patients with long bones fractures by the closed minitraumatic technique using author multifunctional external fixation device (patent 57328 UA) has been developed. The method to optimize osteoregeneration of long bone fractures with the use of bone grafts (patent 62317 UA) has been created. Diagnostic criteria of the risk factors for the loss of bone mineral density, as well as the method of determining of osteoregeneration potential of patients using cell cultures (patent 79708 UA) were developed. In the study group proposed methods of treatment of patients with diaphyseal fractures of the extremities were used. 97.6% of positive results were obtained as compared to 84.5% among identical patients to whom well-known surgical methods were applied. The results of researches are introduced into the clinical practice of KU "Zaporozhye Multidisciplinary Clinical Hospital № 9"; TMO "Multidisciplinary Hospital intensive treatment and emergency care" Melitopol; KU "City Clinical Hospital of Emergency and Ambulance" Zaporozhye; in the surgical department of the central district hospital of Orekhovo; Genichesk central district hospital of Kherson region and the learning process in the relevant departments of SI "Zaporozhye Medical Academy of Postgraduate Education of Ministry of Health of Ukraine", SI "Lugansk State Medical Institute" Ministry of Health of Ukraine. Traumatology and orthopedics.