Dolgopolov O. Diagnostics and surgical treatment of ischemic limb contractures (experimental and research study)

The present thesis solves the scientific problem associated with the diagnostics and orthopedic treatment of patients having ischemic limb contractures. The study discovers new links in pathogenesis of the formation of ischemic limb contractures. In particular, it was experimentally proved that in ischemia there exists a close feedback between the fascial compartment pressure and intraosseous pressure, this being evidence of a direct relationship between the osseous blood supply and the blood circulation in the surrounding tissue muscles. It was established that under the fascial compartment pressure over 50 mm Hg the intraosseous pressure drops to 0. This is the fist study in Ukraine where the possibilities of muscular fiber contraction under the conditions of an acute ischemia were investigated. It was proved that specific signs of the ischemic muscles are tremor and impossibility of forming the motor pattern, since the ischemic muscle does not recover its motor potential due to the lack of reversibility phase during its stimulation. It is also for the first time in Ukraine that classification of the hand ischemic contracture was elaborated thereby making it possible to improve diagnostic procedures, thus promoting proper treatment of patients belonging to this category. Of extrinsic value for the study is an analysis of instrumental data obtained during examinations of patients in a reactive-recovery period of ischemic contracture. So, due the correlation analysis a close positive relationship (r=0.7; p<0.05) was revealed between the linear and cross contractions of muscles and "mosaic" necroses, this enabling the sonographic examination of patients to be performed in the reactive-recovery period, being based only on the muscle thickness change at rest and during contraction. The presence of a significant strong positive relationship between the severity of compartment syndrome and percentage of necrosis in the ischemic muscles (r=0.71±0.028); the increased ischemia severity leads to the increase in the muscular tissue necrotization. A significant negative relationship was established between the percentage of necrosis and vertical ?-entropy of ischemic muscles (r = ? 0.80±0.024) - i.e. the higher is necrosis %, the less are the structural properties of the nearby muscular tissue. On the basis of electromyographic and sonographic examinations as well as analysis of the end functional results of treatment, the basic characteristics of the total (subtotal), ischemic damage and irreversible changes in the muscles were revealed: destructibility of a larger part and abundance of the muscular area, multiple loci of the "total bioelectric silence", absence of areas with normal introduction amplitude at the tree levels of myogaster. Drawing on a complex of diagnostic data obtained, a system of the reconstructive and recovery treatment of patients with ischemic contracture was developed that depends on its period and degree of severity as well as on the concurrent damages. The use of such an approach made it possible to improve by 2.5 times the function of ischemic foot and by 14% the function of ischemic hand with high degree of significance (р < 0.01, р < 0.05).