The dissertation is devoted to increasing the effectiveness of treatment of patients with multiple gunshot fractures of long bones due to the implementation of phased telemedical consultations.
In the structure of gunshot injuries, limb injuries account for 64% of the total number of combat injuries, of which 25.2% are fractures (data from the Military Medical Department of the Ministry of Education and Culture). Gunshot wounds of the upper limbs make up 35.7%, lower - 64.3%; multiple gunshot fractures make up 13.2% [Zarutskyi Y.L. (2014), Khomenko I.P. (2015), Strafun S.S. (2015), Buryanov O.A. (2016)]. The structure of the main complications: chronic osteomyelitis 18.1% [Hritsai M.P., (2017) pseudoarthrosis (12.4%) [Korzh M.O., (2014), Loskutov O.E. (2015), Borzykh O.V., (2016)], contractures of large joints 34.7% (Buryanov O.A. (2016), Yarmolyuk Yu.O. (2017)]. In sources literature, there is enough data to show the equivalence of data collection capabilities of telemedical consultations to "classical" ones. There is enough data on the "minimum" technical support of telemedical consultations. There are data to show the positive effect of telemedical consultations for both "physician-patient" and "physician-physician" in the organization of care for patients with acute stroke (NIHHS scale); effect on the frequency of primary detection of thyroid neoplasms.
In traumatology and orthopedics, there are data on the economic effect of using telemedical consultations to help patients with pelvic injuries; effect on "satisfactory" and "unsatisfactory" results of treatment of patients with clavicle fractures. However, there are no data on 1) the use of telemedicine consultations (in general, telemedicine) in providing assistance to patients during military conflicts; 2) "systemic" use of telemedicine technologies in the treatment of patients with multiple skeletal polytrauma. In the system of restorative treatment of patients with multiple gunshot fractures of long bones, one of the factors identified as promising in optimizing its implementation is the use of mandatory telemedical consultations at the stages of medical evacuation [Buryanov O.A., 2016, Yarmolyuk Yu. .AT. 2018]
The purpose and objectives of the research
• To improve the results of providing assistance to patients with multiple gunshot fractures of long bones based on the definition of rational terms and optimization of surgical intervention methods and to develop an individual rehabilitation program by substantiating and implementing telemedicine technologies in the system of restorative treatment of victims. Objectives of the study:
• To conduct an analysis of literary sources regarding the results of the use of telemedicine in the treatment of victims with gunshot skeletal trauma.
• To conduct an analysis of existing technologies for replacing bone tissue defects and to experimentally substantiate the choice of optimal combinations based on bioglass, blood products and bone marrow aspirate.
• Determine the technical requirements for providing telemedicine technologies (teleconsultations, home telemedicine and biotelemetry) and their integration into clinical activities.
• To form a standard for evaluating "doctor-doctor" and "doctor-patient" teleconsultations in the implementation of the main tasks that must be performed at a separate stage of treatment and to determine the factors affecting the number of teleconsultations.
• Formation of the evaluation standard of teleconsultations for home telemedicine for telemonitoring of the patient's condition after the completion of the conversion stage to the completion of the rehabilitation stage
• Based on the analysis of teleconsultation data and the application of motion monitoring technology using statistical methods of information processing, determine the effectiveness of the use of telemedicine technologies
Research methods - general clinical, laboratory (general blood tests, urine, biochemical blood tests), instrumental (X-ray, CT, ultrasound (Doppler), measurement of subfascial pressure), questionnaires, telemedical consultation and monitoring (using a computer with WEB -camera/smartphones and Internet connection, programs for remote monitoring of movements), statistical.
The object of the study: patients with multiple gunshot fractures of long bones. The subject of the research: the results of instrumental and clinical studies of patients of clinical groups, the results of evaluating the effectiveness of teleconsultation services by the proposed algorithm, the results of mathematical and statistical analysis of the obtained primary digital data.
