Treatment outcomes in patients with multiple and concomitant trauma managed with minimally invasive osteosynthesis technologies and electromagnetic waves of the terahertz range

Purpose. To assess the effectiveness of minimally invasive technologies of osteosynthesis and electromagnetic waves of the terahertz range in patients with multiple and concomitant trauma.

Materials and methods. The process of rehabilitation was studied in 513 patients with polytrauma of varying severity which was more than 26 points on the ISS scale. The patients were diagnosed with 545 injuries of different organs and systems. All patients with severe concomitant and multiple trauma were divided into 3 groups: Group I of controls, treated in1995–2001, consisted of 269 patients whose treatment was conservative and aggressive (surgical, with the use of plating or intramedullary osteosynthesis); Group II was the experimental study group consisting of subgroup A of 202 patients treated in 2002–2009 in whom “damage control” concept was applied and subgroup B of 42 patients treated in 2010–2017 using the damage control tactics and new minimally invasive methods of treatment and devices (non-invasive lung ventilation in intensive care for fat embolism; rational osteosynthesis in closed chest trauma; minimally invasive guided method of transosseous osteosynthesis, including the use of fixators with hydroxyapatite coating; rational surgical approach to pelvic bones; universal guide for reaming the medullary canal) and exposure to electromagnetic waves of the terahertz range (EMWTHR)of the xiphoid process of the sternum to stimulate the immune system.

Results. It was revealed that the use of minimally invasive, low-traumatic methods of treating bone fractures in severe polytrauma and methods stimulating the immune system and tissue regeneration (subgroup II B) contributed to an improvement of anatomical and functional results of treatment by 1.3 times compared with the control group. The quality of life of patients in this group, in comparison with the control group, was 1.6 times higher for injuries of the upper limb and 1.9 times higher for injuries of the lower limb. An integral analysis of the effectiveness of the treatment revealed a reliable increase in the effectiveness to a satisfactory level.

Conclusion. The use of EMWTHR in the complex treatment of such patients is a promising method for stimulating hematological and immunological processes. The first results described in the literature are optimistic.

1. Paffrath T., Lefering R., Flohe S.; Trauma Register DGU. How to define severely injured patients ? – an Injury Severity Score (ISS) based approach alone is not sufficient. Injury, 2014, vol. 45, no. Suppl. 3, pp. S64-S69. DOI: 10.1016/j.injury.2014.08.020

2. Von Rüden C., Woltmann A., Röse M., Wurm S., Rüger M., Hierholzer C., Bühren V. Outcome after severe multiple trauma: a retrospective analysis. J. Trauma Manag. Outcomes, 2013, vol. 7, no. 1, pp. 4. DOI: 10.1186/1752-2897-7-4

3. Gruber N.M., Valeev E.K., Shulman A.A., Iafarova G.G. Patogeneticheskie mekhanizmy reparativnogo osteogeneza pri sochetannoi travme [Pathogenetic mechanisms of reparative osteogenesis in concomitant injury]. Prakticheskaia Meditsina [Practical Medicine], 2016, vol. 1, no. 4 (96), pp. 79-81. (in Russian)

4. Sinitsa N.S., Dovgal D.A., Obukhov S.Iu. Vozmozhnosti primeneniia rannego osteosinteza u detei mladshei vozrastnoi gruppy pri politravme [The possibilities of using early osteosynthesis in the children of the younger age group with polytrauma]. Politravma [Polytrauma], 2014, no. 1, pp. 56-60. (in Russian)

5. Lukin S.Iu., Soldatov Iu.P., Stogov M.V. Kompleksnaia korrektsiia patofiziologicheskikh narushenii u ortopedotravmatologicheskikh bolnykh s primeneniem elektromagnitnykh voln teragertsovogo diapazona na chastotakh izlucheniia oksida azota [Comprehensive correction of pathophysiological disorders in orthopedic-and-traumatological patients with using terahertz-range electromagnetic waves at frequencies of nitric oxide emission]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury [Problems of Balneotherapy, Physiotherapy and Exercise Therapy], 2018, vol. 95, no. 6, pp. 58-66. (in Russian) DOI: 10.17116/kurort20189506158

6. Kazarinov K.D. Biologicheskie effekty elektromagnitnogo polia teragertsovogo diapazona [Biological effects of terahertz-range electromagnetic field]. Elektronnaia tekhnika. Seriia 1: SVCh-tekhnika [Electronic equipment. Series 1: Mirowave technology], 2009, no. 4 (503), pp. 48-58. (in Russian)

7. Kulipanov G.N. Generatsiia i ispolzovanie teragertsovogo izlucheniia: istoriia i perspektivy [The generation and use of terahertz radiation: history and prospects]. Vestnik Novosibirskogo Gosudarstvennogo Universiteta. Seriia: Fizika [Bulletin of the Novosibirsk State University. Series: Physics], 2010, vol. 5, no. 4, pp. 24-27. (in Russian)

8. Chekrygin V.E. Teragertsovyi diapazon na strazhe zdorovia [Terahertz range on guard of health]. Izvestiia Iuzhnogo Federalnogo Universiteta. Tekhnicheskie Nauki [News of the Southern Federal University. Technical Sience], 2009, no. 7 (96), pp. 102-107. (in Russian)

9. Levchenko T.V., Kravtsov S.A., Kornev A.N., Shatalin A.V., Dzuban G.G. Analiz gospitalnoi letalnosti i kachestva klinicheskoi diagnostiki u postradavshikh s politravmoi [Analysis of hospital mortality and the quality of clinical diagnosis in patients with polytrauma]. Politravma [Polytrauma], 2014, no. 3, pp. 24-32. (in Russian)

10. Lukin S.Iu. Immunnye, metabolicheskie i gemostaticheskie izmeneniia u patsientov s tiazheloi travmoi v posttravmaticheskom periode [Immune, metabolic and hemostatic changes in patients with severe trauma in the posttraumatic period]. Sovremennye problemy nauki i obrazovaniia [Current Problems of Science and Education], 2017, no. 2. (in Russian) Available at: https://www.elibrary.ru/item.asp?id=29036168 (accessed 12.05. 2018).

11. Shevtsov V.I., Shved S.I., Sysenko Iu.M. Chreskostnyi Osteosintez pri Lechenii Oskolchatykh Perelomov [Transosseous osteosynthesis for treatment of comminuted fractures]. Kurgan, 2002, pp. 244-244. (in Russian)

12. Oberg U., Oberg B., Oberg T. Validity and reliability of a new assessment of lower-extremity dysfunction. Phys. Ther., 1994, vol. 74, no. 9, pp. 861-871. DOI: 10.1093/ptj/74.9.861

13. Agadzhanian V.V., Pronskikh A.A. Vysokotekhnologichnaia meditsinskaia pomoshch pri travmakh [High-tech medical care for injuries]. Politravma [Polytrauma], 2008, no. 4, pp. 5-8. (in Russian)

14. Salaev A.V., Moiseenko V.A., Kislov A.I., Kulakov V.G., Gatin A.V. Vneochagovyi chreskostnyi osteosintez dlinnykh trubchatykh kostei [Extrafocal transosseous osteosynthesis of long tubular bones]. Izvestiia Vysshikh Uchebnykh Zavedenii. Povolzhskii Region. Meditsinskie nauki [News of Higher Educational Institutions. Povolzhsky Region. Medical Sciences], 2012, no. 2 (22), pp. 91-98. (in Russian)

15. Shteinle A.V. Patologicheskaia fiziologiia i sovremennye printsipy lecheniia tiazhelykh sochetannykh travm (chast 2) [Pathophysiology and modern principles of treating severe concomitant injuries (Part 2)]. Sibirskii Meditsinskii Zhurnal [Siberian Medical Journal], 2009, no. 3, is. 2, pp. 35-42. (in Russian)

16. Nirula R., Mayberry J.C. Rib fracture fixation: controversies and technical challenges. Am. Surg., 2010, vol. 76, no. 8, pp. 793-802.

17. Todd S.R., McNally M.M., Holcomb J.B., Kozar R.A., Kao L.S., Gonzalez E.A., Cocanour C.S., Vercruysse G.A., Lygas M.H., Brasseaux B.K., Moore F.A. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am. J. Surg., 2006, vol. 192, no. 6, pp. 806-811. DOI: 10.1016/j.amjsurg.2006.08.048

18. Pape H.C. Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: damage control orthopedic surgery. J. Orthop. Res., 2008, vol. 26, no. 11, pp. 1478-1484. DOI: 10.1002/jor.20697

19. Gebhard F., Huber-Lang M. Polytrauma – pathophysiology and management principles. Langenbecks Arch. Surg., 2008, vol. 393, no. 6, pp. 825-831. DOI: 10.1007/s00423-008-0334-2

20. Strasser D.C., Uomoto J.M., Smits S.J. The interdisciplinary team and polytrauma rehabilitation: prescription for partnership. Arch. Phys. Med. Rehabil., 2008, vol. 89, no. 1, pp. 179-181. DOI: 10.1016/j.apmr.2007.06.774

21. Friedemann-Sánchez G., Sayer N.A., Pickett T. Provider perspectives on rehabilitation of patients with polytrauma. Arch. Phys. Med. Rehabil., 2008, vol. 89, no. 1, pp. 171-178. DOI: 10.1016/j.apmr.2007.10.017

22. Tiuliaev N.V., Vorontsova T.N., Solomin L.N., Skomoroshko P.V. Istoriia razvitiia i sovremennoe sostoianie problemy lecheniia travm konechnostei metodom chreskostnogo osteosinteza (obzor literatury) [The history and current state of the problem of treating limb injuries by transosseous osteosynthesis method (Review of the literature)]. Travmatologiia i Ortopediia Rossii [Traumatology and Orthopaedis of Russia], 2011, no. 2 (60), pp. 179-190. (in Russian)

23. Lazarev A.F., Solod E.I., Lazarev A.A. Vozmozhnosti i printsipy maloinvazivnogo osteosinteza pri lechenii perelomov kostei [Possibilities and principles of little-invasive osteosynthesis in treatment of bone fractures]. Vestnik Travmatologii i Ortopedii im. N.N. Priorova [Priorov Bulletin of Traumatology and Orthopaedics], 2011, no. 2, pp. 5-11. (in Russian)

24. Pankov I.O., Sirazitdinov S.D. Sovremennye printsipy okazaniia spetsializirovannoi pomoshchi patsientam s tiazheloi politravmoi v usloviiakh travmtsentra I urovnia [Current principles of rendering specialized care to patients with severe polytrauma in a I-level trauma centre]. Prakticheskaia Meditsina [Practical Medicine], 2014, vol. 2, no. 4 (80), pp. 104-108. (in Russian)

25. Pankov I.O., S.D. Sirazitdinov, Asadullin Sh.G., Sirazitdinov D.T. Printsipy okazaniia spetsializirovannoi pomoshchi patsientam s tiazhelymi mnozhestvennymi perelomami kostei konechnostei v usloviiakh travmtsentra i urovnia na sovremennom etape. Damage control v travmatologii [Priniples of rendering specialized care to patients with severe multiple fractures of limb bones in the conditions of a I-level trauma centre at the present stage. Damage control in taumatology]. Sovremennye Problemy Nauki i Obrazovaniia [Current Problems of Science and Eduation], 2014, no. 3. (in Russian) Available at: https://science-education.ru/ru/ article/view?id=13241 (accessed 24.04.2018).

26. Gorodnichenko A.I., Uskov O.N. Chreskostnyi osteosintez apparatami konstruktsii Gorodnichenko v lechenii postradavshikh s politravmoi [Transosseous osteosynthesis using the devices of the Gorodnichenko construction in treatment of the injured persons with polytrauma]. Khirurgiia. Zhurnal im. N.I. Pirogova [Surgery. Pirogov Journal], 2004, no. 9, pp. 50-54. (in Russian)

27. Bondarenko A.V. Rannii chreskostnyi osteosintez po Ilizarovu otkrytykh diafizarnykh perelomov kostei goleni kak factor profilaktiki oslozhnenii i neblagopriiatnykh iskhodov u bolnykh s politravmoi [Early transosseous osteosynthesis of open shaft fractures of leg bones according to Ilizarov as a preventive factor of complications and unfavorable outcomes in patients with polytrauma]. Genij Ortopedii [Othopaedics Genius], 2004, no. 1, pp. 118-122. (in Russian)

28. Kolesnikov V.V., Guselnikova M.A. Tiazhelaia sochetannaia travma i DVS-sindrom: reanimatsionnaia strategiia gemostaza [Severe concomitant injury and DIC-syndrome: resuscitation strategy of hemostasis]. Tromboz, Gemostaz i Reologiia [Thrombosis, Hemostasis and Rheology], 2014. no. 2 (58), pp. 37-43. (in Russian)

29. Kalinina N.M., Sosiukin A.E., Vologzhanin D.A., Kuzin A.A., Kniazev P.S. Travma: vospalenie i immunitet [Trauma: inflammation and immunity]. Tsitokiny i Vospalenie [Cytokines and Inflammation], 2005, vol. 4, no. 1, pp. 28-35. (in Russian)

30. Stogov M.V., Liulin S.V., Kireeva E.A., Tushina N.V., Sviridenko A.S. Otsenka effektivnosti primeneniia nekotorykh laboratornykh testov dlia monitoringa posttravmaticheskogo sostoianiia u patsientov s politravmoi [Evaluation of several laboratory tests to monitor posttraumatic condition of polytrauma patients]. Genij Ortopedii [Orthopaedics Genius], 2017, vol. 23, no. 3, pp. 297-301. (in Russian) DOI: 10.18019/1028-4427-2017-23-3-297-301

31. Ramundo-Orlando A., Gallerano G.P. Terahertz Radiation Effects and Biological Applications. Journal of Infrared, Millimeter and Terahertz Waves, 2009, vol. 30, no. 12, pp.1308-1318. DOI: 10.1007/s10762-009-9561-z