A.A. Razzokov1, M.K. Nazarov2
DIFFERENTIAL DIAGNOSIS OF SEVERE COMBINED CRANIOCEREBRAL INJURY AND FAT EMBOLISM SYNDROME
1Department of Traumatology, Orthopaedics and Military Field Surgery, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
2Tursunzade Central Regional Hospital, Tursunzade, Tajikistan
Objective: To improve the differential diagnosis of severe combined craniocerebral injury (SCCI) and the fat embolism syndrome (FES).
Methods: The analysis of data on 338 patients with SCCI was carried out. There were 236 men (69.8%), women – 102 (30.2%) at the age of 18 to 68 years. Eligible patients were the presence of a concomitant injury with symptoms of traumatic shock and a violation of consciousness. In the control group (42.6%) performed the traditional tactics of diagnostics. In the main group (57.4%), in preventive diagnostic algorithm mode consisted of the identification of the fat globulemia (FG) according to Kornilov, a purposeful diagnosis of SFE, and an assessment of the severity of the craniocerebral components of the considered injury using computed tomography.
Results: In the control group, FES was set only 12 (8.3%) cases, which have been fatal. Total deaths in the control group took place in 58 (40.3%) observations. In the main group among SCCI FES was established in 33 (17.0%) patients; CCI in 99 (51.0%) and FES + CCI in 62 (32.0%) patients. Various manifestations of FES were revealed in 95 (49.0%) patients, which were presented classical – 15 (7.7%), clinical – 29 (15.0%) and subclinical forms – 51 (26.3%). Based on the results of the work, a scale was proposed for the differential diagnosis of FES and CCI, the efficiency of which was 97.4%.
Conclusions: Optimization of SCCI treatment, with regard to the identification of FG, diagnosis of various forms of FES and computer tomography data, allowed to reduce the lethality by 13.5% compared to traditional approaches (26.8% and 40.3%, respectively). With a differentiated analysis in the main group, the specific gravity of lethality among patients with FES was 12.1%, with CCI – 23.2% and with CCI + FES – 40.3%.
Keywords: Combined injury, craniocerebral injury, fat globulemia, fat embolism syndrome, differential diagnosis, lethality
Razzokov Abduvali Abduhamitovich, Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University
Nazarov Mahmadali Kadyralievich, Head of the Neurosurgical Department of the Tursunzade Central Regional Hospital
Address for correspondence:
Razzokov Abduvali Abduhamitovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: (+992) 915 046001