IMPROVEMENT OF TREATMENT TACTICS OF SEVERE COMBINED CRANIOCEREBRAL INJURY IN TERMS OF CLINICAL MANIFESTATIONS OF FAT EMBOLISM SYNDROME
1The Department of Traumatology, Orthopaedics and Military Field Surgery, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
2Tursunzade Central Regional Hospital, Tursunzade, Tajikistan
Objective: The reduction the lethality in the acute period of severe combined craniocerebral injury (SCCI) by improving the treatment tactics, in terms of the clinical manifestations of fat embolism syndrome (FES).
Methods: The results of treatment of 393 patients with SCCI at the age of 14 to 68 years are analyzed. Patients were divided into three groups: I group (traditional treatment) – 144 (36.7%); group II (optimized tactics) – 194 (49.3%); group III – children and adolescents aged 14-18 years – 55 (14.0%). In turn, patients of the II group are divided into the following subgroups: IIA (FES) – 33 (8.4%); IIB (SCCI) – 99 (25.6%); IIC (FES + SCCI) – 62 (15.7%).
Results: The implementation of optimized treatment tactics in combination with the identification and pathogenetic treatment of FES contributed to a reduction in deaths compared to traditional approaches. Overall mortality was 31.0%; 40.3% in group I; 12.2% in group IIA; 23.2% in group IIB; 40.3% in group IIB, and group IIIB – 21.8%. In a differentiated analysis, postoperative lethality as a whole was 26.5%; in group I – 34.1%; in group IIA – 5.3%; in group IIB – 20.8%; in group IIB – 33.9%, and in III group – 14.3%. Mortality after conservative treatment was 55.7%; in group I – 83.3%; in group IIA – 21.4%; in group IIB – 100.0%; in group IIB – 100.0%, and in group III – 35.0%.
Conclusions: The suggested approaches in the treatment of SCCI by improving tactics, properly the clinical manifestations of FES refer to effective ways to reduce the lethality in the acute period of traumatic illness.
Keywords: Severe combined craniocerebral injury, fat globulemia, fat embolism syndrome, optimized treatment tactics, 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
pages 331 - 337