The OBJECTIVE the study is to rate the clinical efficacy of pelvic C-clamp in patients with unstable pelvic ring injuries and signs of intrapelvical ongoing bleeding. MATERIAL AND METHODS. We studied the results of treatment of 87 patients with unstable pelvic ring injuries signs of unstable hemodynamics. Pelvic C-clamp was used for mechanical stabilization of the posterior pelvic half-ring in order to stop the ongoing pelvic bleeding. Surgical methods of hemostasis in addition to the stabilization of the pelvis were used in 30 patients. Control of systolic blood pressure in the dynamics, volume and duration of blood transfusion therapy were carried out to assess the effectiveness of hemostasis. Additionally, spiral computed tomography with intravenous contrast enhancement and pelvic diagnostic angiography were performed. RESULTS. Surgical methods of hemostasis combined with mechanical stabilization of the damaged pelvic ring made allow to achieve the final stopping of the ongoing pelvic bleeding in ¾ patients. CONCLUSION. In severe concomitant pelvic injury, surgical methods of hemostasis in combination with mechanical stabilization of the damaged pelvic ring should be actively used in patients in critical condition.

Current incidence and characteristics of subaxial cervical and thoracolumbar spine injuries in a metropolitan area in Russia (in St. Petersburg) were studied. The results showed the annual incidence of 15.4 cases per 100,000 population, and the relative frequencies found to be high were that of isolated trauma with SCI (41.8% and 23.7%) and of spine injuries in polytrauma patients (7.5% and 7.9%). Also, the relatively low need for allocated specialty beds was adequately supplied in the setting of centralized delivery of acute spine services.

Диагностическая и лечебная тактика при оказании специализированной медицинской помощи больным с заболеваниями позвоночника в условиях отделения неотложной хирургической вертебрологии

Today vertebral hemangioma is not completely understood entity, neither its pathogenesis nor optimal treatment is determined. Nowadays in majority of clinics in this country ineffective radiotherapy remains the first-line treatment. We analyzed results of treatment of 205 patients (286 lesions) with aggressive hemangiomas operated in Department of Neurosurgery of Military Medical Academy and Department of Nuclear Medicine of of Russian Scientific Center of Radiological and Surgical Technologies (Saint-Petersburg, Russia) since 1999 till 2009. Percutaneus vertebroplasty was performed in 167 lesions, radiotherapy was applied in 119 aggressive hemangiomas. Vertebroplasty is more effective for treatment of aggressive hemangiomas in comparison with radiotherapy. Signs of hemangiomas aggression, indications for surgery, and tactics of management were determined. Use of percutaneous vertebroplasty for treatment of aggressive hemangiomas resulted in fast recovery of the patients. This procedure is minimally invasive, it reduces hospital stay and duration of recovery.

Mini-invasive surgery is used more often for the treatment of spinal disc herniations today. Coblation is one of such contemporary methods. The aim of our investigation was to evaluate results of percutaneous disc nucleoplasty using coblation. 35 patients with disc protrusions diagnosed by MRI underwent operations using this method. We used Visual Analogue Pain Scale, took into account time of painless sitting, standing and walking position, and also patients' satisfaction to assess the immediate results of treatment and short-time outcomes. It was noted the better immediate results in group of operated patients in comparison with the non-operated group. It was obvious either on the table or the day after operation. There were 84 and 93% of good results in 3 months and in 1 year after operation, respectively. Coblation is definitely modern and effective way to treat disc protrusions with different types, sizes, and may be used in lumbar spine wherever.

Damage control surgery (DCS) is an important option in the store of war surgery and surgery of trauma. The main purpose of our investigation was to specify the percentage of the injured who need DCS. We performed retrospective study of the patients in the combat operations in Chechnya (1994-2002) and in peacetime (2005-2010). Total lethality in group with the standard surgical approach was 62.3%. It was significantly higher than the lethality in group of patients who underwent DCS - 50.0% (p < 0.05). Thus, the experience of DCS in War Surgery Department confirms that DCS is perspective tendency in treatment of patients with severe and extremely severe trauma, and allows decreasing lethality in 12.3%.