RESUMEN
The article analyses the experience in operative interventions on the pain-conducting tracts of the spinal cord in 24 patients with pain consequent upon injury to the spine and spinal cord. Inferior commissurotomy was performed on 13 patients. It proved effective in cases in which the spinal cord was injured below the level of the 12th thoracic segment. Bilateral chordotomy was conducted in 7 patients with an intensive central pain syndrome. The effect of the operation was positive in sufficiently deep transection of the anterolateral fasciculus. Coagulation of the entry of the posterior roots of the spinal cord was carried out in 4 patients. Preference should be given to it in high affections of the spinal cord.
Asunto(s)
Dolor/cirugía , Traumatismos de la Médula Espinal/cirugía , Médula Espinal/cirugía , Traumatismos Vertebrales/cirugía , Adulto , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Dolor/etiología , Dolor/fisiopatología , Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/fisiopatologíaAsunto(s)
Lesiones Encefálicas/cirugía , Heridas no Penetrantes/cirugía , Conmoción Encefálica/mortalidad , Conmoción Encefálica/cirugía , Lesiones Encefálicas/mortalidad , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/cirugía , Coma/mortalidad , Coma/cirugía , Urgencias Médicas , Hematoma/mortalidad , Hematoma/cirugía , Humanos , Presión Intracraneal , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Factores de Tiempo , Heridas no Penetrantes/mortalidadRESUMEN
Therapeutical correction of intracranial pressure changes were conducted in 14 patients suffering from traumatic intracranial hematomas by endolumbar administration of physiological solution. The distinguishing feature of this method is the possibility of continuous control of the intracranial pressure level by means of long-term graphic recording of epidural pressure. This makes it possible to perform endolumbar administration of physiological solution in a dose which is determined by the initial level of epidural intracranial pressure. Therapeutic correction of intracranial pressure by endolumbar injection of physiological solution proved successful in the initial stages of dislocation of the brain and in stable intracranial hypotension.
Asunto(s)
Conmoción Encefálica/complicaciones , Hemorragia Cerebral/complicaciones , Encefalocele/prevención & control , Hematoma/complicaciones , Presión Intracraneal , Adulto , Hemorragia Cerebral/líquido cefalorraquídeo , Hemorragia Cerebral/cirugía , Femenino , Hematoma/líquido cefalorraquídeo , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & controlRESUMEN
Hemodynamic disorders were studied in 60 patients with isolated craniocerebral injury and in 145 patients with craniocerebral injury and injury to the locomotor apparatus. The authors studied the changes in the mean dynamic arterial pressure, the cardiac contraction rate, the cardiac output, the general peripheral vascular resistance to blood flow, and the circulation volume. It was found that in isolated craniocerebral injury the circulation volume deficiency does not exceed 13%, the mean dynamic arterial pressure and the cardiac output increase. In cases of craniocerebral injury combined with injury to the locomotor apparatus the required level of the mean dynamic arterial pressure is maintained by a higher cardiac output and an increase in the general peripheral vascular resistance to the blood flow. The changes in hemodynamic indices including the circulating volume deficiency depend on the degree of injury to the locomotor apparatus and of craniocerebral injury.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Hemodinámica , Heridas y Lesiones/complicaciones , Presión Sanguínea , Volumen Sanguíneo , Huesos/lesiones , Conmoción Encefálica/complicaciones , Gasto Cardíaco , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Cráneo/lesionesRESUMEN
Bedsores, trophic ulcers, and osteomyelitis in 250 patients with injury of the spine and spinal cord were treated by surgery. Surgical treatment of bedsores in the sacral region with a skin graft in which all the layer and the subcutaneous fat are preserved and which has independent circulation proved most effective. The graft was formed from the lumbar or gluteal region and transposed to the skin defect formed after removal of the nonviable skin areas and scars. In the region of the greater trochanters the grafts were formed from the adjacent to the bedsore tissues of the gluteal region or thigh and the greater trochanters involved in the osteomyelitic process were resected. The surgical management of bedsores in the region of the ischial tuberosities consisted in excision of the skin margins of the bedsore together with the infectious granulomas, bursae, and the cicatrico-granulomatous tissue. In osteomyelitis of the ischium and bedsores in the gluteal region, the bone was resected. A total of 54 resections of the ischial in 47 patients were carried out.
Asunto(s)
Fémur , Isquion , Osteomielitis/cirugía , Úlcera Cutánea/cirugía , Traumatismos de la Médula Espinal/complicaciones , Traumatismos Vertebrales/complicaciones , Adulto , Nalgas , Terapia Combinada , Femenino , Humanos , Masculino , Úlcera por Presión/cirugía , Colgajos Quirúrgicos , MusloAsunto(s)
Hipotermia Inducida , Traumatismos de la Médula Espinal/terapia , Enfermedad Aguda , Hemorragia/prevención & control , Humanos , Hipotermia Inducida/métodos , Periodo Intraoperatorio , Médula Espinal/irrigación sanguínea , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Traumatismos Vertebrales/complicacionesRESUMEN
Changes in epidural intracranial pressure in 52 patients with organic lesions of the brain (tumors, severe craniocerebral injury) was studied for 1-10 days of the acute postoperative period. The tone of the cerebral vessels was studied from the values of pulse and respiratory fluctuations of intracranial pressure during spontaneous and induced hyperventilation, in inhalation of moistened oxygen, when the patient awakens and falls asleep. Duction of intracranial pressure at the peak of the hypocapnic effect and during oxygen inhalation as well as reduction of intracranial pressure at the moment of awakening ("the awakening effect") were recorded. Increased tone of the cerebral vessels was revealed during awakening, evidence of which was a decrease in the amplitude of pulse fluctuations of epidural intracranial pressure. The period of falling asleep was marked by a decrease in the tone of the cerebral vessels which was manifested on the intracranial pressure tracings by increased pulse fluctuations and led to increase of intracranial pressure. It was established that changes in the tone of the cerebral vessels and in their activity determining the different blood content of the brain are among the mechanisms of intracranial pressure regulation.
Asunto(s)
Lesiones Encefálicas/fisiopatología , Neoplasias Encefálicas/fisiopatología , Presión Intracraneal , Lesiones Encefálicas/cirugía , Neoplasias Encefálicas/cirugía , Circulación Cerebrovascular , Humanos , Nitroglicerina , Periodo Posoperatorio , Respiración , Resistencia VascularRESUMEN
Surgical interventions on the pudendal nerves were undertaken in 16 patients with neurogenic disorders in micturition due to spinal cord injuries on different levels of the latter. The operations were performed after careful examinations of the patients and a preliminary novacain block of the nerves in question. A modified approach to the pudendal nerves was employed. Satisfactory results were achieved in 14 patients: spontaneous micturition was restored, the volume of residual urine was significantly reduced. A stable good result in the late follow-up period was observed in 12 patients.
Asunto(s)
Traumatismos de la Médula Espinal/complicaciones , Traumatismos Vertebrales/complicaciones , Vejiga Urinaria Neurogénica/cirugía , Anciano , Desnervación , Humanos , Masculino , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
A 10-year experience gained in the surgical treatment of spastic manifestations in patients with the injured vetebral column and spinal cord is summarized. In 57 cases a total of 60 modified Bischof's operations were performed. A clinical classification has been worked out, at the basis of which there are the intensity and frequency of synergies. Spasticity disappeared in 54 of the patients operated upon. The elimination of the synergy, hypertonicity, mono- and pplysynaptic reflexes created favourable conditions for a subsequent rehabilitative therapy, which included walking and self-service training. Myelotomy proved quite effective irrespective of the time lapsed from the moment of injury.