Method of assessing severity in patients with acute orthopaedic trauma

FIELD: medicine.

SUBSTANCE: when admitted, an acuity patient is analysed for total protein concentration and creatine phosphokinase activity in blood serum. If the analysed values are within normal limits, the absence of skeletal muscles injures is diagnosed; total protein concentration being within normal limits and creatine phosphokinase hyperactivity indicate the presence of an accompanying injury of the skeletal muscles, while lowered total protein concentration with underlying creatine phosphokinase hyperactivity shows progressing hypoproteinemia.

EFFECT: method provides pre-clinical detection of the presence of the accompanying injures of the muscles and progressing hypoproteinemia.

3 ex

 

The invention relates to medicine, namely to laboratory diagnosis, and is used as an additional criterion for assessing the severity of skeletal trauma in the acute period.

Known way to assess the General condition of the patient with traumatic injuries of the skeleton by clinical analysis of blood Management in clinical laboratory diagnostics. Ed. Won. M.: Medicine, 576 S.).

However, this method does not allow to evaluate and differentiate the impact of collateral damage to the muscle tissue on the General state of the organism.

Known way to assess the severity of patients in the acute phase, including determination of the effective concentration of albumin in serum (Application No. 98109859/14 of the Russian Federation. Publ. 27.10.1999).

However, this method is used to assess the severity of traumatic brain injury patients in the acute period and does not differentiate between the impact on the overall health consequences of collateral damage in skeletal muscle.

The present invention is to assess the impact of damage to skeletal muscle injury on the overall health of patients in the acute period.

The problem is solved in that in the method of estimating severity of condition of patients with skeletal injury in the acute phase, including the analysis is komponentov serum, determine the concentration of total protein and activity of creatine phosphokinase and for values of the examined parameters within normal limits diagnose damage to skeletal muscles, and the concentration of total protein in normal and increased activity of CPK - presence of collateral damage in skeletal muscle and at lower concentrations of total protein with increased activity of CPK - development gipoproteinemii.

The invention is illustrated by description and example of its practical use.

The method is as follows.

In the serum of patients with skeletal injury in the acute phase (within days after injury) any standardized method determines the concentration of total protein and activity of CPK. The interpretation of the results is as follows. If both readings are within limits, then diagnose the absence of abnormalities of protein metabolism and damage of skeletal muscles. When the concentration of the total protein within the normal range and increased activity of CPK conclude that the severity of skeletal trauma complicated by damage to skeletal muscle. In cases where the concentration of total protein is below normal, and the activity of CPK exceeds it, then conclude that t is m, that the patient develops hypoproteinemia.

Practical use of the method illustrated by the following clinical observations.

Example 1. The patient And. (25 years), was admitted to the hospital with a diagnosis of a closed fracture of the left tibia. When the biochemical analysis of blood serum content of total protein and activity creatinephosphate was 67 g/l and 97 u/l, which corresponded to the norm and allowed to make a conclusion about the absence of violations of protein metabolism and damage of skeletal muscles in this patient. During the treatment method of transosseous osteosynthesis this conclusion was confirmed, as evidenced by the lack of development of muscle contractures and swelling.

Example 2. Patient Days (32 years), was admitted to the hospital with a diagnosis of a closed fracture of the right femur. When the biochemical analysis of blood serum content of total protein was normal - 67 g/l, the activity creatinephosphate was raised - 356 u/l (normal up to 190 u/l). This was the basis to conclude that this patient's skeletal injury was complicated by damage to the muscles. In the future this conclusion was confirmed by the development Shebalino-extensor contracture of the knee joint, to relieve which the patient underwent a course of physical therapy.

Example 3. Patient C.(35 years old)was admitted to the hospital with a diagnosis of a closed fracture of the left tibia in neither is her third. When the biochemical analysis of blood serum content of total protein was below the norm - 57 g/l (normal 65-80 g/l)and CPK activity exceeded its - 206 u/l, resulting concluded that the injury is complicated by damage to skeletal muscle and hypoproteinemia. This was confirmed by the development of the clinical picture, characterized by the development of contractures and edema, edema of which patients received concomitant clinical and therapeutic treatment.

The use of the proposed method in the clinic RISC "RTO" them. Acad. Gailizarov showed that its use in patients with skeletal trauma allows in the acute period, before the development of clinical manifestations to determine the presence of concomitant injuries of muscles and development gipoproteinemii. The proposed method is simple in execution and interpretation of data, does not need expensive equipment used biochemical tests are standardized. The method can be widely used as an additional screening method for assessing the severity of skeletal trauma.

Method for assessing the severity of condition of patients with skeletal injury in the acute phase, including analysis of the components of serum, wherein determine the concentration of total protein and activity of creatine phosphokinase and for values of the examined parameters within but what we diagnose damage to skeletal muscle, when the concentration of the total protein within the normal range and increased activity of CPK - presence of collateral damage in skeletal muscle and at lower concentrations of total protein with increased activity of CPK - development gipoproteinemii.



 

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FIELD: medicine.

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2 tbl, 4 ex

FIELD: medicine.

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1 tbl, 2 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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FIELD: medicine.

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3 tbl, 2 ex

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26 cl, 21 dwg, 2 tbl

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1 ex, 1 tbl

FIELD: medicine.

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3 ex

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3 ex, 2 tbl

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3 ex

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2 ex, 1 tbl

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1 tbl

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2 ex

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4 ex

FIELD: medicine.

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2 dwg, 6 ex, 3 tbl

FIELD: medicine.

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4 tbl

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2 ex

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4 tbl, 1 ex

FIELD: medicine, clinical toxicology.

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EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

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