EVALUATION OF THE EFFECTIVENESS OF COMPLEX CONSERVATIVE THERAPY IN PATIENTS WITH CLOSED DIAPHYSEAL FRACTURES OF THE TIBIA

Background. Optimization of treatment of tibia fractures remains a complex medical and social problem. Unsatisfactory treatment results (up to 25%) and a high percentage of disability among patients with tibia fractures (up to 30%) stimulate the search for new methods and ways to stimulate bone regeneration. Study objective. To evaluate the effectiveness of complex conservative treatment of patients with closed diaphyseal fractures of the tibia using hyperbaric oxygen therapy (HBOT) and an antioxidant (cytoflavin). Material and methods. A total of 110 patients with closed diaphyseal fractures of the tibia were examined. All patients were divided into 2 study groups: group 1 (comparison group) included 45 people who received standard treatment in the early postoperative period; group 2 (main group) included 65 people whose standard treatment regimen was supplemented with a complex of antioxidant therapy and HBOT. Biochemical blood analysis, inflammatoryintoxication syndrome (procalcitonin, CRP), total antioxidant activity (TAA), and reparative bone tissue regeneration (BALP, P1NP, osteocalcin, phosphorus and calcium ions) were assessed in all patients before treatment, as well as on days 1-2, 5-7 and 15 after surgical treatment. The intensity of pain was assessed using a 10-point visual analogue scale, and the long-term results of treatment were assessed six months after treatment using the Luboschitz-Mattis-Schwartzberg and Johner-Wruhs scales. Results. As criteria for the severity of the inflammatory-intoxication syndrome in patients with closed diaphyseal fractures of the tibia, the threshold levels of CRP and procalcitonin in the blood serum were established – 0.55 ng/ml and 5.6 mg/l, respectively, the excess of which is associated with the development of inflammatory-intoxication syndrome of moderate severity. As criteria for the rate of reparative processes in bone tissue, the threshold values of the venous blood TAA index (1.2 μmol/l) as well as the threshold levels of osteocalcin and BALP (7.8 ng/ml and 45.3 ng/ml, respectively) were established, pathological deviation from which is associated with impaired osteogenesis. The results of the assessment of the clinical effectiveness of postoperative treatment of patients with closed fractures of the tibia using metabolic therapy based on point scales indicate the advantage of the proposed complex metabolic treatment. Conclusions. Complex metabolic therapy including HBOT and administration of cytoflavin demonstrated high clinical efficacy, which allows reducing the length of hospital stay and the number of postoperative complications, including 66.2% of patients with positive results according to the criteria of severity of inflammatory-intoxication syndrome and the rate of reparative processes in bone tissue.