Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector3845010.18821/0869-2106-2017-23-6-331-336ArticlesСтатьиReview ArticleTHE PHENOMENON OF «SECOND HIT» AFTER OPERATIONS OF OSTEOSYNTHESIS IN CASE OF POLY-TRAUMAФЕНОМЕН «ВТОРОГО УДАРА» ПОСЛЕ ОПЕРАЦИЙ ОСТЕОСИНТЕЗА ПРИ ПОЛИТРАВМЕShapkinYu. GШапкинЮ. ГSeliverstovP. AСеливёрстовПавел Андреевич

candidate of medical sciences, assistant of the chair of general surgery the V.I. Razumovsky Saratovsky medical university of Minzdrav of Russia, 410012, Saratov, Russian Federation

канд. мед. наук, ассистент каф. общей хирургии ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, 410012, г. Саратов

seliwerstov.pl@yandex.ruSkripalE. AСкрипальЕ. АThe V.I. Razumovsky Saratovsky medical university of Minzdrav of RussiaФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава РФ15122017236VOL 23, NO6 (2017)ТОМ 23, №6 (2017)33133621072020Copyright ©; 2017, Eco-VectorCopyright ©; 2017, ООО "Эко-Вектор"2017Eco-VectorООО "Эко-Вектор"https://medjrf.com/0869-2106/article/view/38450

In case of poly-trauma the early operations of osteosynthesis under fractures of long bones, unstable fractures of pelvis and backbone bones being an operational trauma, can provoke progression of inflammatory reaction, development of systemic complications and poly-organ inadequacy i.e. causing a «second hit» effect. The pathophysiologic mechanisms of «second hit» phenomenon are complicated and they are implementing by means of modulation of immune response. The risk of development of the given phenomenon depends on period of implementation and method of osteosynthesis, severity of injuries and condition, age, concomitant pathology of patient, presence of chest trauma and craniocerebral trauma. The study of pathophysiology of «second hit» phenomenon is perspective for development and optimization of clinical concepts of treatment of patients with poly-trauma and skeletal damages.

При политравме ранние операции остеосинтеза при переломах длинных трубчатых костей, нестабильных переломах костей таза и позвоночника, являющиеся операционной травмой, могут провоцировать прогрессирование воспалительной реакции, развитие системных осложнений и полиорганной недостаточности, т.е. вызвать эффект «второго удара». Патофизиологические механизмы феномена «второго удара» сложные и реализуются посредством модуляции иммунного ответа. Риск развития данного феномена зависит от сроков выполнения и метода остеосинтеза, тяжести повреждений и состояния пациента, возраста и сопутствующей патологии, наличия травмы груди и черепно-мозговой травмы. Изучение патофизиологии феномена «второго удара» перспективно для разработки и оптимизации клинических концепций лечения больных с политравмой и скелетными повреждениями.

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