[Complications of gunshot wounds and blunt injuries of the spine and spinal cord in early period].

Abstract

Combat injuries to the spine and spinal cord refer to rare, but some of the most severe. Currently, there is a need to improve the treatment and rehabilitation of patients with injuries to the spine and spinal cord. However, the complicated course of the wound infection can become a critical factor influencing the treatment outcome.

Objective: To analyze the structure of complications in the early period and determine the factors that have the greatest influence on the incidence of their development in gunshot wounds and closed injuries to the spine and spinal cord under modern conditions.

Material and methods: The work analyzed the results of a prospective examination and treatment of 300 injured subjects, who received medical care at various stages of medical evacuation. A total of 65.6% of the injured had gunshot wounds, 34.4% - closed injuries to the spine. Mine blast injuries were the most common - 88%, and missile wounds - 12%. Age of the patients ranged from 18 to 59 years, median age was 34. Most observed patients (79.6%) had combined injuries.

Results: The incidence of surgical complications during the treatment in the Vishnevsky Central Military Clinical Hospital in the group of gunshot wounds amounted to 28%, in closed injuries - 7.8%, complications of the wound infection 42.4% and 17.6%, respectively. Liquorrhea has been observed only in the group with gunshot wounds in 5.2% of cases. The instability of surgical hardware has not been recorded in any case. The highest incidence of purulent-septic complications was recorded in the group with gunshot wounds and amounted to 26%, and in the group with closed injuries - 9%. Purulent meningitis has been developed in 3% of patients, all of them had gunshot wounds to the spine. Postoperative wound pyogenesis has been noted in 2.7%. Overall mortality was 6%.

Conclusion: The combination of the damage and severe nature of the injury are common for gunshot wounds and closed injury to the spine and spinal cord. The risk of surgical complications (purulent-septic, postoperative liquorrhea) for patients with gunshot wounds is higher. More frequent development of complications of wound disease, namely pulmonary, urological, infectious (pneumonia), is typical. Wound liquorrhea also statistically significantly increases the possibility of surgical complications.