ANALYSIS OF THE RESULTS OF TREATMENT OF COMBINED AND ISOLATED INJURIES TO THE FACIAL SKULL AS A RESULT OF ROAD ACCIDENTS IN CONDITIONS OF REGIONAL TRAUMA CENTERS

ANALYSIS OF THE RESULTS OF TREATMENT OF COMBINED AND ISOLATED INJURIES TO THE FACIAL SKULL AS A RESULT OF ROAD ACCIDENTS IN CONDITIONS OF REGIONAL TRAUMA CENTERS

 Maslyakov V.V., Barachevsky Yu.E., Pavlova O.N., Proshin A.G., Polikarpov D.N., Pimenov A.V., Pimenova A.A., Akmalov N.A.

 Mari State University, Yoshkar-Ola, Russia,
Samara StateTransport University, Medical University "Reaviz", Samara, Russia,
Northern State Medical University, Arkhangelsk, Russia,
Subdivision "Military Hospital of Federal State Institution "354 Military District Clinical Hospital" of Defence Ministry of RF, Saratov, Russia

The problem of road traffic accidents (RTA) has not lost its relevance to this day. Despite the fact that, according to some researchers, there is a slight decrease in the number of road accidents [1] in the Russian Federation, the number of injuries and deaths in such accidents remains high. One of the injuries that often occurs in road traffic accidents is damage to the face of the skull. Such damage can be both open and closed. The amount of damage to this anatomical region is 23.86 % [2]. In this case, the most frequent and severe damages include concomitant injuries that simultaneously capture the cerebral and facial sections of the skull. These injuries are accompanied by high mortality rates [3]. According to the data presented in the literature, the proportion of such injuries in various regions of the Russian Federation ranges from 28.6 to 85.0 % [4]. In addition, concomitant injuries lead to long-term loss of working capacity and are characterized by very high rates of disability, ranging from 25 to 80 %, which is ten times higher than the figures characterizing isolated injuries [5-7].
It has been proven that the success of treatment for various injuries resulting from an accident, including the facial skull, depends on the correct actions, starting from the stage of transportation of the victim [8-10]. In accordance with the modern concept, which is used for the treatment of polytrauma, the treatment of such patients should be carried out only with the involvement of specialized multidisciplinary hospitals, which are called trauma centers [11-13]. The main task of creation of trauma centers of various levels is to organize the provision of optimal assistance to victims in a specific geographic area, taking into account the health resources of the region [12]. Such trauma centers were created in accordance with the order of the Ministry of Health of Russia dated November 15, 2012, No. 927n. Currently, the literature pays great attention to the treatment of combined and isolated injuries in road traffic accidents, however, the issues of treating injuries to the facial skull resulting from road traffic accidents do not lose their relevance, which is associated with a large number of unsolved problems.
Objective -in conditions of regional trauma centers, to analyze the results of treatment of patients with combined and isolated injuries to the facial skull resulting from traffic accidents.

MATERIALS AND METHODS

The paper presents an analysis of the treatment of 230 patients with facial skull injuries sustained in road traffic accidents who were treated in trauma centers of various levels in the Saratov region from 2010 to 2020. The average age of the patients was 29 ± 5 years (M ± m). There were 159 (69.1 %) men and 71 (30.9 %) women. Medical records, outpatient cards and accompanying sheets of the ambulance team were used as primary documentation. The study included all patients who were delivered by emergency medical teams (EMT) with open and closed, isolated, multiple and/or combined injuries to the facial skull resulting from an accident. The age of the patients started from 15. The patients with combined injuries to the limbs, cervical spine and pelvis, as well as patients who were not delivered by EMT were excluded.
The level I trauma centers included medical institutions capable of providing specialized medical care around the clock (in this study, this is the Saratov City Clinical Hospital No. 9), level II trauma centers - medical facilities with obligatory participation in rendering medical age for a patient at early stages (city hospitals with ICUs, with dentists on their staff, but without round-the-clock dental care).  Level III trauma centers include medical institutions that do not have full-time dentists, whose main task is to assess the condition of the victim, carry out resuscitation measures and, if necessary, perform surgical procedures. In this case, these are the central regional hospitals (CRH).
The assessment of the severity of the condition of patients at admission to the hospital was carried out according to Military Field Surgery-State upon Admission scale. In accordance with this scale, a satisfactory condition is considered at 12 points, a state of moderate severity - 13-20 points, severe -21-31 points, extremely severe - 32-45 points, terminal - > 45 points [14]. Assessment of the severity of the injury and the severity of the condition was carried out retrospectively, after the analysis of patient records. To assess fractures of the upper jaw, the classification proposed by A.A. Timofeev [15], and for fractures of the lower jaw - classification by B.D. Kabakov and V.A. Malyshev.
In the majority of observations (167 (72.6 %)), medical assistance at the prehospital stage was provided by medical teams of the ambulance service. Paramedic teams provided such assistance only in 63 (27.4 %) cases. The time of delivery of the patients to the hospital from the moment of injury averaged 27 ± 8 min (M ± m). At the time of admission, open injuries were registered in 79 (34.4 %) people. Patients with closed injuries to the facial skull prevailed - 151 (65.6 %). Isolated injuries were detected in 134 (58.6 %) victims, combined and multiple injuries - in 96 (41.7 %) patients. Shock of varying severity at the time of admission was registered in 57 (24.8 %) people.
To conduct the study, permission was obtained from the local ethics committee of the Reaviz Medical University. All studies were carried out after receiving an explanation of the purpose and objectives of the study and obtaining permission from patients to participate in the study, which was confirmed by written consent.
In order to carry out mathematical processing of the results that were obtained in the course of the study, the results were initially entered into an electronic database, which was located in a computer. All the data obtained for each surveyed were entered into the database. This base was a card index in a tabular form in Excel format. After entering the data into the database, the analysis of the results was carried out using the descriptive statistics method. The χ2 goodness of fit test was used as a criterion. Statistical significance was defined as p < 0.05. To establish correlations, the nonparametric Spearman's test (r) was used. The interpretation of the correlation coefficient is based on the level of bond strength: r > 0.01-0.29 - weak positive relationship, r > 0.30-0.69 − moderate positive relationship, r > 0.70-1.00 - strong positive connection.

RESULTS

The analysis showed that out of 230 victims of road traffic accidents, 89 (38.7 %) people were delivered to level I trauma centers, 69 (30 %) - to level II trauma centers, and 72 (31.3 %) - to level III trauma centers. At the same time, out of 89 people who were admitted to level I trauma centers for treatment, 58 (38.7 %) patients had isolated injuries, and 31 (13.5 %) - combined injuries. In addition, at the time of admission, open injuries to the facial skull were recorded in 23 (10 %) patients, closed injuries - in 48 (20.9 %) patients. The presence of combined and/or multiple injuries was associated with the fact that shock of varying severity was diagnosed in 18 (7.8 %) patients at the time of admission. It should be noted that in the overwhelming majority of cases (12 (5.2 %)), grade I-II shock was noted. More severe grade III shock was diagnosed in 6 (2.6 %) patients. Among the combined injuries in this group of victims, it is possible to distinguish: injuries to the facial skull and closed craniocerebral injuries (most often, brain concussion) - in 18 (7.8 %) cases; injury to the facial skull and open craniocerebral trauma - 5 (2.2 %) cases; facial skull injuries and closed chest injuries - 2 (0.9 %); injuries to the facial skull and closed abdominal injuries - 2 (0.9 %) cases, injuries to the facial skull and closed injuries to the chest and abdomen - 4 (1.7 %) cases. The distribution of patients according to the severity of the condition at the time of admission using the Military Field Surgery-State upon Admission scale with isolated and combined injuries is shown in Figure 1.

Figure 1. The ratio of victims with combined and isolated injuries according to the severity of the condition at the time of admission to level 1 trauma centers (%)

As can be seen from the data presented in Figure 1, in this group of victims at the time of admission, a satisfactory condition was determined in 19 (8.3 %) people with isolated injuries and in 6 (2.6 %) people with combined injuries; a state of moderate severity, respectively, - 14 (6.1 %) and 9 (3.9 %); severe - 23 (10 %) and 12 (3.7 %); extremely severe - in 2 (0.6 %) and 2 (0.6 %), terminal - 2 (0.6 %) patients with associated injuries. In the process of diagnostics, the following injuries to the facial skull were identified: fractures of the bones of the facial skull - 67 (29.1 %) cases, of which open - 12 (5.2 %) cases, closed - 55 (23.9 %). Of this number of victims, fractures of the upper jaw were noted in 45 (19.6 %), and fractures of the lower jaw - in 22 (9.6 %) cases. The following fractures of the upper jaw were noted: unilateral (sagittal) - 12 (5.2 %) cases; typical - 23 (10 %); combined - 8 (3.5 %) and atypical - 2 (0.9 %) cases. Among the fractures of the mandible: body fractures - 19 (8.2 %) cases, branch fractures - 4 (1.7 %) cases. It should be noted here that in most cases (65 (28.3 %)) fractures of the bones of the facial skull were diagnosed in a timely manner and correctly, with only 2 (0.9 %) cases which had a delay in fracture diagnosis.
To diagnose fractures of this localization, X-ray images in two projections were most often used - 54 (23.5 %) cases, the use of computed tomography (CT) was required only in 13 (5.6 %) cases. Damage to the integrity of the skin of the facial skull without bone fractures was detected in 11 (4.8 %) cases. After admission, these patients underwent primary surgical preparation and wound revision. In that case, at the time of admission, the victim was diagnosed with a combined or multiple trauma, and surgical tactics were determined by the injury that posed a great threat to life. Thus, in case of combined injuries to the facial skull and abdomen, the damage control tactics was used in 2 (0.9 %) cases; this was due to the fact that these patients had damage to the parenchymal organs, which led to an aggravation of the condition. It should be noted that in both cases, these patients had open injuries to the facial skull. In these observations, hemostasis-oriented primary surgical preparation of facial wounds was performed as well as laparotomy, hemostasis (splenectomy, suturing of liver damage), drainage of the abdominal cavity, and after stabilization of the state, full-fledged surgical treatment of facial wounds was performed, as well as bone fragments stabilization. With combined injuries to the facial skull and chest in 2 (0.9 %) cases, according to X-ray data, rib fractures and a middle pneumothorax were revealed. In these cases, primary surgical preparation of the wound and/or stabilization of bone fragments and drainage of the pleural cavity were performed simultaneously. In 4 (1.7 %) cases with combined injuries to the facial skull and closed injuries to the chest and abdomen, primary surgical preparation of facial wounds was performed, aimed at hemostasis, laparotomy and simultaneously drainage of the pleural cavity, and after stabilization of the condition - full suturing of facial wounds, including with the use of cosmetic sutures and stabilization of fragments.
In total, damage control tactics was used in this group of victims in 23 (10 %) cases, which made it possible to reduce the number of complications and deaths. Since the victims were taken to level I trauma centers, where specialized medical care can be provided around the clock, the treatment was carried out in a timely manner and in full volume. Moreover, complications were registered in 14 (6.1 %) cases, and the mortality rate was at the level of 10 (4.3 %) people. The main complications noted in this group were associated with the development of local purulent-septic complications (suppuration of the postoperative wound), and the cause of death was various shock; in this case, all deaths were noted in the first hours or the first day after admission. An important factor that served to reduce the development of complications and deaths was the fact that at the hospital stage, during the transportation of victims by ambulance teams, medical assistance was provided competently and in full volume. It should be noted here that when providing assistance to 89 (38.7 %) patients who were delivered to the level I trauma center, no diagnostic and tactical errors were noted at the prehospital stage.
69 (30 %) victims were delivered to the level II trauma center. Isolated injuries were present in 48 (20.9 %) patients, and combined injuries - in 21 (9.1 %). In addition, at the time of admission, open injuries to the facial skull were recorded in 19 (8.3 %) people, closed injuries - in 64 (27.8 %). Thus, among the victims admitted to level II trauma centers, compared with those admitted to level I trauma centers, there were statistically significantly fewer patients with combined and multiple injuries - 13.5 % and 9.1 %, respectively (r = 0.63 , p < 0.05), and victims with open injuries to the facial skull - 10 % and 8.3 %, respectively (r = 0.68, p < 0.05).
The presence of signs of shock at the time of admission was noted in 26 (11.3 %) victims, which is statistically significantly more than in the victims delivered to the level I trauma center -7.8 % (r = 0.62, p <0.05) . At the same time, among the victims delivered to trauma centers of the II level, shock of the I-II degree was diagnosed in 11 (4.8 %), and the III degree - in 15 (6.5 %) people, which is statistically significantly more than among the victims delivered to the level I trauma center (5.2 % and 2.6 %, respectively) (r = 0.65, p < 0.05). This shows that more severe injuries prevailed in this group of victims.
Among the concomitant injuries in this group of victims it is possible to distinguish injuries to the facial skull and closed craniocerebral injuries (most often, brain concussion) - 6 (2.6 %) cases; trauma to the facial skull and open craniocerebral trauma - 8 (3.5 %); injuries to the facial skull and closed abdominal injuries - 5 (2.2 %) cases, and injuries to the facial skull and closed injuries to the chest and abdomen - 2 (0.9 %) cases. The distribution of patients with isolated and combined injuries according to the severity of the condition at the time of admission using Military Field Surgery-State upon Admission scale is shown in Figure 2.

Figure 2. The ratio of victims with combined and isolated injuries according to the severity of the condition at the time of admission to level 2 trauma centers (%)

Note: * – sign of statistical reliability, using χ2 (p < 0.05) in comparison with the data obtained from the victims of the level I trauma center.

As can be seen from the data presented in Figure 2, among the victims delivered to level II trauma centers, at the time of admission, the condition was regarded as satisfactory in 28 (12.8 %) people with isolated injuries and in 2 (0.9 %) people with combined injury. It should be noted that in comparison with the victims delivered to the level I trauma center, this group was dominated by victims whose condition was assessed as satisfactory with both isolated and associated injuries (r = 0.64, p < 0.05). The state of moderate severity was determined, respectively, in 16 (6.9 %) and 3 (1.3 %) victims; severe - 4 (1.7 %) and 8 (3.5 %) people. When compared with the victims who were delivered to the level I trauma center, there is a statistically significant decrease in the number of patients with isolated injuries in this group (r = 0.57, p < 0.05). An extremely severe condition was detected in 5 (2.2 %) patients with concomitant injuries and terminal condition - in 3 (1.3 %). It was noted that this group was dominated by patients with associated injuries, whose condition at the time of admission was regarded as extremely severe and terminal (r = 0.66, p < 0.05).
In the process of diagnostics, the following injuries to the facial skull were identified in this group: fractures of the bones of the facial skull - 33 (14.3 %) cases, of which open fractures - 9 (3.9 %), closed ones - 24 (10.4 %) ) cases. Of this number of patients in this group, fractures of the upper jaw were noted in 18 (7.8 %) patients, and fractures of the lower jaw - in 15 (6.5 %). At the same time, the following fractures of the upper jaw were noted: unilateral (sagittal) - 2 (0.9 %), typical - 12 (5.2 %), combined - 3 (1.3 %) and atypical - 1 (0.4 %) observation. Among the fractures of the mandible: body fractures - 10 (4.3 %) cases, branch fractures - 5 (2.2 %) cases.
The analysis showed that out of the total number of patients with fractures in this group, they were diagnosed in 21 (9.1 %) cases in a timely and correct manner, while in 12 (5.2 %) cases, delayed diagnosis of such injuries was noted. Diagnostic errors in this case were associated with the lack of the necessary diagnostic equipment in the trauma center of level II. Such victims were later evacuated to the level I trauma center, where the injuries were diagnosed and treatment was carried out in full volume. In those cases when open injuries of the facial part of the skull were diagnosed in the victims at the time of admission, primary surgical preparation of the wound   was performed, aimed at hemostasis; and later, after stabilization of the condition, the patients were referred for treatment to the level I trauma center.
In cases where at the time of admission the victim had a combined or multiple trauma, surgical tactics were determined by the injury that posed a great threat to life. Thus, in case of combined injuries to the facial skull and abdomen, damage control tactics was used in 5 (2.2 %) cases, this was due to the fact that these patients had damage to the parenchymal organs, which led to an aggravation of the condition. Hemostasis-oriented primary surgical preparation of wounds, laparotomy, hemostasis (splenectomy, suturing of liver damage), drainage of the abdominal cavity were conducted. Taking into account the fact that there were no specialists in maxillofacial surgery in level II trauma centers, they were summoned in 15 (6.5 %) cases. The call of specialists "on themselves" was due to the severe condition of the victims, who could not be evacuated to level I trauma centers. In those cases when the victim's condition allowed for evacuation, or after stabilization of the condition, the patients were evacuated to the level I trauma center - 45 (19.6 %) people. The period of treatment for such victims in level II trauma centers ranged from 1 to 5 days.
Analysis of the results of treatment of victims in this group showed that complications developed in 23 (10 %) cases, the main of them were of purulent-septic nature. Mortality was 19 (8.3 %) people. Shock was the main cause of deaths. The rates of complications and lethal outcomes in this group were statistically significantly higher than in the group of victims who received treatment in level I trauma centers (r = 0.68, p < 0.05). This can be explained by several reasons: first, the lack of timely qualified assistance to victims with lesions of the facial skull, which led to a delay in surgical treatment and diagnostic errors; secondly, as the analysis shows, in this group, during transportation by ambulance teams in 5 (2.2 %) cases, mistakes were made that were associated with underestimation of the state; respectively, no anti-shock measures were taken, which led to an aggravation of the condition.
72 (31.3 %) people were delivered to level III trauma centers. Of all victims of this group, isolated injuries were present in 30 (13 %), and combined injuries in 44 (19.1 %) people. Open injuries to the facial skull were in 37 (16.1 %) people, closed injuries - in 39 (16.9 %). Thus, among the victims admitted to level III trauma centers, compared with those admitted to level I trauma centers, there was a statistically about the same number of patients. Out of 72 victims admitted to level III trauma centers, shock of varying severity at the time of admission was registered in 21 (9.1 %) people. At the same time, grade I-II shock was diagnosed in 16 (6.9 %) patients, more severe grade III shock was diagnosed in 5 (2.2 %) patients. Among the combined injuries in this group of victims, the following can be distinguished: injuries to the facial skull and closed craniocerebral injuries (most often, brain concussion) - 18 (9.1 %) cases; trauma to the facial skull and open craniocerebral trauma - 11 (4.8 %); injuries to the facial skull and closed chest injuries - 8 (3.5 %); injuries to the facial skull and closed injuries to the abdomen - 3 (1.3 %) cases, and injuries to the facial skull and closed injuries to the chest and abdomen - 4 (1.7 %) cases. The distribution of patients with isolated and combined injuries according to the severity of the condition at the time of admission using Military Field Surgery-State upon Admission scale is shown in Figure 3.

Figure 3. The ratio of victims with combined and isolated injuries according to the severity of the condition at the time of admission to level 3 trauma centers (%)

Note: * – sign of statistical reliability, using χ2 (p < 0.05) in comparison with the data obtained from the victims of the level I trauma center.

As can be seen from the data presented in Figure 3, among the victims delivered to level III trauma centers, at the time of admission, a satisfactory condition was determined in 15 (6.2 %) people with isolated injuries and in 10 (4.3 %) people with combined injuries. At the same time, in this group, there is a statistically significant increase in the number of casualties with associated injuries, whose condition at the time of admission was regarded as satisfactory (r = 0.54, p < 0.05), in comparison with the victims delivered to the level I trauma center. The state of moderate severity was in 8 (3.5 %) and 12 (5.2 %) patients, respectively, and compared with the data of the victims who were delivered to the level I trauma center. There is a statistically significant increase in the number of patients with associated injuries (r = 0 .56, p < 0.05). Severe condition was in 5 (2.2 %) and 12 (5.2 %) patients, respectively, as compared with the victims delivered to the level I trauma center. There is a statistically significant increase in the number of patients with associated injuries (r = 0.56, p < 0.05). Extremely serious condition was in 2 (0.9 %) patients with isolated injuries and in 7 (3.0 %) patients with concomitant injuries, terminal condition 1 - in 3 (1.3 %) patients with concomitant injuries. As compared to the patients delivered to the level I trauma center, there is a statistically significant increase in the number of patients with associated injuries (r = 0.56, p < 0.05).
In the process of diagnostics, the following injuries to the facial skull were identified in this group: fractures of the bones of the facial skull - 21 (9.1 %) cases, of which open ones - 12 (5.2 %) cases, closed ones - 9 (3.9 %). Of the total number of patients in this group, fractures of the upper jaw were noted in 8 (3.5 %) cases, and fractures of the lower jaw - in 13 (5.6 %). In this case, the following fractures of the upper jaw were noted: unilateral (sagittal) - 2 (0.9 %) cases; typical - 4 (1.7 %); combined - 1 (0.4 %), atypical - 1 (0.4 %). Among the fractures of the mandible: body fractures - 8 (3.5 %) cases, branch fractures - 5 (2.2 %) cases.
The analysis showed that out of the total number of victims with fractures in this group, they were diagnosed in 8 (3.5 %) cases in timely and correct manner, while in 13 (5.6 %) patients they were not diagnosed in a timely manner. It should be noted that the highest percentage of diagnostic errors was revealed in this group, which is associated with several factors: firstly, with the absence or shortage of diagnostic equipment, and secondly, with the absence or shortage of specialized specialists. As well as in cases with victims hospitalized in level II trauma centers, these victims in the overwhelming majority of observations (65 (28.3 %)) were evacuated to a level I trauma center, where injuries were diagnosed and treatment was carried out in full.
In those cases with open injuries of the facial part of the skull diagnosed at the time of admission, hemostasis-oriented primary surgical preparation of the wound was performed, and later, after stabilization of the condition, they were sent for treatment to the level I trauma center. In cases where at the time of admission the victim had a combined or multiple trauma, surgical tactics were determined by the injury that posed a great threat to life. So, with combined injuries to the facial skull and abdomen, the damage control strategy among the victims of this group was applied in 12 (5.2 %) cases, this was due to the fact that the patients had damage to the parenchymal organs, which led to an aggravation of the condition. Hemostasis-oriented primary surgical preparation of  face wounds was performed, as well as laparotomy, hemostasis (splenectomy, suturing of liver damage), drainage of the abdominal cavity. Taking into account the fact that there were no specialists in maxillofacial surgery in level III trauma centers, they were summoned in 23 (10 %) cases. The call of specialists "on themselves" was due to the severe condition of the victims, who could not be evacuated to level I trauma centers. In those cases when the victim's condition allowed for evacuation or after stabilization of the condition, they were evacuated to the level I trauma center ( only 65 (28.3 %) people). The period of treatment for such victims in level III trauma centers ranged from 1 to 7 days.
An analysis of the results of treatment of victims in this group showed that complications developed in 34 (14.8 %) cases, which is statistically significantly higher than among victims delivered to the level I trauma center (r = 0.81, p < 0.05). The main ones were of a purulent-septic nature. Mortality was 21 (9.1 %) people, which is also statistically significantly higher than among the victims delivered to the level I trauma center (r = 0.81, p < 0.05). The main cause of death was shock. The rates of complications and lethal outcomes in this group were statistically significantly higher than in the group of victims who received treatment in level I trauma centers (r = 0.73, p < 0.05). This can be explained by several reasons: first, the lack of timely qualified assistance to victims with lesions of the facial skull, which led to a delay in surgical treatment and diagnostic errors; secondly, as the analysis shows mistakes were made during transportation by ambulance teams in 8 (3.5 %) cases that were associated with underestimation of the state and non-implementation of anti-shock measures, which led to an aggravation of the patient's condition.

DISCUSSION

Based on the data presented, it can be seen that injuries to the facial skull in road traffic accidents are accompanied by a large number of complications - 71 (30.9 %) and deaths - 50 (21.7 %). Moreover, the number of complications and deaths directly depends on the level of trauma centers, where medical care was provided. Thus, the minimum number of complications and deaths was registered in the provision of medical care in level I trauma centers, and the maximum - in level III trauma centers. This is due to a number of factors, both organizational and therapeutic. The first, main reason that led to high rates of mortality and complications is associated with the lack of specialists who are ready to provide round-the-clock specialized care in trauma centers of levels II and III. As a result, diagnostic errors were detected in 27 (11.7 %) cases, and qualified assistance was provided out of time or not in full volume. The second reason that led to the delay in timely diagnosis is the lack of the necessary equipment in level II and III trauma centers. The third reason is the underestimation of the state by the ambulance teams during the transportation of such victims. At the same time, it should be noted that damage control tactics for severe injuries were widely used in trauma centers of all levels, which helped to avoid a greater number of complications and deaths.

CONCLUSION

Damage to the facial skull in road traffic accidents is characterized by high rates of complications, which reach 14.8 %, and deaths, reaching 9.1 %. These indicators depend on the level and timeliness of the provision of qualified assistance.

REFERENCES:

1. Klachkova AV, Semyonova ED. Analysis of road accident statistics in the Russian Federation. Innovative Science. 2020; (12): 26-28. Russian (Клачкова А.В., Семёнова Е.Д. Анализ статистики ДТП в Российской Федерации //Инновационная наука. 2020. № 12. С. 26-28)
2. Lastovetskiy AG, Lebedev MV, Averyanova DA. The frequency and structure of traumatic injuries of the brain and facial departments of the skull in victims of traffic accidents. News of higher educational institutions. Volga region. Medical sciences. 2014; 3(31): 105-115. Russian (Ластовецкий А.Г., Лебедев М.В., Аверьянова Д.А. Частота и структура травматических повреждений мозгового и лицевого отделов черепа у пострадавших в дорожно-транспортных происшествиях //Известия высших учебных заведений. Поволжский регион. Медицинские науки. 2014. № 3(31). С. 105-115)
3. Fokas NN, Levenec AA, Gorbach NA et al. Methodology for the study of cranial-maxillofacial injuries (using the example of the Krasnoyarsk Territory). International Journal of Applied and Basic Research. 2015; (10-5): 826-829. Russian (Фокас Н.Н., Левенец А.А., Горбач Н.А., Павлушкин А.А., Метелев И.А., Кравцова Г.Н. Методология исследования черепно-челюстно-лицевого травматизма (на примере Красноярского края) //Международный журнал прикладных и фундаментальных исследований. 2015. № 10-5. С. 826-829.) URL: https://applied-research.ru/ru/article/view?id=7636 (дата обращения: 14.08.2021)
4. Ryumin AV. Early rehabilitation of victims in traffic accidents. Healthcare. 2013; (2): 54-60. Russian (Рюмин А.В. Ранняя реабилитация пострадавших в ДТП //Здравоохранение. 2013. № 2. С. 54-60)
5. Konetskiy IS. Provision of medical care for patients with craniofacial injury in the conditions of the intensive care unit. Medical Bulletin of Bashkortostan. 2011; (3): 53-58. Russian (Конецкий И.С. Оказание медицинской помощи больным с краниофациальной травмой в условиях реанимационного отделения //Медицинский вестник Башкортостана. 2011. № 3.С. 53-58)
6. Fraerman AP, Syrkina NV, Zhelezin OV, Gomozov GI. Combined traumatic brain injury. Message 2. Emergency care and surgical tactics. Modern Technologies in Medicine. 2010; (4): 128-137. Russian (Фраерман А.П., Сыркина Н.В., Железин О.В., Гомозов Г.И. Сочетанная черепно-мозговая травма. Сообщение 2. Неотложная помощь и хирургическая тактика //Современные технологии в медицине. 2010. № 4. С. 128-137)
7. Khristoforando DYu. Craniofascial injury, diagnostic algorithm. Bulletin of new medical technologies. 2011; 4 (18): 146-147. Russian (Христофорандо Д.Ю. Краниофасцильная травма, диагностический алгоритм //Вестник новых медицинских технологий. 2011. № 4(18). С. 146-147)
8. Maslyakov VV, Barachevsky YuE, Pavlova ON, Polikarpov DA, Pimenov AV, Proshin AG, et al. Analysis of the results of first aid in case of damage to the facial skeleton as a result of road accidents. Safety Issues. 2021; (2): 20-27. Russian (Масляков В.В., Барачевский Ю.Е., Павлова О.Н., Поликарпов Д.А., Пименов А.В., Прошин А.Г. и др. Анализ результатов оказания первой помощи при повреждениях лицевого скелета в результате дорожно-транспортных происшествий //Вопросы безопасности. 2021. № 2. С. 20-27)
9. Maslyakov VV, Barachevsky YuE, Pavlova ON, Pimenov AV, Proshin AG, Polyakov AV et al. Organizational aspects of providing emergency medical care to victims of road accidents with damage to the facial skeleton. Disaster Medicine. 2021; 2(114): 65-67. Russian (Масляков В.В., Барачевский Ю.Е., Павлова О.Н., Пименов А.В., Прошин А.Г., Поляков А.В. и др. Организационные аспекты оказания скорой медицинской помощи пострадавшим в дорожно-транспортных происшествиях с повреждениями лицевого скелета //Медицина катастроф. 2021. № 2(114). С. 65-67)
10. Baranov AV. The analysis of the road accidents with medical consequences on federal Highway M-8 «Kholmogory» in the Arkhangelsk region. Polytrauma. 2020; (2): 15-20. Russian (Баранов А.В. Анализ дорожно-транспортных происшествий с медицинскими последствиями на федеральной автодороге М-8 «Холмогоры» в Архангельской области //Политравма. 2020. № 2. С. 15-20)
11. Goncharov AV, Samokhvalov IM, Suvorov VV, Markevich VYu, Pichugin AA, Petrov AN. Problems of stage treatment of victims with severe combined injuries in the regional trauma system. Polytrauma. 2017; (4): 6-15. Russian (Гончаров А.В., Самохвалов И.М., Суворов В.В., Маркевич В.Ю., Пичугин А.А., Петров А.Н. Проблемы этапного лечения пострадавших с тяжелыми сочетанными травмами в условиях региональной травмосистемы //Политравма. 2017. № 4. С. 6-15)
12. Bosko OYu, Malanin DA, Sebelev AI. Fundamental approaches to the organization of the trauma system of the Volgograd region. Volgograd Scientific and Medical Journal. 2011; (3): 58-62. Russian (Боско О.Ю., Маланин Д.А., Себелев А.И. Принципиальные подходы к организации травмосистемы Волгоградской области //Волгоградский научно-медицинский журнал. 2011. № 3. С. 58-62)
13. Matveev RP, Gudkov SA, Bragina SV. Organizational aspects of providing medical care to victims of road traffic polytrauma: literature review. Disaster Medicine. 2015; 4 (92): 45-48. Russian (Матвеев Р.П., Гудков С.А., Брагина С.В. Организационные аспекты оказания медицинской помощи пострадавшим с дорожно-транспортной политравмой: обзор литературы //Медицина катастроф. 2015. № 4(92).С. 45-48)
14. Gumanenko EK, Boyarintsev VV, Suprun TYu, Lyashedko PP. Objective assessment of injury severity. Saint Petersburg: VMedA, 1999. 110 p. Russian (Гуманенко Е.К., Бояринцев В.В., Супрун Т.Ю., Ляшедько П.П. Объективная оценка тяжести травм. СПб.: ВМедА, 1999. 110 с.)
15. Timofeev AA. Manual of maxillofacial surgery and surgical dentistry. 4th ed. Kiev: LLC Chervona-Ruta-Tours. 2002. 384-484 p. Russian (Тимофеев А.А. Руководство по челюстно-лицевой хирургии и хирургической стоматологии. 4-е изд. Киев: ООО Червона-Рута-Турс. 2002. С. 384-484)

Статистика просмотров

Загрузка метрик ...

Ссылки

  • На текущий момент ссылки отсутствуют.