ABSTRACT

Background. Gunshot spine injuries represent one of the most severe forms of combat-related trauma, associated with an unfavorable prognosis and a high risk of mortality. The clinical severity is determined not only by the primary spinal injury but also by concomitant trauma, extensive wound contamination, and the subsequent development of infectious and inflammatory complications. A retrospective analysis of clinical cases was performed to assess injury patterns, the impact of associated abdominal organ damage, the nature of antibiotic therapy and surgical management, as well as the dynamics and structure of early and late infectious complications.

Purpose. To evaluate the incidence and structure of infectious and inflammatory complications in patients with shrapnel penetrating injuries of the spine and spinal cord in isolated and combined abdominal injuries.

Materials and methods. A retrospective study was conducted on 138 patients with shrapnel penetrating injuries of the thoracic and lumbosacral spine. The patients were divided into two groups: isolated spinal injuries (n=107) and combined injuries involving the abdominal organs (n=31). All the patients underwent surgical intervention, antibiotic therapy, and computed tomography. The incidence, structure, timing of onset, and clinical outcomes of infectious complications were assessed.

Results. The overall incidence of infectious complications was 10.1%. In the group with combined injuries, complications developed in 29.0% of the patients, which was significantly higher than in the isolated injury group (4.7%, p<0.01). The most common complications were paravertebral abscesses (5.1%), osteomyelitis (2.2%), and meningitis (1.4%). All cases of meningitis and sepsis were observed in the patients with combined abdominal injuries, predominantly involving the colon.

Conclusion. Combined injuries of the spine and abdominal organs are associated with a significantly higher incidence of infectious and inflammatory complications, more severe clinical course, and prolonged hospitalization. Patients with gastrointestinal injuries, particularly those involving the colon, should be considered a high-risk group requiring intensive infection control measures and a multidisciplinary treatment approach.

ABOUT AUTHORS

LITERATURE

1. Schoenfeld A. J., Goodman G. P., Belmont Jr P. J. Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during Operat-ion Iraqi Freedom // The Spine Journal. — 2012. — Vol. 12. — № 9. — P. 771–776.
2. Bartlett C. S. Clinical update: gunshot wound ballistics // Clinical Orthopaedics and Related Research®. — 2003. — Т. 408. — P. 28–57.
3. Aarabi B. et al. Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries // Neurosurgery. — 1996. — Vol. 39. — № 6. — P. 1133–1140.
4. Chittiboina P. et al. How bullet trajectory affects outcomes of civilian gunshot injury to the spine // Journal of clinical neuroscience. — 2011. — Vol. 18. — № 12. — P. 1630–1633.
5. Farmer J. C. et al. The changing nature of admissions to a spinal cord injury center: violence on the rise // Journal of spinal disorders. — 1998. — Vol. 11. — № 5. — P. 400–403.
6. Gentleman D., Harrington M. Penetrating injury of the spinal cord // Injury. — 1984. — Vol. 16. — № 1. — P. 7–8.
7. Дулаев А.К. Орлов В.П. Хирургическое лечение военнослужащих с боевыми повреждениями позвоночника на территории Чеченской Республики. В сб.: Состояние и перспективы развития военной травматологии и ортопедии. СПб.: Морсар АВ, 1999. С. 253–256. [Dulaev A.K. Orlov V.P. Surgical treatment of soldiers with combat injuries of the spine in the territory of the Chechen Republic. In: State and prospects of development of military traumatology and orthopedics. Saint Petersburg: Morsar AV, 1999. Pp. 253–256. (In Russ.)].
8. Belmont Jr P. J. et al. Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a US Army brigade combat team // Journal of Trauma and Acute Care Surgery. — 2010. — Vol. 68. — № 1. — P. 204–210.
9. Kelly J. F. et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006 // Journal of Trauma and Acute Care Surgery. — 2008. — Vol. 64. — № 2. — P. S21-S27.
10. Гизатуллин Ш. Х. и др. Лечение огнестрельных ранений позвоночника с использованием метода чрескожной видеоэндоскопии: анализ малой клинической серии // Хирургия позвоночника. — 2022. — Т. 19. — № 4. — С. 77–85.
11. Heary R. F. et al. Thoracolumbar infections in penetrating injuries to the spine // Orthopedic Clinics of North America. — 1996. — Vol. 27. — № 1. — P. 69–81.
12. Крюков Е. В. и др. Микробный пейзаж при инфекциях, связанных с оказанием медицинской помощи у нейрохирургических больных, и антимикробная активность антибактериальных препаратов // Российский медико-социальный журнал. — 2019. — Т. 2. — С. 40–56.
13. Quigley K. J., Place H. M. The role of debridement and antibiotics in gunshot wounds to the spine // Journal of Trauma and Acute Care Surgery. — 2006. — Vol. 60. — № 4. — P. 814–820.
14. Орлов В. П. и др. Лечение огнестрельных ранений черепа и позвоночника в условиях локальных войн и военных конфликтов // Сборник лекций по актуальным вопросам нейрохирургии. — 2008. — С. 295–326.
15. Aryan H. E. et al. Gunshot wounds to the spine in adolescents // Neurosurgery. — 2005. — Vol. 57. — № 4. — P. 748–752.
16. Зубрицкий В. Ф. и др. Профилактика, диагностика и лечение гнойных осложнений у нейрохирургических больных: учеб. пособие. — 2019. — 114 с.
17. Крюков Е.В. и др. Анализ факторов риска инфекционных осложнений после краниоцеребральных операций // Медицинский вестник ГВКГ им. Н.Н. Бурденко. — 2020. — № 1. — С. 51–62. — EDN YLJXAV.