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Selig — Chandler an intra pelvic resection of a locking nerve

Selig — Chandler an intra pelvic resection of a locking nerve (Seelig M. C., was born in 1874, the American surgeon) — surgical intervention at which make a skin section cross over a pubis (on the outer edge of a direct muscle of a stomach or cross). Use a bilateral slanting section more often, making cuts edge of a direct muscle of a stomach. After crossing of an aponeurosis to the center remove a direct muscle, after amotio allocate with a stupid way a locking nerve from vessels and resect. When the locking nerve needs to be crossed on the one hand, use access on the course of a wing of an ileal bone, otstupya knutr on 3 cm.
This operation is shown at the spastic bringing hip contracture, a coxarthrosis with a pain syndrome and the bringing contracture (see Paralysis cerebral, spastic). After operation apply a coxofemoral plaster bandage with a strut for 2 months.
In 1900 R. N. M. Sudeck described a X-ray pattern at some inflammatory diseases of bones and joints when process was followed by quickly coming bone atrophy and radiological was shown by transparency of bone drawing. He called this phenomenon an acute trophoneurotic bone atrophy, having pointed by that to a possible role of disturbance of local vegetative reactions. Any injury of bones, joints, soft tissues (burns, freezing injuries, an electric trauma, fractures), nonspecific purulent processes of an inflammation of bones and joints, diseases or damages of the central and peripheral nervous system, vein thromboses and circulatory disturbances, etc. can be the cause of development of a syndrome of Zudek.
Osteoporosis is observed in peripheral departments of an extremity, to a thicket affecting multiarticular departments (brushes, feet), distalny places of an injury or an inflammation. Zudek's syndrome arises on average in 3-4 weeks after an injury or the disease which caused it.
In a clinical picture of this syndrome allocate three phases. The first — an inflammation: emergence of pain, a hyperemia in the affected extremity and the expressed hypostasis. Temperature increase of skin is locally noted. Palpatorno skin and muscles are painful, tugopodvizhna joints. The second phase — dystrophy: temperature of skin decreases, blood supply in distal departments of an extremity is broken, there is dense hypostasis extending above to all segment of an extremity (from a brush on a forearm, from foot on a shin). Skin is cyanochroic, brilliant, cold to the touch and wet. Growth of nails is strengthened, they become fragile, darken. Tugopodvizhna joints, often develop resistant contractures and even false ankyloses. In skin, fastion and muscles trophic changes appear. Almost constant signs of this phase are joint pain and disturbance of its function, especially at localization of process in distal department of a beam bone, a brush or foot.
The third phase — an atrophy or the ended inflammation is observed at heavy damages or inflammations. In this phase of a sinew are soldered to the bed, decrease in a local metabolism, pallor and an atrophy of skin is noted. There are permanent trophic changes in muscles and skin, rigidity or contractures of joints, functional frustration. The pain syndrome is absent. A long time signs of an osteanabrosis, soft tissues, skin remain; trophic frustration gradually disappear. Bones lose the mechanical properties, are exposed to pathological changes.
Radiological Zudek's syndrome should be differentiated with the destructive inflammatory center in a bone, multiple metastatic cancer nodes, a myeloma, a fibrous osteodystrophy, osteoporosis at osteomalacy and Itsenko's illness — Kushinga.
For the purpose of reduction of hypostasis and pains from the first days apply the raised position of an extremity, its immobilization in functional situation, antiinflammatory therapy. At pains para-articular novocainic blockade or circular, introduction of 1% of solution of novocaine to the most painful sites on 10 — 15 ml in 6 — 7 days within 3 — 4 months are effective. In the first and second phases massage and the passive movements are not recommended, in the third active physiotherapeutic actions, thermal procedures, massage are shown. Rehabilitation treatment is reduced to strengthening of muscles, active physiotherapy exercises, work therapy. Terms of recovery of working capacity at patients with Zudek's syndrome are various, depend on nature of damage, age of the patient and average from 5 — 6 to 12  months.

 
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