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in accordance with international standards and the needs of the state and
society.
References:
1.
Appendix No. 1 to the Decree of the President of the Republic of
Uzbekistan dated October 8, 2019 No. PD-5847, the concept of development
of the higher education system of the Republic of Uzbekistan until 2030
2.
Robert Lundqvist. Quality in Higher Education Approaches to its
management and improvement.- Lulea:1997, pp 33-52.
3.
Burkhalter, B.B. (1996) How can institutions of higher education
achieve quality within the new economy? Total Quality Management, 7, pp.
153-160.
4.
Nizamov A.B, Gafurova Sh.K. Modern approaches to the effective
management of the quality of educational services of higher education in the
training of specialists. Collection of scientific articles of the international
scientific conference "Innovative solutions to engineering and technological
problems of modern production." -Bukhara, 2019, pp. 473-476.
Eranov Sherzod Nuraliyevich - assistant of the department;
Eranov Nurali Fayziyevich - assistant of the department.
Samarkand state medical institute,Uzbekistan.
OUR EXPERIENCE IN THE SURGICAL TREATMENT OF RADIAL HEAD
DISLOCATIONS IN CHILDREN
Eranov Sh.N., Eranov N.F.
Abstract. In this article is analyzed the result of treatment of 83 patients
with radial bone head sprains. The joint capsule itself and the sections of the
ring-shaped ligament, which is more anatomical and physiological
concerning the elbow joint, were used for rehabilitation of the ring-shaped
ligament. The results were evaluated on a scale of "Evaluation of elbow
surgery". The scale allows us to determine the severity of pain syndrome,
the amplitude of movements in the elbow joint, the condition of the joint, the
strength of the arm and the degree of daily living activity. Good and excellent
results with an evaluation after 6, 12 months (>70 points) were obtained in
56 patients, which was 57.4%, satisfactory results (50-69 points) were
observed in 26 (31.3%).
Keywords: dislocation of the radius head, annular ligament, Monteggia
fracture.
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Relevance. At present, children's and adolescents' injuries are becoming
one of the main problems of the medical and biological plan due to the
increase in the number and severity of injuries. Elbow joint injuries in
children, according to various authors, account for 40 to 50% of all
musculoskeletal injuries. And post-traumatic complications as a result of
elbow joint injuries occupy the first place and in 29.9% of cases lead to
persistent disability of patients [1,3,4].
In terms of the frequency of errors and complications in the treatment
of injuries in this area, they take the first place relative to other joints
forming the elbow joint, which requires a more thorough and detailed study
[2,5]. Unsatisfactory results of treatment of elbow joint injuries remain high
to date, reaching 21% and have no tendency to decrease [6,7]. It is not
uncommon to treat elbow joint injuries as concomitant lesions in a distant
time when good results are no longer possible [8,9,10,11]. There is
practically no scientific literature covering the tactics of treating old injuries
to the shoulder-radial joint. All this indicates the need to further explore of
more optimal options for surgical restoration of the annular ligament in case
of its damage.
The goal: restoration of the annular ligament in case of various
dislocations of the head of the radial bone in children according to our
method.
Materials and methods. Our report is based on the study of the results of
treatment of 83 children who were in hospital from 2017 to 2020. Of these,
isolated dislocations were in 62 patients (74.6%), with injuries to Montagge
in 21 patients (25.4%). There were 54 (65.1%) boys and 29 (34.9%) girls.
The lesions localized to the right in 41, left in 39 and bilateral in 3 patients.
By age: up to 5 years - 22 patients, 6-12 years - 46 patients, 13-18 years - 15
patients.
The following operative methods of treatment have been performed for
patients:
- Open reposition of the head of the radial bone, with reconstruction of
the annular ligament - in 52 patients;
-Osteosynthesis of the ulnar bone, open reposition of the head of the
radial bone with reconstruction of the annular ligament - in 21 patients;
-Osteotomy of ulnar bone, open adjustment of the head of the radial
bone with reconstruction of the annular ligament - in 10 patients.
Surgery technique: lateral access, 2 cm above the outer epicondyle
through the joint, 4 cm into the forearm area. Hypodermic cellulose
unseparated. Muscles attached to the outer supersaturus are dissected from
the front, from the bottom, from the rear of the supersaturus. Shoulder
condyle head is visible. Tendon â capsule soft tissue is dissected laterally and
longitudinally 1-1,5cm in order to expose the head of the radial bone. When
Scientific research results in pandemic conditions (COVID-19)
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such dissection is performed, damage to the r.profundus branch of the radial
nerve cannot still be feared. The superficial layer of the muscle of the radial
neck region is dully moved medially, a deep branch of the radial nerve is
found in the thickness of the supinator muscle. It is exposed to the anterior
joint capsule - it is necessary to cut out the flap capsule safely to recreate the
annular ligament.
Usually, the sites of the radial-elbow joint will be filled with scar tissues.
It is acutely separated from the ulnar bone, starting from the center to the
periphery, towards the residue of the annular ligament, at the posterior edge
of the ulnar incision. The head is displaced to the native place, adheres by
pressing to the back with the newly formed ligament (flap from the capsule),
the degrees of fixation of the radial head during bending, extension, rotation
of the forearm are checked. Flap is cut out to create annular ligament from
anterior surface of joint capsule. The direction of the incision to the internal
boundary of the head of the radial bone goes horizontally, then changes
direction to the distal side, towards the anterior edge of the radial incision
of the ulnar bone, where, usually, the annular ligament is naturally attached.
Thus, in the thickness of the formed flap there is also an annular ligament
itself. The flap is laid on the neck region of the radial bone and attached by
stitching to dense fibrous tissue at the posterior edge of the radial incision
of the ulnar bone. The head of the radial bone after adjustment continues to
maintain a tendency towards anterior, medial displacement, which creates
a load on the formed similarity of the annular ligament. Therefore, in order
to prevent its stretching and possible recurrence of dislocation, additional
temporary immobilization by Kirchner 's wire is carried out through the
head elevation of the shoulder and head of the radial bone. Layer-by-layer
suture. In the postoperative period, immobilization with plaster splint lasted
up to 3 weeks in the position of supination. Then patients received a course
of iodide potassium electrophoresis, therapeutic gymnastics, massage.
Results and discussion: Analysis of treatment results was carried out by
clinical and X-ray methods. The results were evaluated on the Elbow Surgery
Score scale. The scale makes it possible to determine the manifestations of
pain syndrome, the amplitude of movements in the elbow joint, the
condition of the joint, the strength of the hand and the degree of daily
domestic activity. The maximum score (100) on this scale corresponds to a
healthy elbow joint. Good and excellent results were obtained after 6. 12
months (> 70 points) in 56 patients, which was 57.4%, satisfactory results
(50-69 points) were observed in 26 (31.3%). Relapse in the form of a
subluxation was observed in 1 child.
When performing open a reposition of the head of the radial bone in
children, with old trauma, we consider it appropriate to pay attention to the
following points:
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-Creating of the annular ligament of the radial bone from the anterior
capsule of the ulnar joint;
- Excision of scar tissue from radial incision of ulnar bone.
Thus, in case of changes in the shoulder joint during the surgical
intervention, it was shown that the joint capsule was located between the
head of the radial bone and the joint end of the shoulder. Similar changes
were observed in 80% or more patients. Such changes cast a new light on a
problem of pathology of old dislocations of the radial head and justify the
proposed tactics of operative treatment of patients.
Conclusion: The reasons for old dislocations of the radial head are
explained by errors of diagnosis, untimely medical care concerning the
treatment of patients, when the parents of the patients considered the
trauma not serious. To recreate the ring ligament, we used the joint capsule
itself and sections of the annular ligament, which is more anatomical-
physiological one with respect to the elbow joint. Surgical treatment of
children with dislocations of the head of the radial bone, reconstruction of
the ring ligament, transarticular fixation of the head of the beam, allowed us
to achieve good and satisfactory functional results in 96.4% of cases, and
anatomical - in 94.7% of cases.
Reference:
1. Eranov S.N., Eranov N.F. Experience of surgical restoration of annular
ligament with dislocations of radial bone head in children (in Russian) //
Achievements of science and education
, 2020; 6 (60) pp.74-76.
2. Eranov Sh.N., Pardayev S.N., Jurayev I.G., Shopulatov I.B., Kholxujayev
F.I. To the question of surgical treatment of an elderly disposal of the head
of the radius bone in children (in Russian) //
Science and education
, 2019;
26 (75) pp.58-70.
3. Merkulov V.N., Dergachev D.A., Dorokhin A.I. Arthroplasty in the
treatment of post-traumatic contractures and ankilosis of the elbow joint in
children // Children's surgery, â 4, 2014 pp.34-38.
4.Meltsin I.I., Pavlov V.A., Afaukov I.V., Kotlubaev R.S., Lyashchenko O.A.
Shoulder joint injuries in children (in Russian) // Children's surgery, 2016;
20 (1) pp.23-26.
5. Ovsyankin, N.A.; Naumochkina, N.A.; Pozdeeva, N.A. Operative
treatment of the patients with the beam head dislocations and the forearm
rotation contracture with obstetric paralysis of the upper limb (in Russian)
// Orthopedics, traumatology and reconstructive surgery of children's age.
Volume 2. issue 1. 2014 â pp.32-38
6. ProshchenkoYa.N. Causes of instability in distal radiolocardial joint in
children // Children's surgery, â 1, 2015- pp.28-30.
Scientific research results in pandemic conditions (COVID-19)
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7. Urinbayev, P.U.; Eranov, Sh.N. Surgical treatment of the aged radial
bone head dislocations in children (in Russian) // Meth. recom.
8. Khujanazarov I.E.Khojanov I.Yu. The role of radiography and elbow
joint MSKT in surgical correction of post-traumatic elbow joint deformation
in children (in Russian) // Journal of Clinical and Experimental Orthopedics
named after I.E. Khujanazarov. G.A.Ilizarov â 3, 2016- pp.43-49
9. Benson, M., Fixsen, J., Macnicol, M., Children's Orthopedics and
Fractures. Third Editorials. 2012
10. Goyal T, Arora SS, Banerjee S, Kandwal P, Neglected Monteggia
fracture dislocations in children: a systematic review. J PediatrOrthop B.
2015 24(3) pp.191-199
11. Liu R, Miao W, Mu M, Wu G, Qu J, Wu Y. Ulnar rotation osteotomy for
congenital radial head dislocation. J Hand Surg Am. 2015 40(9) pp.1769-
1775
Davron Boydadaev, independent researcher of Namangan Institute of
engineering and technology
ECONOMIC DIAGNOSTICS OF THE HIGHER EDUCATION
D. Boydadaev
Economic diagnostics should also include criteria for selecting
alternatives to improve the performance of the facility. Economic
diagnostics by assessing the results of activities, gathering and analyzing
information, appears to link other constituents. In this case, economic
diagnostics can help to select and implement the characteristics needed to
obtain specific results. The methods and assessments used in diagnostics
should not only passively reflect the actual state of affairs, but also allow
them to identify problems and make decisions in a timely manner to adjust
the strategy and tactics of the facility.
The main purpose of economic diagnostics is to assess the financial and
economic situation and to identify sustainability and to identify
opportunities and resources for development. To achieve this goal, of
course, the main directions of financial and economic policy will be used.
Economic diagnostics is one of the important tools in pursuing this policy.
According to the results of economic diagnostics it is possible to compare
the position of the research object in the society or to assess the changes in
its condition over different time periods.
As a result of economic diagnostics the areas of activity of the facility
determine the factors and causes that impede achievement of common
goals. To do this, the diagnostic relies on numbers, compares numbers, and
seeks to describe the factors that cause changes in numbers. At the same
time, it is based on a clear understanding of the specificity of the diagnostic
