FEATURES OF SURGICAL TACTICS FOR PATIENTS WITH COXO-VERTEBRAL SYNDROME

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Abstract

Purpose of the study – to design the algorithm of selection for rational surgical tactics for treatment of patients with coxo-vertebral syndrome.

Material and methods. 175 patients with coxo-vertebral syndrome were included into the study who underwent total hip replacement in the period from 2009 till 2016. The authors analyzed outcomes of treatment of 134 patients at midterm follow up of 9 months (range from 8 to 10 months) after the surgery. Mean age of patients was 54,4±12,7 y.o. Patients were subdivided into a test group (94 patients) and control group (81 patients). Standard THR approaches were used in the control group by restoring anatomical center of rotation and lower leg length. The suggested algorithm of the optimal procedure selection was applied in the test group. Clinical and functional data was evaluated by Harris Hip Score and Oswestry score. Radiographic evaluation was performed based on x-rays of vertebral-pelvic complex in standing position, by functional x-rays, CT and MRI. Evaluation of differences significance between the groups was performed by MannWhitney U-test and McNemar test.

Results. Application of proposed surgical approaches allowed to increase the number of patients with good clinical and functional outcomes (test group – 82,4%, control group – 26,7%) and achieve better function of hip joint and patients’ life quality in short-term postoperative period. Excellent outcomes by Harris hip score were observed in 53,2% of patients, in control group – in 9,7%. Share of the patients complaining of lumber pain, limping and need for a walking stick after THR in the test group was less than in control group. Share of patients demonstrating pain at palpation of spinous processes, with positive test of elevated extended leg and radicular syndrome was also significantly less in test group as compared to control group.

Conclusion. Practical application of proposed algorithm for selection of a rational tactics of surgical treatment for patients with combined degenerative and distrophic pathology of the hip joint and spine allows in short-term after THR to statistically significantly improve treatment outcomes in comparison with patients that underwent conventional preoperative planning and THR.

About the authors

A. L. Kudyashev

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Author for correspondence.
Email: a.kudyashev@gmail.com

Alexey L. Kudyashev – Cand. Sci. (Med.), Deputy Head of the Department and Clinic of Traumatology and Orthopedics 

6, ul. Akad. Lebedeva, St. Petersburg, 194044

Russian Federation

V. V. Khominets

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Vladimir V. Khominets – Dr. Sci. (Med.), Head of the Department and Clinic of Traumatology and Orthopedics Russian Federation

V. M. Shapovalov

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Шаповалов Владимир Михайлович – доктор медицинских наук профессор кафедры и клиники военной травматологии и ортопедии Russian Federation

P. A. Metlenko

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Pavel A. Metlenko – Cand. Sci. (Med.), Director of Orthopedic Department of the Department and Clinic of Traumatology and Orthopedics Russian Federation

M. V. Miroevsky

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Philipp V. Miroevsky – Cand. Sci. (Med.), Doctor at the Department of Traumatology and Orthopedics Russian Federation

M. V. Rezvantsev

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Mikhail V. Rezvantsev – Cand. Sci. (Med.), Deputy Head of the educational-methodical department Russian Federation

A. V. Teremshonok

Kirov Military Medical Academy of the Ministry of Defense of Russian Federation

Email: fake@neicon.ru
Andrei V. Teremshonok – Cand. Sci. (Med.), Head Teacher of the Department and Clinic of Traumatology and Orthopedics Russian Federation

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