Vol 18, No 2 (2012)

СОВРЕМЕННЫЕ ТЕНДЕНЦИИ В ОРТОПЕДИИ

MODERN TRENDS IN ORTHOPEDICS: THE KNEE ARTHROPLASTY

Tikhilov R.M., Kornilov N.N., Kulyaba T.A., Saraev A.V., Ignatenko V.L.

Abstract

Using PubMed the authors analyzed publications dedicated to knee arthroplasty that were published in 2011. The modern trends of knee joint replacement include improvement of implants and instruments; partial knee replacement as alternative to TKA; reducing of surgical trauma due to less-invasive approaches; achieving of deep flexion after TKA; using of computer navigation and individual cutting blocks to make surgery more precise; optimization of rehabilitation process in pre-, intra-and postoperative period; including multimodal pain control; development of complex strategies for prevention of intra- and postoperative complications. In this review the attention was attracted to the most discussed in 2011 subjects: development of new designs and materials of knee implants; navigation, robotics and individualized resection blocks; partial knee replacement; infection, blood loss and venous thromboembolism after TKA; influence of different factors on arthroplasty outcomes, especially components and leg alignment, patella resurfacing, PCL retention or substitution, uncemented fixation, mobility of PE insert, severe pre-op deformities or stiffness, previous intra-articular fractures and tibia or femur osteotomies, soft tissue deficit etc.
Traumatology and Orthopedics of Russia. 2012;18(2):5-15
pages 5-15 views

ORIGINAL ARTICLES

FEATURES OF SURGICAL TREATMENT OF THE SACRUM FRACTURES

Samokhvalov I.M., Kazhanov I.V., Tyurin M.V., Ganin V.N., Denisov A.V.

Abstract

The analysis of the frequency, structure and circumstances of the sacrum fractures in 148 patients, as well as evaluated the results of treatment 65 patients using conventional techniques and 83 with multiphase surgical tactic. The use during the first stage of external fixation devices, Ganz pelvic frame and active surgical treatment due to a quick stop the intrapelvic bleeding led to a decrease of the frequency of mortality by 2.6 times. The use of highly informative diagnostic methods and multi-stage surgical treatment in patients with concomitant pelvic injuries have reduced mortality by 1.4 times, the number of physical complications - by 1.6 times, local complications - by 2.4 times, the length of hospital stay - by 1.6 times, the frequency of permanent disablement - up to 28.9%, to restore the ability to work with 76.7% of patients within the first year.
Traumatology and Orthopedics of Russia. 2012;18(2):16-21
pages 16-21 views

USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF THE SHOULDER JOINT

Kutyanov D.I., Rodomanova L.A.

Abstract

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.
Traumatology and Orthopedics of Russia. 2012;18(2):22-28
pages 22-28 views

EVALUATION OF INFLAMMATORY CHANGES IN JOINTS AT PATIENTS WITH HEMOPHILIA ACCOMPANIED RECURRENT HEMARTHROSIS

Davydkin I.L., Kosyakova Y.A., Lartsev Y.V., Kapishnikov A.V.

Abstract

Objective: to search for new diagnostic approaches for estimating the prevalence of posthemorrhagic phase of inflammation in the joints of patients with hemophilia accompanied recurrent hemarthrosis. Using the method of computerized infrared thermography measured the temperature above the knee, ankle and lower leg. Analysis of the data held with a specially developed algorithm that forms the basis of a computer program for computer (2009). It is established that with increasing temperature over the joint at high risk of recurrence monthly hemarthrosis. If the joint hemarthrosis was not, then an increase in temperature may indicate a latent flowing inflammation. Assessing the prevalence of inflammation in the joints of patients with hemophilia has prognostic value: widespread inflammation is characterized by continuous recurrent course, for a limited - monthly recurrent hemarthrosis, in the absence of inflammation in the joint, as evidenced by normal or low-grade fever, recurrent hemarthrosis are likely rare.
Traumatology and Orthopedics of Russia. 2012;18(2):29-33
pages 29-33 views

TREATMENT OF OLD ACHILLES TENDON RUPTURES

Koryshkov N.A., Platonov S.M., Larionov S.V., Matveeva N.Y., Koryshkova L.V.

Abstract

From 1998 to 2010 32 patients (14 men, 18 women), aged 15-65 years, underwent surgical treatment for old Achilles tendon rupture. In all cases correct diagnosis was made not earlier than 1 month after injury. The importance of clinical Thompson test and sonographic examination for diagnosis of Achilles tendon rupture is underlined. For the restoration of Achilles tendon V-Y plasty was used. Surgery was performed in a period of 1 to 13 months in patients with subcutaneous Achilles tendon ruptures. Follow-up results of patients in the postoperative period ranged from 6 months to 10 years (mean follow-up 1 year 7 months). Date of observation in the postoperative period ranged from 6 months to 19 years. Marginal necrosis wound occurred in 3 (10%) patients, re-rupture of the Achilles tendon to tendon suture zone - in one patient, even in one patient on day 14 became infected. Violations of the foot innervation were no detected.
Traumatology and Orthopedics of Russia. 2012;18(2):34-40
pages 34-40 views

HEMATOLOGICAL PARAMETERS OF ENDOGENOUS INTOXICATION FOR ASSESSING THE SEVERITY OF COURSE AND EARLY DIAGNOSTICS OF PYO-INFLAMMATORY COMPLICATIONS IN PATIENTS WITH LONG BONE FRACTURES

Pisarev V.V., L’Vov S.E.

Abstract

314 patients were examined. The dynamics of changes in hematological parameters for assessing the severity of endogenous intoxication and prediction of postoperative pyo-inflammatory complications in surgical treatment of fractures of long bones has been studied. It is established that syndrome of endogenous intoxication by patients with fractures of long bones develops in the first 2 days from the time of injury There is risk of developing infectious complications of postoperative wound by patients whose hematologic indices are not reduced to 3 days before the normal range. The value of the index-day operations above the normal values increases the risk of infectious complications in the wound during subsequent treatment. Infectious inflammation in postoperative wound is characterized by normal LII values and GPI. To assess the risk of complications it is necessary to carry out the KLA at 3nd and 12th days of the postoperative period concerning LII (leukocyte index of intoxication), GPI (hematologic toxicity index), PTI (indicator of the severity of intoxication). Since the various indices of intoxication have predictive value in a certain period of time of injury
Traumatology and Orthopedics of Russia. 2012;18(2):41-47
pages 41-47 views

OPPORTUNITIES IN FORECASTING OF PURULENT COMPLICATIONS AT HIP REPLACEMENT IN OLDER PATIENTS

Tkachenko A.N., Bakhtin M.Y., Zharovskikh O.S., Scherbakov A.A., Topchiy P.A.

Abstract

The study includes retrospective analysis of data of 520 old and senior age patients after hip replacement. 20 prognostically significant criteria of development of postoperative period purulence were identified. Registration of these criteria in prospective study (123 clinical observations) has helped to definitely reduce a frequency of purulent complications of operative wound in comparison with frequency in the group of retrospective studies (from 7,1% to 4,1% for the second group). Efficiency of the offered program has made 80%.
Traumatology and Orthopedics of Russia. 2012;18(2):48-53
pages 48-53 views

REPLACEMENT OF PROXIMAL INTERPHALANGEAL JOINTS IN HAMMER TOE DEFORMITY

Petrosyan A.S., Zagorodniy N.V., Protsko V.G., Sultanov E.M., Khamokov Z.K., Butaev B.G., Zakharyan N.G.

Abstract

Objective: to assess the results of Hammertoe Implant Procedure (HIP) in the treatment of hammer toes deformation. 28 operations were carried out in 16 patients aged 26 to 58 years with stage II-III (according to the classification of MI Kuslik) of hammer toes from September 2009 to March 2011. In 50% of them surgeries were performed on one foot, in the second half - on two feet. Mean duration of follow-up was 12.4 months, range 6-21. Results: evaluation of the results was carried out by scale of AOFAS. A significant improvement was noted after HIP: in average score before surgery - 47, in the postoperative period - 92. In evaluating the average preoperative pain score was 24.3, postoperative - 36.0 (complete absence of pain is estimated to be 40 points). Improving the function of the foot with an average of 19 before surgery after surgery reached 41 points, while the position of the fingers (the alignment of the foot and toes) is changed from the average value of 2.4 to 12.4 after surgery. Conclusion. Analysis of results showed the effectiveness of the HIP method in the treatment of hammertoe 2-3 fingers. HIP has allowed to achieve good functional and cosmetic results in early and the follow-up postoperative period. In our view, HIP with complex deformations forefoot can be used as an adjunct to other types of reconstructive surgery on the anterior part of the foot, and cases with recurrent strains hammer toes after surgery, HIP can be operation of choice.
Traumatology and Orthopedics of Russia. 2012;18(2):54-59
pages 54-59 views

THEORETICAL AND EXPERIMENTAL STUDIES

EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

Mashkov V.M., Sabodashevskiy O.V., Netylko G.I., Zayceva M.Y., Nakonechniy D.G.

Abstract

Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group), one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group). During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.
Traumatology and Orthopedics of Russia. 2012;18(2):60-66
pages 60-66 views

CASE REPORTS

COMPLEX TREATMENT OF PATIENT WITH MULTIPLE FRACTURES OF THE VERTEBRAE IN THE THORACIC SPINE

Vissarionov S.V., Pavlov I.V., Gusev M.G., Lein G.A.

Abstract

The authors presented an example of a complex treatment of pediatric patient with multiple fractures of the vertebrae in the thoracic spine. The child was operated on the burst fracture of a Th5 vertebra. Due to the presence of vertebral compression fractures Th8 a course of conservative treatment by the orthosis in hyperextension brace. Follow-up was 15 months.
Traumatology and Orthopedics of Russia. 2012;18(2):91-95
pages 91-95 views

METHODS OF EXAMINATIONS

PECULIAR IMMUNOLOGICAL PROPERTIES OF CHRONIC POSTTRAUMATIC OSTEOMYELITIS

Chepeleva M.V., Klyushin N.M.

Abstract

A comparative study of cellular immunity parameters was performed in patients with long bone chronic posttraumatic osteomyelitis in regard to osteomyelitis stages. Thirty patients with the fistulous form of long bone chronic posttraumatic osteomyelitis and 13 patients with long bone chronic posttraumatic osteomyelitis in the remission stage were examined using laser flow citometry. It was revealed that a moderate leukocytosis, increased monocyte and neutrophile absolute number as well as increased CD25 and HLA-DR-positive T-lymphocyte number are typical for chronic osteomyelitis regardless of the pathological process stages. The remission stage in patients with chronic posttraumatic osteomyelitis is accompanied by moderate activation of humoral immunity (increased B-lymphocyte (CD19+) number and increased production of IgG). The decrease in the peripheral blood lymphocyte number and well as reduction of HLA-DR expression on monocytes creates prerequisites for the development of fistulous osteomyelitis form and can be an indication for administering the preparations of immunomodulating action.
Traumatology and Orthopedics of Russia. 2012;18(2):67-70
pages 67-70 views

EXPERIENCE EXCHANGE

ANALYSIS OF LONG-TERM RESULTS OF SHOULDER ARTHROPLASTY

Nenashev D.V., Varfolomeev A.P., Maykov S.V.

Abstract

The retrospective analysis of 97 shoulder arthroplasties during 1998 to 2009 was performed. The hemiarthroplasty were fulfilled in 92 patients and total shoulder replacement in 5 patients. Total rate good and satisfactory results consists 32,0%, poor results - 68,0% (66 patients, include 5 patients with total shoulder arthroplasty). The lower level of good results was revealed in patients with chronic fractures and fracture-dislocations of shoulder. It related with changes bones of shoulder and muscles of shoulder (rotator cuff). In the studied group of patients there was no proper pre-operative diagnostics of the rotator cuff, articular surface of the scapula, which shows the need for careful preoperative examination to determine the indications for shoulder arthroplasty and select the type of prosthesis. Unsatisfactory results of total arthroplasty related to screw migration (in case of the transacromion approach) and to the development of subacromial impingement. The conclusion about the need to narrow the indications for use of the scapular component «Ortho-P». The authors showed preference to cemented implants without a metal base. It is necessary to introduce in practice the anatomic implants of the third generation allowing the fullest play the anatomy and biomechanics of the shoulder joint.
Traumatology and Orthopedics of Russia. 2012;18(2):71-78
pages 71-78 views

EXAMINATION OF HAND FUNCTION AFTER POLLICIZATION USING INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH

Shvedovchenko I.V., Kasparov B.S., Shaidaev E.Z., Kol’Tsov A.A.

Abstract

We analyzed the results of 63 pollicizations to 51 children with congenital and posttraumatic pathology of the hand with the age from 6 months till 18 years old. To examine the hand function before and after pollicization we used International Classification of Functioning, Disability and Health. Authors determined criteria and analyzed the ability to live restrictions before and after pollicization. The carried out analysis has shown that before operative treatment in most cases (94%) patients had heavy and absolute difficulties of infringement of function of force of the hand isolated muscles and muscular groups, infringement of change of structure and difficulty of hand use. At an estimation of the remote pollicization results positive outcomes have been reached at 49 (96%) patients from 51. Formation of bilateral pinch possibility at patients kept only easy and moderate difficulties of infringement of function of the hand.
Traumatology and Orthopedics of Russia. 2012;18(2):79-85
pages 79-85 views

SURGICAL APPROACH IN TREATMENT CHILDREN WITH TRANSCONDYLAR FRACTURES OF THE HUMERUS

Proshchenko Y.N.

Abstract

The author presents the results of surgical treatment of 58 patients with transcondylar fractures in age from 3 to 18 years who were divided into two groups depending on the type of surgical approach. In the control group (26 patients) traditional posterior approach with dissection or intersection of the triceps was used, but in the main group (32 patients) - a modified low-traumatic posterior approach. The follow-up period was 3,4 ± 0,5 years. The results showed that the use of a modified posterior approach promotes to achieve a good functional result: range of motion in the joint - 140 °, while in the control group using the traditional posterior approach - only 120 °. A modified posterior approach is indicated for the treatment of children with extension transcondylar fractures, not accompanied by injury of blood vessels of the neurovascular bundle after a single unsuccessful reduction.
Traumatology and Orthopedics of Russia. 2012;18(2):86-90
pages 86-90 views

TRAUMA AND ORTHOPEDIC CARE

THE MANAGEMENT OF VIP-SYNDROME

Tikhilov R.M., Koryachkin V.A., Chupris V.G., Lovchev A.Y., Vasiliev Y.I.

Abstract

The concept of VIP-syndrome and basic principles, which can prevent diagnostic and treatment errors, provide medical assistance to VIP-patient are described.
Traumatology and Orthopedics of Russia. 2012;18(2):96-98
pages 96-98 views

REVIEWS

POSSIBILITIES AND PROSPECTS OF DOUBLE EFFECT DRUGS APPLICATION FOR SYSTEMIC OSTEOPOROSIS PHARMACOTHERAPY OF PATIENTS WITH BONE FRACTURES

Kochish A.Y., Ivanov S.N., Stafeev D.V., Minasov T.B.

Abstract

Scientific literature analysis shows that osteoporotic bone fractures appear to be actual and socially significant problem of modern medicine. Patients’ treatment with this pathology should be complex and include osteoporosis pharmacotherapy. The perspective drug for this case is strontium ranelate. Experimental and clinic researches show its positive influence on osteoporotic fractures healing, possibility to increase implants stability by osteosynthesis, moreover it can improve microarchitectonics of bone tissue and functional results of treatment of patients with such a pathology. However, strontium ranelate application efficiency with osteoporotic bone fractures patients requires further investigations.
Traumatology and Orthopedics of Russia. 2012;18(2):99-104
pages 99-104 views

CRITICAL ANALYSIS OF THE MECHANOSTAT THEORY PART I. REORGANIZATION MECHANISMS OF SKELETAL ARCHITECTURE

Avrunin A.S., Tikhilov R.M., Shubnyakov I.I., Parshin L.K., Melnikov B.E.

Abstract

The paper contains a critical analysis of the mechanostat theory. It is shown that for continuous modeling and osteoklastic-and-osteoblastic remodeling is not providing the necessary safety margin of skeletal structures and reduce risk of fractures. It is established that at each level of the hierarchical organization of a skeleton there are also other mechanisms of its reorganization. The functioning of this system is controlled by mechanisms of osteocytes and purposefully provides two effects: the first -preservation of bone structures deformability according to demanded productivity of convective fluid movement mechanism of a lacunary-tubular system, second - the optimization of the cross-section of the cavities of a lacunary-tubular system, respectively, the required level of throughput for the flow of fluid. As a result, the parameters of mechanical-metabolic environment surrounding the osteocytes are stored in the homeostatic limits, which increases cell viability, and hence bone and skeleton as a whole. However, this is often at the expense of the strength properties of bone structures.
Traumatology and Orthopedics of Russia. 2012;18(2):105-116
pages 105-116 views

JUBILEE

ZORYA VASILY I.

Article E.
Traumatology and Orthopedics of Russia. 2012;18(2):117-118
pages 117-118 views

LINNIK STANISLAV A.

Article E.
Traumatology and Orthopedics of Russia. 2012;18(2):119-119
pages 119-119 views

HISTORY OF THE DEPARTMENT OF TRAUMATOLOGY AND ORTHOPAEDICS OF THE ST.PETERSBURG MECHNIKOV STATE MEDICAL ACADEMY

Linnik S.A., Romashov P.P., Saldun G.P.
Traumatology and Orthopedics of Russia. 2012;18(2):120-122
pages 120-122 views
pages 123-150 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies