Vol 17, No 1 (2011)

The authors analyse the results of the performance of arthroscopy stitch on the injured capsule with the use of anchor on 46 patients with anterior recurring instability of the shoulder joint within a period of time from 6 months to 4 years. When assessing the results of the given treatment, functional scales, clinical examination methods and radiological methods have been used. The article presents the results of arthroscopy diagnosis of the interior joint damage accompanying the recurring instability of the shoulder joint. The effectiveness of the conducted operations was 93,5%. The occurrence of postoperative relapses of joint instability (reoccurring dislocations) in 3 patients (6,5%) was caused by the presence of significant damage of bone formations in the shoulder joint – the shoulder-blade joint socket and the shoulder-bone head as well as the reduction of the strength and elasticity of the soft-tissue structures.

The authors studied results of treatment of lumbar pain syndromes with blue light (a wavelength of 470 nanometers). The clinico-neurologic observation, neuropsychological testing, an electromyography, rheovasography in terms till 12 months after treatment were carried out. The blue light allows to stop a pain syndrome at 93,3% of patients with a lumbar ischialgia, to enlarge terms of remission and to reduce quantity of exacerbations that leads to improvement of quality of life of patients. Complex treatment of patients with lumbar ischialgia with application of blue light has allowed to receive excellent and good results in 94,4 % of cases, while the same treatment, but without blue light – in 82,9%.

The aim of the study was to investigate optimal assembly of the computer assisted Ortho-SUV Frame for correction of the distal femur deformities which will provide the maximal bone fragments mutual movements and have the minimal assembly sizes. For it 360 bench tests on 12 model was performed. The dependence of the Ortho-SUV Frame reduction capabilities (translation, angulation, torsion) and distance between supports, places of struts fixation and use of Z-shaped plates for struts fixation was investigated. It is found that in Ortho-SUV assembling to provide the necessary requirements 3/4 ring supports is reasonable. Distal support should be placed at the level VII, proximal at the distance 150–200 mm higher. For fixation of the strut 1 to the proximal support position 2 should be used, for the strut 3 – the place between position 5 and 6, for strut 5 – position 10; for fixation of the strut 2 to the distal support position 4 should be used, for fixation of the strut 4 – position 8, for strut 6 – position 12. Use of the Z-shaped plates in fixation of strut 1 and 5 increases the reduction capabilities on 11.4–25.5% in average. Use of modular transformation of the frame allows decreasing the bulkiness of the frame after deformity correction. Investigated assembly was applied in treatment of 14 patients. In all the cases the aim of Ortho-SUV frame use (deformity correction) was reached.

During the period from 2007 to 2010 38 operations of the hybrid knee arthroplasty and 24 cementless knee arthroplasty (LCS De Puy) were performed. In the control group of patients 100 operations in cement knee replacement (LCS De Puy) ware carried out. In the studied groups of patients women dominated – 125 (77,1%). The patients’ age ranged from 38 to 88 years (average – 62 years). Treatment results were evaluated in accordance with the scales of Joseph & Kaufman and WOMAC, based on postoperative radiographs, the measurement of femoral-tibial angle. In the study and control groups in the early postoperative period, as well as future annual observation period of 3 years, the authors obtained the same results. Thus, hybrid and cementless arthroplasty are indicated in patients with good bone quality metaepiphysis femur and tibia bones, those young adults with high levels of physical activity, as well as in cases where it is desirable to eliminate or minimize the use of polymethylmethacrylate bone cement for fixation of femoral components.

Cold plasma ablation is widely used in knee arthroscopy during past decade. We studied its influence on knee joint cartilage in a human in vitro and in dogs in vivo. Histomorphological study was performed in a human cartilage right after the exposition of CPA. In animals MRI and morphological study were performed after three months of exposition of CPA. It was shown that CPA was able to cause immediate changes of collagen in the human cartilage in vitro and also death of chondrocytes in animal in vivo after three months. The depth of necrosis of the cartilage in animal was significantly deeper the subhondral bone.

The successful experience of revision arthroplasty at acetabular component instability complicated by its prolapse into the small pelvic cavity. The authors underline the need for a comprehensive preoperative examination of patients in preparation for revision surgery, careful planning of the operation and dynamic observation of patients in the postoperative period.

Ankle joint replacement remains the most promising but at the same time one of the most challenging fields of orthopedics. In this article the authors analyzed the history of ankle joint replacement development with meticulous details of the prosthesis structure as well as complications occurring with different generations of the prosthesis. Major tendencies of development and improvements of the prosthesis are described while taking into account the complicated biomechanics of the ankle joint. Based on the completed analysis the conclusion was made that using new materials in combination with improved structure allows for major improvements in the ankle joint replacement.

The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

The technique of tibial condylar fracture osteosynthesis designed in our institute happened to be effective for urgent surgery in 30 consecutive patients with using relatively cheap plates of domestic production. We met no residual deformities, nonunions, marked joint stiffness, deep infection or blood transfusions. Two patients had migrations of pins used for additional fixation of comminuted impression. Pins were removed in outpatient department. Urgent osteosynthesis of tibial condylar fractures made favorable background for surgery and wound healing which allowed to discharge patients from hospital at 5–9-th day. Shortening of hospital stay was quite safe for patient and positively appreciated by insurance companies.

The analysis of results of treatment a primary traumatic dislocation of a shoulder in 36 patients is carried out. The significant amount of adverse results was revealed that testifies to necessity of change of a technique of treatment this pathology, especially in patients of elderly age.

With the help of X-ray, radionuclide and ultrasonographic examinations in children with sequelae of hematogenous osteomyelitis, the formation of the distraction regenerate was studied. Preservation of potency to the normal osteogenesis was observed. Formation of the osseous regenerate was accompanied by an active total blood flow and accumulation of radionuclides. Some retardation of bone formation after 2,5–3,0 months due to loss of compensatory capacity of the vascular bed during distraction and as a consequence of slowing the processes of tissue metabolism in the regenerate were observed.

On the basis of three-dimensional analysis of the humerus bones was shown that the plate, placed on posterior-and-medial surface of the lower section of these bones, should be twisted in terminal portions and bended on both ends in the contact surface direction and should have an intermediate untwist sector. The results among 31 operatively treated patients with 32 distal third diaphyseal fractures of the humerus were analyzed. Was stated that the modified osteosynthesis of distal third diaphyseal fractures of the humerus associates with lower risk of iatrogenic damage it, provides fixation stability and significantly better outcomes (Students criterion – 2,7), which allows to use that method of internal fixation in cases where the performance of intramedullary nailig is not possible.

The usage of bone plastics by cylindrical autotransplant in cases of posttraumatic changes of knee joint is described. Knee joint arthrodesis is supposed to be used as alternate in term of replacement impossibility (for example, high-grade deformity, the age (osteoporosis), concomitant diseases that can lead to complicate operation).

The comparative assessment of indexes of musculoskeletal system and connective tissue diseases incidence in the Chuvash Republic in the period from 1999 to 2009 based on the data of state statistical observation and selective targeted clinical examination of the population is presented. The needs of the population in trauma and orthopedic care and priorities for the development of specialized service are defined.

The issue of development of venous thrombosis and embolism still remains a serious problem in the traumatology and orthopedics. To maintain a balance between efficacy of thromboprophylaxis and the risk of serious bleeding in special patient groups the authors encourage to undertake the choice of anticoagulant on an individual basis taking into account the patient's weight, as his liver and kidneys, the duration of prophylaxis course, the possibility of laboratory monitoring of coagulation parameters after discharge from hospital. The authors analyze the possibility of the use of new oral anticoagulants in patients after hip or knee arthroplasty.

The detailed biography of the famous Austrian scientist and surgeon Lorenz B hler ia presented, his contribution to the development of modern traumatology is opened.

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