Vol 17, No 2 (2011)

The authors analyzed the results of different surgical approaches during 144 revision TKA. The need in extension of standard approach appeared in 24 (22,2%) patients: Coonse-Adams in 9 (8,3%), tibial tuberosity osteotomy in 6 (5,6%), quadriceps snip in 4 (3,7%) and combination of two lateral approaches to the distal femur and the knee in 5 (4,6%) patients with distal femur fracture for simultaneous osteosynthesis and implant revision. During revision TKA method of choice is the standard approach to the knee. Extensive approaches allow better visualization during surgery but may compromise knee function.

The results of treatment 103 patients in term of 4-6 months after total hip and knee replacement were examined. Established that in the operated limb disorders of regional blood flow in the form of chronic lympho-venous insufficiency and changes in the functional state of neuromuscular apparatus in the form of muscle dysfunction, autonomic dysfunction occured. According to detected characteristics the medical rehabilitation for patients of the 1st group (52 patients) was based on the combination of therapeutic factors complex usage, each of which exerts a specific effect on pathogenesis of a certain syndrome or their different combinations, and developing therapeutic factors are summarized and potentiated. That is why balneo-radon-kinesiotherapy, intermittent pneumocompression, low-frequency magnetotherapy, transcranial electroanalgesia, electrical myostimulation, pelotherapy, taking of central myorelexanat tizanidine were included in the treatment program. Among the patients of the 2nd group medical rehabilitation was based exclusively on motion state and bodily exercises. The analysis of treatment showed the advantage of syndrome-pathogenetic approach, applied for the 1st group of patients: joint range of motions increased by 33,1%, venous drainage increased by 24,4%, neuromuscular apparatus duty improved by 51,8%, involuntary nervous system balance normalized, functional outcome of the medical rehabilitation improved by 73,1%.

We observed 503 patients with various pathologies of hip joint. 555 interventions with total hip joint replacement were conducted. 52 patients were operated on both sides. Total number of male patients was 219; the number of female patients was 284. Age of patients varied from 18 to 82. 24 patients were under 25 y.o.; 117 patients were 26–40 y.o.; 232 patients were 41-60 y.o.; 130 patients were older than 60. Cement-free restoration of implants took place in 196 cases. Trilogy + VerSys ET combination was used in 156 cases; Trilogy + Alloclassic combination was applied in 40 cases. Hybrid restoration (ZCA + VerSys ET) was used on 297 patients; completely cement restoration (ZCA + CPT) was applied in 62 cases.

The results of a comparative study of platelet-rich plasma (PRP) and glucocorticosteroids (GCS) for local treatment of greater trochanteric pain syndrome (GTPS) are presented. 40 patients with GTPS were randomized into groups of 20 persons. The condition of patients was analyzed on a scale of pain during the day (VAS) and index WOMAC. 40 women with GTPS at six months of observation show that the local injections of PRP is superior to therapy with corticosteroids. The data of the study allow to expand the scope of the PRP and the first to recommend this therapy for GTPS. Local PRP therapy is distinguished by the absence of undesirable reactions, and high efficiency in GTPS exceeding the glucocorticosteroids.

From November 2007 to December 2010 on 25 patients with pes planovalgus accompanied by os tibiale externum were operated. Age of patients ranged from 16 to 35 years. In 80% of cases operations were performed on one foot, and 20% – at the same time on two feet. Treatment results were evaluated on a scale American Orthopaedic Society Foot and Ankle (AOFAS). The average pain scores improved from 14.3 to 29.0, the improvement of foot and heel functions – from 29.4 to 42.0, while the correct position has changed from the average value of 2,7 to 8,5. Radiography showed an average reduction of longitudinal arch angle to about 12.3, a decrease astragalocalcanean corner – at 8 on, the increase in height of the arch – on 5-8 mm. The study results confirmed the involvement of the presence of os tibiale externum to the development of planovalgus deformity. Treatment of such patients requires a comprehensive approach, the main stage of which is to remove the extra bone. Subtalar artroereisis in conjunction with plasty of tendon of posterior tibial muscle and transposition of the tendons of flexor digitorum longus is effective and modern methods of surgical correction of pes planovalgus with os tibiale externum.

The authors presented the results of own observations 38 patients with congenital flexion contractures of the elbow joint. The detailed anatomical and functional evaluation of 47 affected upper limbs were perfected. Based on the analysis of clinical and radiological data a working classification was developed, which identifies three forms of disease: typical, atypical and intermediate.

The study of peripheral hemodynamics in the arteries and veins of the posttraumatic hand stumps of 67 patients was performed before and during traction of the tissues with a mini-fixator using electrothermometry and Doppler sonography.
Digital arteries before treatment in the conditions of reduced finger stumps motor activity show that all Doppler sonography recordings are decreased relative to the values of the unaffected fingers in the intact limb.
During transverse traction intended for skin stock growing in the interdigital webspaces there was no significant dynamics of the recorded Doppler sonography values in the digital arteries. The compensatory vascular response to metabolic query and oxygen need is registered in the lengthened tissue by longitudinal traction effect on the finger phalanges when the tissue can be grown by more than 100% of the initial stock, that results in a 1.5–2 fold increase of the linear and volumetric systolic blood flow velocity in the digital arteries and skin capillaries that is associated with the changes in the artery viscoelastisity which is of a vasoconstriction type.

The influence of both, the composite material based on the protein-mineral components including the prolonged form of the recombinant human bone morphogenetic protein 2 (rhBMP-2) and the method of the titanium implant’s surface treatment, on the reparative osteogenesis and adhesion strength of the bone tissue – implant’s surface contact was evaluated. Covering of implants with the composite coating promotes significant acceleration of the bone tissue regeneration processes in the site of implants loading. The composition coating with prolonged form of the rhBMP-2 promoted increasing of the neogenic bone tissue’s adhesion with the implants, as compared with the coating without recombinant human bone morphogenetic protein. The implants treated with microarc oxidation demonstrated higher values of the breakout force during the separation of the implants from the bone than the implants treated with sandblasting method.

This article reports about actual questions of integrated treatment of children with ancestral paralysis of upper extremities. Analysis of domestic and foreign literary sources concerning the development of orthopedists’ view on the nature of this pathology, the reason of its origin, its early diagnostics and its early conservative and operative therapy was carried out. The character of operative intervention on the segment of upper extremities depending on the age of an infant, severity of evident pathology and results of treatment is presented.

The review of the most meaningful classifications and the terms used in treatment of open injuries of the hand is presented. The presented classifications nominally are divided into three groups: the classifications constructed on descriptive signs, constructed by a scale principle and constructed by the mixed principles.
Characteristics of the most used terms of the open damages of a brush, such as combined damages, a severe trauma of a hand, traumatic amputations, etc., and their interpretation by various authors are given.

The results of treatment of 100 patients in age from 13 to 18 years who were in the institution for reconstruction of foot deformities were analyzed. The complex treatment of children with recurrent clubfoot and secondary foot deformities in adolescence consists in reconstruction of tendon-ligamentous and bony structures of the foot with the use, if it is indicated, of external fixation devices with simultaneous intensive physiotherapy aimed at improving of microcirculation and bone formation as well as correction of mineral metabolism.

Applied topographic and anatomic studies on 12 lower limbs of seven premature stillborn children have allowed to substantiate the possibility of formation and free transplantation in children of the epimethadiaphyseal fibula graft with two blood supply sources. In view of the obtained data, it has been developed and successfully tested clinically the original reconstructive microsurgical operation, which allows to replace in children simultaneously extensive (more than 50% of length) defects of the distal radius with preservation of function of the growth plate of the transplanted bone.

Complex clinico-statistical study of the rate, structure, dynamics and conditions of the locomotor apparatus traumas in ambulatoris patients (82207 children, 20351adolescents and 293798 adults), hospitalized ones (2359 children and 5796 adults) and 439 died during 1998-2008 in Astrakhan has been cassied out. Age – sex groups of highes risk in getting traumas, most of whom are in the household and in streets under falling, due to antilaw actions and accidents have been formed. Possibility of getting injuries for adults increases in January and July, for children – in May and September, for adolescents – in April and October. Wide range of modem computer and telecommunication technologies as the new forms of preventive activity should be recommended.