Vol 17, No 3 (2011)

During 83 revision TKA we found out the need of bone defect compensation in 93,3% of cases. The autologic bone was used in 12 (7,5%) patients, spongeous allograft in 45 (28,1%), femoral head allograft in 10 (6,3%), structural allograft in 22 (13,8%), femoral or tibial sleeves in 17 (10,6%) and femoral or tibial augmentation blocks in 50 (31,3%). Middle-term results of revision TKA (27 months in average) were evaluated in 57 (68,7%) patients using KSS and WOMAC scores. Positive results were achieved in 48 (84,2%) patients. In 9 (10,8%) cases deep infection developed in different periods of time after surgery. Hence during revision TKA the surgeon should be ready to use different methods of bone defect compensation.

The article presents the experience gained by orthopedic unit of Saratov Regional Clinical Hospital at knee joint replacement with modern implants. We analyzed use of Zimmer NexGen CR and LPC implants for initial total knee joint replacement in 285 patients. The monitoring continued for 5 years. Good and excellent results were observed in 92% of cases. Pyogenic complications were observed in 2.3% of cases. The article describes the methods of surgical intervention and post-surgical rehabilitation. We consider our experience with Zimmer NexGen LPS and CR knee-joint implants as positive and prospective for further use.

Results of correction of femur deformations by Ilizarov method and with apparatus Orto-SuV working on the basis of computer navigation are analyzed. For elimination of difficult deformations in order to avoid multiple external fixator remounting with stage-by-stage radiological control it is expedient to use apparatus Orto-SUV. In order to elimination of moderate and simple deformations (except torsion) as hexapods and traditional techniques can be a choice method. The use «Orto-SUV» apparatus allows to reduce time necessary for deformation correction and osteosynthesis term in 1,4–2,4 times (for average and severe deformations).

The results of 10 years of nonsurgical treatment of 350 children with idiopathic congenital clubfoot by different methods at the same hospital are compared. Biomechanically-based methods, such as Ponseti method are highly effective in treatment of idiopathic congenital clubfoot. During the 2 years follow-up good results of treatment were achieved.

29 children with monoarthiritis were included in our study. Besides routine clinical and laboratorial examination, knee arthroscopy with synovial biopsy was performed in all patients. Visual examination of synovial hyperplasia and hyperemia and microscopic examination was performed. Patients were divided into 2 groups with primary and secondary (associated with joint traumatic damage) synovitis. Patients with primary synovitis had significantly lower disease onset age, lower hemoglobin level and higher ESR and CRP and disease duration compare with secondary synovitis group. Intensive and very intensive type of synovial hyperplasia more frequently in first group, in second group more frequently mild and moderate type of synovial hyperplasia occurred. Correlation between synovial hyperplasia and hyperemia has been revealed (r=0,72, p<0,000), between hyperplasia and type of hyperplasia (r=-0,55, p<0,000), and between hyperplasia and arthritis course (r=0,42, p=0,04) was noted in primary synovitis and no any correlation in secondary synovitis. Hyperplasia stage correlated with progressive disease course (r=0,44, p<0,05) and degree with X-ray stage (r=0,48, p<0,05) in primary sinovitis. Conclusions: arthroscopy with synovial biopsy has been suggested in children with chronic monoarthritis without inflammatory activity.

Testing of internal fixation hardness of proximal ulnar fractures (simulated) with different internal extramedullar fixators was performed (hardness for break, hardness for tension, hardness for torsion). Hardness for break and tension appeared sufficient for all internal extramedullar fixators. On the other hand, hardness for torsion was different. It increased for fracture fixed with additional screw through three fragments for all fixators and for fracture fixed with long compressive screw and plate (patent).

The hip and knee replacement was widely adopted in orthopedic surgery. It is high on the list on intervention volume, size of bleeds and to development of the general and local complications. Infectious complications are one of the basic and most expensive problems with significant socially losses after arthroplasty. Early diagnosis, selection of surgical tactics, accurate identification of the responsible microorganisms and choice of an effective antibiotic are important components of successful treatment of prosthetic joint infection. Main principles of diagnostics and rational antibacterial therapy of prosthetic infection are presented in the review.

The objective of the investigation involves study of the rate of torticollis and the informative value of ultrasonic examination for differential diagnosis of torticollis in children of the first year of life. Screening of 1000 newborn infants was performed, in 115 of whom clinical signs of torticollis were revealed. The used techniques of diagnostics that included clinical examination, examination by neurologist, and the ultrasonic study made it possible to divide the torticollis patients into groups and to reveal the rate of this condition in newborn infants. It was concluded that use of the clinical, ultrasonic techniques of examination enables one to identify the form of torticollis and to prescribe adequate early therapy.

Surgical treatment of scoliosis on the background of cerebral palsy is carried out by the correction and polysegmental fixation of the spine and helps to improve balance the body, activate patient in a wheelchair, to prevent the subsequent progression of spinal deformity and rib cage, and improve self-care patients.

The experience of videothoracoscopic spondylodesis in 16 patients with lesions of the thoracic and first lumbar vertebrae was presented. The authors described an original approach which consists in carrying out the anteroposterior spine fusion by performing a needle transpedicular fixation and and videothoracoscopic spondylodesis for one anesthesia.

Applied topographic-anatomical studies were carried out on 12 fixed lower extremities and revealed that in the anterior portion of the middle gluteus muscle 4 cm in width the upper branches of the gluteal vessels are always held supplying the area of the iliac crest. Taking into account the received data the authors proposed a new method of femoral neck osteosynthesis with non-free autoplasty by the autograft from the iliac crest, which is moved at constant muscle-vascular supply pin and fixed with screw in the fracture. Osteosynthesis using the proposed method was performed in 24 patients and provided the union of fractures in all cases in a period of 5 to 8 months. Analysis of long-term results of treatment of 22 patients performed 3 years after the operations showed good function of injured joints and no evidence of avascular necrosis of the femoral head in 18 (83.3%) cases.

This study analyzes the main aspects of the formation as irreversible and reversible loss due to road traffic injuries. Analysis of the irreversible losses was based on data from official national statistics on deaths due to accidents in the years 1971-2008, as well as relevant data to WHO. The purpose of this study is to develop a methodology for assessing the avoidable health loss due to traffic injuries as a basis for determining priorities and reserves to reduce health and social consequences of accidents on the major categories of victims.

The system of medical aid for neurotrauma in the region with low population density in the case of the Komi Republic was studied. Neurosurgical care to the population of the republic last decade had an intense focus of development. Currently, neurosurgical service is based entirely in Syktyvkar, and is represented by three neurosurgical departments. Due to the low population density (2.3 people 1 km2), the centralization of specialized medical care and inadequate equipment of district and regional hospitals, special significance remote consultation, as well as adequate ways of evacuation with neurotrauma.

A significant amount of the data that microorganisms under natural conditions dwellings exist mainly in a kind of the difficult enough organized microbic communities which have received the name of Biofilms has by this time collected. They influence a current of chronic inflammatory diseases, and recently obtained data forms the basis to assume that Bioflms also play an essential role in disturbance of a current of processes of healing of chronic wounds. Biofilms possess high level of tolerance to antibodies, antibiotics, antiseptics, disinfectants and phagocytes. Methods of treatment of wounds with Biofilms include obligatory frequent clearing of a wound together with usage of wound coverings and antimicrobial agents for prevention of reinfection and suppression of reforming of Biofilms.

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15.04.1957 – 26.06.2011