No 1 (2009)

The authors observed the stages of developing of optimal combined (pin-wire) external fixation assemblies for forearm long bones fractures. Using 3-D paramethric modeling in software complex Solid Works the rigidity of bone fragments fixation in system «forearm skeleton + external fixation device» (105 series of experiments). Computer model adequacy is proved in experiments on cadaver material (15 series of experiment). The assemblies which provide good reduction capabilities while minimal number of transosseus elements, the smallest frame sizes and have the opportunity of module transformation are determined. They are approbated in treatment of 57 patients. Good and excellent results are achieved in 96 % of cases.

The authors developed the new methodological approach to restoration of motor skill of possession by the reconstructed hand with use of adaptive training with electromyography. New techniques of adaptive training after various reconstructive interventions and an estimation technique manipulating skills of a hand are presented. Application of the electromyographic biological feedback has allowed to achieve restoration manipulating skills with effectiveness ratio on the average 3,75. Bilateral hand grip has been restored at all patients.

Приведены результаты хирургического лечения 24 больных остеохондрозом позвоночника. Операции произведены на следующих уровнях: VL4 - 5 - 13, VL5-VS1 - 11. Удаление грыжи диска произведено традиционным интерламинарным доступом у 10 пациентов, по методике Каспара - у 14. Дискэктомия с максимальным удалением желтой связки и с сохранением эпидуральной клетчатки и вен, а также пластика послеоперационного дефекта с помощью дорсолюмбальной фасции является патогенетически обоснованным методом, позволяющим создать благоприятное условия для нервно-сосудистых образований позвоночного канала, что предупреждает развитие послеоперационного рубцово-спаечного эпидурита и улучшает результаты хирургического лечения больных с грыжами поясничных межпозвонковых дисков.

In treatment of 88 patients with different posttraumatic abnormalities of osseous regeneration autotransplantation of marrow in conjunction with crystalline chymotrypsin dissolved in was applied. Analysis of results showed effectiveness of proposed method in delayed union by 100% cases, in ununited fractures - by 91,7%, in hypertrophic pseudoartrosis - by 91.7%, in hypotrophic pseudoartrosis - by 76,6%, and in pseudoartrosis in combination with marginal bone defect - by 66,7%. Rigid fixation of fragments is indispensable condition of beneficial effects achievement.

The objective of the study was the analysis of possibility of correction of contractures in children with spastic cerebral palsy after combined (neurosurgical and orthopedic) treatment. The total amount of patients was 29 (41 segments). Neurosurgical options included selective neurotomies of the branches of tibial nerve in spastic deformities of the feet in all of the patients were treated (41 procedures respectively). Orthopedic options included tenomyoplastic procedures (Achilles tendon lengthening, gastrocnemius aponeurotic lengthening) in 26 of the patients presenting with accompanying fixed contractures. Preoperative and postoperative investigation included clinical assessment (range of passive and active motion, Ashworth scale assessment) and electroneuromyography. The surgical procedure was performed by intraoperative electrostimulating control. The average postoperative follow-up was 11 months, 20 patients (28 segments) were surveyed. Decrease of the muscle tone was recognized in all of the cases, the average rate of diminishing was 57.5 %. The clonic reaction of foot was diminished or disappeared in 73 % of the cases. Achilles reflex was normalized in all of the patients. Electromyographic data did not reveal any trends. Particular deformation relapse was observed in 19 segments. The analysis of the presented material allows making a conclusion that combined single-event neurosurgical and orthopedic treatment is the method of choice in presence of the high tone and progressive or existing muscular contracture in evidence of inefficiency of conservative treatment in children with cerebral palsy.

The acute torticollis is usual and frequent cause of child's hospitalization. 208 patients 2-17 years of old with this syndrome were analyzed. Epidemiology, clinics, diagnostic and treatment are presented. The surgical algorithm of child's acute torticollis is suggested.

Research objective: on the basis of modern methods of radiodiagnostics to study the peculiarities of pathologic reconstruction at patients vitamin D-resistant rickets depending on age of patients and at various stages of treatment. Nine patients with vitamin D-resistant rickets were examined using CT and MRI before, after treatment and during the remote period. Methods of a computer tomography (КТ) and a magnetic resonance tomography (МРТ) survey. X-rays of 17 patients with of pathologic bone tissue reconstruction were studied. The age of patients varied from 12 till 42 years. Radiological changes in a zone of reconstruction of cortex in age aspect appeared as a wedge shape, planar, rectangular zones of resorption. CT and MRI are additional methods of diagnostics that reflect changes in bone architectonics, growth zones, periosteum, degree and character of reconstruction of internal bone structure after deformity correction, effectiveness of surgical treatment.

The authors studied the results of operative treatment of trochanteric fracture with the use of different devices for osteosynthesis at 817 patients. In 553 cases DHS (dynamic femoral screw) were applied, in 159 - DCS (dynamic condylar screw), in 105 - PFN (proximal femoral nail). Long-term results in terms from 1 are to 5 years are studied at 485 (61,4%) patients. The choice of device for osteosynthesis is determined by the type of injury. At stable fractures it is expedient to use the dynamic femoral screw, at unstable fractures the intraosseous fixators are more effective (proximal femoral nail, Gamma-nail). Application of dynamic condylar screw is justified at intertrochanteric fracture at young patients. At the patients of elderly and senile age it is necessary to execute osteosynthesis by the intraosseous fixators.

The results of examination and operative treatment of 28 patients with sciatic nerve lesions are presented. Sciatic nerve injury and functional outcome were described, tactic and treatment recommendations were given in dependence to injury mechanisms, location, time to surgical repair, surgical techniques.

The authors examinated 565 children with defects of a hand, who were subjected to the rehabilitation, including prosthetics. The manufacturing of prothesis for 8 (1,4 %) patients appeared impossible or rather difficult. The description and illustrations of some cases of incorrectly chosen tactics of surgical treatment of children with defects of a hand in medical establishment of Russia are presented. After treatment they have been directed to clinic of our centre for prosthetics. At a choice of tactics of surgical treatment the considered and rational approach taking into account possibility of the subsequent prosthetics in the specialized centers is optimum.