No 3 (2009)

The appropriateness of united donor site selection on dorsal wrist and hand suitable for formation and transfer of five different island bone grafts to navicular bone was grounded in the course of topographic-anatomic study using 25 upper extremities of 13 adult wandering cadavers. The study results were confirmed during 28 successful surgeries using such autografts performed at Army Medical College in 28 patients at the age of 15-50. The comparative analysis of results of treatment these patients operated with developed and traditional methods revealed the great effectiveness proposed surgical procedures.

The authors examined two groups of patients with the total number of 417. In the first group (215 people) they applied a methodological approach based on the discrimination of the main clinical syndromes on every stage of osteoarthrosis and in the process of rehabilitation such means and methods that influence the pathogenesis disturbances diagnosed were used. In the second group of patients rehabilitation was conducted with regards of inflammatory process activity in the joint, irrespective of the stage of osteoarthrosis and peculiarities of clinical disease course. The advantages of new practice of rehabilitation process planning of the patients from the first group are shown with the help of special methods of. Therewith the more definite them an second group patients regression of the inflammation changes of the joints is revealed: reduction of thermal skewness, reduction of exudates amount and thickness of synovial membrane, normalization of synovial epithelium analysis, growth of anti-inflammatory cytokines amount. At the same time the decrease of the destruction processes activity in the joint cavity is marked (the decrease of tissue cellular elements in the synovial membrane liquid, the growth of the sickness of the joint cartilage) and, improvement of the synovial homeostasis and regional blood circulation. As a result of these positive changes the decrease of the pain syndrome intensity was revealed and also the improvement of the functional state of the joints, and the increase of the amount of movement within them.

Combined low-frequency electro-, magnetotherapy and infrared laser-therapy causes the regress of the clinical manifestations at the damages of lower extremities muscle, improves its function and can be effective as the base method of rehabilitation therapy in the treatment of sportsmen with the injuries of the muscular system of the lower extremities of the mild-to-moderate degree.

The complex study of 7 children with diastematomyelia of the lumbosacral spine of age 1.5-4 years was performed using electromyograpy, electroneuromyograpfy and Doppler ultrasonography. The authors revealed the changes in muscular tissue electrogenesis in low extremity, changes in the vascular bed of the affected extremity and disturbances in the neurological status.

Is suggested a theoretical foundation for the concept in accordance with which hierarchic organization of the skeleton should be regarded as a factor regulating the structure of fatigue injuries, taking into account the known morphological markers of fatigue destruction of osseous structures, peculiarities of hierarchic organization of the skeleton, laws of the science of materials. The authors present the history of the question, literature findings about the density of fatigue microinjuries in vivo, modern knowledge concerning the mechanisms of microinjuries marking and development of local predisposition to their formation.

Authors analyzed results of osteosynthesis by locking and not-locking nails in treatment of 64 patients with diaphyseal extra-isthmal A1 type tibial fractures. Patients were divided into two clinical groups. The first group consisted of 20 patients with juxta-isthmal fractures, the second - 44 patients with juxta-metaphyseal fractures. The obtained data show that the use of locking nails and rectangular section nails produced good results at juxta-isthmal fractures. In cases of juxta-metaphyseal fracture the use of rectangular section nails was associated with a greater risk of complications compared to locking nails.

The author's methods of surgical treatment of bilateral pelvic injuries are described. The results from 6 to 12 months after surgery are presented. The excellent and good results were achieved in 77% of patients with injury class B3 and C2.

On the basis of statistical findings, received by monitoring of levels of temporary labor disability happened as the result of injuries, poisonings and musculoskeletal diseases in adult population of Leningrad - St. Petersburg, the analysis of dynamics of basic temporary labor disability levels was done. The article introduces with basic findings gained in 30-year investigation. The level of temporary labor disability due to injuries and musculoskeletal diseases for better obviousness was calculated separately for each age group.

The authors described the history of low-invasive spine surgery developing; positive and negative aspects of every method. The aetiology and pathogenesis of degenerative dystrophic spine diseases are also shown. The modern percutaneous punctural methods of treatment of these diseases are considered.

Based on the literature data, the author analyses the effectiveness of the main operative methods of the mobile correction of the equino-plano-valgus foot deformation (EPVDF) in children with infantile cerebral palsy (CP). The main aspects of the etiopathology and clinical presentations of the pathology and methods of its diagnosis are highlighted. Based on the lot of literature sources, the author makes a conclusion about the lack of surgical methods, that permit to carry out the correction all the EPVDF components in the patients with CP without arthrodesis of the any foot joint, transarticular osteotomy or devices implantation. The development of the operative interventions without any anatomy disturbing or joint functions of the numerous patients and possessing reconstructive opportunities is one of the most perspective directions in surgery of the foot pathology of the children with spastic EPVDF.

Article is devoted pressing question of children's traumatology and orthopedy - early diagnostics diseases of the musculoskeletal system at children. In it short-lived results of orthopedic screening of newborns are presented.