卷 18, 编号 3 (2012)

Objective: to assess the influence of various factors on blood loss and blood parameters in the postoperative period in patients undergoing hip replacement surgery with and without tranexamic acid. Material and methods. The operations of primary and revision hip arthroplasty were performed in 646 patients with various pathology of the hip by two surgery teams. Patients were divided into two groups: with the use the tranexamic acid - 284 and without its application - 362. We determined the amount of intraoperative blood loss, blood parameters (hemoglobin, red blood cells, platelets) before surgery and in the first, third and sixth days after the operation. Also the analysis of drainage system influence is carried out. Results. The tranexamic acid application during total hip arthroplasty allows to reduce intraoperative blood loss, to optimize the process of normalization red blood in the postoperative period. The renunciation of wound drainage decreased the total amount of blood loss on average 2.2 times and respectively, the need for blood transfusions.

In order to optimize surgical intervention the results of surgical treatment of 324 patients with tumor-like lesions of bone were studied. Study group comprised 211 people who were executed cryosurgical intervention. In 113 patients (control group) a similar intervention was performed, but without the cryosurgical exposure. In the study group the subjective and objective assessment of outcome of treatment was significantly different (at χ² = 9,5 p <0,01). It is explained by the variability of complications after the cryosurgical procedures. It was found that the ratio of types of surgical procedures carried out in this pathology, has changed over time. The number of intralocal and regional resections have increased while the number of segmental resections have decreased (at t = 2,7 p <0,05). The introduction bone cryosurgical procedures in clinical practice allowed to decrease the number of segmental resections from 27.6% to 4.8% and to increase the range of intralocal resections from 25.8% to 77.7%. The recurrence rate was 2.4% in the main group and 7.1% - in the comparison group.

Objective - to analyze the long-term results of surgical treatment of patients with injuries of middle- and lower cervical spine in diving. Materials and methods. An analysis of surgical treatment of 27 patients and assessment of the long-term results of 20 patients in a period of 6 months to 6 years were performed with analysis of clinical, neurological, radiographic data and mortality. Results. Mostly the C5 vertebra was damaged - in 17 patients (63%). Compression fractures of vertebral bodies met in 6 (22%), compression-comminuted fractures - in 16 (59%) patients, dislocations - in 5 (19%). All patients had neurological disorders. All observations noted rigid stabilization of the spine with an implant made of porous nickel-titanium, the presence of bone-metal block at the level of the damaged vertebral body Mortality in the postoperative period was 26%. In the long-term period the initial neurological symptoms were observed in 7 (30%) patients, 13 (48%) patients had marked regression of neurological symptoms. Full functional maladjustment was observed in 6 patients with no motor function below the damaged segment, originally belonging to groups A and B on the classification of H.L. Frankel. Moderate and mild degree of functional adaptation disorders were present in 5 and 4 patients respectively. In the remaining patients we did not reveal a functional maladjustment. Range of motion in the cervical spine in all patients was considered as good. Conclusions. Anterior decompressive-stabilizing surgeries on the spine with an implant made of porous nickel-titanium and metal plate CSLP allows reliably stabilization of the injured spine and the rehabilitation of this severe category of patients.

Objective - an assessment of influence an oxygen mode in tissues and rigidity of bone fragment fixation on blood supply in bone regenerate during the treatment by ILizarov's method of patients of different age with closed fractures of shin bones. Blood flow velocity in a region of closed tibia fracture was investigated using high-frequency Doppler ultrasound in the treatment of patients by Ilizarov (193 cases). The rate of blood flow in the area of fracture was increased in first weeks after injury and normalized with the increase of bone regenerate stiffness. In patients aged over 40 years in the tissues of the damaged shin a greater decrease in oxygen tension and a relatively greater increase in blood flow velocity in the zone of bone regenerate were noted.

Purpose - a complex assessment of the neuromuscular apparatus in different age groups of children with congenital clubfoot before and after surgery. Material and methods. The study included 80 patients (23 girls and 57 boys) with moderate and severe congenital clubfoot between the ages of 0 to 18 years. In 46% of patients a bilateral lesion was noted, in 54% - unilateral. All patients who received surgical treatment tendon-muscle plasty by the Sturm-Zatsepin method, modified in the Turner Institute, were carried out. Long-term results of surgical treatment were investigated in terms of 1 to 5 years. Neurophysiological studies were carried out on a multi-channel computer complex "Neuro-MEP-4" (Russia). Contractive ability of the tibial, peroneal, and gastrocnemius muscles of lower leg was assessed by global electromyography (EMG) for the affected and healthy sides. In order to receive the normal age indexes of electrogenesis the identical study was conducted in 30 subjects in each age group without pathology of the lower extremities. Results. Significant abnormalities of the functional state of the neuro-muscular system in shin were revealed in patients with congenital clubfoot. The analysis of the EMG results in patients admitted for conservative treatment (group 1) showed that in unilateral disease there is a decrease of electrical activity of leg muscles on the affected side. If bilateral symmetrical lesions observed decreasing of muscle electrogenesis were noted compared with the age norm. There are quantitative and qualitative changes in electrogenesis, which are characterized by secondary changes in the muscles on the background of segmental abnormalities. After surgical intervention in patients 0-3 years the positive dynamics of the neuro-muscular functional state of the shin was achieved, which allows to recommend surgical treatment of congenital clubfoot in children in age till three years. Revealed violations of the conductivity on the peroneal nerve motor fibers in children with congenital clubfoot require constant neurological monitoring before and after surgery.

Purpose: rationale for using bony landmarks of the femoral intercondylar space for an accurate determination of ACL attachment during arthroscopic reconstruction. Material and methods: anatomic research of 57 femur bones in which were studied anterior cruciate ligament femoral footprint, lateral intercondylar ridge and lateral bifurcate ridge. Results: research has shown, that lateral intercondylar ridge was present at 52 supervision (91 %), and its average length was 15.4 ± 0.46 mm; lateral bifurcate ridge was determined in 28 (49 %), which average length was 3.95 ± 0.26 mm. Conclusions: these bone formation can be considered as the reference structure for the identification of the anterior cruciate ligament femoral insertion.

Injuries of the bone anterior edge of the glenoid cavity of scapula is noted in 90% of patients with recurrent shoulder instability and it is the cause of recurrent dislocation in 67% of cases. The authors have presented a description of techniques and benefits of arthroscopic autoplasty (autografting) of scapula glenoid. A total of 10 operations were performed in 9 men and 1 woman. The average age of operated patients was 27,1±4,7 years. All patients were injured during contact sports. In the preoperative and immediate postoperative period computer tomography of damaged shoulder was performed in all patients with reconstruction in 3D images. The size of the bone defect was evaluated by 3D scans and averaged 29.7%. During the first stage free bicortical grafts with varying sizes from the wing of the ilium were harvested. Preartroscopic stage permits to avoid swelling of paraarticular structures during arthroscopy and allows to correct positioning and fixation autografts in the joint. The arthroscopic signs of defect and the technique of immersing of previously prepared free fragment through a wide 10 mm cannula and subsequent minimally invasive fixation with cannulated screws in scapula neck were described. This operation is an alternative to the transposition of coracoid process, does not require special tools and a long operating time (average 60-80 min), excludes injuries of brachial plexus branches and surgical trauma of subscapularis muscle, does not disturb the normal anatomy of the shoulder joint. There were no neurological complications, recurrences of instability in the immediate postoperative period.

The article outlines Dobbs’ method in the treatment of children having heavy vertical talus. The results of 23 clinical observations of children with congenital planovalgus deformity of 38 feet during 11 years are examined. The age of patients ranged from 1 month to 13 years. 40 operations were performed on these patients. The analysis shows that the best results were achieved in the treatment of children (17 feet), who were previously treated with Dobbs’ method, which included step-wise plastering combined with minimally invasive surgical procedures and subsequent orthopedic regime of "life in braces". With the introduction of the method the frequency of open reduction of the talus in this group of patients in our clinic has substantially declined, so Kumar et al. and Coleman et al. surgical interventions are reserved for the treatment of children, whose feet deformities were detected too late or recurred due to lack of effectiveness of the Dobbs’ method.

Among the various anesthetic options the combination of spinal anesthesia with the implementation of regional nerve blocks of the lower extremity and local anaesthesia of area of the wound with long-acting local anesthetics is more interesting. However the recommendations for the choice of postoperative analgesia of the foot do not exist, inspite of the pain syndrome. The prospects for wider use of regional blocks include the use of electrical stimulator in conjunction with ultrasound identification of the nerve trunks, the use of infusion pumps and catheter techniques blockades.

Reliable fixation of bone splinters with the latest constructions increases the role of kinezotherapy in rehabilitation of the patients with fractures at all stages of treatment. The 50-years’ experience of surgical work in the Department of Traumatology and also regular examinations of patients at the out-patient department of the Institute persuade the author that knowing the basis of kinezotherapy is necessary for operating traumatologists who are the first to give recommendations for the patients marking the main stages and methods of functional therapy. The essential particularities and details of kinezotherapy after application of modern implants are revealed in the article. It is necessary to underline that exercises being maximally easy are very important and necessity of calculation of gravitational loading for the patients with the fractures of proximal parts of extremity is essential.

The aim of the study was to establish the frequency and features of uncomplicated compression fractures of vertebral bodies in children and to determine its place in the rank structure of children’s injuries. In order to achieve this goal in 2011 the medical records were studied studied: case register of emergency trauma care, hospital records, medical records, X-ray archive. The authors have found that fractures of vertebral bodies took place XVIII ranking in the structure of child’s injury, which accounted for 0.55% of traumatic injuries. Frequently the fractures of vertebral bodies occur in children aged 8-12 years. Mainly the vertebra ThVIII was injured - 11.44% of cases. Children with fractures of vertebral bodies constitute 15.66% of inpatient emergency trauma patients in a specialized children’s orthopedic trauma department

The aim of this survey is the analysis of typical misbeliefs distribution about back pain among medical staff. Study design: cross-sectional discreptive study 110 medical professionals took part in this study. 48 of them were medical students (4th and 5th year of education), 62 were licensed medical doctors with ten years of experience in average. All participants were interviewed with special questionnarie containing 36 false statements about the spine and back pain. Every subject was asked to indicate whether he agrees or disagrees with each statement. The rate of incorrectly given answers was 63% in average for physicians (from 22% to 94%) and 60% in average for students (from 36% to 83%). In a small subgroup of neurosurgeons the rate of mistakes was 32% (varied from 11% to 47%). This study gives evidence of the high total level of misbeliefs about back pain among both licensed physicians and medical students. It is likely that majority of physicians do not use modern biopsychosocial model of back pain. Moreover they often act as carriers of irrational beliefs which could have negative influence on long therm effects of back pain.

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