卷 18, 编号 4 (2012)

The purpose of this study was to determine relationships between bone elements of the knee and popliteal artery. Type of study: anatomy and clinical. Materials and methods consist of 12 cadaveric knees, 14 MRI of the knee, 59 arteriograms of lower extremity 6 of cadaveric knees were x-rayed in the axial and sagittal planes at each of 3 flexion angles (180°, 130° and 90°) to determine the distance between posterior cruciate ligament and popliteal artery. During the study was also measured lengths of bone tunnels for arthroscopy posterior cruciate ligament reconstruction. Was fined, that in 100% of cases popliteal artery was in lateroposition (form 1 to 6 mm). The maximal distance between posterior cruciate ligament and popliteal artery were noted at flexion 90°. The length of the tibial tunnel was in a range from 63 to 78 cm, femoral - from 38 to 47 mm. Methods aimed at reducing risk of popliteal artery injury are offered.

The aim of the work was to study the echography visualization-based structural features of muscles and the wrist radial flexors for surgical treatment of 56 patients with the elbow flexion-and-extension contractures. The result of surgical treatment in the main group of patients consisted in the increase of the elbow extension angle. Muscle pattern was similar to a typical, normal ultrasound image. The most characteristic feature was a significant decrease in the muscle belly thickness. The thickness of fore-arm flexor muscular layer was 29,2% decreased for the brachium injured amounting to 16.5 ± 4.7 mm (P ≤ 0.05), and that for the intact segment - to 23.3 ± 2.6 mm. In the immediate periods after treatment the signs of atrophy remained. It manifested by the significant decrease of the anterior muscle group thickness with regard to the intact segment values. The index of the echo intensity of m. biceps brachii in operated limb increased by 53.7% compared to preoperative values, reaching 22.8 ± 2.1 conv. u (P <0.05), and m. brachialis - 30 conv. u (P> 0.05). Before the treatment in patients aged 8-13 years the relative strength of the forearm muscles was reduced by 12% compared with those on the contralateral limb (P <0.05) according to t-test, and in the older age group - 20.9% (P <0.01). With increasing of movement range in the late periods after treatment were observed satisfactory contractile response of the upper limb muscles. At different stages of reconstructive and restorative treatment of patients with posttraumatic elbow contractures it is advisable to use a combination of ultrasonic imaging of muscles and hand dynamometry with the definition of the relative strength of the muscles.

Objective: to develop the surgical treatment of patients with congenital metacarpal synostosis. Material and methods. 65 operations were performed in 58 children. with congenital metacarpal synostosis. Surgical intervention was determined by the localization of congenital metacarpal synostosis and the presence of concomitant deformities. Results. Excellent and good results were observed in 69,4% (33 hands) cases, satisfactory - in 30,6% (15 hands), unsatisfactory results were not obtained. At the same time excellent results were obtained in patients with less severe variants of metacarpal synostosis, good treatment results were observed in children with more severe associated abnormalities, as well as in cases where the correction is not performed metacarpal shortening. Overall, the results were significantly (p <0,05) better after application of advanced methods, including correction of all components of the strain. Satisfactory results were found out in patients with severe comorbidity, a total fusion of the metacarpal bones and fingers, the total PPS. Conclusions. Surgical treatment options for all congenital metacarpal synostosis should be individualized and be concluded in the performance of bone and plastic surgery to remove metacarpal synostosis and related deformities.

Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale), a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05). The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05) and the second verticalization (70%, 25% and 17%, p ≤ 0.05). Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients) the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition). Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90%) patients, satisfactory - in 6 (7,5%) and poor - in 2 (2,5%). In the control group a good anatomical results were obtained in 7 (17,5%) patients, satisfactory - in 14 (35%), poor -in 19 (47,5%). Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.

There is a report of two clinical cases of reverse shoulder joint replacement. In the first case, reverse arthroplasty performed in post-traumatic avascular necrosis of the humeral head. In the second case, the arthroplasty with reverse prosthesis was performed because of insufficiency of rotator cuff, and due to this, dislocation of unipolar shoulder. In both cases we achieved good functional outcome.

The review of domestic and foreign literature on a problem of treatment of the low limb deformities in young children with arthrogryposis is revealed in the article. Questions of medical tactics and its peculiarities in one and both sided congenital hip dislocation are touched upon. Basic worldwide tends of hip surgery development and effectiveness of different methods in arthrogriposis are revealed. Views of domestic and foreign authors on a problem of knee joint contractures treatment are represented and different conservative and surgical methods according to severity of deformities are described. Results of clubfoot treatment of different authors are shown in the article. Ponseti method and its possibilities for clubfoot correction in arthrogryposis are specified. Questions of treatment of planovalgus deformities are also touched upon as well as problems of orthotic supply in accordance with type of the deformities and its combination.

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