卷 21, 编号 4 (2015)

Purpose of the study - to evaluate in different groups of patients variability of anatomical changes that may affect the difference in the length of the lower extremities and affect on the results of the preoperative planning. Material and methods. As study material we used long film X-ays of 142 patients. A main group comprised 69 patients with varying severity of hip dysplasia. Control group consisted of 73 patients without hip pathology. All patients were performed long film X-rays, and measurements of relative and absolute lengths of the lower limbs, followed by analysis of the data. Results. Analysis of the measurements showed that none of the patients had absolutely equal length of the lower limbs, even in the control group in 56.2% of the observations noted the absolute difference of the lower extremities length more than 5 mm, and in 9.6% of patients - from 20 to 35 mm. In assessing the difference of the lower extremities length on AP pelvic view in the main group only one patient of 69 had the same length of the legs, and in 61 cases the difference was more than 5 mm, that it was clinically significant. Of practical interest is the fact that in the main group shortening of the operated limb was observed in 51 of 69 patients in AP views of the pelvis, but the results of measurements of the anatomical length of limbs long film X-rays compared with measurements of the relative shortening on the pelvis AP views showed that clinically significant difference exceeding 5 mm between measurements observed in 68.1% of cases. The greatest difference between the measurements of the limbs length on the pelvis AP views and long film X-rays observed in patients with unilateral hip dislocation and averaged 17.0 mm. Conclusion. Performing preoperative planning in patients with dysplasia only on pelvis AP views not allow properly compensate the difference of the lower extremities lengths, which may adversely affect the functional results of surgery and as a result, the patient’s satisfaction. Therefore, planning THA, especially at high hip dislocation, it is necessary to calculate the difference of the lower extremities lengths considering as the difference of the lengths on AP pelvis views and long film X-rays.

Introduction. Recently, new model of Oxford mobile-bearing unicompartmental knee arthroplasty (UKA, Oxford Microplasty®, Zimmer Biomet, IN, USA) was launched to improve previous version (Oxford Phase 3, Biomet, IN, USA). Still, there are few reports demonstrating the results of this noble UKA prosthesis in the literature. Thus, the aim of this study is to report and assess the postoperative radiological outcomes of the Oxford Microplasty ^® instrument. Materials and methods. From March 2013 to October 2013, twenty-one patients (23 knees) underwent mobile UKA for medial compartment osteoarthritis using this noble instrument. Postoperative radiological outcomes were measured for operated lower limb alignment and implant position, and they were compared with those of 64 UKAs using the Oxford Phase 3 which had been performed from January 2010 to August 2012. Pre-and post-operative deformity of the knee in the coronal plane, the location of the mechanical axis with respect to the center of the tibial surface, positioning of the tibial and femoral components and varus and valgus alignment for the tibial and femoral components were evaluated. Results. In the Microplasty® patients, preoperative HKA angle was 172.8±2.5° and postoperative HKA angle increased to 177.7±2.8° (p<0.001). There were no significant differences in postoperative HKA angle between Oxford Phase 3 and Microplasty group (178.4° vs. 177.7°, p>0.05). There were no significant differences in postoperative limb alignment and component position between the Microplasty group and Oxford Phase 3 group except femoral component flexion (11.9±2.1° vs. 2.6±4.1°, p<0.001). In addition, there were not any outliers in measurements of the components in the Microplasty group. Conclusion. UKA using Oxford Microplasty® includes noble tools including femoral sizing spoon, G-clamp, longer IM rod, two-peg femoral component, and IM link system to help with ease of use, precision, efficiency, and reproducibility. Increased flexion of femoral component and increased total arc of femoral component will be more suitable especially for Asian patients who perform more flexion such as squatting and sitting on the floor in daily living activities.

Flatfeet are divided into rigid and mobile forms. Rigid flatfeet usually lead to the development of pain. The most common reason of rigid flatfeet is a tarsal coalition. Mobility of the tarsal joints is checked by specific clinical tests. The study investigated the sensitivity and specificity of foot mobility tests - the “tip toes test”, Jack test, manual examination of passive and eversion and inversion. The study found the following parameters: the sensitivity of the “tip toes test”, Jack test was 87% and 85%, specificity - 65% and 64%. The sensitivity of the manual examination of passive and eversion and inversion was - 80%, specificity - 88%. The last test has a high specificity compared to the “tip toes test” and Jack test. Detection limits the mobility of the tarsal joints can be an indication for radiography for the detection of tarsal coalitions.

Periprosthetic fractures are one of the most serious complications after hip replacement. Nineteen periprosthetic femoral fractures operated on during the period 2011-2015 were followed-up retrospectively. Periprosthetic fractures were classified according to the Vancouver classification. The functional results were evaluated using Harrison scale. Bone healing and implant stability were evaluated clinically, on plain radiographs and computed tomography. The periprosthetic fractures in all patients occurred in the postoperative period. Time from operation until fracture varied from 2 weeks to 11 years. A wedge-shaped cemented or cementless stems were implanted during the first surgery: Versys ET, Spotorno, CPT (Zimmer, США): cementless fixation was performed in 16 (84,2%) patients, hybrid -in 2 (10,5%) and cemented fixation - in 1 (5,3%) patient. The fractures of greater trochanter were diagnosed in all patients with type A periprosthetic fractures. In type B1 periprosthetic fracture (8 patients) open reduction, cerclage wiring and internal plate osteosynthesis were applied. Loosening stems in 3 patients with type B2 fractures were replaced with Wagner cementless revision component (Wagner SL Revision Stem). Angle-stable plate osteosynthesis and cerclage wiring were also performed. Closed reduction and internal minimal invasive plate osteosynthesis were performed in patients with type C periprosthetic fractures. Bone consolidation was achieved in 18 (94,7%) patients, the average term was 14,3±5,2 weeks. The average Harris hip score in all patients 3 months after treatment was 64,9±16,7 points, and in 12 patients (63,2%) after a year - 86,5±15,9. Femoral periprosthetic fractures require a specialized approach to choosing the treatment tactic depending on the fracture type and quality of bone tissue. It is necessary to evaluate the femoral component stability, especially in differential diagnosis of type B1 and B2 periprosthetic fractures. Computed tomography is one of the necessary methods of diagnosis.

Atlanto-axial rotatory fixation (AORF) develops on the background of acute torticollis. Widely adopted terms such as C1 subluxation or atlantooccipital rotational subluxation do not reflect the core of this pathology and carry negative weight in the diagnostics and treatment of AORF. Retrospective analysis of the diagnostics and treatment outcome of 5 children with confirmed AORF diagnosis and literature review were performed. Clinical method, radiography and functional computer tomography were used to verify the diagnosis. De-rotational halo-traction and open correction with screw fixation were applied for treatment. Head position was managed to be improved in all patients. In one case the reduction was performed using correction in suboccipital segments and in other 4 cases the correction and fixation by Harms and de-rotational halo-traction allowed to correct torticollis. The pain syndrome had been arrested completely. Disease outcome resulted in formation of C1-C2 fibrous or bone fusion regardless the method of treatment. The patients with neglected AORF represent a great challenge for diagnostics and treatment. When conservative treatment fails it is necessary to involve de-rotational halo-traction with possible application of open reduction and posterior fusion. The purpose of treatment is to eliminate torticollis and pain using creation of proper C1-C2 alignment. The motions in atlantooccipital joint do not restore due to formation of the fibrous or bone fusion.

Hip arthroplasty is a common surgery, the success of which largely depends on its planning. Traditionally, arthroplasty planning performed on X-ray film, but this method has many shortcomings, including the well-known systematic repression for analogue X-ray systems to digital. The wide range of implant templates for the planning available in numerous of foreign special planning programs for arthroplasty, but all of them are very expensive. A team of authors from Sechenov First Moscow State Medical University, Lomonosov Moscow State University and Petrovsky National Research Centre of Surgery developed an original computer program for hip arthroplasty planning that allows to plan not only in the DICOM format, but also in photographs of traditional X-ray film. In the process of their work, it has been proved that the projection distortion when photographing X-ray applied to the X-ray viewer without a tripod is 1.95%. Practical testing of the planning program was carried out with 316 total hip arthroplasty surgeries. It turned out that for acetabular component the number of matches was 301 (95.3%), and for femoral components - 304 (96.2%). There were no cases of changing the type of components during surgeries. Thus, the created domestic import-substituting planning program allows working with a variety of image formats and making it possible to digitize X-ray film.

The authors presented uncommon case of revision hip arthroplasty performed for aseptic loosening of the acetabular component implanted in a false acetabulum in patient with high hip dislocation. During revision surgery both components were replaced with implantation of cup to the true acetabulum. After 10 years after surgery the support ability of the operated limb is maintained, functional outcome - 82 points on Harris scale.

A case of refractory neuropathic pain syndrome in patient who underwent monopolar shoulder replacement is presented. The patient had right lung tumor metastasis in the right humeral head. Severe neuropathic pain syndrome, not responding to 6-months conservative treatment, developed in post-operative period. Pulsed radiofrequency ablation of C4-C6 nerve roots via interscalene access was performed. The procedure allowed the patient to stop taking painkillers and improved his quality of life. The patient was monitored for 2 months.

Aim. Based on own and literature date to define biologically rational elements of complex approach to bone mass loss prophylaxis and treatment. Nowadays there are two points of view regarding bone mass loss prophylaxis and treatment. The first favor pharmaceuticals as a basic and physical exercises as additional. According to the second, therapeutic and prophylactic significance of physical exercises in maintenance and development of structural and functional capacities of musculoskeletal system is fundamental. The latter approach correspond to evolutionary formed biological model in that muscles act upon levers - bones that connected by means of joints and provide the movement of the body against gravity. The present work from pathogenethically point of view establish the systemic approach to the bone mass loss prophylaxis and treatment. It is based on physical exercises while additional pharmacotherapy that should aim for optimization of regulatory function of bone cells, first of all osteocytes providing for adaptational reorganisation of bone structures.

This report provides information ang brief description of current freely available computer programs for statistical analysis of the results in biomedical research.

The purpose - to identify the Х-ray anatomical features of the dislocated hip in children with arthrogryposis, to compare Х-ray and CT scans of hips in patients with arthrogryposis and DDH. Materials and methods. We examined the 98 X-rays and CT scans of the pelvis (120 hips) in children aged from 5 months to 7 years with a hip dislocation in arthrogryposis (main group) and DDH (control group). Results. Cranio-lateral displacement of the femoral head was less pronounced in the main group than in the control. Deficiency of the roof and anterior acetabular margin are typical for the comparison groups, but these changes are significantly less pronounced in the main group (p<0,0001). Also revealed that the posterior acetabular margin developed significantly greater in the main group. For the patients in the main group up to 3 years, the pathological femoral antetorsion is not typical in contrast to the control group (p<0,0001), however, it occurs in older age (p<0,14). At the compared groups the true values of the NSA do not exceed the age norm. Conclusion. Examination protocol of the hip dislocation in children with arthrogryposis must include X-ray and CT of the pelvis for reliable evaluation of the femoral and acetabular component and preoperative planning.