卷 22, 编号 4 (2016)

The purpose of the study – assessment of the efficacy of local application of tranexamic acid in TKA and the choice of the optimal dosage. Materials and methods. 48 patients were included in open-prospective study and were randomized to one of four groups. In the first group tranexamic acid was used as intravenous bolus at the beginning of the operation at a dose of 15 mg/kg. Additionally, after the installation of the prosthetic components, the surgeon performed periarticular infiltration of soft tissue by tranexamic acid solution at a dose of 15 mg/kg. In the second group of patients tranexamic acid was used as 500 mg intravenous bolus before surgery, and 500 mg locally after installation of the prosthesis components. In the third group of patients received tranexamic acid once at the beginning of the operation at a dose of 15 mg/kg iv bolus. In the fourth group tranexam was used after surgery once at a dose of 10 mg/kg. Results. In the first group of patients were achieved statistically significant, 5-6 times, reduction of blood loss on drainage in comparison with other groups, where the volume of postoperative blood loss was not significantly different between groups. Also in the first group recorded the smallest decrease in hemoglobin at the 5th postoperative day compared to the third and fourth groups. Complications associated with the use of tranexamic acid were not revealed. Conclusion. The method of periarticular infiltration by tranexamic acid in combination with its intravenous use in knee joint replacement is an effective and safe method for reduction of post-operative blood loss.

Purpose – to develop a comprehensive physio- and functional treatment with biological response method to improve rehabilitation outcomes in patients after hip joint arthroplasty. Materials and methods. The study included 154 patients who underwent hip joint arthroplasty. All patients were divided in two groups – test group (82 patients) and control group (72 patients). In addition to conventional rehabilitation the patients of the test group underwent 10-12 procedures using biological response equipment. Outcomes were evaluated by clinical examination (VAS pain dynamics, goniometry), functional diagnostics (EMG), biomechanical examination (stability) as well as life quality assessment by SF-36. Patients were followed up to one year. results. In result of the study the authors observed regress in complaints and clinical symptoms in patients of both groups. VAS evaluation demonstrated that in the test group pain decrease was more significant (at 15-20% at various time stages), was reported earlier (5,0±0,9 days) and persisted during the follow up period. ROM increase of operated hip in the test group was 15-20% higher than in control group according to goniometry analysis. Patients of both groups demonstrated increased range and frequency of biopotential in examined muscles as well as a reduced displacement of gravity center of the body. However, a larger degree of above changes was observed in patients of the test group following biological response procedures that provide for exercise of affected muscles as well as for antagonistic muscles. Life quality improvement was faster in patients of the test group. Conclusion. The authors reported correlating results of clinical and biomechanical examinations, electromyography and life quality assessments that altogether prove efficiency and prospects of presented comprehensive rehabilitation treatment utilizing biological response method in patients after hip joint arthroplasty.

According to current concepts, the influence of autologous platelet-rich plasma (PRP) and high molecular hyaluronates (HA) on the repair of hyaline cartilage during its inflammatory and degenerative changes has been insufficiently studied yet. The objective of the work was to evaluate the morphological changes in the structure of hyaline cartilage in experimental osteoarthritis after intra-articular injection of PRP and/or HA. Material and methods. The authors used 50 adult rats of Wistar line, weighing 250±2,2 g., distributed into five groups of 10 animals (two control and three experimental groups). An experimental gonarthosis was simulated on four groups of animals. Animals of the first experimental group received intra-articular injection of PRP, the second group – HA, the third – both PRP and HA. Results. No morphological signs of degenerative and inflammatory changes in the first control group were identified. Following osteoarthritis simulation the articular cartilage thinned to 121±20,4 microns (p<0,05) and the volume fraction of chondrocyte decreased to 1,2±0,6% (p<0,05). The authors observed an uneven coloration of collagen fibers with severe tinctorial properties disorder of the articular cartilage matrix. After the RPR introduction the authors observed tickening of the articular cartilage up to 275±18,9 micron (p<0,05) and the volume fraction of chondrocytes up to 18,4±2,0% (p<0,05). The contour of the cartilage surface became smoother with the formation of a cell-free zone. Collagen fibers demonstrated a uniform distribution, tinctorial properties of cartilage matrix in all areas were preserved, no signs of inflammation were noted. After HA introduction the authors observed thickening of the cartilage plate up to 264±21,3 microns (p<0,05) and the volume fraction of chondrocytes up to 11,6±1,2% (p<0,05). The surface of the cartilage featured uneven contours due to multiple areas of pulping. Uneven tinctorial properties of cartilage matrix, thickness and orientation of collagen fibres were retained. No signes of inflammation were observed. After the combined consecutive application of PRP and HA cartilage thickness increased up to 268±15,3 microns (p<0,05) and the volume fraction of chondrocytes increased up to 12,7±0,9% (p<0,05). Individual portions of pulping on the cartilage surface were observed. Tinctorial properties of the cartilage matrix were preserved; the focal uneven staining of collagen fibers in the basal zone was observed. No signs of inflammation were noted. Conclusion. During osteoarthritis simulation in knee joints of experimental Wistar line rats the authors observed severe structural changes in articular hyaline cartilage including complete destruction accompanied by vascular proliferation and granulomatous inflammation. Intraarticular injections of PRP, HA as well as PRP in combination with HA during the simulation of osteoarthrosis were accompanied by a decrease in the severity of degenerative and dystrophic processes and improval of tinctorial properties of articular cartilage matrix. Sole application of PRP or consecutive application of PRP followed by HA were observed as having the more significant reparative effect on articular cartilage as compared to HA.

Purpose – to study histomorphometric characteristics and pathogenic mechanism of peroneal nerve neuropathy in experimental lower leg lengthening by one millimeter per day in four increments. Methods. The authors performed lengthening of lower leg in 12 adult mongrel dogs at 14-15% of initial length by Ilizarov technique. 28 days after the leg distraction, 30 days after its fixation in the device and 30 days after the Ilizarov fixator dismounting the authors withdrew the animals from the experiment. Peroneal nerve portions were examined using light microscopy, histomorphometry of the full-color images of the giant epoxy semifine sections stained with methylene blue and diamond fuchsin. Results. Planimetric investigation demonstrated 15% decrease (p<0.05) in the total area of nerve fiber bundles after distraction confirming transverse contraction of intrafascicular content. Fibrosis, increased cellularity of epineurium as well as the decrease in adipocyte number and size was observed in result of distraction and fixation. Neuropathy of the peroneal nerve was observed in one of the 12 animals – more than 80% of myelinated fibers demonstrated destructive changes, the large arteries of epineurium demonstrated obliterated lumina, part of arteries had necrobiotic changes in the cellular elements of the walls. In the remaining animals the proportion of the transformed myelinated fibers in the experiment time frame amounted to 6.0±1.4%, 4.3±1.3% and 4.2±0.4% (normally: 1.9±0.3%), no marked vascular damage was observed, the number of epineural vascular modules increased up to 6.0±1.5 (contralaterally – up to 4.0±1.6), the number of endoneural microvessels was increased at 35.5%, 10.9% and 38.9% (p<0.05) in respect of intact norm (141.8±8.7 per 1 mm2). Reduced proportion of capillaries with open lumina confirmed vasomotion disorder. The changes analysis in the distribution of myelinated fibers by diameter and mean size indicates the distinct axonal atrophy, deand re-myelinaton. The mean diameter of axons and myelin thickness remained respectively 7% and 14% below normal (p<0.05) in 30 days after the fixator dismounting. Conclusion. Good structural preservation of the majority of peroneal nerve fibers during leg lengthening in the manual fractural mode is ensured by integrity and hypervascularization of the nerve membranes. Axonal atrophy and hypomyelination observed in part of the fibers is associated with epineurium thinning due to decreased adipocytes content and their size. Histologically documented neuropathy was observed in one case of twelve along with lumina obliteration of main epineural arteries.

In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years). Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months). The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be widened to various orthopaedic centres and will undoubtedly improve the quality of treatment for such patients.

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