编号 4 (2008)

The short-term results of treatment and follow-up in 37 patients with the osteomyelitis of proximal femoral part and the area of acetabulum including 26 patients with deep periprosthetic infection after hip replacement were followed in period from 6 till 44 months after the carrying out of operations according to worked up technique supposing the radical surgical debridement of infectious nidi and the single-stage replacement of cavities by means of island flap from lateral wide hip muscle. Good results were received at the medium terms of observation 21,3±9,2 months in 70,6% of cases and the recidivation of osteomyelitis was detected in 5,9%. The carried out analysis of clinical material allowed to determine indications for the operation and contraindications to surgery.

From 2004 till 2008 the index of intracompartmental pressure was analysed at 58 patients with comminuted fractures of the lower legs and significant damage of soft tissue. 72,4% of them had moderate rise of intracompartmental pressure (from 15 to 29 mm Hg) and in 27,6% the pressure was high (more than 30 mm Hg). We develop the subcutaneous endoscopy-assistant method of the fascial dissection. This technic had a lower risk of damage the vessels, nerves and muscles. 12,1% patients had an open decompression, 34,5% - subcutaneous, and in 53,4% by endoscopy-assistant fasciotomy. The tibial fractures was treated by external fixations or locked tibial nails. Monitoring of intracompartmental pressure showed the high effectivenes of subcutaneous endoscopy-assistant fasciotomy, such as after the open decompression.

The modifications of Bristow-Latarjet operation were developed. 228 patients were operated using these methods. The trauma was the origin of repeated dislocations in 134 cases, and the dysplasia of joint - in the rest 94 cases. There were 194 (85,1%) men and 34 (14,9%) women. Patients at the age of 20 till 40 prevailed - 157 (68,9%). The treatment follow-up was studied in 209 (91,7%) patients in the period from 1 till 15 years. The examination included: radiography and the contrast arthrography of joint in two projections, computer tomography and contrast computer tomography, the US (ultrasonic scanning) of humeral joints, the electromyogram and electroneuromyogram of shoulder girdle muscles. According to the results of the examination operations for the replacement of the bony defect of the anterior edge of glenoid cavity, operations for the increase in the articular platform of scapula and capsular plasty were carried out. These methods allow not only to restore anatomical interrelation in humeral joint and strengthen its anterior wall, but also to eliminate the persistent disjunction of the jointed surfaces of humeral bone head and glenoid cavity that allows to generate the dynamic stability of humeral joint.

52 patients aged from 14 to 37 years with sequelae of the acute haematogenous osteomyelitis in the proximal femoral metaepiphysis were examinated. These patients had a hip arthroplasty with demineralized osteochondral allografts. In 73,1% cases satisfactory results of the treatment were observed.

The work deals with the results of wound discharge microbiological investigation in patients with open fractures, who were treated at RISC "RTO". The microflora of infected wounds has been established to differ depending on fracture localization, and this dependence is reflected in both - the different composition of species and the ratio of founded gram-positive and gram-negative bacterial monocultures and their associations as well. The greatest number of the wounds, complicated by infection, has been found in patients with open fractures of foot bones (90%). The microflora of gunshot fractures and those of foot bones is characterized by the presence of the great number of bacterial associations. There were no reliable differences found in the number of gram-positive bacterial cultures isolated depending on fracture localization. At the same time, wounds in patients with leg and foot fractures were found to be disseminated with gram-negative bacteria to the greatest extent (17,5% and 14,2%, respectively).

With the purpose of the study of organism systemic immune response to the use of the cement and cementless fixation of endoprostheses in the nearest and remote terms after implantation the analysis of the indices of the immune state of 109 patients with gonarthrosis and coxarthrosis of III stage aged from 40 to 73 was carried out. The authors draw a conclusion that the reaction of immune system to actively functioning implant makes itself by the moderate activation of humoral immunity and the hyperproduction of TNFa against the background of the moderate depression of a cellular component of immune system. The dynamics of the indices of systemic immune response to large joints replacement are conditioned by surgical intervention directly and don't depend on the type of the fixation of implant.

The data about 376 patients with the partial acute (61,4%) and old (38,6%) injuries of knee anterior crucial ligament in which we didn't resort to its reconstruction were analyzed. Two variants of the policy were assessed: the resection of stump or the injured part of the ligament and non-intervention in anterior crucial ligament. Basic factors influencing the choice of the variant of treatment were detected. The analysis of the results of the clinical and biomechanical assessment of the outcomes of treatment with the use of the methods of mathematical statistics testifies that saving policy at the incomplete injuries of anterior crucial ligament gives persistent positive effect.

The device for the objective study of knee stability in sagittal plane was described. It allows to carry out the quantitative assessment of anterior and posterior shin dislocation at the deficiency of cruciform ligaments. Suggested device differs in the simplicity of its use and guarantees the lesser error of measurements in comparison with analogs. The introduction of new device into practice will allow to assess quantitatively the degree of knee instability after the injury of cruciform ligaments as well as analyze objectively the functional results of surgical treatment.

59 patients were examined in the period till one year after total hip replacement. The experimental group of 10 persons was chosen. There were no postoperative complications at final examination. Active function-restorative treatment was carried out to all of them. Clinical and working prognoses are favorable. The analysis of the employment assistances of these patients detected that the people of easy physical labor and mental work, become invalids, work by profession without restriction. Consequently the authors came to conclusion that it is necessary to change the practice of the acknowledgement of patients as the invalids of II and I groups, prolong medical certificates for larger term.