Vol 27, No 1 (2020)

Articles
Rib deformity correction in children with pectus excavatum
Kolesov S.V., Khaspekov D.V., Snetkov A.A., Sar A.S., Kazmin A.I.
Abstract

The article is devoted to a comparative analysis of the surgical treatment of pectus excavatum. A prospective, single-center, non-randomized study of the immediate results of the correction of pectus excavatum in children and adolescents is presented.

Material and methods. The treatment results of 40 patients (27 men and 13 women) aged 3 to 18 years, operated between March 2005 and March 2016 were analyzed. All patients were examined according to the standard algorithm: chest MSCT, spirometry. All patients were divided into 2 groups. Group I — patients operated on by the open resection method with plastic surgery of the costal arches (n=27). Group II — patients operated with the use of minimally invasive technology according to NUSS, which does not provide for correction of deformation of costal arches (n=13).

Results. In group II, significantly less blood loss was noted (35.7 ml versus 137 ml in group I, p<0.05), shorter duration of surgery (230 min versus 27.5 min in group I, p<0.05). It is worth noting the earlier discharge from the hospital in patients with minimally invasive correction of deformity.

Conclusion. Minimally invasive thoracoplasty is an effective way to correct pectus excavatum in children and adolescents, which can significantly reduce the duration of surgery and intraoperative blood loss, is comparable in basic terms with reconstructive surgery, but inferior due to the lack of correction of deformation of the rib arches.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):6-10
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Lumbosacral pain in athletes and ballet dancers: spondylolysis and spondylolisthesis. Conservative treatment
Mironov S.P., Cykunov M.B., Burmakova G.M., Andreev S.V.
Abstract

The aim of the study was to develop an algorithm for conservative treatment of lumbosacral pain syndrome (PCBS) caused by spondylolysis in athletes and ballet dancers.

Materials and methods. The study included 212 patients — athletes and ballet dancers with PCBS caused by spondylolysis (171 people) and grade I–II spondylolisthesis (41 people) of the lumbar vertebrae. Clinical, neurological, and X-ray studies, ultrasonography, computed tomography, scintigraphy, functional testing, as well as markers of bone resorption (calcium in urine) and bone formation (alkaline phosphatase) were performed.

Results. All patients underwent conservative treatment: functional therapy, physiotherapy, ozone and drug therapy. Functional rehabilitation treatment included three stages: 1 — relief of pain; 2 — restoration of support ability and stability of the spine; 3 — restoration of special motor skills. As a result of treatment, the functional parameters of the muscles stabilizing the spine improved (tone, contractile activity, bioelectric parameters), and the muscle imbalance was eliminated. After treatment, in radiographs, in most cases, a defect was observed in the arch of the vertebra, but it was much smaller in width and did not affect professional performance. Complete restoration of the bone structure in the area of the arc defect was observed only with acute pathology, complete cessation of sports load and a long (1 year or more) sparing regimen (9 people). Excellent and good results were obtained in 171 (80.7%) patients, satisfactory — in 36 (16.9%) patients. Five (2.4%) patients with spondylolisthesis were not able to continue their professional activities, the result of conservative treatment was regarded as unsatisfactory. Three of them were subsequently underwent surgical treatment.

Conclusion. The development of an individual program of conservative rehabilitation treatment for athletes and ballet dancers with spondylolysis and grade I and II spondylolisthesis, adequate and timely use of rehabilitation features lead to eliminating muscle imbalance and strengthening muscle corset. This, in turn, will contribute to the relief of pain, restoration of professional performance, prevention of progression of the area of bone reconstruction of the vertebral arches and spondylolisthesis

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):11-18
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Algorithm of treatment results HIV-infected patients with extra articular long bone fractures
Doronin N.G., Khoroshkov S.N., Maksimov S.L., Yarigin N.V.
Abstract

Algorithm of treatment results HIV-infected patients with extra articular long bone fractures

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):19-25
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Prevention of complications depending on the level of amputation (exarticulation) of the lower limb
Bolotov D.D.
Abstract

In the mid-end of the last century, unification was carried out to select the level of limb trimming, based on the principle of achieving the maximum possible functionality in the stump-prosthesis system. Over time, due to the development of surgical techniques and the level of prosthetic and orthopedic products, previously developed schemes for choosing the level of amputation have lost their relevance. However, the most typical complications and the associated decrease in prosthetics functionality continue to occur in the current time period. The article provides an analysis of the possible variants of complications in relation to the level of limb truncation, options for their prevention and elimination, and how the general assessment of the effect on the stat-dynamic function of the stump length at various levels is presented.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):26-30
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Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty
Ukolov K.Y., Ayzenberg V.L., Kapirina M.V., Mikitina M.E.
Abstract

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic.

Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement.

Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups.

Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups.

Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):31-35
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Pharmacological preconditioning — a new method of prevention and correction of hemodynamic disorders in elderly patients with hip fractures during surgery
Vasilkov V.G., Marinchev V.N., Emelina N.G.
Abstract

Purpose of study. The problem of the safety of elderly patients with hip fractures during surgery is discussed in with article. Various types of anesthesia (general or regional) have both direct and indirect effects on hemodynamic parameters.

Patients and methods. 210 patients were examined and divided into 3 groups according to type of anaesthesia: spinal, epidural and general anaesthesia based on propofol and sevoflurane with caudal block. In each of the groups are used different infusion preload solution (Ringer’s solution, Mafusol, Kardioksipin) before anesthesia care. The object of research is the central hemodynamics BP, HR, CO, SI and SVR. Results were recorded at several stages of operation and anesthesia.

Results and сonclusion. The data, results of one investigation characterizes positively influence antihypoxants- antioxidants in combination with a combined method of anesthesia on central hemodynamics in the analyzed groups of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):36-42
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Arthroscopically-assisted knee joint arthrodesis by custom-made intramedullary locking nail with simultaneous femur deformity correction (case report)
Korchagin K.L., Chugaev D.V., Solomin L.N., Sorokin E.P., Lasunskiy S.A.
Abstract

Post-traumatic intra- and extra-articular deformities of the bones forming the knee joint, multiple previous surgeries, fibrous ankylosis of the knee joint is unfavorable background for performing total knee joint arthroplasty. In case of refusal to perform knee arthroplasty, the «gold standard» is knee arthrodesis. Standard techniques used in performing this operation are traumatic and associated with a high volume of intraoperative blood loss. Using such a surgical option as arthroscopically-assisted arthrodesis can reduce the level of surgical invasive- ness and minimize blood loss, while allowing you to perform this operation no less effectively than using traditional approaches. As a clinical example, we have presented arthroscopically-assisted arthrodesis of the knee joint in a patient with posttraumatic deformity of the femur and fibrous ankylosis of the knee joint with a good medium-term functional result.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):43-52
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Combination of different thoracoplasty methods for recurrent pectus excavatum correction. Case report
Kolesov S.V., Khaspekov D.V., Snetkov A.A., Sar A.S., Kolesov G.S.
Abstract

A case of surgical treatment of recurrent funnel-shaped chest deformity with the formation of a complex pathological configuration of the anterior chest wall with the III degree of sinking of the sternal-costal complex in a 35-year-old woman is presented. After primary thoracoplasty, the patient underwent mammoplasty with implant placement, which made it difficult to correct the deformity, due to the high risk of damage to both the capsules formed around the implants and the implants themselves. In addition to the sinking of the sternum and adjacent ribs, the patient had a pronounced deformation of the costal arches according to the «pterygoid» type, which also required correction. In order to correct this deformity, we used a combination of two well — known thoracoplasty methods-open resection and mini-invasive by D. NUSS. Thoracoplasty performed in this way allowed to significantly reduce the trauma of the operation, avoid complications, eliminate damage to the implants and, ultimately, get a pronounced cosmetic result that fully meets the patient’s wishes.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):53-56
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Therapy of traumatic injuries of the spinal cord by magnetic nanoparticles: experimental aspects of promising technology
Kolesov S.V., Shvets V.V., Sazhnev M.L., Panteleev A.A., Gorbatyuk D.S.
Abstract

In this analytical review an attempt to sum up the available data in magnetite nanoparticle-marked stem cells utilization is made. Now this question remains on the experimental study level. Available data is diversified and needs an integral look to be taken. It is found that magnetite nanoparticles are non-toxic for the cells and do not interrupt physiological metabolic pathways. They can also be captured by cell using different transporters. Cells containing the magnetite nanoparticles can migrate along the magnetic flux lines. Animals with traumatic spinal cord lesions that got the nanoparticles-containing cell therapy showed the neurological status improvement. There is very little data in usage of this method in clinical practice; the solution of this problem requires more clinical trials.

 

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):57-76
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Current view on vertebral hemangioma
Grushina T.I., Titov A.A.
Abstract

An analytical review of publications devoted to various aspects of vertebral hemangioma was conducted from following electronic databases: Scopus, Web of Science, MedLine, The Cochrane Central Register of Controlled Trials, ScienceDirect, PubMed, and elibrary, CyberLeninka. The review contains actual data on the frequency of its occurrence, the possible causes of appearance and variants of development. The issues of diagnosis of vertebral hemangioma are considered in the historical context: clinical manifestations, objective modern sur- vey methods. Special attention is paid to the morphological and pathogenetic criteria for changes in the verte- bra. It is connected with the fact, that the diagnosis “vertebra hemangioma” prior to the morphological study is more a collective concept than a definitive diagnosis. It is noted that the modern concept of therapeutic tac- tics is based on the nature of course of vertebral hemangioma: aggressive and non-aggressive forms. The article presents the criteria for its aggressiveness according to domestic and foreign authors. The main methods of treating neoplasm are presented: radiation therapy, alcoholization, puncture embolization of tumor vessels, puncture vertebroplasty, stenthoplasty, open interventions. In the conclusion of the review, it is emphasized that if medical tactics in case of aggressive vertebral hemangiomas are actively developed by scientific researchers, today studies on sufficient clinical material with the long-term analysis of differentiated application of physio- therapeutic treatment of the patients with vertebral pain syndromes in combination with non-aggressive vertebral hemangioma do not exist.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):77-83
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Evolution of shoulder arthroplasty
Maykov S.V.
Abstract

This article is devoted to the establishment and development of one of the most difficult areas of modern orthopedics, namely arthroplasty of the shoulder joint. We represent the evolution of views on this problem, stages of development and formation of the modern philosophy of replacement of the shoulder joint, constructive features of different shoulder joint implants and indications, which determine the selection of the type of arthroplasty.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):84-90
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Actual features of express diagnostic of acetabular fractures. Part III. Atypical fractures diagnostic algorithm. Associated local injuries
Stoyukhin S.S., Lazarev A.F., Gudushauri Y.G.
Abstract

Authors shows atypical fracture patterns and rational algorithm for express diagnostic of this fractures. Associated local injuries are described.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):91-97
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Platelet-rich plasma use for shoulder epicondylitis treatment
Ochkurenko A.A., Savelyev S.N., Baymatov T.O.
Abstract

Epicondylitis is the most common cause of elbow pain, affecting up to 3,0% of the adult population. A comparative study of platelet-rich plasma (BTP) and betamethasone (diprospan) in the treatment of epicondylitis of the shoulder. 50 patients received injections of betamethasone 2-fold with an interval of 14 days. The main group-50 patients received 2 injections of BTP with an interval of 14 days. The results were evaluated using the psychometric scale Patient-Rated Tennis Elbow Evaluation (PRTEE) after 1, 6 and 12 months. Patients receiving Betamethasone showed the lowest level of pain after 1 month, with a gradual tendency to reduce the clinical effect after 6 months and the increase in clinical symptoms of the disease after 12 months. after treatment. The clinical effect after the use of BTP increases to 6 months with a slight tendency to reduce the effect to 12 months. Our studies have shown a high, up to 86,0% effectiveness of the applied methods of treatment of internal and external epicondylitis of the shoulder using PRP in comparison with glucorticosteroids.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):98-102
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He was in a hurry to do good Professor Alexander V. Skoroglyadov (1941—2019)
 
Abstract

Obutary

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(1):103-103
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