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Vol 27, No 2 (2020)

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Short Messages
Preoperative planning of surgical procedures on the hand using a bone model made from the polymer clay
Zolotov A.S., Dyachkova J.A., Sidorenko I.S.

The authors proposed a method of preoperative planning of surgical procedures on the hand using a bone model made from polymer clay. A detailed description of the method and an example of its clinical use are given. This method proved to be effective in treatment of seven patients with deformities of the phalanx of fingers and metacarpal bones. The proposed method of preoperative planning helps the surgeon to perform the intended operation correctly.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):5-9
Original studies
Early complications of reverse total shoulder arthroplasty
Lychagin A.V., Kesian G.A., Kalinskу E.B., Sukharev N.A.

Background. The frequency of early complications after reverse shoulder arthroplasty remains high enough, and the overall complication rate is reported from 4.7% to 38%.

Methods. We did 23 primary reverse shoulder arthroplasty and used clinical information after these operations in our study. As a comparative material, we used date from registers of foreign countries, as well as information from special literature.

Results. Early complications were found in five cases (21.7%) in our study: two cases (8.7%) of a periprosthetic fracture; three patients (13.2%) had dislocation components. We studied these complications and formulated rules preventive measures.

Conclusions. (1) The most common early complications after revers total shoulder arthroplasty were instability components, periprosthetic fracture. (2) These types of complications arise due to unbalanced soft tissues, inadequate selection of the size of the glenosphere, interposition of soft tissues, and inadequate term of loads on the operated limb. (3) The number of these complications can be reduced by observing preventive measures at all stages of treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):10-14
The value of the shape of the arrangement of the articular surfaces of the clavicle and acromion for the mechanism: both the dislocation of the acromial end of the clavicle and its fracture
Miziev I.A., Baksanov H.D., Akhkubekov R.A., Bifova B.R.

Objective. To prove the dependence of a fracture or dislocation of the acromial end of the clavicle on the features of the shape of the arrangement of the articular surfaces of the clavicle and acromion.

Materials and methods. We conducted anatomical studies on 50 unfixed and unopened corpses of people of both sexes and aged 20 to 60 years. Among them, there were 35 men and 15 women. At the same time, we observed three forms of variability in the arrangement of the articular surfaces of the acromion and clavicle.

Results. We studied the radiological forms of the location of the articular surfaces of the clavicle and acromion in 50 patients with a collarbone fracture and in 50 patients with dislocation of the acromial end of the clavicle from 20 to 55 years old, among them 30 were men, 20 women. In all cases, the trauma mechanism was indirect. A certain relationship was revealed between the frequency of a fracture or dislocation and the form of arrangement of the articular surfaces of the acromion and clavicle. Clavicle fracture more often (78.0%) occurred with a vertical arrangement of the articular surfaces of aroma and clavicle.

Conclusion. Anatomical and clinical-radiological studies have shown the dependence of the fracture or dislocation of the acromial end of the clavicle on the peculiarities of the arrangement of the articular surfaces of the clavicle and acromion.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):15-18
The value of the MTHFR polymorphisms in pathogenesis of nontraumatic necrosis of femoral head
Panin M.A., Zagorodnii N.V., Samokhodskaya L.M., Boiko A.V.

Introduction. Among the etiological factors of non-traumatic avascular necrosis of the femoral head are the following: the prolonged use of corticosteroids, alcohol abuse, systemic lupus erythematosus, sickle cell anemia, the Legg – Calve – Perthes disease, ionizing radiation, cytotoxic agents, etc. At the same time necrosis of the femoral head might occur in the absence of the above factors (idiopathic necrosis). The reasons for idiopathic avascular necrosis could be a mechanical obstacle to the flow of blood, thrombotic occlusion of vessels, extravascular compression.

The purpose of this study is to examine the role of C677T gene mutation of the MTHFR gene in the development of non-traumatic avascular necrosis of the femoral head.

Materials and methods. During this study there was a comparative analysis of the frequency of the C677T gene allelic variants conducted in 41 patients with a verified diagnosis of non-traumatic avascular necrosis (main group) and 320 healthy individuals (control group). The survey program included the study of polymorphisms of MTHFR C677T gene by PCR.

Results. Differences in the frequency of occurrence of C allele of C677T gene MTHFR in the heterozygous state in case of non-traumatic avascular necrosis and in its absence were not statistically significant (51.2% against 37.2% respectively, χ2 = 3.014, p = 0.083). The genotype TT (T in the homozygous state) of the C677T MTHFR gene was detected in 19.5% of the main group patients. A similar index in the control group was two times lower and amounted to 9.0 percent, the differences between groups statistically significant, χ2 = 4.314, p = 0.038.

Conclusion. The study showed the importance of having the T C677T MTHFR gene in the pathogenesis of non-traumatic avascular necrosis of the femoral head. The data obtained and the analysis of the current literature suggests that this polymorphism is one of genetic predictors of non-traumatic avascular necrosis of the femoral head and other cardiovascular diseases as well.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):19-23
Morphofunctional remodeling of bone tissue during periprotheric fractures in the femoral component
Batpenov N.D., Rakhimov S.K., Stepanov A.A., Orasbaev D.A., Manekenova K.B., Smailova G.K.

Periprosthetic fractures in the area of the femoral component after hip replacement are one of the reasons for performing revision surgery. The treatment is always associated with many complications and therefore does not lose its relevance. The aim of our research was a pathomorphological study of bone tissue repair and reactive changes in the soft tissues around the periprosthetic fracture after arthroplasty. The research results will predict the long-term outcome and stability of the revision endoprosthesis.

Materials and methods. The materials for pathomorphological studies were biopsy, (11 — periprosthetic fractures in the zone of the femoral component, 5 — from the hip joint), fragments of bone tissue from the zone of the periprosthetic fracture, femoral canal, altered connective tissue obtained by repeated interventions in the area of periprosthetic fracture, and revision endoprosthetics. Pathomorphological studies of biopsy specimens of bone fragments and soft tissues were carried out after conventional histological processing with the production of histological sections, 5–7 μm thick, followed by staining with hematoxylin and eosin and according to Van Gieson.

Results. Morphological signs of structural disorganization of bone tissue in the fracture zone were revealed after fragments of bone and soft tissues were removed from the fracture zone; various options for repair of bone tissue were investigated, as well as reactive changes up to ischemia from the surrounding soft tissues were observed. Signs of damage to the tubules, lacunae and trabeculae, and with them the intraosseous branches of the supplying artery were noticed. Bone tissue repair in the area of periprosthetic fractures was carried out in various ways: due to activation of osteoblasts, through endesmal osteogenesis (from preexisting fibrous structures), endochondral osteogenesis (from provisional corns), as well as mixed osteogenesis from complexes of bone–cartilaginous tissue. Slowing of osteogenesis was the reason for the formation of appositional gluing lines in bone trabeculae, which are considered as a morphological sign of delayed osteogenesis. The absence of multinucleated osteoclasts in the bone tissues we studied is apparently due to the fact that pathological osteolysis with signs of ischemia does not develop in the fracture zone.

Conclusion. The results of our histopathological studies indicate that by the time of revision endoprosthetics in the area of femoral fractures, morphological signs of a slowdown in reparative osteogenesis develop with the pathological functional remodeling of bone tissue and microischemia in the bone and, of course, in the surrounding soft tissues.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):24-29
Serum markers for immunological response to metal alloys of endoprostheses
Shatokhina S.N., Zar V.V., Zar M.V., Shabalin V.N.

A study of solid-phase structures of blood serum using wedge-shaped and marginal dehydration methods (Litos system technology) was conducted in order to find out the causes of an inflammatory reaction followed by fibrosis in the second operated joint in a patient with bilateral knee arthritis. The study was aimed at identifying specific morphological markers that characterize the body’s response to the endoprosthesis material. Its solid-phase structures indicated the activation of a hyperergic reaction with daily incubation of blood serum with an alloy of titanium, aluminum, and vanadium. On the contrary, the immunological activity of blood serum can be suppressed and the structures present in it can be transformed into amorphous detritus with the incubation of an alloy of cobalt, chromium, and molybdenum. It was observed from the study that the nature of the immunological reaction of a sensitized organism depends on the type of metals that are part of the endoprosthesis. The immune response causes inflammation of the periarticular tissue, followed by its fibrosation and the formation of a scar demarcation shell that separates the periarticular tissue from the endoprosthesis and performs the function of an immunological barrier on the alloy of titanium, aluminum, and vanadium. On the other hand, an immunological reaction causes the destruction of inflamed periarticular tissue, followed by gradual destruction of the articular bag on the alloy of cobalt, chromium, and molybdenum.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):30-34
Evaluation of safety and efficacy of Hylan G-F 20 (Synvisc-One®) in patients with knee osteoarthritis in clinical practice
Kuropatkin G.V., Ahtyamov I.F., Stanislav M.L., Kushnir V.A., Belenkiy I.G., Kopenkin S.S., Tamazyan V.O., Vezikova N.N., Klyuchevskiy V.V.

Combined therapy of osteoarthritis (OA) includes intra-articular injections of hyaluronic acid. A prospective observational multicenter noncomparative study was conducted in compliance with routine clinical practice in patients with knee OA I–III stages in order to assess 1-year long-term safety and efficacy of Hylan G-F 20 (Synvisc-One®, one injection of 6 mL). Patients came for observation at 3, 6, and 12 months after intra-articular injection of Hylan G-F 20. The primary objective of the study was evaluation of pain severity while walking and rest by using the WOMAC VA3.1 (Western Ontario and McMaster Universities Osteoarthritis Index) scale after 26 and 52 weeks compared to baseline. Quality of life was measured by EQ-5D (EuroQuality of Life—five dimensions); patient’s general condition was measured by PTGA (Patient Global Assessment) and COGA (Clinical Observer Global Assessment). Results of the study were based on data of 121 patients (79.51% — women, 21.49% — men), mean age 62.97 ± 12.47 years. Positive clinical response was observed in 12 months (52 weeks) after Hylan GF-20 administration: pain severity versus baseline was decreased by 48.92% (p < 0.001) as per WOMAC A, stiffness in the joints versus baseline by 49.72% (p < 0.001) as per WOMAC B, difficulties in the daily life versus baseline by 41.54% (p < 0.001) as per WOMAC C. Seven adverse events were detected in five patients (4%), and one serious adverse event (cardiovascular abnormalities) was noticed during the entire study that was unrelated to the study drug. The extent of clinical response did not correlate with the stage of osteoarthritis. The quality of life was improved by 35.28% (p < 0.001) according to the questionnaire EQ-5D. The general condition of the patients was improved by 37.50% (p < 0.001) as per COGA and 42,86% (p < 0.001) as per PTGA. No patients were discontinued the study due to adverse event or any other reasons. Intra-articular injections of Hylan G-F 20 6 mL were associated with acceptable safety and efficacy, and the therapeutic effect was observed up to 52 weeks.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):36-44
A device for prosthesis length correction
Bolotov D.D.

In some cases, the parameters of the stump may undergo changes while walking on the prosthesis of the thigh or lower leg. The volume of the stump can change rapidly with certain pathologies (vascular diseases, multiple cicatricial changes), while a temporary increase in volume can occur in case of, for example, overload. In other cases, the parameters change gradually and, as a rule, downward. The result of a change in their volume is a change in the distance of the greater trochanter—floor, which leads to temporary or permanent overload of individual muscle groups when walking, a change in gait, and the formation of secondary changes from the various structures of the musculoskeletal system. The use of an insert in the carrier module in the form of a prosthesis length corrector allows to improve the quality of the rehabilitation and life of the disabled person and also avoids a significant number of secondary complications.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):45-49
Conservative correction of the transverse arch of the foot in patients with flat foot
Bardyugov P.S., Parshikov M.V.

Objective. The aim of the study is to analyze the design features of orthopedic appliances used to preserve or restore the transverse arch of the foot and determine the most promising product.

Materials and methods. Orthopedic products that were used to correct forefoot flattening in 350 patients aged 17–82 years were analyzed. Of the total number of patients, 321 were women, and only 29 were men; 252 people were diagnosed with transverse flatfoot of stages 1–2, while maintaining high elasticity of the arches, and in 34 cases, there was a pronounced rigidity. Flatness was combined with valgus deformity of one finger in the range of 20–300 in 218 patients. The pathological process reached stages 3–4, and the degree of elasticity of the arches was low in 98 patients. The products were used after various operations in 86 patients, while they were used as a conservative correction in the rest.

Results. All orthopedic appliances were divided into groups according to several criteria (design features and functional perspectives). An analysis of the strengths and weaknesses of the first three allowed us to identify the fourth group, which included products that provided the ability to adjust the size of the forefoot and at the same time restored the transverse arch. They were successfully used both in the rehabilitation period, after various reconstructive operations, and with conservative treatment.

Conclusion. One of the main goals in the treatment of this category of patients is restoration of the transverse arch of the foot during flattening (surgically, conservatively, or in combination), should be used according to indications and, if necessary, be combined with other corrective elements. All this will allow to achieve both therapeutic and cosmetic results and ultimately improve their quality of life.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):50-59
Assessment of clinical efficacy of the acoustic binaural beating method in the complex preparation of patients for hip replacement
Sekirin A.B., Prikuls V.F., Maybrodskaya A.E.

Objective. To increase the efficiency of the complex of therapeutic and rehabilitation measures in preparation for hip joint endoprosthetics.

Materials and methods. 66 patients in whom it was planned to perform hip joint endoprosthetics took part in the research. They were divided into two groups. The main group (n = 32) included patients who underwent 5 binaural beats as a relaxation program. In the comparison group (n = 34) the patients received a standard set of measures to prepare for this operation. All patients were screened for depression and anxiety using the standardized hospital scale for anxiety and depression (HADS) before the study. We also recorded the initial levels of reactive and personality anxiety using the Spielberger – Hanin test. We repeated the test in both groups after 7 days to evaluate the dynamics of the test.

Results. The conducted research showed that in the main group on the background of binaural beating procedures, reactive (from 57.2 ± 3.8 to 42.4 ± 5.2 points, p = 0.014) and personal anxiety (from 58.9 ± 4.1 to 44.7 ± 3.8 points, p = 0.003) were significantly reduced. In addition, the application of binaural beats method resulted in a significant decrease of HADS alarm subscale indexes (p < 0.001) in patients of the base group — from 12.8 ± 2.8 to 8.5 ± 0.7 points. While patients in the comparison group had significantly less expressed decrease of this parameter — from 11.7 ± 3.1 to 10.9 ± 1.6 points (p < 0.01). On the HADS depression subscale there was also a marked decrease in the main group to 7.1 ± 0.8 points, this value was statistically significantly lower (p = 0.011) than in the comparison group — 10.2 ± 1.2 points.

Conclusion. The conducted research has shown that the use of the binaural beats method in the complex of measures to prepare patients for hip joint endoprosthetics helps to improve their psycho-emotional status. This is manifested by a decrease in personal and reactive anxiety in the Spielberger – Hanin test, as well as the severity of depression and anxiety on the HADS scale. The advantages of the method are non-invasive and easy to use, and the disadvantages include the duration of the procedure and poorly studied mechanism of action.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):60-65
The role of microRNA in degeneration of the intervertebral disc
Beylerli O., Gareev I.F., Pavlov V.N.

MicroRNAs (miRNAs) are a class of small noncoding RNA molecules that negatively regulate gene expression at posttranscriptional levels. MiRNAs regulate many normal physiological processes, and also play an important role in the development of most disorders. The expression levels of miRNAs are characterized by endogenous properties and tissue specificity. These characteristics increase the likelihood that miRNAs can serve as useful clinical biomarkers in the diagnosis of certain diseases. Chronic lower back pain is usually associated with degeneration of the intervertebral disc (IDD), which is closely associated with apoptosis, impaired extracellular matrix, cell proliferation, and an inflammatory response. This process is characterized by a cascade of molecular, cellular, biochemical, and structural changes. Currently, there is no clinical therapy that shows the pathophysiology of disk degeneration. The presence of unregulated expression of miRNA in patients with degenerative disk disease indicates a vital role of miRNAs in the pathogenesis of IDD. It becomes apparent that epigenetic processes affect the evolution of IDD as much as the genetic background. Deregulated phenotypes of pulp nucleus cells, including differentiation, migration, proliferation, and apoptosis, are involved in all stages of the progression of human IDD. In this review, we will focus on the role and therapeutic value of miRNAs in IDD.



N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):66-71
Allergy or periprosthetic infection?
Kagramanov S.V.

Allergy or periprosthetic infection?

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):35-35
In memory of Alexander Viktorovich Balberkin

In memory of Alexander Viktorovich Balberkin

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):72-72

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