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Vol 25, No 2 (2018)

Articles
COMPARISON OF THE USE OF PEDICLE SUBTRACTION OSTEOTOMY (PSO) IN PRIMARY AND REVISION OPERATIONS
Panteleev A.A., Gorbatyuk D.S., Sazhnev M.L., Kaz’min A.I., Pereverzev V.S., Kolesov S.V.
Abstract

Purpose of study: to evaluate clinical and roentgenologic results of the use of pedicle subtraction osteotomy (PSO) in primary and revision operations to determine the feasibility of radical spinal sagittal imbalance correction at primary surgical intervention.Patients and methods. Retrospective review of 42 patients (30 men and 12 women, mean age — 58.5 years) with rigid spinal deformities who underwent PSO was performed. Revision interventions (group R) were performed in 23 cases, primary (group P) — in 19 cases. The comparative analysis of spino-pelvic parameters and global spine balance, demographic indices, volume of intraoperative blood loss, duration of surgical intervention, complications in the late postoperative period and quality-of-life indices by SRS-22 and ODI scores was performed. Results. Minimum follow up period was 12 months. Osteotomy was more often performed at L3 level. No differences in the extent of fixation, duration of surgical intervention and degree of segmental correction were detected. The average blood loss was significantly lower in group P (p<0.05). Analysis of the late postoperative period changes in roentgenologic parameters showed statistically significant differences for the lumbar lordosis index as well as inconsistency between the lumbar lordosis and pelvic index that were better in group P. Quality of life increased significantly in both groups with the only statistically significant difference in ODI that was better in group P. Serious complications were observed in 47.8 and 38.6% of cases in group R and group P, respectively (p<0.05). Revision interventions were required in 26.1% of cases in group R and in 15.8% — in group P. Conclusion. In primary surgical interventions use of PSO technique enables to correct global spinal sagittal balance more effectively. Its use in primary interventions ensures lower volume of intraoperative blood loss as well as lower risk of pseudarthrosis formation and neurologic disorders development.

N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):5-12
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INFLUENCE OF SPINOPELVIC PARAMETERS ON THE DEVELOPMENT OF SACROILIAC JOINT PAIN SYNDROME AND EFFICACY OF ITS TREATMENT
Volkov I.V., Karabaev I.S., Ptashnikov D.A., Konovalov N.A., Lapaeva O.A.
Abstract
Purpose: to study the influence of spinopelvic parameters on the risk of sacroiliac joint (SIJ) dysfunction development and prognosis of its treatment in patients with degenerative-dystrophic diseases of lumbosacral spine. Patients and methods. Prospective nonrandomized study included 197 patients: 79 patients with SIJ syndrome verified by the test block (main group) and 118 patients with other causes of low back pain (control group). In the main group the treatment tactics consisted of intraarticular injections of glucocorticosteroids and radiofrequency SIJ denervation. The result was deemed positive when pain intensity reduction made up 50% by Numerical Rating Scale (NRS-11) and/or 20% by Oswestry Disability Index (ODI) with effect preservation for 12 months and more. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) were measured. PI-LL difference was calculated as well as PT/PI and SS/PI ratio, type of posture by P. Roussouly and leg length discrepancy were assessed.Results. Positive treatment results were achieved in 63 (79.75%) patients from the main group. The comparison of 2 groups showed that the main risk factor was the index of PT/PI ratio the odds ratio 6.39 (95% confidence interval (CI) 2.19-8.33; p=0.021) for the risk of SIJ dysfunction development and 4.1 (95% CI 1.98-5.86; p=0.031) for the negative treatment prognosis with that index threshold of 0.28 and 0.32, respectively.Conclusion. The detected reliable dependence between the retroversion degree and SIJ dysfunction development and treatment prognosis may become the basis for new additional studies
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):13-20
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3D MODELLING AND PRINTING IN PRIMARY AND REVISION ARTHROPLASTY
Zagorodniy N.V., Chragyan G.A., Aleksanyan O.A., Kagramanov S.V., Polevoy E.V.
Abstract
Introduction. Acetabular arthroplasty in patients with the abnormal pelvic bone anatomy is a challenging task. In recent years the method of 3D modelling and printing of custom acetabular components is widely used at acetabular arthroplasty in patients with marked bone defects.Purpose of study: to evaluate the accuracy, convenience of the positioning and efficacy of the primary stabilization of custom acetabular components in patients with bone defects at primary and revision hip arthroplasty. Patients and methods. Eighteen surgical interventions using 3D modelling and printing, i.e. 12 for hip instability, 6 — for posttraumatic coxarthrosis were performed. The study included 9 women and 9 men with mean age 60.9±15.8 years. By Paprosky classification in 2 cases the defects corresponded to Type I, in1 case — Type IIA, in 4 cases — Type IIB (posttraumatic coxarthrosis), in 2 cases — Type IIIA, in 10 — Type IIIB out of them 2 cases with pelvic bone separation. Custom components were produced using the method of direct metal laser sintering (DMLS). The whole technologic process took from 4 to 8 weeks and was conducted jointly with the engineers. Results. Exact match of implant form and the defect was observed in 89.9% of cases. In 2 patients with pelvic bone separation additional correction of bone structures was required when placing the acetabular component. In radiograph from 2 to 8 months after surgery the constructions were stable.Conclusion. 3D technology for the custom-made acetabular components is a method of resolving the problem in patients with marked acetabular defects. It enables to plan the surgery, simplifies the choice for screws positioning avoiding their interference. The design features of the implant are three rigid flanges with screw holes that create additional contact with intact parts of the ischial, iliac and pubic bones. Screw fixation ensures initial rigid stability until the biological fixation is achieved.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):21-29
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SURGICAL TREATMENT OF PATELLOFEMORAL ARTHROSIS IN WORKING AGE PATIENTS (PRELIMINARY REPORT)
Said F.M., Akhtyamov I.F., Kudryavtsev A.I., Helo M.D.
Abstract
Introduction. Choice of treatment tactics for the patellofemoral arthrosis (PFA) is a complex and controversial issue especially in patients under 40 years.Purpose of study: to evaluate the early results of combined surgical interventions in patients with PFA. Patients and methods. Prospective cohort study included 24 patients (14 women and 10 men) aged 18– 45 years (mean age 31.5±4 years). Preoperative roentgenography, MRI, assessment by VAS, OKS and KSS were performed to all patients. The degree of patellofemoral joint disorders was assessed using the elaborated clinical scale that enabled to divide patients into two groups. Group 1 (n=8) with marked changes and group 2 (n=16) with the moderate changes. Corrective plasty of shin extensor mechanism with ventralization of the tibial tubercle by Fulkerson in combination with arthroscopic debridement was performed to all patients. Results. In 6 months after surgery the improvement of anatomic and functional status was observed in all patients. The pain intensity score evaluated according to the VAS scale decreased on the average from 6.6 before surgery to 2.0 at the time of the last follow-up. In the 1st group of patients preoperative and postoperative estimation by VAS made up 6±2 cm and 3±1 cm (p=0.003), by KSS — 55±2 and 61±3 points (p=0.001), by OKS — 22±4 and 32±3 points (p=0.001), respectively.Conclusion. Application of the complex of multidirectional surgical techniques (reconstruction, modelling) enables to achieve good anatomic and functional results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):30-35
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PERIOPERATIVE ANESTHESIA: TO DO OR NOT TO DO?
Firsov S.A., Lepilov A.S., Matveev R.P., Savinkin V.S.
Abstract
Introduction. In patients with chronic loco-motor system diseases the pain often persists after arthroplasty and does not respond to symptomatic therapy.Purpose of study: to evaluate the efficacy of perioperative use of Meloxicam in patients after hip arthroplasty. Patients and methods. The follow-up covered 120 patients (mean age 64.4±5.23 years) after hip arthroplasty. In the main group (n=60) Meloxicam was given 7 days prior to and 3 weeks after surgery; after intervention narcotic analgesic was used on the request. In control group (n=60) the patients were only on narcotic analgesic on request after operation. Treatment results were assessed by 100-millimeter visual analog scale (VAS) and D’Aubigné-Postel Score.Results. Seven days before the surgery the pain severity in the main and control groups was comparable: 85±2.3 and 84±2.1, respectively. In 2 days after operation the pain relief was more pronounced in the main group — 69±2.1 mm versus 82±3.4 mm in the control group (p<0.05). In 3 months those indices made up 10±2.1 and 35±12.6 mm (p<0.001), respectively. In the main group the result was assessed as the excellent and good in 22 patients, in the rest of patients as satisfactory by d’Aubigné-Postel Score. In the control group the good result was recorded in 9, satisfactory — in 47 and poor — in 4 cases.Conclusion. Meloxicam may be considered as an effective perioperative analgesic in large joints arthroplasty.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):36-40
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EXPERIMENTAL SUBSTANTIATION OF A NEW METHOD FOR PREPARATION AND PLACEMENT OF QUADRUPLED SEMITENDINOSUS AUTOGRAFT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Slastinin V.V., Fain A.M., Sychevskiy M.V., Bondarev V.B.
Abstract
Purpose: to modify the cortical technique of quadrupled semitendinosus autograft fixation for anterior cruciate ligament reconstruction that enables to achieve tight contact of the tendon within the bone tunnels.Material and methods. Several described methods of graft fixation directed to the formation of maximum contact area between the popliteus tendon graft and the bone are analyzed. In the proposed technique a semitendinosus graft is fixed by cortical fixatives. During graft placement its proximal and distal ends are corrugated and increase in diameter providing additional close intra-tunnel fixation of the graft. Testing for rupture was performed on the material (6 semitendinosus tendons) from 3 cadavers. Potential fixation tightness within the tunnels was assessed by the degree of graft diameter enlargement after its placement.Results. At corrugated sutures tightening the proximal and distal diameters of the graft ends increased by 2.5±0.55 and 2.67±0.55 mm, respectively. Testing for rupture showed elastic deformation mean value of 364.83±69.16 N. Conclusion. The proposed modification for cortical technique of semitendinosus autograft fixation enables to ensure the close contact of the tendon within the bone tunnels and sufficient strength for the patients’ rehabilitation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):41-46
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HISTOLOGY OF BONE LESION AND CORRELATION OF CLINICAL, CLINICAL-LABORATORY DATA AND MORPHOLOGIC INDICES IN DESTRUCTIVE FORM OF OSTEOMYELITIS WITH LATENT COURSE (BRODIE’S ABSCESS)
Grigorovskiy V.V., Gritsai N.P., Gordiy A.S., Lyutko O.B., Grigorovskaya A.V.
Abstract
Urgency. Although the basic pathomorphologic features of bone lesion in destructive form of osteomyelitis with latent clinical course (Brodie’s abscess) are known from the literature, the thorough analytical clinical-morphologic studies have not been yet conducted.Purpose of study: Based on the results of the study to establish correlation dependence between clinical, clinical-laboratory indices and morphologic foci parameters.Material and methods. Fragments of pathologic foci tissues from 25 patients with Brodie’s abscess (31 samples) were the study material. The results of clinical, visualizing and clinical-laboratory methods as well as morphometric semi-quantitative indices characterizing the state of foci tissues were used for the gradationfrequency and correlation analysis.Results. In Brodie’s abscess the bone tissue morphologic changes are presented by spongiosa necrosis and resorption. More often the cases with granulation tissue within the internal capsule of a membrane prevailed. The evidence of exudative inflammation corresponded to the low degree of activity, of a productive one — to high activity. In the majority of cases small sequesters within the capsule tissues were detected. Reliable (p<0.05) correlations that corresponded to absolute values of correlation coefficient ra in the range of 0.3 — 0.7 were determined for the following indices: “patient’s age” — “exudative inflammation within the capsule”, “white blood cells” — “pattern of capsule connective tissue”, “white blood cells” — “productive inflammation within the capsule”, “white blood cells” — “presence of sequesters”, “Antistaphylococcal antibodies” — “exudative inflammation within the capsule”.Conclusion. Determined clinical-morphologic correlations could be used to improve both clinical and morphological diagnosis of bone inflammatory lesions.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):47-55
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EXPERIENCE IN TREATMENT OF DISTAL HUMERAL EPIMETAPHYSEAL INTRA-ARTICULAR FRACTURES USING COMBINED OSTEOSYNTHESIS BY SUBMERSIBLE SCREWS AND EXTERNAL FIXATION HINGE DISTRACTION SYSTEM
Shuiskiy A.A., Kesyan G.A., Urazgil’deev R.Z., Karapetyan G.S., Arsen’ev I.G., Dan I.M.
Abstract
Purpose of study: to evaluate the results of distal humeral epimetaphyseal intra-articular fractures treatment by the proposed combined osteosynthesis technique.Patients and methods. From 2014 to 2017 thirty three patients (21 male, 12 female) aged 22-68 years were treated for the distal humeral epimetaphyseal intra-articular fractures of types 13B1.2 — 13B3.3, 13C1.3 and 13C3.1t by AO/OTA classification. The technique included open reposition, transchondral osteosynthesis using titanium alloy (n=18) and biodegradable (n=15) cannulated screws followed by the application of the external fixation hinge distraction system. The results were evaluated roentgenologically and by DASH Score. Results. Follow up period made up from 3 to 12 months. Fracture consolidation was achieved in all patients. Functional treatment results were evaluated by DASH Score. In 30 patients the results were assessed as excellent, in 3 — good. No poor results were recorded.Conclusion. The advantages of the proposed technique are the early initiation of active and passive movements in the operated joint to prevent contracture and posttraumatic arthrosis development, reduction of risks of fracture fragments secondary displacement and screw migration, joint unloading owing to articular surfaces dosed distraction, ensuring of the operated joint stability. The result did not depend on the type of cannulated screw used.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):56-62
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TOTAL HIP ARTHROPLASTY IN PATIENTS WITH INCREASED BODY MASS INDEX AND OBESITY
Ardashev S.A., Akhtyamov I.F., Gil’mutdinov I.S., Al’-Lami M.A.
Abstract
The modern native and foreign literature data on the hip arthroplasty results in patients with overweight including the data on the choice of the material and method of surgical intervention, risk and rate of perioperative complications, rehabilitation results are analyzed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):63-70
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TANTALUM BASED IMPLANTS: EXPERIMENTAL AND CLINICAL ASPECTS OF APPLICATION
Gorbatyuk D.S., Kolesov S.V., Sazhnev M.L., Pereverzev V.S., Kaz’min A.I.
Abstract
The review tries to generalize the data on the efficacy of tantalum based implants’ (including the components of endoprostheses). At present the information on both experimental (on animals) and clinical results of such implants application is available. It is stated that tantalum coating, especially the one treated with alkaline solutions in their production, possesses marked osteoinductive properties. In presence of additional hydroxyapatite or octacalcium phosphate coatings the latter play the role of peculiar “centers of osteogenesis” around which the chemical growth of the future bone mineral matrix takes place that is subjected to remodeling subsequently. It is also shown that tantalum based porous implants are capable of osteointegration and biological fixation with growth of new bony tissue in the pores and trabeculae of the implant and no fibrotic changes at bone-implant interface are detected. Histologic and biochemical data confirm the efficacy of osteogenesis on such implants. Despite certain encouraging results the clinical use of such implants in patients of older age groups requires an additional study.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):71-83
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DEDICATED TO THE MEMORY OF PROFESSOR NIKOLAY M. VOLKOVICH (1858 – 1928) (IN COMMEMORATION OF 160TH ANNIVERSARY OF BIRTH AND 90TH ANNIVERSARY OF DEATH OF AN EMINENT SCIENTIST)
Morgoshiya T.S., Syroezhin N.A.
Abstract

The main milestones of the life and scientific activity of Professor N.M. Volkovich well-known for his researches in abdominal surgery, traumatology, orthopaedics, otorhinolaryngology, urology, gynecology and neurosurgery are presented. The little known facts of his life are described. Particular mention was made to the contribution of N.M. Volkovich to traumatology.

N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):84-87
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REPORT OF THE XI ALL-RUSSIAN CONGRESS OF TRAUMA AND ORTHOPAEDIC SURGEONS
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Abstract

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N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):88-91
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