Vol 25, No 2 (2018)

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.

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.

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.

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.

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.

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.