Vol 25, No 3-4 (2018)

Purpose of the study: to provide a scientific basis for the recommendations on clinical use of lateral extraarticular tenodesis (LEAT) from semitendinosus tendon (ST) graft as an additional element for knee stability in anterior cruciate ligament (ACL) anatomical anterograde reconstruction. Patients and methods. Treatment results were evaluated for 162 patients (mean age 27.2±2.8) with marked rotational joint instability (Pivot shift test 3+) after arthroscopic anterior cruciate ligament reconstruction (ACL-R). In 44 (27.2%) observations ACL-R was supplemented by LEAT from ST (group 1), in 118 (72.8%) the isolated anatomical anterograde plasty of ACL was performed (group 2). Lysholm Knee Scoring Scale, KOOS and 2000 IKDC were used for the assessment of the results. Results. Follow up period made up at least 2 years. Statistically significant differences between the groups were recorded in 21 months after intervention and later. In 43 (97.7%) patients from the 1group and 111 (94.1%) patients from the 2group excellent and good results (A and B by 2000 IKDC) were achieved. In 1 (2.3%) and 7 (5.9%) patients the results were assessed as satisfactory (C by 2000 IKDC), respectively. No statistically significant differences between the groups were recorded by Lysholm Knee Scoring Scale and 2000 IKDC (p>0.05). The average scores by KOOS that indicated the presence of pathological processes in the knee joint and characterized patient’s sport activity were statistically (p<0.05) better in patients from the 1group. Conclusion. LEAT from ST is a clinically effective supplement to the anatomical anterograde ACL-R in patients with marked rotational joint instability (Pivot shift test 3+) that enables not only to improve the overall knee stability but also to reduce the rate of unfavorable symptoms at follow up terms over 21 months after operation.

Introduction. Total knee replacement has become a standard planned intervention at specialized clinics. The study of surgical results is not as urgent as the follow up of the patients with concomitant pathology because various complications are most often registered in this group. Purpose: to evaluate the efficacy of total knee arthroplasty in patients with increased body mass index at early rehabilitation steps. Patients and methods. Open prospective comparative study included 75 patients with III-IV stages of gonarthrosis by Kellgren-Lawrence. Mean age of the patients made up 63.8±6.87 years. Main group included 48 patients with excessive body mass and alimentary-constitutional obesity of different degree, the control group - 27 patients with normal body mass index. The duration of intervention, volume of blood loss intraoperatively and drainages was assessed. Evaluation of clinical functional results was performed OKS, KSS and visual analog scale (VAS) before surgery, at discharge, 3 months and 1 year after surgical intervention. Results. In comparison to the patients with normal body mass index the patients from the main group showed slightly higher duration of the intervention and intraoperative blood loss - by 13.05% (p=0.027) and 12.8% (p=0.003), respectively. In the main group the severity of pain syndrome by VAS decreased from 90.4±14.4 to 9.6±0.4 mm (p=0.0001), evaluation of clinical functional results by KSS increased from 47.39±1.63 to 88.02±2.01 points, by OKS - from27.3±4.3 to 43.2±6.5 points (p=0.001). In the control group the severity of pain syndrome by VAS within 1 year follow up decreased from 86.2±2.4 to 3.8±0.7 mm (p=0.002) and clinical functional indices by KSS increased from 52.2±10.1 to 93.8±1.3 points (p=0.001), by OKS - from28.4±1.6 to 44.7±1.9 points (p=0,001). Conclusion. The study results demonstrate the high potentialities of arthroplasty in patients with alimentary obesity and confirm the necessity of its performance for the improvement of the patients’ future quality of life.

Purpose: to study the efficacy and safety of levobupivacaine as the main component of infiltration anesthesia after knee arthroplasty. Patients and methods. Open randomized study included 284 patients (20 - 81 years) after total knee arthroplasty. Patients were divided into 2 groups, 142 patients in each group, depending on the anesthetic used (levobupivacaine or ropivacaine). The severity of pain syndrome within the first 48 hours after the operation by VAS, the need for the use of narcotic analgesics, presence of side effects was evaluated. Results. The mean time of acute pain occurrence was 255±83 min in ropivacaine group and 238±87 min in levobupiavacaine group (p=108). In 4 hours after surgical intervention 30 and 43% of patients from ropivacaine and levobupiavacainegroups required narcotic analgetics, respectively. Neither serious side effects nor complications directly related to infiltration anesthesia were recorded. Conclusion. Infiltration anesthesia with both levobupivacaine and ropivacaine is simple, safe and effective method for pain arrest after surgical interventuions of the knee joint.

Introduction. Despite the fact that instability of the patella is a common pathology within the structure of knee joint diseases and injuries in children, currently there is no complete information on the basis of which one could judge the effectiveness and preference of a particular method of treating instability of the patella in children. Purpose of study: to evaluate the efficacy of surgical treatment techniques in children with post-traumatic instability of the patella. Patients and methods. The study was performed on the basis of examination and treatment data on 127 patients aged from 8 to 17 years with post-traumatic instability of the patella. Arthroscopic stabilization by Yamamoto technique, modified at our department, was performed in 49 patients, patella stabilization with transposition of the tibial tuberosity - in 67 patients, with the medial patellofemoral ligament autoplasty - 9, corrective osteotomy - in 2. Treatment efficacy was assessed using AKPS and 2000 IKDC knee joint assessment scores. The questionnaires were carried out at admission, in 1, 2-4 and 4-7 years after surgery. Results. At early terms after operation (up to 2 years) in the group of children after stabilization of the patella by modified Yamamoto technique good and excellent results were observed in 77.8% of cases, after transposition of the tibial tuberosity - in 73.3%, after stabilization of the patella with medial patellofemoral ligament autoplasty - in 88.9%. Long-term follow up (5-7 years) showed 90.9 and 86.5% of cases from the 1st and 2nd groups, respectively. Conclusion. The proposed algorithm for examination and treatment provides the most effective treatment and enables to obtain good and excellent results in the majority children with post-traumatic instability of the patella.

The aim of the study is to evaluate results of follow-up in patients with femur pseudarthrosis complicated by chronic osteomyelitis who underwent biomechanically validated transosseus fixation. Materials and methods. A retrospective study of transosseus fixation in 72 patients with femur pseudarthrosis complicated by chronic osteomyelitis was conducted. Described fixation was completed according to the biomechanical fixation conception from 2011 to 2017. Hybrid external fixator was applied to 38 (52,8%) patients, rod-based external fixator - to 34 (47,2%). Results. Full bone consolidation and pyoinflammatory process remission in treated femur bone is achieved in all cases. Results classified as excellent were acquired in 21 patients (29,5%), good - in 41 (57,7%), satisfactory - in 7 (9,8%), unsatisfactory - in 2 (3%). patients results were classified as unsatisfactory because of lacking of weight-bearing ability of the leg because of other reasons not related to consolidation. Conclusion. In patients with infected femur pseudarthroses external fixation using biomechanical conception allows to provide up to 97% positive clinical outcomes of the treatment.

Modern traumatology and orthopaedics is inconceivable without high-quality X-rays diagnostics. In the recent years special equipment that enables to obtain the length-measured images of different parts of a human body was introduced into clinical practice. The details of examination process, i.e. the position of a patient, position of an extremity and many others require special knowledge and experience. The aim of the study is to optimize the possibilities for obtaining the length-measured images of the different parts of a skeleton using modern X-rays equipment. The peculiarities of the determination of segments’ axes and length in patients with lower extremity deformities and shortening are presented; the most typical mistakes are analyzed. The results of the study are of great importance for medical expertise as well as for data documentation in practical, scientific and teaching activities.

Central pain syndrome (CPS) is a neurological disorder caused by damage or dysfunction of the central nervous system. Both conservative and operative methods of treatment are used in its treatment, but in most cases their effectiveness is rather low. We are presenting the clinical observation of a 60-year-old patient with spinal cord injury at the level of Th10 due to a car accident that occurred 44 years before the treatment in our clinic, who suffered from phantom pain that occurred after bilateral above the knee amputation because of advanced peripheral vascular disease. Due to the ineffectiveness of the conservative treatment, it was decided to proceed with spinal cord stimulation. The presence of pronounced postoperative changes in the area of spinal cord injury has complicated the transcutaneous placement of trial leads at the L1-L2 and Th12-L1 level. We managed to introduce leads at the level of Th7-Th8 and position them at the level of Th5-Th7. During continuous neurostimulation the pain in the sacrum, in the area of the hip joints, the phantom pain was relieved. The patient stopped using all pain medications. Spinal cord stimulation can be utilized as an alternative treatment for patients with intractable CPS.

Osteonecrosis of femoral and tibial condyles is a serious disease resulting in severe forms of arthrosis/arthritis and requiring arthroplasty. Postarthroscopic osteonecrosis is rather rare complication after arthroscopic intervention on the knee joint usually due to meniscus rupture. The surgeons and patients are often not prepared for this complication development. The review covers the common cases of femoral and tibial condyles osteonecrosis after arthroscopic intervention. Potential risk factors are identified; the peculiarities of diagnosis and treatment tactics are described.

The difficulties of differential diagnosis of mucopolysaccharidoses (MPS) type I are conditioned by low population rate of the pathology that results in untimely and inadequate treatment. Case reports for 20 patients with MPS I are presented. Special attention is paid to the orthopaedic manifestations of the pathology that can be determined since the first months of life.

Two acting heads of the chairs of Kazan universities present a short historical background on the formation of the Kazan School of Traumatology and Orthopedics. The organization by Professor M.O. Friedland of a prosthetic-orthopedic infirmary in 1918 and subsequent organization of the chair of traumatology and orthopaedics at Kazan state institute for the improvement of physicians’ knowledge and skills is considered to be the starting point. However since the middle of the 19century the medical care was rendered in injuries and at Kazan University students were trained in surgical science and treatment of fractures. The first experience in anesthesia, introduction of antiseptics, improvement of desmurgy and the treatment of gunshot wounds were the basis for any surgical specialty. German professors, the founders of Kazan University, laid down the foundations and their first students N.I. Studenskiy, V.I. Razumovskiy and M.O. Fridland has contributed to the formation of a specialty in Kazan. At present time the chairs of traumatology and orthopaedics are organized at three universities and at the Center for High Technologies every physician and surgeon have an opportunity and to acquire new knowledge and skills.