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Vol 26, No 2 (2019)

Articles
Lumbosacral pain in athletes and ballet dancers: spondylolysis and spondylolisthesis
Mironov S.P., Burmakova G.M., Orletsky A.K., Tsykunov M.B., Andreev S.V.
Abstract
Purpose of research. Development of diagnostic algorithm for lumbosacral pain syndrome (PCBS) caused by spondylolysis and spondylolisthesis of I-II degree in athletes and ballet dancers. Material and methods. 212 patients - athletes and entertainers of BA - summer with PCBS caused by spondylolysis (171 persons) and spondylolisthesis of I-II degree (41 persons) of lumbar vertebrae were under observation. Clinical and neurological, x-ray studies, ultrasonography, computed tomography, scintigraphy, as well as the study of markers of bone tissue re - sorption (calcium in urine) and bone formation (alkaline phosphatase) were carried out. Results. Clinical manifestations spondylolysis malespecific (pain after exercise); with the progression of instability and incipient spondylolisthesis pain, strengthening - esja at sharp movements, increased muscle tone of extensors of the back and the rear muscle groups of the thigh. Decisive in the diagnosis are radiological methods. Information content of standard spondylograms is 84.6%, functional-96.7%. To clarify the localization, the size of the arc defect, as well as in subsequent control examinations, an additional study is carried out in 3/4 projections (information content of 99.2%). A highly sensitive informative method is scintigraphy, which allows to determine the presence of bone tissue rearrangement in the first days after the injury. The focus of hyperfixation, or Vice versa, hypothically radiopharmaceutical characteristics would constitute an increase or decrease of metabolic processes. With the help of scintigraphy, you can track the dynamics of reparative processes and determine the timing of the resumption of professional activities. Ultrasonography also helps to detect instability in the vertebral segment in the early stages of its development and monitor the dynamics in the treatment process. Detection of osteopenia evidence of a violation of bone metabolism, which must be considered in the treatment-be sure to use drugs that affect bone metabolism and calcium homeostasis. Conclusion. The combination of standard, functional radiographs, as well as x-rays in oblique projections and scintigraphy is quite adequate for the diagnosis of splondylolysis, spondylolisthesis and the detection of instability in athletes and ballet dancers.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):5-13
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Features of surgical treatment of intra- and periarticular fractures of the lower third of the femur in patients with polytrauma
Solod E.I., Zagorodni N.V., Lazarev A.F., Abdulkhabirov M.A., Alsmadi Y.M., Dmitrov I.A.
Abstract
Treatment of patients with fractures of femur has a particular relevance in modern traumatology, especially in patients with polytrauma. The treatment of such fractures is complicated by the fact that it depends not only on the nature of the fracture, but also on the general condition of the patient. These fractures are caused by high-energy trauma, they have the tendency to be splintered or fragmented, and often accompanied by neurovascular complications, especially in the distal part. Such fractures are often accompanied by soft tissue damage. Purpose: improving the results of treatment of intra-and periarticular fractures of the distal femur in patients with polytrauma. Material and methods. In the present study, a prospective analysis of using conversion osteosynthesis in the treatment of 72 patients with intra-and periarticular fractures of the lower third of the femur patients with polytrauma, according to the ISS severity scale (ISS 17-40) was performed in a multidisciplinary hospital. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 5-7 days, which prevented the occurrence of traumatic shock and prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with intra-and periarticular fractures of the lower third of the femur. The use of the technique of transferring the fixation of fragments by the external fixation to the internal osteosynthesis (conversion) contributed to a reduction in the duration of treatment of patients in the hospital with fractures of the long bones.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):14-18
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Free vascularized femoral condyle bone graft in treatment of tubular bone nonunions
Golubev I.O., Kukin I.A., Merculov M.V., Shiryaeva G.N., Bushuev O.M., Kutepov I.A., Sautin M.E., Balura G.G., Sarukhanyan A.R.
Abstract
Vascularised bone graft from femoral condyles - are relatively new method in treatment of bone nonunions, small bone defects and loss of articular cartilage. In this article experience of using of vascularized bone grafts from medial and lateral femoral condyles, operation technique and clinical cases with long-term results were described. In conclusion, authors generated basic indications for free vascularized bone grafts from femoral condyles.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):19-23
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Experimental and clinical aspects of combined method of replacement osteochondral defects of the knee
Zagorodniy N.V., Vorotnikov A.A., Airapetov G.A., Saneeva G.A.
Abstract
Injuries and diseases of large joints occupy a leading place in the list of urgent problems of orthopedics. Various methods of treatment of this pathology are regularly offered in the literature, but most of them do not allow restoring a full-fledged hyaline cartilage. Background. To improve the results of organ-preserving treatment of patients with osteo-chondral defects of large joints. Methods. A prospective study was conducted on 30 large animals (60 knee joints) aged 1.5 to 3 years. We divided the animals into 3 groups of 10 individuals (20 joints) in each, based on the method of replacement of the osteo-chondral defect. In all cases, a full-layer defect formed from the hyaline cartilage by a mill with a diameter of 4.5 mm, depth of 7 mm with the capture of the subchondral bone in the medial condyle of the right thigh. Artificial defects restored by one of the following methods. The left joint considered a control joint and the defect formed by the same technique was not filled. Results. The result was evaluated in 1 month, 3 months and 6 months viewing the nature and degree of defect fill. Specific volumes of such tissues as chondrocytes, cartilage matrix and the average depth of the defect from the thickness of the native cartilage are better in group 3, and connective tissue is less in group 3. Conclusion. In the group without defect replacement, the obtained data are comparable with the studies of other authors, according to which bone and cartilaginous defects practically do not regenerate on their own. Our proposed method with the use of extracellular collagen matrix, autocartilage and plate rich plasma is less aggressive in comparison with autochondroplasty and the result can be more stable compared to microfracturing or tunnelization.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):24-31
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Meyer dysplasia in children’s connective-tissue disorders phenotype (the results of observation in the Municipal Children’s Polyclinic №2, Stavropol city)
Vorotnikov A.A., Zakota D.Y., Saneeva G.A., Airapetov G.A.
Abstract
Aim. The research of the prevalence, nosological structure, clinical presentations, and pathogenetic features of different forms of coxal epiphyseal pathology including Meyer dysplasia in small children based on the results of clinical and instrumental observation on outpatient orthopedic admission. Material and methods. In 12,000 children from 0 to 5 years, an orthopedic examination was conducted with an assessment of external dysmorphogenetic signs of connective tissue dysplasia, an ultrasonic examination of hip joints, an in-depth X-ray examination. The step-by-step examination algorithm was structured and detailed according to the presence and severity of the coxal region pathology, children’s age. Conclusion. The combination of dysplastic phenotype with joints formation inhibition in children aged 1 year is a predictor of Mayer’s dysplasia and must be the reason for a detailed examination of the hip joints with use of visual diagnostic methods.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):32-36
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Rehabilitation diagnosis in the pathology of the musculoskeletal system using categories of the international classification of functioning. Part 2 (discussion)
Tsykunov M.B.
Abstract
In accordance with the recommendations of the World Health Organization, the categories listed in the International Classification of Functioning (ICF) should be used to assess the structure, function, activity and participation. In recent years, the assessment of the state of the body is no longer possible without the use of scales, but a large number of them do not always allow specialists to understand each other. The creation of a unified system, which will collect various tools for assessing the patient’s condition, will provide serious assistance in the work of members of a multidisciplinary team in the process of medical rehabilitation. In addition, it will help in the formulation of rehabilitation diagnosis and in more accurate determination of rehabilitation potential. The dimension of a number of generally accepted scales to describe disorders of the musculoskeletal system does not coincide with the categories of ICF. This paper attempts to eliminate this contradiction. To describe a number of disorders that affect the function of the musculoskeletal system and are traditionally used in orthopedics, the category other or not described can be used. In the presented system of evaluation are given equal-weighted scale with the dimension adopted in the ICF. This system can be used as a basis for the preparation of medical rehabilitation programs and evaluation of their effectiveness.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):37-42
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Dynamic fixation of the lumbar spine dynamic fixation of the lumbar spine
Byvaltsev V.A., Kalinin A.A., Pestryakov Y.Y., Aliev M.A.
Abstract
The review of modern literature data on the use of dynamic fixation in degenerative diseases of intervertebral discs and facet joints of the lumbar spine is presented. The frequent cause of temporary loss of working ability and primary disability, poor results of conservative treatment for degenerative changes in the lumbar segments stipulate the high medical and social significance of this problem. Quite often the use of classical decompression techniques and rigid fusion does not eliminate clinical symptoms on account of pseudarthrosis formation in the operated segment and significant degeneration development in the adjacent one. The use of dynamic implants is aimed at restoring spatial segmental relationships with the preservation of natural biomechanics of the spine. Taking into consideration the variety of constructions and the high rate of their introduction into practice, the literature data present conflicting information on the results of their application. The authors expound modern data on the clinical results and instrumental potentialities of various dynamic devices application. The topical unsolved issues that necessitate the conduction of long-term multicenter clinical studies on the management of this pathology are identified.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):43-55
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Clinical historical aspects of treatment of (part I)
Gudi S.M., Epishin V.V., Korochkin S.B., Kuznetsov V.V., Samokhin A.G., Pakhomov I.A.
Abstract
Treatment of patients has been accumulated with deformity of the first ray of the foot has a long history and vast experience in this area of orthopedics. The clinical histories of the review of the treatment’s evolution of patients are presented with Hallux valgus. The ways of development and improvement of the basic methods are described in the historical plan with an estimation of their advantages and lacks.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):60-66
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Intraoperative periprosthetic femoral fractures at total hip arthroplasty. Review of classifications and treatment techniques
Polevoy E.V., Zagorodniy N.V., Kagramanov S.V., Chragyan G.A., Aleksanyan O.A.
Abstract
The review covers the problem of intraoperative periprosthetic femoral fractures at total hip arthroplasty including the causes, classification and treatment techniques. This complication may occur at any step of the intervention, may differ by localization and pattern. All these will determine the preferable surgical treatment technique.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(2):67-72
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