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Vol 26, No 4 (2019)

Articles

Clinical experience in the treatment of fragility pelvic fractures

Solod E.I., Lazarev A.F., Petrovskiy R.A., Ananin A.V., Abdulkhabirov D.A., Alsmadi Y.M.

Abstract

Purpose of study: determine the optimal approach to the treatment of patients with pelvic fractures against a background of low bone mass. Patients and methods. During the period from 2017 to 2018, 64 patients were treated (average age 78±7.4 years) with fragility pelvic ring injuries. Fractures according to AO/OTA classification A2 - 5 (7.8%), B1 - 18 (28.1%), B2 - 28 (43.7%), B3 - 8 (12.5%), C1 - 3 (4.6%), C2 - 2 (3.1%). Long-term results were evaluated after 6 and 12 months, according to the Majeed scale and the «Timed up & go» test. Results. Intrahospital mortality was 7 (10.9%) people. The annual mortality rate was 31.2%. Results after a year were monitored in 44 patients. Good results in 40 patients, 3 satisfactory, 1 poor result. The previous level of activity was restored by 30 (68.1%) of 44 patients. Conclusion. The treatment of elderly patients with pelvic fractures on the background of osteoporosis should be multidisciplinary with the appointment of postoperative rehabilitation in specialized hospitals, comprehensive treatment of osteoporosis and therapist’s supervision to compensate for premorbid background. The decision on the final fixation of the pelvis should take into account the nature of the fracture, the degree of its stability, the level of patient activity before and after the injury, the degree of compensation of the general condition, the severity of osteoporosis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):5-11
pages 5-11 views

Mid-term results of multi-ligament posterior and anterior cruciate ligament reconstruction using a modified method of bone tunnels drilling

Shulepov D.A., Salihov M.R., Zlobin O.V.

Abstract

The problem of diagnosis and treatment of chronic anterior-posterior instability of the knee joint in multi-ligamentous injuries remains relevant, both medically and socially. Conservative treatment of patients with this pathology is ineffective due to severe instability and gross violation of the biomechanics of the knee joint. Currently, there is no consensus on the tactics of surgical treatment of this disease, and on the method of plastic replacement of the lost ligamentous apparatus. Objective. To evaluate the clinical results of the modified technique of arthroscopic plastic surgery of both cruciate ligaments of the knee joint. Patients and methods. Based on previous anatomical studies, the authors formulated the basic principles of safe formation of bone tunnels in simultaneous arthroscopic plastic surgery of the anterior (PKS) and posterior (ZKS) cruciate ligaments. An original method of surgery aimed at minimizing the risk of injury to the popliteal artery during the formation of the tibial bone tunnel is proposed. In the period from 2010 to 2017, the Department of endoscopic surgery treated 20 patients with damage to the SCS and SCS using this technique. The results were evaluated 6 and 12 months after surgery. Clinical examination, IKDC and Lisholm-Gillqist questionnaires and the visual analog pain assessment scale (VAS) were used to evaluate clinical results. Results. The average score on the IKDC questionnaire was 34.16±13.31 points before surgery, and 34.89±18.37 points on the lisholm - Gillqist questionnaire. 6 months after surgery - 58.75±6.38 and 69.78±14.10 points according to IKDC and Lisholm-Gillqist, respectively, which is statistically significant (p<0.05) higher than before surgery. A year after the operation, the positive dynamics was observed even more clearly (p<0.01): 76.83±9.26 and 82.00±6.38 points, respectively. The final result of the evaluation according to the IKDC Protocol: 11 (55.0%) patients were assigned to group A (good result), 6 (30.0%) to group B (close to good result), 2 (10.0%) to group C (satisfactory result) and 1 (5.0%) patient to group D (unsatisfactory result). Conclusion. The obtained clinical results allow to evaluate the proposed method as effective. In this case, the method of forming bone tunnels has a number of advantages compared to the classical technique, including minimizing the risk of intraoperative damage to the structures of the popliteal neurovascular bundle.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):12-21
pages 12-21 views

Pathological fractures of long bones of the skeleton in children and adolescents in benign tumors and tumor-like diseases

Snetkov A.I., Batrakov S.Y., Akinshina A.D., Gorelov V.A., Balametov S.G.

Abstract

This article provides an analysis of 82 patients for the period from 2000 to 2018 aged 5 to 18 years with pathological fractures of the long bones of the skeleton on the basis of benign tumors and tumor-like diseases. Most often, fractures were observed with a solitary bone cysts - 24, an aneurysmal bone cyst - 19, fibrous dysplasia - 20, neosteogenic fibroma - 7, Ollier’s disease - 6, osteofibrous dysplasia - 2, giant-cell tumor - 3, hemangioma - 1. On the basis of the Department of Pediatric Bone Pathology and Adolescent Orthopedics of N.N. Priorov National Medical Research Center of Traumatology and Orthopedics all patients underwent a comprehensive physical exams and surgical treatment. The clinical and radiological picture was studied and the features of the course of pathological fractures were revealed depending on the nosology of the tumor process. It is shown that when a pathological fracture occurs, the treatment approach should be individualized depending on the location of the focus, the patient’s age and nosology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):22-32
pages 22-32 views

compare of outcomes of minimally invasive and open surgical techniques in patients with symptomatic lumbar spine stenosis on the background of scoliotic deformity

Mlyavykh S.G., Bokov A.E., Aleynik A.Y., Yashin K.S.

Abstract

Objective: to compare the results of minimally invasive and open surgery in the treatment of the patients with combined symptomatic degenerative stenosis and scoliotic deformity of the lumbar spine. Patients and methods. A retrospective comparative analysis of the long-term results of 54 patients was performed. The patients were devided in two groups: open surgery (group 1, n=39) and minimally invasive surgery (group 2, n=15). Different approaches were used based on the type of deformity (according to Berzhano and Lamartine), localization and extent of lumbar stenosis. The evaluation of volume of decompression, blood loss, time of surgery and postoperative treatment, intraoperative complications, pain and patients condition were measured using clinical scales ODI, ZCQ, SF-12 was performed. Results. No differences in the type of deformity, the severity of stenosis and clinical manifestations between groups were discovered before treatment. All characteristics of the surgery (except the intraoperative complications) - blood loss, duration of surgery, and hospital stay - were significantly less in the minimally invasive group. Postoperative assessment has shown in group 1 greater regression of axial pain syndrome (p=0.03), in group 2 greater regression of radicular syndrome (p=0.03). Assessment of quality of life based on questionnaires after 2 years has revealed no differences between groups. Conclusion. Using of minimally-invasive decompression and decompression-stabilizing surgical technologies in patients with combined stenosis and deformity of the lumbar spine allow to eliminate the syndromes of neural compression, provide sufficient correction of segmental relationships and improve the quality of life.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):33-42
pages 33-42 views

Analisis of posture in school-age children according to optical topography

Nigamadyanov N.R., Tsykunov M.B., Ivanova G.E., Lukyanov V.I.

Abstract

Purpose of study: the study of posture in school children in three planes according to computer optical topography. Patients and methods. A screening examination of 1835 children was performed using computer optical topography of the back, the average age was 11.2±1.7 years, girls 930 (50.6%), boys 905 (49.3%). Results and conclusion. The study showed that computer optical topography is a highly effective method for screening diagnostics of posture disorders in school children, posture disorders are a common condition, according to the topographic classification of posture disorders, occur in 69.46% of school age children.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):43-45
pages 43-45 views

Actual features of express diagnostic of acetabular fractures. Part II. Complex fractures diagnostic algorithm

Stoyukhin S.S., Lazarev A.F., Gudushauri Y.G.

Abstract

Authors shows rational algorithm of choosing fracture type according to Judet-Letournel classification. Case presentation is based on complex («associated») fracture types.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):46-54
pages 46-54 views

De Quervain’s disease (etiology, pathogenesis, diagnosis and treatment). Part II

Novikov A.V., Shchedrina M.A., Petrov S.V.

Abstract

De Quervain’s disease, despite its low prevalence, is accompanied by pain syndrome, dysfunction and a decrease in the strength of the hand. This leads to a significant decrease in the quality of life of the patient, disruption of his work and daily activities. Patients with de Quervain’s disease, make up a significant part of those who turn to orthopedists, surgeons, rehabilitation doctors. However, the individual features of the structure of the first back canal of each person, formed in the process of phylogenesis, the lack of data on the exact cause of the disease cause the complexity of diagnosis and treatment of the disease. In the first part of the lecture, devoted to de Quervain’s disease, modern literature data concerning the features of the anatomical structure of the first back canal, the etiology and pathogenesis of the disease are summarized. It also presents a description of the clinical picture of de Quervain’s disease, tests and instrumental methods of diagnosis, the algorithm of examination of the patient with this pathology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):55-68
pages 55-68 views

70 years Nurlan D. Batpenov

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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):69-69
pages 69-69 views

80 years Victor V. Trotsenko

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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):70-71
pages 70-71 views

100 years since the birth of Zoya P. Lubegina

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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):72-73
pages 72-73 views

In memory of Professor Z.I. Urazgildeev

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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(4):74-74
pages 74-74 views

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