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Vol 24, No 2 (2017)

Articles
Use of Metaphyseal Sleeves in Revision Knee Arthroplasty
Girkalo M.V., Norkin I.A.
Abstract
Purpose. To study the short-term results of revision knee arthroplasty performed using metaphyseal sleeves. Patients and methods. During the period from 2013 to 2015 the total number of 40 patients was operated on. Type I femoral defects (by AORI classification) were diagnosed in 11 (27.5%), type II - in 26 (65.0%), type III - in 3 (7.5%) cases. Type I tibial defects were diagnosed in 2 (5.0%), type IIa - in 24 (65.0%), type IIb - in 11 (27.0%) and type III - in 3 (7.54%) cases. Metaphyseal femoral sleeves were used in 8 and metaphyseal tibial sleeve - in 40 patients. Results. Follow up period made up from 12 to 43 (mean 32.8) months. Excellent and good results by KSS scale were achieved in 30 (75.0%) of patients, by functional KSS scale - in 24 (60.0%) patients. Mean point by Knee Society Total Knee Arthroplasty Roentgenographic Evaluation scale in patients with femoral and tibial metaphyseal sleeves made up 2.35 versus 0.375 that confirmed the absence of progressive bone resorption. No one case of aseptic instability of the revision implant was observed. Repeated surgical intervention due to reinfection and knee joint contracture with pain syndrome was performed in 2 (5.0%) patients. Conclusion. The obtained data enable to recommend the use of metaphyseal sleeves for revision knee arthroplasty in patients with tibial and femoral defects of types II and III by AORI classification.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):5-10
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Mathematic Modelling of Stress in Healthy Knee Joint and After Arthroplastywith Different Typesof Endoprostheses
Smetanin S.M., Kavalerskiy G.M.
Abstract
Purpose of study. To study stressed-deformed state of the healthy knee joint and after arthroplasty using endoprostheses with either preservation or substitution of the posterior cruciate ligament by the method of numerical mathematical modelling. Materials and methods. Peculiarities of stress distribution in bones were determined on three mathematical models - healthy knee joint and joint after arthroplasty using endoprostheses with either preservation or substitution of the posterior cruciate ligament at the set load (80 kg) in straightened leg and either 45° or 90° knee flexion. Results. In healthy knee joint with a straightened leg the stress in the tibia is 2.3 times higher than in the femur. With knee flexion the stress in bone tissue increases and this increase is more intensive in the femur. After arthroplasty using endoprosthesis with substitution of the posterior cruciate ligament the stress in the tibia and femur is higher at all flexion angles as compared to arthroplasty using endoprosthesis with posterior cruciate ligament preservation Conclusion. The obtained data may be used for mathematical substantiation of the advantage of endoprosthesis with preservation of the posterior cruciate ligament and in complex with the data of national and international registers will enable to optimize the treatment tactics in patients to whom knee arthroplasty is indicated.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):11-16
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Russian Version of HSS Knee Replacement Expectations Survey: Language and Cultural Adaptation
Cherkasov M.A., Ibiev A.S., Saraev A.V., Kornilov N.N.
Abstract
Purpose . To perform language and cultural adaptation of the Hospital of Special Surgery (HSS) Knee Replacement Expectations Survey and evaluate its reliability. Material and methods . To preserve the HSS validity its language and cultural adaptation was performed in several steps: (1) direct translation, (2) synthesis of the intermediate version, (3) back translation, (4) expert commission review and creation of the 2nd intermediate version, (5) pre-testing and formation of a final version, study of reliability with evaluation of Cronbach’s alpha and intra class correlation coefficient (ICC). Total number of 35 patients (mean age 54.2 years) with terminal-stage gonarthrosis who were admitted for total knee arthroplasty (TKA) participated in the study. Results . Cronbach’s alpha and intra class correlation coefficient (ICC) for the translated and adapted version of HSS Knee Replacement Expectations Survey made up 0.871 and 0.82 (95% confidence interval 0.725-0.897) that was indicative of high correlation between Russian version and the original. Conclusion . Russian version of HSS Knee Replacement Expectations Survey is a reliable tool and can be used for the evaluation of patient expectations prior to TKA.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):17-21
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Influence of Implant Acetabular Component Orientation on Hip Stability
Shubnyakov I.I., Boyarov A.A., Tikhilov R.M., Denisov A.O., Efimov N.N.
Abstract
Introduction. Acetabular component malposition at total hip arthroplasty is a common situation that may affect the frequency of dislocation and the rate of implant friction unit wear. The purpose of the study was to determine the influence of different factors on the variability of acetabular component orientation and evaluate the role of orientation in dislocation development. Patients and methods. Total number of patients made up 1408. Out of them 695 patients were operated on at RSRITO named after R.R. Vreden using standard approaches (group 1), 184 - using low invasive approach (group 2) and 55 patients were admitted with implant head dislocation (group 4). At City St. Petersburg hospitals 474 patients (group 3) were operated on. Orientation of acetabular component (inclination and anteversion angles) was evaluated on digital pelvis and plain hip roentgenograms. Dispersion unifactorial analysis was used to evaluate the dependence of the precision of acetabular component positioning upon the surgeon’s experience, patient’s body mass index, type of surgical approach and the use of guide for acetabular component implantation. Results. Within the first postoperative year the rate of femoral component dislocation in group 1 made up 0.9%. Within the Lewinnek safe zone 76.6% of acetabular components were implanted with the use of a guide and 71.8% without. The rate of dislocation in group 2 made up 71.8% and 63.4% of components were implanted within the safe zone. In group 3 the intra-hospitalization dislocation developed in 1.9% of patients and satisfactory positioning relative to Lewinnek safe zone was achieved in 68.2% of cases. The risk factors for acetabular component malposition included high body mass indices, use of low invasive approach and insufficient experience of the operating surgeon. No direct influence of acetabular component orientation upon the femoral component dislocation was detected. Conclusion. Further studies directed to the more detailed analysis of additional factors that either directly or indirectly affect the implant function and to the optimization of surgical technique that would enable the reproducibility of total hip arthroplasty results are required.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):22-31
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Characteristics of Pain Syndrome in Patients with Lumbosacral Discogenic Pathology in Post- OPERATIVE PERIOD
Gospod A.O., Krupatkin A.I., Kuleshov A.A., Sokolova T.V.
Abstract
Purpose of study. Evaluation of the pain sources and comparative analysis of chronic pain syndrome peculiarities in patients with various types of disc herniation before and after surgical intervention at lumbosacral level. Patients and methods. The study included 80 patients (20-60 years old) with discogenic pathology at lumbosacral level. The type and size of herniation was assessed by MSU classification. Every patient went through a complex evaluation of low back pain sources, pain syndrome characteristics and personality before and on day 10 after surgery. Results. The most common cause of pain was a musculoskeletal syndrome that was more pronounces in the older (41-60 years) group. Neither correlation between the degree of degenerative dystrophic changes and type and size of discogenic pathology, nor the relation between the disc herniation size and type and neurologic symptoms development was detected. The relation between the intensity and other characteristics of pain syndrome and type of disc herniation was not detected too. Analysis of pain syndrome characteristics and mechanisms in complex with the assessment of pain sources revealed the group of patients with high pain and emotionally affected indices before and after surgical intervention and mild vertebrogenic and other pain sources. That group made up 13% of the total number of patients; the majority of them (75%) were females (mean age 37.8±5.0 years) and in 50% of cases the herniation size and localization corresponded to type 2A. Taking into consideration a high degree of disability and other pain indices in postoperative period we do not recommend surgical intervention in this group of patients. Conclusion. Management of patients with lumbosacral intervertebral disc herniation requires the evaluation of all pain sources and pain syndrome aspects.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):32-39
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Early Results of the Study of Reparative Peculiarities of Various Osteoplastic Materials in Experimental Bone Defects
Egiazaryan K.A., Lazishvili G.D., Akmataliev K.I., Ettinger A.P., Rat’ev A.P., Volkov A.V., Korobushkin G.V., Polivoda M.D.
Abstract
Purpose. To determine the optimum osteoplastic material for activation of reparative osteogenesis and substitution of traumatic defects in metaepiphyseal spongy bone tissue. Material and methods. Comparative experimental morphological study was performed on 12 matured male Chinchilla rabbits with body weight 2500-2800g. A model of critical defects of spongy bone tissue was used. Bone defects were filled with 3 types of osteoplastic material: composite calcium sulphate bone cement; xenogenous hydroxyapatite-based material with granulated paste of synthetic peptides (P-15); β-tricalcium phosphate-based material with gauging liquid (calcium phosphate bone cement). Results. Implantation of calcium sulphate bone cement showed rapid osteogenesis stimulation at terms 1.5 months and reduction of newly formed bone tissue mass by 3rd month due to active resorption of the residual material. Implantation of hydroxyapatite-based material with P-15 resulted in osteogenesis stimulation on its surface however because of its mechanical instability and absence of active resorption of that material only a moderate formation of bone trabeculae was observed. At implantation of β-tricalcium phosphate-based material an active resorption of osteoplastic material, formation of trabecular system and its reorganization into trabecular network of femoral metaepiphyseal spongy bone accompanied by the formation of mature bone trabeculae was noted by month 3. Conclusion. Mechanical stability of osteoplastic material and subsequent gradual resorption as well as formation of mature bine trabeculae indicates the efficacy of β-tricalcium phosphate-based material.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):40-47
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Bacteriostatic Characteristics of Bone Substituting Constructors Obtained from Composite Materials Based on Natural Polymers, Calcium Phosphates and Vancomycin
Karalkin P.A., Sergeeva N.S., Komlev V.S., Sviridova I.K., Kirsanova V.A., Akhmedova S.A., Shanskiy Y.D., Kuvshinova E.A., Fedotov A.Y., Teterina A.Y., Barinov S.M., Kaprin A.D.
Abstract
Introduction. The local delivery of therapeutic antibiotic concentrations to the zone of surgical intervention in bone pathology enables either to prevent or significantly decrease the rate of osteomyelitis development. It that study the efficacy of vancomycin inclusion and release from three dimensional constructors based on sodium alginate, gelatin and octacalcium phosphate and vancomycin intended for bone defect substitution was studied. Materials and methods . Prototyping of 3D constructors was performed by extrusion 3D printing. Various concentrations of vancomycin were added as an additional component at the stage of preparation of hydrogel (“ink”) for printing. Physical testing of the constructors included electron microscopic evaluation of their microstructure and porosity as well as the study of mechanical strength for compression and stretching. Functional activity of printed constructors with respect to the test strain S. aureus ATCC 6538-P was assessed by a disc-diffusion method in vitro and on the model of infected excision skin wound in rats - in vivo. Results . Analysis of the kinetic curves showed that the principal release of the drug in the model liquid took place within the first day. The total volume of the bound and released vancomycin made up approximately 20% of the calculated initial amount for all three concentrations. Formation of the marked growth inhibition zone of S. aureus strain in presence of vancomycin rich constructors was demonstrated in vitro. Insertion of constructors into the zone of infected skin defect resulted in a decrease of inflammatory processes severity and rate as well as accelerated the terms of complete wound healing. Conclusion. Study results showed the principle potentiality of bone substituting implants 3D-printing using multicomponent hydrogel compositions without change of separate components characteristics.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):48-56
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Percutaneous Transpedicular Fixation in Traumatic Spondylolisthesis of L5 Vertebra
Slinyakov L.Y., Chernyaev A.V., Donchenko S.V., Simonyan A.G.
Abstract
The use of percutaneous transpedicular fixation in traumatic spondylolisthesis of L5 vertebra without neurologic complications in 37 years old patient is presented. Surgical intervention, technical capability and peculiarities of surgery when using low invasive technique for vertebral body reduction are described. In cases of non-complicated injury percutaneous transpedicular fixation could be a prospective alternative to a standard fixation technique. However it should not be recommended to wide clinical application as it requires special skills and experience in use of low invasive systems and appropriate instrumentation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):57-60
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Advantages and Disadvantages of Various methods for Dupuytren’s Contracture
Ulishchenko A.A., Golubev I.O.
Abstract
Current methods for Dupuytren’s contracture treatment - conservative, radical surgical, low invasive are presented. Their advantages and disadvantages are discussed. Unfortunately no one method allows to avoid relapses at various terms after treatment. In the lack of common approach to the choice of treatment tactics the low invasive techniques such as needle aponeurotomy, collagenase injections, percutaneousaponeurotomywith lipofilling (lipografting)are becoming more popular.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):61-68
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Modern View on Pathogenesis of Non Traumatic Osteonecrosis
Panin M.A., Zagorodniy N.V., Karchebnyi N.N., Sadkov I.A., Petrosyan A.S., Zakirova A.R.
Abstract
Non traumatic osteonecrosis of the femoral head is one of the leading causes of hip function loss in young patients. At the late stages of this disease the only way to restore motor activity is total hip arthroplasty. Literature review presents the systematic analysis of the most significant causes of this disease (long-term intake of corticosteroids, alcohol abuse, thrombophilia). Pathogenetic mechanisms of femoral head vascularization disturbance are considered. In recent decades the fundamental genetic studies enabled to establish that pathogenesis of femoral head osteonecrosis is based on the polymorphisms of genes that ensure coagulation cascade, and angiogenesis disturbance.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):69-75
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Traumatism in Operating Crew of Inland Water Transport
Shapovalov K.A.
Abstract
The purpose of the work was to present the state of traumatism with loss of working ability in operating crew of inland water transport during the period from 1906 to 2015. Search and selection of publications was carried out by the catalogues of the Central Scientific Medical Library, electronic library eLIBRARY.RU and electronic search engines Index Copernicus, PubMed. Peculiarities of the rate and structure of the circumstances of social-hygienic and occupational accidents among industrial workers were detected on the example of operating crew of river water transport depending on the gender, age, profession, ship management service, working experience, circumstances of accident, characteristics of traumatic agent, alcoholic intoxication, seasonal navigation period, weekly working hours, the voyage duration and latitudes. Clinical characteristics of the injuries was given, treatment results and outcomes were analyzed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):76-85
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G.A. Onoprienko
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N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):86-87
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V.I. Zorya
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N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):87-88
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Report on the VII All-Russian Symposium with International Participation “Urgent Issues if Tissue and Cell Transplantology”
Tarasov A.N., Lekishvili M.V., Ochkurenko A.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):91-94
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D.I. Cherkes-Zade
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N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(2):95-95
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