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Vol 23, No 4 (2016)

Articles

Surgical Treatment of Femoral Neck Fractures with Dynamic Derotation Оsteosynthesis

Dubrov V.E., Yudin A.V., Shcherbakov I.M., Ragozin A.O., Matveev A.L., Zyuzin D.A., Saprykina K.A.

Abstract

Fracture of the femoral neck is a common injury of the human skeleton. High rate of postoperative complications induces to the search of optimum osteosynthesis technique. Treatment results for 259 patients (182 females, 77 males, mean age 72 years) with femoral neck fractures were analyzed. In study group (n=114) a dynamic derotation osteosyntesis and in control group (n=145) - DHS, a bundle of V-shaped curved pins, cannulated screws were used. Mathematic modelling of bone-implant system in different variants of derotation fixator screws position under load was performed. Use of dynamic derotation constructions in Garden 1 and Garden 2 femoral neck fractures ensured a consolidation of fractures in all clinical observations, in Garden 3 fractures - in 46.4%. Early dosage weight bearing not exceeding 60% of the body weight did not result in either fragments displacement or raise of the rate of femoral head avascular necrosis development. In patients under 60 years it is preferably to use dynamic derotation constructions with 4 screws placed in the femoral neck.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):5-11
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Effect of Postoperative Wound Drainage on the Frequency of Red Blood Cells Transfusion after Primary Hip Arthroplasty

Grechanyuk N.D., Zver’kov A.V., Ovsyankin A.V., Zhiburt E.B.

Abstract

The effect of postoperative wound drainage on the frequency of red blood cells transfusion after primary hip arthroplasty was assessed. Prospective comparative study included 632 patients. The patients were divided into 2 groups depending on whether the postoperative drainage was performed (1st group) or not (2nd group). Duration of surgery, volume of intraoperative blood loss, the level of hemoglobin before surgery and during the first postoperative day, frequency and volume of red blood cells transfusion during the whole period of hospital treatment was evaluated. In group 1 donor red blood cells transfusion was required in 1.3%, in group 2 - in 0.8% of cases (p>0.05). No data on the effect of postoperative wound drainage upon the frequency of red blood cells transfusion after primary hip arthroplasty was obtained.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):12-16
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Peculiarities of Drainage after Total Knee Arthroplasty

Kavalerskiy G.M., Smetanin S.M., Chenskiy A.D., Gritsyuk A.A., Lychagin A.V.

Abstract

Treatment results for 65 patients were analyzed depending on the approach to the knee joint drainage after arthroplasty. Active drainage was performed using two large-diameter tubes (group 1, n=16), one large-diameter tube (group 2, n=20), one small-diameter tube (group 3, n=15). In group 4 (n=14), no drainage was performed. Hemoglobin level, knee joint circumference at the level upper patellar pole, volume of drainage discharge and the number of days for exudation via contraperture after drainage tube removal (groups 1-3), pain intensity by visual analog scale, terms of wound gluing and sutures removal, frequency of hemotransfusion were assessed. Statistically significant expediency of active drainage with 1 large-diameter tube and pleats was proved. Without drainage a statistically significant lower decline in hemoglobin levels on 3rd and 5th postoperative days was observed but the terms for wound edges adhesion and the period of knee edema increased.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):16-21
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Risk Factors of Venous Thrombosis Development at Primary Hip Arthroplasty

Ziatdinov B.G., Akhtyamov I.F.

Abstract

The purpose of the work was to determine the factors responsible for the development of lower extremity deep vein thrombosis (DVT) after total hip arthroplasty in patients with aseptic femoral head necrosis and coxarthrosis. Complex clinical laboratory examination was performed in 56 patients aged 26 - 85 years (mean 59.11±2.42). At hospitalization stage 11 (19.64%) cases of DVT development were recorded. It was stated that more often thrombosis developed on the background of the lower limb veins pathology (varicose great saphenous vein, changes in deep veins after great saphenous vein thrombophlebitis). In group of patients with DVT statistically significantly more often the inflammatory reaction markers (leukocytosis and ESR), thrombocytosis as well as shortened APTT and increased fibrinogen levels. Besides, for DVT patients the more prolonged surgery, more marked blood loss and more often use of cement were typical. Such peculiarities may play a certain role in the development of thrombohemorragic complications after total hip arthroplasty and should be taken into consideration as a risk factor of venous thrombosis development at this type of surgical intervention.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):22-27
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Clinical Economic Analysis of the Use of Enoxaparin, Rivaroxaban and Dabigatran Etexilate for Venous Thromboembolism Prophylaxis (VTP) in Patients after Vast Orthopaedic Operations

Es’kin N.A., Dergach E.V., Pyadushkina E.A.

Abstract

Clinical economic analysis of the use of enoxaparin, rivaroxaban and dabigatran etexilate for venous thromboembolism prophylaxis (VTP) in patients after vast orthopaedic operations within the RF public health system was performed. For cost calculation the modelling of decision tree where the presence/absence of clinically significant hemorrhages as the index of anticoagulant safety and VTP incidence as efficacy index were considered. The model was based on the meta-analysis of the published randomized studies results and indirect comparison performed using those data. Only direct medical costs were taken into account. Anticoagulant therapy costs were calculated for the drug dosing regimen according to the use instructions registered in RF. The time horizon of the model was in line with the average duration of thromboprophylaxis after orthopaedic operations: 21 day for enoxaparin and dabigatran, and 25 days for rivaroxaban. Determinate analysis of sensitivity including the evaluation of clinical and economic efficacy of drugs after either total hip or knee arthroplasty was performed. Total costs per patient made up 11 486.99 rub for enoxaparin, 9 035.07 rub for dabigatran and 6 172.63 rub for rivaroxaban use. During sensitivity analysis rivaroxaban preserved its advantage in all scenarios. Rivaroxaban is a preferable drug for VTP prophylaxis after vast orthopaedic interventions as with higher clinical efficacy it requires lower costs.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):28-33
pages 28-33 views

Morphologic Substantiation of Distraction as a Preparatory Step for Bioactive Interphalangeal Hand Joint Arthroplasty in Fibrous Ankylosis

Bugrov S.N., Davydenko D.V., Shirokova N.Y., Novikov A.V., Petrov S.V.

Abstract

The work is dedicated to the study of the morphologic peculiarities of proximal interphalangeal joint capsule before and after distraction in order to substantiate the use of distraction technique as a preparatory step for proximal interphalangeal hand joints bioactive arthroplasty in fibrous ankylosis. The study was conducted on the samples of small fragments of proximal interphalangeal hand joint capsule (11 patients) before distraction and 2 months after distraction apparatus removal. Control group (conventional norm) was presented by 6 autopsy samples. Light microscopy using standard staining methods and immunohistochemical examination were performed. Activation of angiogenesis processes, i.e. 3.5 times increase of vascular bed, 3.4 times growth of mature labrocytes number, both partially and maximum degranulated, as compared with the nondistracted tissue and control group. Direct correlation between the growth of mature labrocytes number and fibroblasts, and the quantity of newly formed vessels per unit of tissue area was detected. Distraction enables to raise the vitality and resistance of pathologically changed joint tissues to damaging factors (hypoxia), activates functional status of joint surrounding tissues and could be considered as a preparatory step for fibrotically ankylosed interphalangeal hand joints bioactive arthroplasty.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):34-39
pages 34-39 views

State of Synovial Medium in Patients with Degenerative Dystrophic Changes of Knee Joint Accompanied by Articular Surface Defects

Matveeva E.L., Gasanova A.G., Chegurov O.K.

Abstract

The purpose of the work was to determine the concentrations of mineral elements in subchondral bone and synovial fluid of patients with degenerative dystrophic knee joint diseases accompanied by articular surface defects. Subchondral bone and synovial fluid were used as a study material. Analysis of mineral content indices included the determination of calcium, phosphate, magnesium and chlorides concentrations by spectrophotometry. It was shown that the indices of basic electrolytes, i.e. of calcium and phosphate ions, in bone and synovial fluid did not correlate with each other and changed in different directions. Calcium content decreased in the bone while phosphate ions - in synovial fluid.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):40-43
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Peculiarities of Reparative Osteogenesis of Injured Thoracic and Lumbar Vertebral Bodies at Different Terms after Trauma

Bogomolova N.V., Shul’ga A.E., Zaretskov V.V., Smol’kin A.A., Norkin I.A.

Abstract

The analysis of the results of morphologic examination of vertebral body bone tissue obtained intraoperatively from 43 patients (20 - 67 years) with thoracic and lumbar spine injuries at different terms after trauma was performed. All patients were operated on via anterior approach to create ventral fusion. In the examined serial samples of vertebral body structures the quality and regeneration potential of bone tissue were assessed. It was shown that cell differentiation during the osteogenesis process was closely associated with angiogenesis. In the zones with active growth of microcirculatory bed vessels the normal cycle of osteoblast and osteocytes took place while hypoxia and acidosis resulted in pathologic osteogenesis. In patients under 50 years, both males and females) the full value consolidation time averaged 5 months. In patients over 50 years, independently of the gender, the decrease of spongy structures volume and bone mineral density was observed. The recommendations on surgical treatment tactics of patients with thoracic and lumbar vertebral body injuries were given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):44-49
pages 44-49 views

Full -Function Restoration of Achilles Tendon with Nanofibrous Implant (experimental study)

Senotov A.S., Ol’khov A.A., Sklyanchuk E.D., Fadeeva I.S., Fadeev R.S., Fesenko N.I., Prosvirin A.A., Lekishvili M.V., Gur’ev V.V., Iordanskiy A.L., Akatov V.S.

Abstract

Creation of implants for the restoration of ligaments and tendons in their complete/massive injury is an urgent task. The efficacy of the restoration of completely resected Achilles tendons after implantation of a new material consisting of absorbable pledged threads Dar-Vin USP 5/0 and conductive nonofibrous scaffolds of polyhydroxybutyrate placed around the threads into the zone of defect was studied in Wistar rats. Either nanofibrous implant (experiment) or pledged threads (control 1) were placed into the zone of completely resected Achilles tendon (control 1), or the postresection wound was sutured without placement of any material (control 2). It was stated that from 2nd to 13th week after implantation of nanofibrous implant the animals from the experimental group used their hind paws in full volume. In control groups 1 and 2 the animals moved with difficulties. In the experimental group of animals in 6 and 13 weeks after implantation a soft tissue regenerate connecting the calcanean tuber and gastrocnemius muscle was present with the absence of gastrocnemius muscle contracture as compared with the control groups. Histologic examination showed the similarity of the regenerate on nanofibrous implant with the native Achilles tendon. Thus, the suggested implant ensured functional and morphologic restoration of totally resected Achilles tendon in rats and can be considered as a perspective prototype of new materials initiating effective regeneration of ligaments and tendons in their massive injuries.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):50-54
pages 50-54 views

Elaboration of New Treatment Methods for Spinal Cord Injuries Using Magnetic Nanoparticles in Combination with Electromagnetic Field (Experimental Study)

Kolesov S.V., Panteleev A.A., Sazhnev M.L., Kaz’min A.I.

Abstract

The latest studies on the use of magnetic nanoparticles (MNP) in biological systems prove their high biocompatibility and possibility to interact with various types of cells including the neurons. This may serve as a basis for potential restoration of the neuronal network after nerve tissue integrity damage. The purpose of the study was to determine the influence of MNP on the restoration of hind paws function in experimental animals after spinal cord transection (by 50, 80 and 100%) under the influence of a magnetic field. Magnetic nanoparticles were inserted into the injury zone via plastic catheter. The degree of function loss and its subsequent restoration was assessed by BBB Locomotor Scale and induced potentials on the first postoperative day and then weekly within one month. Statistically significant (p<0.001) increase of both the induced potentials’ amplitude and mean functional indices was reordered only in group with 50% spinal cord transection. Also in that group the less marked scar changes and the highest neuronal cells survival rate was observed. Use of MNP under the influence of external magnetic field promotes the restoration of motor function and increases the conductivity of injured spinal cord tissues in experimental animals in the mean long term period. The mechanism of such restoration needs further study.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):55-60
pages 55-60 views

Influence of Inclination Angle on the Polyethylene Insert Wear in Experimental Module of Hip Endoprosthesis

Kolesnik A.I., Gavryushenko N.S., Bulgakov V.G., Frolov E.B., Fomin L.V.

Abstract

Localization and the area of polyethylene insert wear in friction pair ofthe experimental module of hip joint (HJ) endoprosthesis was studied under laboratory dynamic conditions simulating its biomechanics at HJ external rotation contracture. It was stated that localization and the area of wear depended on the angle of horizontal inclination infriction pair of HJ endoprosthesis. Almost the same areas of polyethylene wear in anterior and posterior insert segments were observed when inclination angle was equal to that of the hip joint. Reduction of inclination angle resulted in the increase of wear surface in the anterior segment and its decrease in the posterior one. Displacement of the wear zone into the anterior segment was accompanied by the reduction of total insert wear area. At repeated loadings it created conditions for the higher polyethylene insert wear.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):60-65
pages 60-65 views

Perspectives of Arthroscopic Surgery at Treatment of Elbow Joint Diseases

Salikhov M.R., Kuznetsov I.A., Shulepov D.A., Zlobin O.V.

Abstract

The present review is dedicated to the problems and treatment techniques in elbow joint diseases. Basic methods of conservative and surgical treatment for osteoarthritis in the initial stages, chondromatosis, elbow osteochondritis dissecans and lateral epicondylitis are considered. Potentialities of arthroscopic interventions for the treatment of these conditions are presented and the main problems as well as the urgent aspects of arthroscopic treatment for elbow joint orthopaedic pathology at the current stage of surgery development are considered.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):66-73
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History, Present and Future of Knee Arthroplasty

Prokhorenko V.M., Mamedov A.A., Baitov V.S.

Abstract

The review covers different aspects of knee joint arthroplasty. With improvement of arthroplasty techniques the joint implants are constantly perfected: the more strong alloys with high biocompatibility are used for their production, design is developed using mathematical models, endoprosthesis friction node are subjected to long-term bench testing. All these innovations are directed at the improvement of implant quality, increase of their survival time, minimization of toxic effect on the patient’s organism. Taking into account all advantages and disadvantages of the available joint implants with different design and various friction pairs being detected from literature data and by our experience it was concluded that elaboration of joint implant with increased wear resistance is required.
N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):74-81
pages 74-81 views

Plan of scientific and practical events in traumatology and orthopedics for 2017

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N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):82-83
pages 82-83 views
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Index of Articles Published in 1-4, 2016

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N.N. Priorov Journal of Traumatology and Orthopedics. 2016;23(4):86-88
pages 86-88 views

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