Vol 19, No 4 (2012)


Two-Step Total Hip Arthroplasty in Deep Periprosthetic Infection

Voloshin V.P., Eryomin A.V., Onoprienko G.A., Lekishvili M.V., Vasil’ev M.G.


Modern notions about surgical techniques for the treatment of deep purulent processes in the zone of hip implant are presented. In 13 cases surgical sanitation without implant removal was performed. In case of implant loosening treatment tactics was determined by the possibility of total revision arthroplasty. In 76 patients with periprosthetic infection surgical sanitation was aimed at inflammation arrest and restoration of extremity weight bearing after compelled implant removal. In 44 patients resection arthroplasty with formation of neoarthrosis by Girdlestone was performed. In 17 cases a two-step surgical intervention with implantation of antibiotic impregnated cement spacer followed by revision arthroplasty was used. Clinical, microbiologic and immunologic criteria of favourable treatment outcome with minimum risk of inflammatory process relapse were determined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):3-9
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Experimental Substantiation of Shape Forming and Sanitation Function of Cement Spacers at Treatment of Hip Periprosthetic Osteomyeliti

Dzyuba G.G., Reznik L.B., Erofeev S.A., Pavlinov G.B.


Degree and terms of acetabular bone structures reparation, indices of total and local immunity were evaluated in experiment (12 dogs with osteomyelitis). In the main group surgical treatment consisted of proximal femur resection with implantation of articulating spacer. In control group resection arthroplasty was performed. Roentgenologic and morphologic data showed marked reparative regeneration of acetabular bone structures under the influence of inserted spacer at terms up to 16 weeks. At application of spacers immunologic picture was characterized by rapid restoration of pro- and anti-inflammatory cytokines balance as well as by the absence of immunomodulatory effect on phagocytic link of the immune system.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):10-14
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Results of Cementless Femoral Components Use at Revision Hip Arthroplasty

Zagorodniy N.V., Nuzhdin V.I., Bukhtin K.M., Kagramanov S.V.


Results of 98 revision total hip arthroplasties performed using cementless stems during the period from 2000 to 2012 are presented. In 1 st group of patients (36 operations) revision SLR stems were used. In group 2 (34 interventions) and group 3 (28 interventions) Solution stems and Wagner stems were implanted, respectively. Detailed characteristic of implants was given with account to the type of fixation. Follow up was from 3 to 6 years. Excellent and good results were achieved in 21 patients (58.33%)from the 1 st group, 14patients (41.18%) from the 2 nd group and 16 patients (57.14%) from the 3 rd group. Analysis of intraoperative, early (up to 6 months) and late (over 6 months) complications was performed. Recommendations for choice of revision femoral components depending on the degree of bone tissue defect are given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):15-21
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Pathophysiologic Aspects of Soft Tissue Microcirculation in the Zone of Long Bones Pseudarthrosis

Mironov S.P., Es’kin N.A., Krupatkin A.I., Kesyan G.A., Urazgil’deev R.Z., Arsen’ev I.G.


Thirty four patients with delayed consolidating fractures and long bones pseudarthrosis and 30 healthy individuals (control group) were examined using laser Doppler flowmetry and computed thermography. It was shown that during the osteogenesis process no isolated changes in bone circulation took place but the potentialities of blood flow in the extremity segment as a whole were mobilized. Important role of bone surrounding soft tissue circulation for provision of adequate osteogenesis was confirmed. In case of pseudarthrosis formation microcirculation system, especially its nutrient part, responded «keenly» to the changes in regional metabolism and bone regeneration. That stipulated diagnostic and prognostic importance of soft tissue microhemocirculation study in the zone of pseudarthrosis. Preoperative functional examination of soft tissue circulation enabled to determine risk group for nonconsolidation ordelayed consolidation of fractures. For better result special treatment tactics can be used (osteogenesis stimulators, free vascularized autografts, etc.).
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):22-26
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Potentialities of Computed Navigation at Primary Total Knee Replacement

Kavalerskiy G.M., Murilev V.Y., Rukin Y.A., Lichagin A.V., Elizarov P.M.


During 2007—2012 total knee replacement with computed navigation was performed to 449 patients, aged 32 to 84 years. Indications to the application of that method were the deformities of lower extremities in frontal plane over 15°; inability to use intramedullary guides; rough changes in range of movements. In the majority of cases (478, 93.2%) devices with posterior stabilization were used. Postoperatively mechanical axis of the extremity was evaluated by X- rays, functional results — by Oxford scale. Mean follow up made up 29.5 months. Two years and over after surgery mean point by Oxford scale was not below 40. Use of computed navigation enabled to insert the implant components more accurately, to determine the correct balance of ligamentous system and to decrease the complication rate.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):27-31
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Experimental Morphologic and Clinical Substantiation of Autothrombocytic Growth Factors in Complex Treatment of Achilles Tendon Rupture

Kesyan G.A., Berchenko G.N., Nakhapetyan T.G., Gavryushenko N.S., Uraxgil’deev R.Z., Mikelaishvili D.S., Arsen’ev I.G., Muradyan D.R., Dan I.M.


Study of the influence of autothrombocytic growth factors upon the injured tendinous tissue was performed. Experimental results (60 Chinchilla rabbits, 3—5 kg) showed that administration of autologous platelet-rich plasma (PRP) into Achilles tendon (AT) injury zone promoted activiza- tion of reparative processes with diminution of inflammatory manifestations; increase in angio- genesis, proliferative and synthetic fibroblasts activity, fibrillogenesis processes; earlier tendon healing. Clinical study included 57 patients (33—68years) with acute (8—48 hours) and old (1—12 months) AT ruptures. After AT surgical reconstruction(Cuneo tendon sutures in acute AC ruptures and Chernavsiautoplasty in the old ones) PRP was additionally administrated to 30 patients from the main group. Treatment results were evaluated by J. Leppilahti and AOFAS scales in 4 months after surgical intervention. In no one patient from the main group AT reruptures were recorded while in control groupreruptures were recorded in 26% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):32-37
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Surgical Treatment for First Metatarsal Joint Deforming Osteoarthrosis of Various Etiology

Yezhov M.Y.


Examination and treatment results were presented for 17 patients with deforming arthrosis of the first metatarsal joint. In the 1 st group (12 patients) total arthroplasty of the first metatarsal joint was performed using Total Toe System implants. Second group included 5patients with dysplas- tic osteoarthrosis of the first metatarsal joint and iatrogenic aseptic necrosis of the head of the first metatarsal bone resulted from excessive medial resection of the head. In 3 patients from group 2 custom made implants and specially designed instruments were used. All patients from the 1 st group were examined in 3—12 months postoperatively. Joint condition showed 82points by AOFAS scale compared to 31 before surgery. In patients from the 2 nd group treatment results made up 88 points by AOFAS scale.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):38-41
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Potentialities of Percutaneous Technique in Revision Surgery of Forefoot Static Deformities

Berezhnoy S.Y., Protsenko A.I., Kostyukov V.V.


Results of the analysis of repeated surgical interventions (34 patients, 43 feet) after previously performed surgeries for forefoot static deformities are presented. In all cases various percutaneous techniques were used. Mean follow up was 6 months (3 months — 4 years). Surgical results were assessed using patient satisfaction criterion. Satisfaction with treatment results was recorded in 95% ofpatients. It was shown that potentialities ofpercutaneous technique enabled to solve the majority offorefoot static deformityrevision surgery problems. The conclusion was made that strict order of patient management after reconstructive foot operations enabled to perform early reoperations before severe complications development.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):42-46
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Reconstructive Restorative Surgical Interventions in Complex Treatment of Children with Legg-Calve-Perthes Disease

Barsukov D.B.


For optimization of anatomic and functional treatment results pre- and postoperative roentgenologic data were analyzed for 120 patients aged from 6 to 14 years with Legg-Calve-Perthes disease accompanied by severe affection of epiphysis. Mean follow up period after reconstructive (remodeling) surgical interventions, i.e. corrective osteotomy of the femur, pelvic osteotomy by Salter, combinations of those 2 techniques, triple pelvic osteotomy made up 10 years. It was shown that remodeling of femoral head was possible only when the degree of bone coverage was equal or exceeded 1. If that parameter was below 1 the conditions for deformity progression developed. Roentgenologic variants of the affected joint anatomic structure that enabled to define concretely the indications to a certain type of femoral head surgical remodeling were determined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):47-54
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Some Aspects of Funnel Chest Diagnosis in Children

Shamik V.B., Davud B.A.


Examination results for 294 children aged 7 days — 17 years with funnel chest deformity were presented. Anthropometric measuring of the chest was performed. New method for calculation of chest flattening index was used. New ways for the determination of deformity index, area of entrance to the cavity and cavity volume were suggested. Notion of «deformity coefficient» was introduced; local and diffuse types of funnel chest were identified. Dependence between the indices of chest deformity in sagittal plane, patient’s age and deformity severity was established.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):54-57
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Radiomorphologic Peculiarities and Density of Tibial Cortical Plate at Different Stages of Lengthening

D’yachkov K.A., D’yachkova G.V., Alexandrov Y.M.


State of maternal bone before and after lengthening was studied using computed tomography in 94 patients with shortening and deformities. It was shown that depending on shortening and deformity etiology the cortical plate possessed typical differences that consisted in different crosssectional shape and density. During distraction and fixation of the limb after its lengthening in the apparatus, cortical plate had a heterogeneous structure with resorption zones of different size and density in all groups of patients. Depending on the disease etiology and amount of lengthening organotypical bone remodeling after lengthening lasted for 1—3 years.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):58-61
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Low Invasive Approaches at Treatment of Patients with Severe Concomitant Injury and Dominant Chest Injury

Tseimakh Y.A., Levin A.V., Gontarev I.N., Zimonin P.E., Tolstihina T.A.


For the purpose of increasing the efficacy of complex treatment of 72 patients (main group) with severe concomitant injury and dominant chest injury low invasive treatment, i.e. local differential fibrinolytic therapy, valvural bronchoblocking, videothoracoscopy was applied. One hundred twelve patients (comparative group) were under traditional treatment (blind drainage of pleural cavities, thoracotomy, etc). Unilateral thoracic injuries were detected in 165 (89.7%) patients, bilateral — in 19 (10.3%). In 141 (76.6%) patient chest injuries were accompanied by subcutaneous and intercondylar emphysema. Elaborated treatment and diagnostic tactics as well as differentiated approach to the use of low invasive techniques enabled to increase the number of recovered patients — 61 versus 54 patients from comparative group (p<0,05) and to reduce the rate of chronical process development — 9.7% versus 24.1%, respectively (p<0,05).
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):62-67
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Clinical-Morphological Features and Correlative Dependence of Clinical, Sonographic Data and Histologic Indices of Lesion in Soft Tissue Ganglion of the Wrist

Grigorovsky V.V., Strafun S.S., Shipunov V.G.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):68-76
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First Experience in Treatment of Upper Extremity Postoperative Tourniquet Pareses

Merkulov M.V., Golubev I.O., Krupatkin A.I., Bushuev O.M., Shiryaeva G.N., Maksimov A.A., Kutepov I.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):79-82
pages 79-82 views

Recurred Dislocation of Ulnar Nerve and Medial Head of Triceps Tendon

Zolotov A.S., Pak O.I.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):82-84
pages 82-84 views

Fifty Years of Ultra High Molecular Polyethylene Use in Total Joint Replacement. Success, Problems, Perspectives

Kolondaev A.F., Balberkin A.V., Zagorodniy N.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):85-94
pages 85-94 views

Index of Articles Published in 1-4, 2012

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N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):94-96
pages 94-96 views

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