Vol 19, No 4 (2012)

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.

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.).

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.

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.

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.

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).