Vol 19, No 3 (2012)

Articles
Forty-Year Experience in Application of Correction Osteotomies for Blount Disease Treatment
Tenilin N.A., Bogos'ayn A.B., Karataeva D.S.
Abstract
Long-term results (up to 40 years) of surgical treatment using different types of correction osteotomy in 51 children with Blount disease showed that the operation was necessary but a delayed measure. The authors showed that when deformity achieved the degrees requiring surgical intervention with bone transaction the deforming gonarthrosis inevitably developed at terms up to 10 years after operation. The main causes of varus deformity recurrence were determined, i.e. presence of active but disturbed growth and ossification processes, distal osteotomy level, absence of intraoperative hypercorrection, inobservance of postoperative orthopedic regimen. The only way to achieve good results is early operative intervention directed to growth normalization and formation of proximal tibia with spontaneous deformity correction during the period of child's growth.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):3-8
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Variants of Spine Deformity Correction in Children with Idiopathic Scoliosis of Thoracic Localization
Vissarionov S.V., Kokushin D.N., Drozdetsky A.P., Belyanchikov S.M.
Abstract
Treatment results for 24 patients (21 girls and 3 boys), aged 14—17 years, with idiopathic thoracic scoliosis are presented. In all cases right-side type of deformity was observed. The main arch of curvature ranged from 52° to 92° by Cobb. The operation was performed from dorsal approach with application of metallic devices with transpedicular supporting elements using 3D-CT navigation. Depending on anatomical and anthropometric peculiarities of vertebral bone structures within the curvature arch, two variants of surgical correction were applied. Correction of the first type was performed in 18 patients; second type of correction was applied in 6 children. Second type of deformity correction differed from the first one by the sequence of rods implantation relative to the sides of main arch and corrective maneuvers at deformity correction. In the first group postoperative deformity correction in frontal plane made up 92—99%, derotation correction of the apical vertebra from 72 to 94% versus 91—100% and from 11,4 to 29,4% in the second group.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):9-13
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Application of Cross-Section Corrective («Translation») Forces at Surgical Treatment for Scoliosis
Jalilov Y.R., Verdiyev V.Q., Jalilov T.Y.
Abstract
Surgical treatment results for 53 patients with III—IV stage of scoliosis are presented. In all patients original endocorrector has been applied. Endocorrector is based on the application of cross-section corrective («translation effect») forces that enable to shift the vertebrae of the main scoliotic arch to the median line of the trunk. Endocorrector was the most effective in curvature arch under 75° and provided 35—45° correction. Mathematic modeling of a situation «endocor- rector—curved spine» was performed as well as the pattern of forces created by endocorrector and participated in the scoliotic deformity correction was studied. Surgical intervention enabled to achieve stable fixation of the spine with its sagittal contours preservation. At long-term follow up (1—6 years) loss of correction did not exceed 8—10°. In scoliosis with arch over 75° step-by- step corrections were performed and loss of correction could make up 15°.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):14-19
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Comparative Experimental Study of Hook and Pedicle Fixation Systems Used at Surgical Treatment of Spine Deformities
Kuleshov A.A., Lisyansky I.N., Vetrile M.S., Gavryushenko N.S., Fomin L.V.
Abstract
Using human cadaver spines we compared the stiffness of pedicle screws and laminar hooks under cyclic and static pull-out loads. Transpedicular and hook fixation (sub- and supralaminar) of cadaveric thoracic spine segments was performed. Axial pull-out strength was measured using w+b (walter + bai ag) servoelectric testing machine (LFV-10-T50, Switzerland). Static pull-out tests were performed on 7 spine blocks with transpedicular and 7 blocks with hook fixation. The same blocks were tested under cyclic loads. At cyclic pull-out loading 800 N strength with 5 Hz frequency was applied. It was shown that at increasing static load hook implants could bear 1417 N at average. At higher loads the vertebral arch was destroyed. Transpedicular implants could bear 2286 N at average and at higher loads the screw migrated from the arch root. Cyclic tests showed that hooks could bear 2935 cycles at average and at prolonged loading the arch was destroyed. The hooks could bear the full; program of cyclic loads without destruction (18 000 cycles).
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):20-24
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Clinical, Roentgenologic and Pododynamography Results of Minimum Invasive Total Hip Arthroplasty
Laykher F., Sandler K., Scheider S., Babisch J., Seleznyov M.N., But-Gusaim A.B., Sirotin I.V., Pimenov A.A., Rot A.
Abstract
Clinical, roentgenologic and pododynamographic data were analyzed for 195 patients after 207 total hip arthroplasties performed via modified minimum invasive anteroexternal approach by Watson-Jones during the period from 2004 to 2006. Clinical results showed reduction of rehabilitation period and significant relief of postoperative pain syndrome. The rate of complications corresponded to that at conventional technique application. Despite slight varus position of the femoral component roentgenologic examination results were also comparable. Analysis of gait showed its considerable improvement and decrease in preoperative asymmetry between healthy and operated sides already in 4 months after operation. Residual differences were almost not observed in 6 months after intervention. Obtained clinical results confirmed the advantages of the applied technique.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):25-31
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Results of Cemented Femur Components Application at Total Hip Revision Arthroplasty
Zagorodniy N.V., Nuzhdin V.I., Bukhtin K.M., Kagramanov S.V.
Abstract
Treatment results for 114 total hip revision arthroplasties (1992—2011) with cemented femur components were analyzed. The most common indication for surgery was aseptic instability of hip implant. In 1 st group (42 operations) cemented stems Bi-Metric (Biomet Orthopaedics) and in 2 nd group (72 operations) cemented stems ESI (Endoservis) were used. Surgical technique was described and causes of complication development were analyzed. Mean follow-up made up 11 years. In the 1 st group excellent results were achieved in 2 (4.76%) cases, good in 34 (80.95%), satisfactory in 3 (7.14%) and poor in 3 (7.14%) cases. In the 2 nd group corresponding results were achieved in 3 (4.17%), 47 (65.28%), 15 (20.83%) and 7(9.72) respectively. Analysis of the reasons for complication development was performed. It was stated that femur defects of type 3 on level 1 by AAOS classification resulted in fatigue fractures of cemented revision stems.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):32-38
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Clinical Efficacy and Safety of Primary Thrombotic Complications Prevention after Orthopaedic Operations
Kulinchik T.V., REbrova O.Y., Margieva A.V., Avkcent'eva M.V., Voskresenskiy O.Y., Petrova N.V., Reino E.V.
Abstract
Comparative study of clinical efficacy and safety of dabigatran etexilate (DE) and other widely used anticoagulants (AC) in primary thromboprophylaxis after orthopedic interventions was performed. Retrospectively 828 patients from 13 hospitals located in 10 different Russian towns were evaluated. Seven hundred sixty one patients (91,9%) underwent total arthroplasty of either knee or hip joints and 67 patients — other orthopedic operations. Clinical efficacy of AC was evaluated by the rate of postoperative vein thrombosis, safety of AC — by the rate of postoperative bleedings. No statistically significant difference in the incidence of venous thromboembolism at DE and other AC intake after total arthroplasty (distal thrombosis — 4% [2%, 7%] and 4% [2%, 6%] in DE and other AC subgroups, respectively; proximal thrombosis — 0% [0%, 1%>] in both subgroups and after other orthopaedic interventions (distal thrombosis — 4% [0%, 18%] and 3% [0%, 13%]; proximal thrombosis — 4% [0%, 18%] and [0%, 9%] in DE and other AC subgroups, respectively) was detected. The incidence of bleeding after arthroplasty also showed no significant difference between DE and other AC (minimum postoperative bleeding was 1% and 1% in DE and other AC subgroups, respectively; massive bleeding — 0% in both subgroups. No postoperative bleeding was observed after other orthopaedic interventions. Thus clinical efficacy and safety of DE is comparable to other widely used AC for thrombosis prevention.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):39-47
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Iatrogenic Neuropathy of Extremity Peripheral Nerves
Savitskaya N.G., Abdrayzyakova D.M., Yankevich D.S., Pavlov E.V.
Abstract
Retrospective clinical-ENMG analysis of data on 419 patients with mononeuropathy of different genesis (traumatic and nontraumatic) was presented. In 48 patients (11.4%) out of them mononeuropathy was of iatrogenic character. Neuropathy of radial and peroneal nerves was detected more often, 48% and 28%, respectively. Main causes of nerve injury were the mistakes in preoperative planning and inobservance of operative technique. It was showed that in most cases iatrogenic injury of nerve could be avoided. The ways of iatrogenic neuropathy prevention included the optimization of surgical and particularly traumatologic tactics.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):47-52
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Influence of Sympatectomy upon Outcomes of Autoneuroplasty after Upper Extremity Nerve Injuries
Merkulov M.V., Golubev I.O., Krupatkin A.I., Kuz'michyov V.A., Bushuev O.M., Shiryaeva G.N., Kutepov I.A.
Abstract
Study on the assessment of influence of sympatectomy upon the regeneration of human upper extremity nerves is presented. During the period from 2008 to 2012 ninety patients (83 men, 7 women) aged 12 — 60 years were treated for the defects of median, radial, ulnar and musculocutaneous nerves. The length of defects was from 2.5 to 20.0 cm . In 46 patients from the main group autoneuroplasty was combined with sympatectomy (thoracoscopic clipping of sympathetic trunk at Th3 — Th4 level). In 44 patients from the control group sympatectomy was not performed. During the period from 1.5 to 2 years after operation increase in reinnervated muscles force up to M3 — M4 was registered in 47.7% of patients from the main group versus 10.9% of patients from the control one and restoration of sensation up to S3 — S3+ in 65.9 and 13.04% of patients respectively (p <0.05). Earlier and more effective restoration of blood flow and pressure in microcirculatory bed in the denervated segment of the extremity was noted as compared with the control group.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):53-58
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Total Arthroplasty of 1st Metatarsophalangeal Joint. Short-Term Results
Petrosyan A.S., Zagorodniy N.V., Yolkin D.V., Protsko V.G., Zakharyan N.G., Mazalov A.V., Grigor'ev V.V.
Abstract
During the period from April to December 2011 seventeen total arthroplasties of 1 st metatarsophalangeal joint for III—IV stage deforming osteoarthrosis was performed to 11 patients (7 men, 4 women) aged 39—68 years. In 9 cases bone cement was used for implant fixation, in the rest of cases — press-fit technique. In 3 cases Goman operation was simultaneously performed on 2—3 toes, in 1 case Weil osteotomy was performed. Treatment results were assessed by AOFAS scale. Mean follow up term made up 8.6 months. Excellent and good results were achieved in 8 (72.7%) patients, satisfactory — in 2 (18.2%), poor — in 1 (9.1%) patient. Total arthroplasty of 1 st metatarsophalangeal joint is an alternative to arthrodesis and enabled to restore both joint function and stability.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):59-63
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Use of Tranexamic Acid at Knee Joint Arthroplasty
Vlasov S.V., Pronskikh A.A.
Abstract
Results of comparative study of the efficacy and safety of intraoperative application of tranexam versus autoplasma in patients with planned surgical blood loss and high risk of venous thrombosis development has been presented. One hundred seven patients admitted for total knee replacement were divided into 2 groups. In the main group (55 patients) intraoperative intravenous infusion of 10 mg/kg tranexam were used. In the control group (52 patients) intraoperative hemodilution with autoplasma was performed. Hemostasis indices (APTT, INR, SFMC, D- dimer) and lysis index were studied before surgery and in postoperative period. Ultrasound scanning of lower extremity veins was performed before surgery and in 4—5 days after intervention. The volume of intraoperative blood loss in two groups did not differ. In the postoperative period the drainage blood loss in the main group was more than twice lower as compared to the control group (p=0,037). In postoperative period statistically significant increase in SFMC and D-dimer indices was noted in both groups. However after tranexam application the increase in fibrin lysis products content was reliably less marked than in control group. US investigation of lower extremities showed distal veins thrombosis in 2 patients from control group and no cases of thrombosis in the main group.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):64-69
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Tribochemical Component of Oxidative Stress Development at Artificial Joints Implantation. Part 4. Use of Lubrication and Antioxidant Action of Bone Fat in Total Hip Implant
Gavryushenko N.S., Bulgakov V.G.
Abstract
Human bone fat possesses expressed lubrication action, essentially reduces the torque moment of various friction units, inhibit formation of toxic free radicals. With the purpose of patient's bone fat use in Movshovich — Gavryushenko hip joint implant an arthro-medullar canal that connect bone marrow cavity and wear bearing surface of implant is present. Axial loadings of this implant cause flow of liquid bone fat via canal to friction unit thus promoting improvement of tribologic parameters and inhibiting the development of free radical reactions. Application of bone fat can reduce or completely block the action of several negative factors that deteriorate outcomes of total joint replacement.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):70-74
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Technology for the Treatment of Navicular Bone Fractures
Sysenko Y.M., Samusenko D.V.
Abstract
A special device assembled from standard details of Ilizarov apparatus is described. The device enables not only to perform the reduction of navicular bone fragments but provides their stable fixation as well. Conditions for walking on the first days after transosseous osteosynthesis with gradually increasing loads upon the operated extremity are created. Clinical case is presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):75-77
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Revision of O.N. Gudushauri Joint Implant Made of Corundum Ceramics
Kagramanov S.V., NIkolaev I.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):78-79
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Benign Tumors, TumorLike and Inflammatory Diseases of Wrist Bones
Ochkurenko A.A., Molov K.K.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):80-86
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Federal State Budget Institution «Scientific-Research Pediatric Orthopaedic Institute after G.I. Turner» of the Ministry of Public Health and Social Development of Russian Federation — 80 years
Baindurashvili A.G., Ovechkina A.V.
Abstract
В 2012 г. Детский ортопедический институт им. Г.И. Турнера отмечает 80 лет со времени своего учреждения и 120 лет со времени основания в Петербурге Приюта для детей калек и паралитиков.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):87-89
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N.P. Demi
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N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):90-91
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Report on the V All-Union Symposium with International Participation «Actual Issues of Tissue and Cell Transplantation»
Lekishvili M.V., Shangina O.R., Ochkurenko A.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(3):92-94
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