Vol 21, No 2 (2014)

Articles
Congenital Hip Deformity Morbidity in Children of Russia Based on Official Statistic Data 2011-2013
Es’kin N.A., Andreeva T.M.
Abstract
Congenital hip deformity morbidity in children was studied on the basis of official statistic data in the period 2011-2013. It was detected that total and primary morbidity was characterized by wide ranging values with significant year after year changes, great value discrepancy between urban and rural population. For early diagnosis and treatment of pathology the elaboration and application of screening program for detection of pathologic changes in the hip during first months of life, the standards for treatment of patients with congenital hip deformity and protocols for management of patients depending on severity of pathological changes were proposed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):5-11
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Analysis of Results of Kyphotic Deformity Reduction Using Puncture Vertebroplasty and Stenoplasty in Patients with Traumatic Compression Fractures of Thoraco-Lumbar Localization
Byval’tsev V.A., Kalinin A.A., Sorokovikov V.A., Belykh E.G., Panasenkov S.Y., Griror’ev E.G.
Abstract
Correction of posttraumatic deformity and stabilization of injured segment play an important role in treatment and complication prevention after traumatic compression vertebral body fractures. Possibilities of deformity reduction using vertebroplasty and a combination of distractive titanium cage with insertion of bone cement into vertebral body (stenoplasty) are not well studied. Retrospective comparative analysis of clinical efficacy and degree of kyphotic deformity reduction using puncture vertebroplasty (1 st group, n=15) and stenoplasty (2 nd group, n=15) in patients with traumatic A1 compression fractures of thoraco-lumbar vertebral bodies was performed. Severity of pain syndrome (VAS) and degree of injured segment deformity (kyphotic angle and wedge-shaping index) were assessed. In both groups surgical intervention resulted in marked pain reduction but in long-term period it was less significant for 2 nd group (p=0.0035). Postoperatively kyphotic angle median and wedge-shaping index changed statistically significant in 2 nd group from 12.60 (10.50; 13.40) to 2.50 (1.90; 3.20) (p=0.0015) and from 25.3% (22.8; 26.7) to 9.3% (8.9; 11.4) (p=0.0022), respectively and not significantly in 1 st group from 13.10 (11.40; 14.30) to 12.90 (11.20; 14.00) (p= 0.93) and from 26.5% (24.0; 28.8) to 25.9% (23.8; 28.4) (p=0.86), respectively. Progression of posttraumatic kyphosis in late postoperative period was noted in 1 st group (P M Ü=0.042) but not in 2nd group (P =0.58). In traumatic A1 compression fractures stenoplasty enabled to perform kyphotic deformity correction in the early period of spinal injury, to achieve significantly greater reduction of kyphotic angle and to preserve the result in remote postoperative period as compared to puncture vertebroplasty
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):12-18
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Use of Nitinol Rods for Lumbosacral Spine Fixation (Prospective Randomized Clinical Study)
Kolesov S.V., Shvets V.V., Kolobovskiy D.A., Kaz’min A.I., Morozova N.S.
Abstract
One hundred thirty operations were performed in patients (57 males, 73 females) with degenerative lumbar spine diseases during the period from 2010 to 2012. Mean age of patients made up 57 (45-82) years. Depending on the type of intervention all patients were divided into 2 groups: in 60patients (1 st group) dynamic stabilization with nitinol rods without fusion and in 70patients (2 nd group) rigid fixation of lumbar spine with titanium rods was performed. Outcomes were analyzed in 1.5 years after surgery. VAS, ODI and SF36 questionnaires showed improvement of patients’ condition in both groups. Restoration of lordosis was from 22 to 35° and from 23 to 37° in 1 st and 2 nd groups, respectively. No screw instability, bone tissue resorption around the screws and adjacent segment pathology was noted in group 1. Functional X-rays showed preservation of mobility (5+1.2°). In 2 nd group formation of pseudarthrosis was recorded in 5patients, adjacent segment pathology - in 20 including 5 patients who required repeated surgical intervention. Transpedicular lumbosacral spine fixation using nitinol rods is an effective technique that enables to preserve movements in lumbosacral spine in combination with stable fixation
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):19-24
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Modern Potentialities of Acetabular Osteosynthesis
Solod E.I., Lazarev A.F., Gudushauri Y.G., Kakabadze M.G., Sakharnykh I.N., Stoyukhin S.S.
Abstract
Analysis of long term (1-10 years) results for 64 patients aged 17-70 years with various types of acetabular fractures both isolated and in combination with multiple and concomitant injuries was performed. Operations were performed by low invasive technique using 7.3 mm diameter screws with flattened thread and threaded end 2.8 mm diameter. Excellent results by Harris scale were achieved in 45 (70%), good - in 12 (19%), satisfactory - in 7 (11%) patients. Advantages of single-step percutaneous osteosynthesis of acetabulum with fixation of other segments in multiple injuries are noted.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):25-32
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Results of Bone Plasty with Allografts in Revision Hip Arthroplasty
Zagorodniy N.V., Nuzhdin V.I., Bukhtin K.M., Kagramanov S.V.
Abstract
Results of 79 revision hip arthroplasties using bone defects plasty with allografts were analyzed. Plasty of defects in the zone of acetabulum was performed in 62 operations (group I), alloplasty of femoral defects - in 17 interventions (group II). Mean follow up period made up 5 (3-14) years. In group I excellent treatment results were recorded in 18 (29.03%) cases, good - in 23 (37.1%), satisfactory - in 15 (24.19%), poor - in 6 (9.68%) cases and in II group in 4 (23.53%), 6 (35.29%), 5 (29.41%) and 2 (11.76%) cases, respectively. It was shown that in revision arthroplasty application of allografts increased the risk of suppurative complication development while insertion of distal fixation revision stems enabled to avoid allograft application in femoral defects.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):33-39
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Experience in use of Wagner SL Revision Stem for Revision Hip Arthroplasty
Kavalerskiy G.M., Murylyov V.Y., Rukin Y.A., Kholodaev M.Y., Elizarov P.M.
Abstract
Experience in revision hip arthroplasty with change of femoral stem was analyzed for 165 patients. In 107 operations (64.8%) Wagner SL Revision Stems were used, in the rest of cases - femoral components of other manufacturers. Distribution of patients by femoral defect type by Paprovsky was the following: I type - 27 patients, II type - 75, IIIA type - 59, IIIB and IV type - 4 patients. Good results at use of Wagner SL Revision Stems and stems of other manufacturers were comparable and made up 87.9 and 86.2%, respectively. Achieved data enabled to make conclusion that Wagner SL Revision Stem use is reasonable for patients with hip implant instability in I-IIIA femoral bone deficit, as they are cheaper than the modular revision stems and their design prevents the wear in the area of modular junction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):40-45
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Injuries of ACL with Avulsion of Bone Fragment from Tibial Intercondylar Eminence in Children and Adolescents
Merkulov V.N., Dovluru R.K., El’tsin A.G., Mininkov D.S.
Abstract
Experience in arthroscopic treatment of 54 patients aged 5-18 years with ACL injury and bone fragment avulsion from the tibial intercondylar eminence is presented. Type I injury (by Meyers & McKeever - Zaricznyi classification) was diagnosed in 2 %, type II - in 49%, type III - in 40% and type IV - in 9% of patients. In patients with type I injury arthroscopic intervention was performed for concomitant injuries diagnosis and knee joint sanitation. In patients with II-IV types of injury arthroscopic osteosynthesis of tibial intercondylar eminence fractures with wire loop by original technique was performed. Excellent results were achieved in 44 (81.1%), good - in 7 (12.1%) and satisfactory - in 3 (6.8%) patients. Neither complications nor cases of nonunion were noted. Advantages of the proposed technique are the minimal traumatization of tibial growth zone, rigid fracture fixation, possibility to use this method of fixation in comminuted fractures
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):46-51
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Rational Choice of Treatment for Initial Stages of Gonarthrosis in Patients with Systemic Osteoporosis
Rodionova S.S., Es’kin N.A., Matveeva N.Y., Morozova N.S.
Abstract
Results of open controlled study of 60 outpatients aged 45-70 years, with systemic osteoporosis (postmenopausal and idiopathic) and I-II stages of gonarthrosis by Kellgren - Lawrence classification are presented. All patients were divided into 2 groups: study group (n=30) and control group (n=30). Additional treatment for gonarthrosis (Artra drug for 3 months) was prescribed only to patients from the study group. It was shown that study drug decreased significantly (p<0.001) pain intensity by VAS that was accompanied by either marked elimination or disappearance of synovitis by US study results. On the contrary, patients from control group showed trustworthy increase of pain intensity (p=0.015) by that term. Improvement of condition in study group was achieved in 90.4% of patients by physician’s assessment and in 95.5% by patients’ assessment. On the contrary, in control group aggravation of condition was observed in 75.0% and 84.8% of patients, respectively.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):52-56
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Peculiarities of Bone Tissue Regeneration at Application of Osteoplastic Material in Experimental Model of Purulent Bone Wound
Bugrov S.N., Mitrofanov V.N., Aleinik D.Y., Kulakova K.V., Zhivtsov O.P., Lekishvili M.V.
Abstract
Results of study of new osteoplastic material conditionally named «Kombas» were presented. That material consisted of nondemineralized animal collagen in a form of chips impregnated by vascular endothelium growth factor. The first step of experiment included in vitro study of the material was for cytotoxicity in diploid fibroblast cultures of 4-6 passages. At the second step purulent bone wounds were modelled in 36 Chinchilla rabbits. After debridement bone defect in the study group of animals (n=18) was filled with study material, in control group (n=18) the defect was not filled. Radiologic (X-ray, CT) and morphologic examination were performed at terms 1, 2 and 3 months. For objectification of the achieved data integral indices were proposed. Index of bone defect restoration in study group was 70% higher in 1 month, 47 % - in 2 months and 24% - in 3 months, as compared to the control group. In control group the index which characterized the completion of reparative processes exceeded that index in study group by 42% in 2 months and by 54% in 3 month of observation. Study results showed that elaborated material was not cytotoxic, possessed plasticity, marked osteoinductive and osteoconductive properties, as well as an ability to substitute bone tissue defects under conditions of purulent bone cavity in animal experiment.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):57-63
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Pathohistologic Changes in Hip Tissues and Clinical-Morphologic Correlations in Diseases Complicated by Femoroacetabular Impingement Syndrome
Grigorovskiy V.V., Filipchuk V.V., Kabatsiy M.S.
Abstract
The purpose of the work was to detect clinical-morphologic correlative dependences in patients with clinically marked femoroacetabular impingement (FAI) syndrome basing on the study of pathomorphologic changes in hip joint tissues, semiquantitative quantification of pathologic changes intensity, frequency analysis of their occurrence in nosologic groups of comparison. Study was performed on specimens of hip joint tissues - femoral head, acetabulum, acetabular labrum and joint capsule, resected during indicated corrective surgeries for femoral head aseptic necrosis and juvenile epiphysiolysis. Clinical-morphologic study revealed various pathologic changes: dystrophic-destructive, ischemic-necrotic and productive-inflammatory. In patients with FAI syndrome clinical and morphologic correlative dependences varied by absolute value, sign and degree of reliability of association coefficient parameters, i.e. groups of patients with certain nosologic units retained the peculiarities of rate and characteristics proportions in correlative dependences
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):67-73
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Applied Anatomy of Median and Ulnar Nerve Branches in Operations for Forearm Muscles Neurotization
Golubev I.O., Zhuravlyov S.A.
Abstract
To determine the potentialities of median nerve motor branches neurotization by the ulnar nerve and vice versa the anatomy of muscular branches of median and ulnar nerves in the forearm was studied in detail. Study was performed on 20 upper extremities from 10 adult cadavers. The number of branches, their length and precise place of divergence from the main trunk were assessed. It was stated that topographic anatomy of muscular branches of the median and ulnar nerves in the forearm was quite invariable. For neuratization from the median nerve the longest branches that passed to pronator teres muscles and superficial flexor muscle of fingers can be used; from the ulnar nerve - long branch to the ulnar flexor muscle of wrist.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):74-77
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Method to Analyze the Complications in Traumatology and Orthopaedics Based on the Form of Recording the Conformity of Fragment Biomechanical Characteristics with Fixator Arrangement
Kesyan G.A., AV Z.V., AV T.V., Kuz’menkov K.A.
Abstract
The most common mistake resulting in the development of pseudarthrosis and suppuration is inadequate choice of metal construction that prevents from performing biochemically substantiated osteosynthesis. A form for recording the conformity of bone fragment biomechanical characteristics with fixator arrangement that enables to plan surgical intervention as well as to perform retrospective analysis of osteosynthesis quality regardless of the type of chosen metal construction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):78-82
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Experience in Transosseous Arthroscopic Restoration of Shoulder Rotator Cuff
Lomtatidze E.S., Kubashev A.A., Belyak E.A., Lazko F.L., Prizov A.P.
Abstract
Results of arthroscopic treatment for 10 patients (10 shoulder joints) with rotator cuff rupture using transosseous suture are presented. Mean age of patients made up 49 (38-63) years. In 2 cases the size of defect was under 1 cm, in 6 cases - 1-3 cm, in 2 cases - 3-5 cm. Mean score by UCLA scale was 13 (8-14) preoperatively and 26 (24-28) in 3 months after intervention. Advantages of the described technique include rapidity of performance, low price and provision of anatomic restoration of injured structures.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):83-85
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Low Invasive Achilles Tendon Suture in Outpatient Surgery Using Achillon System
Samkov A.S., Zeinalov V.T., Panov D.E., Koryshkov N.A., Ivanov K.S., Khodjiev A.S., Sobolev K.A.
Abstract
Experience in treatment of 10 patients with Achilles tendon subcutaneous traumatic rupture is presented. All patients were men aged from 30 to 54 years. Remoteness of injury was under 10 days. All operations were performed using Achillon system. Follow up period made up from 6 months to 2 years. In 9 patients complete restoration of tendon function with good excursion in the suture zone was confirmed by US examination. In 1 patient failed suture in 8 weeks after surgery required an open tendon suturing. Achillon system combines all possibilities of open suture and advantages of low invasive technique and can be recommended to application in outpatient practice.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):86-89
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New Method for 3D-Testing of Spinal Stabilizer Muscles
Mironov S.P., Tsykunov M.B.
Abstract
Data on testing of spinal stabilizer muscles using isokinetic dynamometer are presented. It is shown that achieved test results enable to detect muscular imbalance even at subclinical level and to elaborate individual rehabilitation programs.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):90-94
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Ju.I. Ejov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):95-95
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I.G. Grishin
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(2):96-96
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