Vol 20, No 3 (2013)

Articles
Radionuclide Evaluation of Pulmonary Perfusion in Patients with Severe Thoracic Scoliosis Before and After Surgery
Karalkin A.V., Lisyanskiy I.N., Kuleshov A.A., Vetrile M.S.
Abstract
The purpose of the study was to evaluate the influence of severe scoliosis surgical correction upon pulmonary microcirculation. The study included 8 patients aged 12— 27 years with severe thoracic scoliosis. Angle deformity by Cobb ranged from 80 to 140° (mean 120.4°). Deformity correction and fixation was performed on the concave side of thorax using multilevel CotrelDubousset instrumentation (CDI) and elevating thoracoplasty (ET). Perfusion radionuclide pulmonary scintigraphy was performed prior to, 3 months and 1 year after surgery. Analysis of pulmonary scintigrams included both the qualitative (visual) and quantitative assessments. Besides, examination of external respiration function (spirometry and spirography) was performed. Mean postoperative Cobb angle made up 67.4°. No loss of correction was noted. Prior to surgical intervention pulmonary scintigrams showed deformation of lung fields, displacement along the vertical axis towards opposite to curvature side, decreased perfusion in the zone of intercostal retraction on the concave side of thorax. Postoperatively restoration of vertical axis, increase of lungs size and improvement of perfusion were observed. Mean vital lung capacity increased from 1510 (540-2280) to 2090 (640-3010) ml. Thus, combined application of CDI and ET enabled to perform adequate correction of severe thoracic scoliosis as well as to improve pulmonary microcirculation and radionuclide perfusion scintigraphy was a highly informative method for the evaluation of lung condition.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):3-10
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Transfemoral Approach at Revision Hip Arthroplasty
Zagorodniy N.V., Nuzhdin V.I., Bukhtin K.M., Kagramanov S.V.
Abstract
Results of 41 revision hip arthroplasties (41 interventions) via transfemoral approach were analyzed. That approach was used in stem fracture — 12 (29.26%) cases, cement removal — 20 (48.78%) cases and removal of partially ingrown cementless stem — 9 (21.95%) cases. Techniques of window, oblique, longitudinal oblique osteotomy and resection of greater trochanter were applied. As compared with standard revision intervention the duration of operation was about 40 minutes longer (159 min versus 125 min) and blood loss increased almost for 1 liter (2240 ml versus 1510 ml). Intraoperative complications were registered in 5 (12.20%) patients including 1 case of transverse femur fracture at oblique osteotomy (2.44%), 1 case of femur fracture at window osteotomy (2.44%), 2 cases of greater trochanter fracture (4.88%), 1 case of femoral cortical perforation by the cutter at distal stem fragment removal (2.44%). Excellent and good results were obtained in 30 (73.17%) patients. Indications to every type of transfemoral approach are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):11-17
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Use of Spacers for the Treatment of Deep Periprosthetic Infection of Hip and Knee Joints
Murylyov V.Y., Kholodaev M.Y., Rukin Y.A., Lychagin A.V., Karpov V.V., Rimashevskiy D.V., Elizarov P.M.
Abstract
Experience in treatment of 27 patients with deep periprosthetic infection is presented. In 17 patients infectious process was localized in the zone of hip implant, in 10 patients — in the zone of knee implant. Sanitation without implant removal was performed in 2 cases of early deep infection. Two-step revision arthroplasty was performed in 25 patients with late deep infection. First the implant was removed and spacer was inserted, then spacer was changed for a revision implant. In 12 patients individual articulating spacers with antibiotics were used. No relapse was noted in 23 patients at terms up to 58 months. Thus, two-step revision arthroplasty with application of spacers showed its high efficacy in treatment of patients with late deep periprosthetic infection.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):18-24
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Role of Girdlestone Operation in Treatment of Infectious Complications after Total Hip Arthroplasty
Khon V.E., Zagorodniy N.V., Zhadin A.V., Kuz’menkov K.A., Tsiskarashvili A.V.
Abstract
During the period from 2001 through 2012 one hundred forty eight patients (mean age 49 years) underwent surgical intervention for periprosthetic pyo-inflammatory complications. Removal of joint implant was performed in terms from 1 month to 25 years after total hip replacement. In 105 (72.4%) patients Girdlestone operation was performed after primary and in 43 (27.6%) — after revision arthroplasty. Removal of joint implant, hip fistulosequestrnecrectomy and weight bearing neoarthrosis formation was performed. For neoarthrosis formation in acetabular dysplasia and vast resection of proximal femur an external fixation device was used. Good results were achieved in 68 (70.8%) patients: inflammatory process was arrested and weight bearing ability of the limb was restored. Satisfactory result was observed in 28 (29.2%) patients. In 15 (15.6%) out of them inflammatory process was cupped off but no adequate weight bearing neoarthrosis was formed. Girdlestone operation is the last possibility to restore the weight bearing ability of the limb and is used in patients in whom revision arthroplasty cannot be performed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):25-30
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Arthroscopic Reconstruction of Anterior Cruciate Ligament with Allogenic Lyophilized Patellar Ligament Graft
Tretyakov V.B., Malyuchenko L.I.
Abstract
Comparative analysis of long-term outcomes of arthroscopic intervention for 373 patients with isolated ACL injuries was performed. Surgical interventions were performed using arthroscopic technique and block (bone—tendon—bone) allograft of patellar ligament. In 95 patients lyophilized block allograft from patellar ligament was used as a plastic material. Histologic and biochemical results of allogenic graft examination confirmed the preservation of tendinous tissue structure and strength characteristics after lyophilization and radiation sterilization (г-irradiation). Initial condition and long-term surgical outcomes were evaluated by IKDC scale: mean score prior and after surgery made up 50.96 and 81.23 (p<0.05), respectively. Treatment results between the groups were comparable. Mean follow up period was 1.5 (1—3) years. Obtained results showed that arthroscopic ACL reconstruction using lyophilized block allografts from patellar ligament was an effective and save treatment technique which enabled to achieve good clinical results in joint stabilization and correction injured ACL proprioceptive function.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):31-35
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Arguments and Facts of Thrombosis Prophylaxis in Surgical Traumatology and Orthopaedics
Lazarev A.F.
Abstract
Modern data on the rate of venous thromboembolism development after orthopaedic surgeries as well as the results of international prospective ETHOS study (17 countries including Russia, 161 centers) are presented. The aim of the study was to assess post-operative venous thromboembolism prophylaxis prescribed and received in patients after high-risk orthopaedic surgeries (total hip arthroplasty, femur osteosynthesis, total knee arthroplasty) as compared with the 2004 American College of Chest Physicians (ACCP) guidelines. Peculiarities of thrombosis prophylaxis in Russia centers are shown.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):36-42
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Interdigital Hyperkeratosis of the Foot: Orthopaedic Approach to Surgical Treatment
Berezhnoy S.Y., Protsenko A.I., Kostyukov V.V.
Abstract
Surgical treatment results for 27 patients with interdigital keratosis of the foot were analyzed. To determine the predisposing factors for keratosis development data of clinical and roentgenologic examination were used. In all cases transcutaneous technique that enabled to avoid surgical intervention directly on a pathologic focus was applied. Mean follow up period made up 6 months. It was shown that transcutaneous surgical intervention was an effective and reproducible method for interdigital keratosis treatment. That technique provided positive results with minimum risk of postoperative complications in the majority of cases and could be used at outpatient department.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):42-45
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Surgical Treatment of Talus Osteochondral Lesions with Platelet-Rich Plasma
Muradyan D.R., Kesyan G.A., Levin A.N., Kesyan O.G., Mazur A.V., Kravec I.M.
Abstract
Wide application of cell therapy particularly platelet enriched plasma (PRP) in modern orthopaedics enabled to improved treatment results in certain orthopaedic diseases and injury consequences. Treatment results for 7 patients (2 men and 5 women) with osteochondral lesions of talus (OLT) are presented. Mean age of patients was 26 years, mean duration of disease — 4 years. By Brendt and Harty roentgenologic classification I—II degree of OLT was diagnosed in 1 and III—IV degree — in 6 patients. In all patients mosaic chondroplasty of talus with implantation of PRP gel was performed. Postoperatively mean AOFAS index raised from 53 to 92. Follow up period made up around 2 years.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):46-50
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Surgical Treatment of Malunited Fractures of Radius Distal Metaepiphysis
Golubev I.O., Krupatkin A.I., Maksimov A.A., Merkulov M.V., Bushuev O.M., Shiryaeva G.N., Kutepov I.A., Grishin V.M.
Abstract
Sixty three patients with malunited distal radius were treated on from 2008 through 2012. Out of them complex regional pain syndrome was diagnosed in 12 and carpal canal syndrome — in 4 patients. Basing on the examination results the roentgenologic classification of malunited distal radius that enabled to determine the surgical tactics was suggested. Main type of surgical intervention was corrective osteotomy. When radius shortening exceeded 3 mm bone graft from the crest of upper flaring portion of the ilium was used. In patients with complex regional pain syndrome paravasal sympathectomy was performed additionally. In I—II stage of carpal canal syndrome only corrective osteotomy was performed while in II-III stages additional release of hypertrophic transverse carpal ligament and neurolysis in the zone of compression and ischemia were performed. In 12 months after surgery mean score by DASH scale decreased from preoperative 62.2±8.0 to 19.6±7.0 (p<0.0001). Percentage of range of movement restoration in the operated joint varied from 71—75% (flexion-extension) to 93% (pronation-supination) as compared to the health extremity.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):51-58
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Treatment Results for Patients with Proximal Humerus Fractures
Nabiev E.N.
Abstract
Surgical treatment results for 135 patients with proximal humerus injuries are presented. According to AO classification type A fractures were diagnosed in 86 (63.7%), type B — in 44 (32.5%) and type C — in 5 (3.8%) patients. In 53 (39.3%) patients osteosynthesis with devices elaborated at clinic were used. Treatment results showed that in young and middle aged patients with good bone tissue quality with type A fractures T- and L-shaped fixatives and elaborated at clinic device that provided interfragmental compression should be used. In patients with type B fractures and low bone density either sparing synthesis by Weber — Muller or elaborated at clinic device with blocking screws and in patients with type C fractures — either synthesis with pins or primary shoulder arthroplasty were recommended.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):59-64
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Efficacy and Safety of Two-Level Block of Brachial Plexus in Surgeries on Proximal Upper Extremity
Dubinenkov V.B., Lyuboshevskiy P.A., Larionov S.V., Zvorygina M.S., Koryshkov N.A.
Abstract
Study results for 71 patients (mean age 58.3±3.4 years) who were operated on for the injury of shoulder joint, upper and middle humerus are presented. Surgical intervention was performed under regional anesthesia. Block of superficial cervical plexus and intercostobrachial nerve was applied in all cases. Additionally in the main group (n=37) two-level block of brachial plexus (BBP): interscalene blockade in complex with supraclavicular one was used, in control group (n=34) — one-level block, i.e. either interscalene or supraclavicular was performed. Pain syndrome was assessed by visual analogue scale. It was shown that in surgical interventions on proximal upper extremity two-level BBP provided higher quality of anesthetic effect and postoperative analgesia, enabled to decrease the expenditure of opioid analgesics within the first postoperative day and, hence, the risk of related side effects development. Number of complications was not significantly different between the two groups.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):65-68
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Revision of Sivash Endoprosthesis 41 Years after Primary Operation
Zagorodiy N.V., Nuzhdin V.I., Bukhtin K.M., Kagramanov S.V.
Abstract
Clinical observation of a female patient who at the age of 16 underwent total hip replacement by Sivash implant due to congenital left hip dislocation is presented. The reason for revision intervention that was performed in 41 years after primary arthroplasty was the fracture of the implant stem. The stem was removed via 2 transfemoral approaches. Modular revision stem for distal fixarion was implanted. Treatment result is considered to be satisfactory: no pain is present and weight bearing ability is restored.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):69-73
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Treatment of Haglundfs Syndrome
Butaev B.G., Prostko V.G., Mastakyan A.M., Tamoev S.K., Abakarov I.A.
Abstract
Experince in treatment of 45 patients with HaglundTs syndrome was presented. In 24 patients open operative technique was applied, 21 patients were treated using endoscopic technique. In 33 out of 45patients treatment results were evaluated 6-24 months after operation. Four criteria took into account: amplitude of foot motion, extremity function, pain intensity and satisfactory of patients. Excellent and good results were achieved in 13 patients after open operation and 15 patients after arthroscopic operation. Advantages of intervention using arthroscopy were shown.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):73-76
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Importance of Bone Tissue Quality in Risk of Osteoporotic Fracture Development
Rodionova S.S.
Abstract
Evaluation of the importance of quantitative and qualitative characteristics of bone in provision of its strength is given on the basis of the results of own studies of strength of the bioptates from the upper flaring portion of the ilium and literature review. Techniques for invasive and noninvasive evaluation of bone strength assessment and possibilities to use achieved data for the prognostication of risk of fractures that is important both scientifically and practically as enables to prescribe treatment timely are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):77-81
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Treatment Methods of Posttraumatic Defects of Extremity Long Bones
Kalenskiy V.O., Ivanov P.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):81-87
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Syndrome of Traumatic Spinopelvic Dissociations: Diagnosis, Surgical Treatment Techniques
Donchenko S.V., Slinuakov L.Y., Chernyaev A.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):88-92
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In Commemoration of the 90th Anniversary of M.V. Volkov
Mikhailova L.K.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):93-93
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In Commemoration of the 100 Anniversary of V.A. Emelyanov
Ovsyankin A.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):94-94
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