Vol 22, No 2 (2015)

Articles
Early and Mid-Term Results of Primary Hip Arthroplasty Using Il’za Endoprosthesis
Mironov S.P., Balberkin A.V., Zagorodniy N.V., Karpov V.N., Kolondaev A.F., Shavyrin D.A., Snetkov D.A.
Abstract
The problems of hip arthroplasty under conditions of wide introduction of that surgical intervention into clinical practice and the perspectives of cementless wedge-shaped femoral stems use are discussed on the example of high-technology home endoprosthesis “Il’za” are discussed. Technical characteristics of the implant, peculiarities of surgical procedure with its application, early and mid-term clinical and roentgenologic results of 581 operations are considered. Stable deterioration of hip function has been noted in 1, 2 and 3 years after operation - from 37.6 points by Harris hip score to 89.3, 92.2, and 89.1 points, respectively. Survival of the femoral component in 6 years after arthroplasty made up 98.6%, general survival - 96.2%. Universality of this femoral component that enables to achieve its stable primary and secondary fixation in the absolute majority of patients is proved. The achieved data allow to talk of the reliability of wedge-shaped femoral hip stems and significant prospective for their use in wide clinical practice.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):5-12
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Risk Factors for Periprosthetic Infection after Large Joint Arthroplasty
Slobodskoy A.B., Osintsev E.Y., Lezhnev A.G., Voronin I.V., Badak I.S., Dunaev A.G.
Abstract
Risk factors for the development of purulent complications after large joints arthroplasty were studied by the results of 3641 operations (3210 patients). Hip, knee, shoulder and elbow arthroplasty was performed in 2523, 881, 105 and 132 patients, respectively. Hip and knee revision replacements were performed in 221 cases and in 492 cases surgical interventions were performed for dysplastic coxarthrosis, congenital and acquired deformities, under conditions of bone tissue deficit and other complicated cases. Three hundred fifty one patients were operated on due to acute injury. Periprosthetic infection was diagnosed in 58 cases (1.59%). It was stated that risk factors for periprosthetic infection development included severe concomitant pathology (diabetes mellitus,operations somatic diseases, degree of their severity and duration, HIV infection and other conditions), surgical interventions for dysplastic coxarthrosis and complex total hip replacement. In those cases the risk of complications increased by 1.5-3.5 times. Pyo-inflammatory process in the area of hip joint in history as well as every repeated surgery on the hip increased therisk of postoperative complications significantly. No differences in complication rate depending on the type of fixation and implant manufacturers were noted.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):13-18
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Magnetic Resonance Imaging of the Whole Body (DWIBS). Potentialities and Perspectives for Application in Bone Pathology
Morozov A.K., Makhson A.N., Karpov I.N.
Abstract
The purpose of the study was to determine the role and place of whole body MRI with DWIBS in diagnosis of human loco-motor system oncologic pathology. Two hundred fifty six patients with presumptive diagnosis of oncologic disease were examined. Obtained signal was evaluated by true signal intensity scale in minimal examination volume (voxel), either drawn through the volumetric lesion or in an isolated area of arbitrary shape. Study results were verified using standard MRI protocols (T1, T2, STIR), contrast enhancement, MSCT, radionuclide and morphologic examination. High sensitivity of the technique to pathologically changed tissues with reduced water diffusion coefficient was demonstrated. Magnetic resonance diffusion-weighted whole-body imaging with DWIBS may be recommended as noninvasive screening technique for the diagnosis of both primary and secondary (metastases) oncologic process.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):19-24
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Early Outcomes of Reverse Shoulder Arthroplasty for Tumors of the Humerus
Karpenko V.Y., Derzhavin V.A., Bukharov A.V., Danilova T.V., Andreev M.S.
Abstract
At present in 90% of patients with malignant tumors of long bones and large joints the organ-saving intervention - oncologic joint replacement can be performed. The risk of complications after such operations on the upper extremity is low however the adequate functional results can not be achieved. The analysis and evaluation of oncologic and functional results after application of anatomic (group 1, n=28) and reverse (group 2, n=14) shoulder prostheses in patients with proximal humerus tumors was performed. Mean age of patients made up 32±4 and 38±3 years in the 1st and 2nd groups, respectively. Primary bone tumors were diagnosed in 19 (68%) patients from the 1st and 12 (86%) patients from the 2nd group. Mean follow up period was 42 months. Progression of the disease at terms from 6 to 14 months was observed in 4 patients with primary malignant bone tumors. Functional result by MSTS scale was 60-80% in 3, 40-60% in 6 and under 40% in 19 patients from the 1st group. In 2nd group functional result ranged from 80 to 100% in 6, from 60 to 80% in 6 and from 40 to 60% in 2 patients. Application of modular reverse prosthesis for the treatment of patients with proximal humerus tumors is a perspective technique as it enables to increase functional result and social adaptation of patients significantly.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):25-30
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Predictors of Vein Thrombosis at Lower Limb Joints Arthroplasty in Oncologic Patients
Garyaev R.V., Rychkov I.A.
Abstract
Purpose of the study was to detect the factors that stipulated risk of vein thrombosis at arthroplasty of lower limb joints in oncologic patients. Retrospective data on 374 patients after hip and knee arthroplasty aa well as after total femur replacement were studied. The following risk factors were studied: age, gender, weight, height, body mass index, preoperative hemoglobin level, tumor morphology, presence of pathologic fracture, use of tranexamic acid, tourniquet application, type of regional anesthesia, intraoperative blood loss, duration of surgical intervention. Statistical analysis was performed using the method of multifactorial logistic regression. Independent risk factor for perioperative vein thrombosis was the age of patient (likelihood ratio χ2=26,6; р=0,000) In patients of 40 years and older the rate of thrombosis was higher as compared to younger ones: 24.4% (31/127) versus 6.1% (15/247); p =0.000; odds ratio 5; 95% confidence interval 2.6 - 9.7. Preoperative risk of vein thrombosis increased not only with patient’s age but in presence of pathologic fracture as well (likelihood ratio χ2 = 29,8; р=0,000) Other studied factors did not increase the rate of thrombosis. In presence of pathologic fracture the possibility of early anticoagulant therapy should be considered. Both prolonged epidural and peripheral nerve blockades can be used at such surgical interventions without risk of vein thrombosis rate increase.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):31-35
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Russian Experience in Rational Thromboprophylaxis in Traumatology and Orthopaedics
Firsov S.A., Levshin A.G., Matveev R.P.
Abstract
Analysis of safety and efficacy of the currently marked peroral anticoagulants was performed in long term follow up of patients after large joints arthroplasty. Total number of 5025 patients after total knee arthroplasty and 5216 patients after total hip arthroplasty were examined. All patients were divided into groups depending on the prescribed anticoagulant. The course of anticoagulant therapy made up 35 days and 6 weeks after surgery, respectively. US examination of the veins of lower extremities was performed to all patients prior to and on day 5 after operation. In patients on Dabigatran the rate of clinically significant deep vein thrombosis was lower than in group of patients on Rivaroxaban and Apixaban, but the rate of postoperative hematomas in lust two groops was higher.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):36-42
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Treatment of Patients with Ruptures of Clavicular Acromial End using Designed Pin and Cortical Screw
Danilov M.A., Borozda I.V.
Abstract
Comparative treatment results are presented for 154 patients with closed injuries of the acromioclavicular joint. Main group included 34 patients who were operated on using the proposed fixation technique with designed K-wire and screw. The technique was elaborated with regard for the data of biomechanical studies. In control group (120 patients) fixation was performed with Lee hook ( n =76), K-wires ( n =25) and hook plate ( n =19). Proposed method was considered to be an effective (95.5 points by Constant-Murley score) and low-cost treatment technique characterized by short terms of hospitalization, (13.0±0.71 days) and temporary disability (40.4±0.71) days as well as by low rate of postoperative complications (3 (8.8%) cases).
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):43-49
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Iatrogenic Supraclavicular Nerve Injuries in Surgical Treatment of Clavicle Fractures
Zolotov A.S., Feshchenko M.S., Pak O.I.
Abstract
Incidence and pattern of disturbed sensitivity in the zone of surgical intervention was studied in 24 patients with clavicle fractures. Traumatic damage of supraclavicular nerve (not related to surgery) was observed only in 1 case. Disturbance of sensitivity in the zone of surgical intervention was noted in 21 (87.5%) patients. Mean area of anesthesia made up 44.5±29.3 cm2 (from 8.0 to 125.5 cm2). That complication developed at both horizontal and vertical surgical approaches. Intraoperatively supraclavicular nerves were visualized and preserved in 6 patients however disturbed sensitivity in early postoperative period was observed in 4 cases. Preventive isolation of supraclavicular nerves does not always ensure the preservation of sensitivity in early postoperative period.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):50-54
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S.S. Rodionova
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N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):54-54
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Comparative Evaluation of the Results of Surgical and Conservative Treatment of Planovalgus Foot Deformity in Children
Kozhevnikov O.V., Kosov I.S., Ivanov A.V., Gribova I.V., Bolotov A.V.
Abstract
Comparative evaluation of treatment results was performed for 122 patients, aged 1.5 - 18 years, with planovalgus foot deformity. Complex treatment included surgical intervention (modification of foot reconstruction by Kummer-Kouel-Ramsey, subtalar joint arthroereisis and two step combined technique) in combination with the method of functional biomanagment. Results were assessed at terms from 6 months to 4 years basing on the data of objective instrumental examinations (computed podography, roentgenography, electromyography) and the data on the international AOFAS system. It was stated that conservative treatment ensured stabilization of the condition and increase of mean point by AOFAS scale made up 5.82. In the same time complex treatment contributed to the restoration of osteoarticular interrelation and ensured functional competence. Mean estimate by AOFAS scale increased by 29.48 pointsin that group of patients. Positive results of complex anatomo-functional approach to the treatment of children withplanovalgus deformity enable to consider the proposed technique as a prospective one.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):55-59
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Main Problems in Organization of Specialized Medical Care, Including High-Tech Traumatologic and Orthopaedic Care, to Children in Novosibirsk Region
Shalygina L.S., Myl’nikova T.A., Finchenko E.A.
Abstract
Complex evaluation of the state and organization of specialized medical care, including high-tech traumatologic and orthopaedic care, to children in Novosibirsk region is presented. Official statistic data from CITO named after N.N. Priorov, Health Ministry of Novosiborsk region and basic indices of the Health Ministry of Novosiborsk region for 2005-2012 have been used. The main problems in organization of expert traumatologic and orthopaedic care to children in Novosibirsk region were identified: poor diagnosis of osteomuscular system diseases resulting from insufficient training of trauma and orthopaedic surgeons, general and pediatric surgeons; imbalance in territorial distribution of the staff. All that condition low availability of expert medical care for rural population, including the high-tech one; imbalance in the volume of medical care; non-compliance of bedspace structure with the recommended standards (deficit of orthopaedic beds); low level of medical rehabilitation; insufficient volumes of high-tech medical care. The revealed shortcomings should be taken in consideration at elaboration of measures directed to the perfection of specialized traumatologic and orthopaedic care to children in Novosibirsk region.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):60-65
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Radical Dorsal Interventions in Treatment of Kyphotic Deformities (Literature Review)
Mikhailovskiy M.V., Novikov V.V., Udalov I.G.
Abstract
Widely used in clinical practice surgical interventions directed to the correction of severe kyphotic spine deformities, i.e. Ponte osteotomy, Smith-Peterson osteotomy, pedicle subtraction osteotomy and vertebral column resection are presented. Surgical techniques, surgery planning based on spinal and pelvic sagittal contour parameters, treatment results are described.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):66-75
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Hip-spineSyndrome and its Significance in Complex Treatment of Patients with Combination of Degenerative Dystrophic Pathology of Hip Joint and Spine (literature review)
Kudyashev A.L., Khominets V.V., Shapovalov V.M., Miroevskiy F.V.
Abstract
In foreign literature a combination of degenerative dystrophic changes in hip joint and lumbosacral spine accompanied by their mutual aggravation is referred to as hip-spine (coxo-vertebral)syndrome. This pathologic condition is characterized by the variety of clinical forms, morphologic manifestations and degrees of the pathologic process intensity that predetermines objective difficulties in diagnosis and treatment of such patients. The main role in the process of degenerative dystrophic changed development is played by biomechanical factors including vertebropelvic relationships. In the overwhelming majority of patients with coxarthrosis the low back pain is caused by the changes in spinal motion segments that progress with the development of hip deforming arthrosis resulting in biomechanical disorders. All that leads to objective difficulties in diagnosis of this complex pathology and patients’ dissatisfaction with the hip arthroplasty results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):76-82
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Revision Hip Arthroplasty: Epidemiology, Causes, Risk Factors (foreign literature review)
Kaminskiy A.V., Marchenkova L.O., Pozdnyakov A.V.
Abstract
Publications related to revision hip arthroplasty were analyzed. Data of National Registers from different countries were presented, problems of epidemiology and prognostication of need in revision arthroplasty were highlighted, the causes (demographic, clinical, surgical, rehabilitation) and the most significant risk factors that conditioned the failure of primary hip arthroplasty were described.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):83-89
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Nikolay Nikolaevich Priorov - Life Devoted to Traumatology and Orthopaedics (In commemoration of 130th anniversary of birth)
Knopov M.S., Taranukha V.K.
Abstract
The article presents the life and creative path of the outstanding home trauma and orthopaedic surgeon, talented public health organizer, noted man of science, founder of prominent scientific school, Academician of USSR AMSc, Honored Science Worker of RSFSR Nikolay Nikolaevich Priorov.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(2):90-92
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