Vol 18, No 1 (2011)

Articles
Use of Cellular Technologу at Surgical Correction of Congenital Lower Limb Length Discrepancy in Children
Mironov S.P., Omel'yanenko N.P., Kozhevnikov O.V., Il'ina V.K., Ivanov A.V., Karpov I.N., Lazarev V.A., Mironov S.P., Omel'yanenko N.P., Kozhevnikov O.V., Il'ina V.K., Ivanov A.V., Karpov I.N., Lazarev V.A.
Abstract
First results of application of cultivated autologous stromal bone marrow cells for the stimulation of distraction bone regenerates' reparative regeneration in 8 patients aged from 3.7 to 16 years with congenital lower extremity length discrepancy (main group) are presented. In 24 children with similar pathology aged from 2.5 to 14 years (control group) no cellular technology was used. In the main group duration of treatment reduces to 4.5-6.5 months versus 7.5- 11 months in the control one. That enabled to avoid potential complications related to the long-term fixation of the extremity in the distraction apparatus.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):3-9
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Restoration of Bone Tissue in Femoral Condyles' Critical Defect in Rabbits Using Bioresorbable Calcium Carriers and Multipotent Mesenchymal Stromal Cells
Mamonov V.E., Shipunova I.N., Svinareva D.A., Proskurina N.V., Ryashentsev M.M., Chemis A.G., Glasko E.N., Drize N.I., Mamonov V.E., Shipunova I.N., Svinaryova D.A., Proskurina N.V., Ryashentsev M.M., Chemis A.G., Glasko E.N., Drize N.I.
Abstract
Study of the efficacy of autologous bone marrow multipotent mesenchymal stromal cells (MMSC) with bioresorbable calcium carriers for the restoration of bone tissue in the site of critical distal femur spongy bone defect was performed in rabbits. System of rabbit's MMSC cultivation has been elaborated. After 2 - 3 passages MMSC were placed on bioresorbable calcium carriers and implanted into the site of preliminary created defect with 6 cm diameter. It was shown that implantation of MMSC in combination with bioresorbable carriers into the defect resulted in filling of spongy bone defect within 6 months after operation. The data obtained open promising perspectives for the application of MMSC in combination with appropriate carriers in tissue engineering for the treatment of vast skeleton injuries.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):10-15
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Use of Reconstructive Microsurgery Technologies in Complicated Knee Joint Arthroplasty
Tikhilov R.M., Kochish A.Y., Rodomanova L.A., Kutyanov D.I., Afanas'ev A.O., Tikhilov R.M., Kochish A.Y., Rodomanova L.A., Kutyanov D.I., Afanas'ev A.O.
Abstract
Results of surgical treatment of 19 patients in whom total knee replacement was performed in combination with various reconstructive microsurgical operations were analyzed. It was shown that application of microsurgical technologies provided new potentialities in total knee arthroplasty first of all in atypical and complicated cases. Advantages of step-by-step treatment presupposing firstly the restoration of integument in the knee joint region followed by its total arthroplasty were revealed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):16-21
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New Potentialities in Surgical Treatment of Proximal Humerus
Solod E.I., Lazarev A.F., Gudushauri Y.G., Kakabadze M.G., Roskidaylo A.S., Lazarev A.A., Solod E.I., Lazarev A.F., Gudushauri Y.G., Kakabadze M.G., Roskidailo A.S., Lazarev A.A.
Abstract
Original method of stressed osteosynthesis for the treatment of proximal humerus is proposed. Primary tension of Y-shaped pin fixative and secondary tension that is created at its intramedullar insertion and blocking enable to achieve stable fixation of fragments without inflicting additional intraoperative injury in patients of any age and independently of their general condition. Preservation of blood supple in fragments, low traumatic osteosynthesis, and possibility of patients' early rehabilitation define the prospective of this technique for the treatment of patients with fractures on the background of osteoporosis. The importance of drug therapy for osteoporosis in the early postoperative period is shown. Experience in treatment of 62 patients aged from 23 to 78 years is presented. Control group included 30 patients with similar fractures who were treated using osteosynthesis. In the main group good results were achieved in 82.3% of patients, satisfactory - in 17.7%, no poor results were observed. In control group good results made up 40%, satisfactory - 56.7%, poor 0 3.3%.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):21-27
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Development of Hip Joint in Early Aged Children after Open Hip Reduction
Pozdnikin I.Y., Pozdnikin I.Y.
Abstract
Peculiarities of hip joint development after its open reduction were studied in 45 early aged children. Depending on the pathology severity, terms of treatment initiation and its quality the types of postoperative hip joint development were determined. It was shown that open hip reduction was most effective in children under 12-15 months old on condition of early detection of hip irreducibility and refusal of repeated attempts of closed reduction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):28-32
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New Method for the Treatment of Early Forms of Femoral Head Aseptic Necrosis (Preliminary Report)
Akhtyamov I.F., Anisimov O.G., Budyak Y.V., Kovalenko A.N., Korotkova A.S., Akhtyamov I.F., Anisimov O.G., Budyak Y.V., Kovalenko A.N., Korotkova A.S.
Abstract
The authors have elaborated a new method for conservative treatment of femoral head aseptic necrosis (FHAN) at early stages of the disease (prior to cartilaginous layer collapse). The method consists of performance of prolonged epidural analgesia by administration of local anesthetic through epidural catheter with dosed speed for 6 - 8 days. Drug sympathectomy results in vascular tension drop that favours the improvement of microcirculation in hip joint region. Results of that method application in 24 patients show that it enables to cup off the pain syndrome and restore patient's functional abilities directly after treatment course completion. Remission lasts for up to 12 months. Application of the proposed method enables to postpone performance of total hip arthroplasty for the period of up to 6 years.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):33-37
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Use of Implants on the Basis of Silicium Monocrystals for Prevention of Extremities' Deformity in Physis Damage (Experimental Study)
Nikityuk I.E., Garkavenko Y.E., Nikityuk I.E., Garkavenko Y.E.
Abstract
Experimental study of the influence of crystalline silicium upon the damaged physis of the proximal femoral growth zone was performed in 24 Chinchilla rabbits. Defect of growth zone was created by drilling (2.6 mm in diameter). In first experimental group a metallic screw was inserted into the created defect. In the second group silicium monocrystal 5x5x0.5 mm was placed into the defect next to the metallic screw. In control animals only the defect was created. In animal from 1st and control groups roentgenological picture showed the development of deformity in the operated extremity. No deformity was detected in animals from 2nd experimental group. Positive effect of crystalline silicium upon the damaged growth zone function was noted. Further study of this phenomenon may be perspective for the elaboration of new implantation materials with a view to stimulate regeneration of affected physis, preservation of its function, bones deformity prevention and correction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):38-43
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Reconstructive Operations in Malunited Fractures of Distal Radius Epimetaphysis
Mel'nikov V.S., Korshunov V.F., Mel'nikov V.S., Korshunov V.F.
Abstract
Experience in surgical treatment of 112 patients with malunited fractures of distal radius epimetaphysis is presented. Indication to surgical intervention was fragments consolidation with displacement that was accompanied by marked wrist joint deformity and hand function disturbance. In all patients osteotomy and bone plasty were performed followed by application of distraction device. In the postoperative period dosed distraction of bone fragments up to their complete reposition and rehabilitation treatment was performed. Long term results were assessed for all 87 patients: good result was achieved in 67 (77%), satisfactory - in 17 (19.5%) and poor - in 3 (3.5%) patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):43-47
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On Pathogenesis of Recurrent Club Foot
Kosov I.S., Kozhevnikov O.V., Mikhaylova S.A., Kralina S.E., Kadzhaya L.K., Kosov I.S., Kozhevnikov O.V., Mikhailova S.A., Kralina S.E., Kadzhaya L.K.
Abstract
Complex study of motor skills in children with congenital club foot was performed at CITO laboratory of clinical physiology and biomechanics, and clinic of pediatric orthopaedics. Subjects for electrophysiological and biomechanical examination were 34 patients with congenital unilateral club foot (19 boys and 15 girls) aged from 3 to 16 years. Intact extremity indices were used for comparison. Study in open biokinematic contour mode on the affected side showed decrease in voluntary bioelectric activity of anterior tibial muscle by 34-60% and gastrocnemius muscle by 7-19%. Spectrum analysis of EMG and computed mechanography showed the decrease of tonic fibers activity in peroneal muscles of the lower leg with its increase in posterior group of muscles. Stabilometry and study of gate parameters on the affected side showed synergetic type of anterior and posterior muscles interaction with preservation of antagonistic type in the normal extremity. Suprasegmentary pattern of affection (lesion) was detected by method of stimulation electromyography. The data obtained confirm the influence of pathologic motor skill on the development of deformity recurrences at surgical treatment of children with congenital club foot.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):48-54
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Subtalar Arthroeresis in Posterior Tibial Tendon Dysfunction
Tamoev S.K., Zagorodniy N.V., Protsko V.G., Sultanov E.M., Khamokov Z.K., Dubovik G.O., Tamoev S.K., Zagorodniy N.V., Protsko V.G., Sultanov E.M., Khamokov Z.K., Dubovik G.O.
Abstract
The purpose of the study was to evaluate the efficacy of subtalar arthroeresis for II stage tibial tendon dysfunction by Johnson and Storm classification. From November 2007 to August 2009, 18 patients with that pathology were operated on. After implantation of Kalix® II endorthesis the plasty of posterior tibial tendon was performed. The results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) scores system. After treatment average estimate by AOFAS increased from 47.2 before operation to 79.0 after surgery, pain index from 16.3 to 30.0, foot function from 28.7 to 41.6, foot position from 2.6 to 8.4. According to X-ray data the longitudinal arch angle decreased by 14.3° at an average and talar-calcaneal angle by 8°. Study results showed that technique of subtalar arthrodesis was effective enough for correction of flat foot resulted from II stage posterior tibial tendon dysfunction. Combination of that technique with tendon plasty ensured the full-value reconstruction of the foot.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):55-59
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Age-Related Dynamics of Roentgenologic Characteristics of Pelvis and Spine Osseous Growth Activity in Patients with Idiopathic Scoliosis
Tesakov D.K., Tesakov D.K.
Abstract
Roentgenologic examination of pelvis and spine osseous growth activity was performed with the purpose to determine the peculiarities of its age-related dynamics in patients with idiopathic scoliosis. Total number of 2006 patients (1770 females and 236 males) was examined. Age if patients ranged from 4 to 20 years. Severity of spine deformity corresponded to I-IV stages. Activity of pelvis growth was assessed by Risser test (R), of spine growth - by Sadof'eva test (S).Results of those tests were divided into three groups of osseous growth activity state: group of active growth included indices R-0 - R-III and S-0 - S III, group of stabilized growth - R-IV and S-IV, group of completed growth - R-V and S-V. It was stated that in idiopathic scoliosis pelvis and spine came into periods of apophyseal ossification, synostosis and osseous growth completion at later age terms than at norm - the lag made up from 1 to 4 years. It was also detected that in given pathology the spine itself started and completed its physiologic growth with 1-3 years delay as compared with pelvic bones. The obtained results indicated that in idiopathic scoliosis Risser test results should be considered as an objective but indirect information on spine growth activity. Direct objective precise information on the spine growth activity could be obtained by Sadof'eva test that reflected directly the stage of leading affected organ development in that pathology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):60-67
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Standardization of Traumatologic and Orthopaedic Care: Alternative Version
Mattis E.R., Es'kin N.A., Mattis E.R., Es'kin N.A.
Abstract
The necessity in standardization of medical care directed to the improvement of diagnosis and treatment quality is obvious. However the methodic aspect of the current standardization and resulting standards not quite correspond to the hopes set on them. The authors adduce an alternative method of standardization. Method for standards elaboration based on the system of continuous monitoring of patients' condition has been created at CITO. At present the ideology and a number of practical elements of such system have been elaborated including the elements that have been tested in thousands of observations and which have proved their efficacy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):68-72
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Russian Version of Oswestry Questionnaire: Test Validity and Reliability
Cherepanov E.A., Cherepanov E.A.
Abstract
The purpose of the study was the evaluation of Russian Oswestry questionnaire (disability index) version 2.1a reliability. Evaluation was performed on the basis of prospective cohort examination of 101 patients. All patients were questioned at the time of first examination, within 2-5 days after first visit and after completion treatment. Repetition of results, internal consistency of the test, correlation with visual analog scale (VAS) and SF-36 questionnaire subscales were studied. Repetition of results made up 0.96, Cronbach's a coefficient - 0.919, correlation with VAS - 0.668. Adapted of Russian Oswestry questionnaire version 2.1a is a valid and reliable tool. It is recommended for application in practical and scientific work for the evaluation of vital activity disturbances in patients with low back pains. The study was approved by Prof. J. Fairbank, the author of Oswestry questionnaire.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):73-79
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Long-Term Result of Complex Treatment for Recurrent Congenital Club Foot (Case Report)
Kralina S.E., Kralina S.E., Kadzhaya L.K., Kadzhaya L.K.
Abstract
An example of successful complex treatment of 8 years old patient with severe recurrent club foot is presented. Treatment included surgical restoration of osteoarticular interrelations in the foot and elimination of muscle imbalance. For the restoration of shin muscles' reciprocal interrelations and formation of proper motor skill, training of muscles according to the method of functional biocontrol was applied. Treatment result was assessed after 3 years: no deformity relapse was observed, function of the extremity was completely compensated.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):80-82
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Treatment of Femoral Head Aseptic Necrosi
Akhtyamov I.F., Kovalenko A.N., Anisimov O.G., Akhtyamov I.F., Kovalenko A.N., Anisimov O.G.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):84-89
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Analysis of Mistakes in Diagnosis and Treatment of Hand Injuries from Position-Provision of Medical Care Quality
Bugaev D.A., Bugaev D.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):89-92
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Z.I. Urazgil'deev
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N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):93-93
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E.A. Nazarov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(1):94-94
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