Vol 18, No 2 (2011)

Articles
Potentialities and Principles of Low-Invasive Osteosynthesis at Bones Fractures Treatment
Lazarev A.F., Solod E.I., Lazarev A.A., Lazarev A.F., Solod E.I., Lazarev A.A.
Abstract
Experience in surgical treatment of 519 patients with bone fractures of different localization been treated during 2000 - 2009 was analyzed. In 335 patients low-invasive percutaneous osteosynthesis with application of original and known low-invasive technologies was performed. In 184 patients with similar fractures osteosynthesis by standard conventional techniques was performed during the period from 2000 to 2004. Comparative analysis of early and long-term treatment outcomes showed the advantage of low-invasive osteosynthesis techniques at treatment of fractures with different localization. Main principles and peculiarities of low-invasive osteosynthesis were determined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):5-11
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Stabilizing Potential of Modern Internal Metal Constructions for Osteosynthesis of Metadiaphysial and Diaphysial Femur Fractures (experimental study)
Rekvava G.R., Gavryushenko N.S., Lazarev A.F., Kuz'menkov K.A., Rekvava G.R., Gavryushenko N.S., Lazarev A.F., Kuz'menkov K.A.
Abstract
Study of fixation potential of various fastening elements of modern intramedullar and external metal constructions, strength characteristics of internal fixatives at different levels of the femur as well as their stabilizing potential in metadiaphysial and diaphysial femoral fractures was performed on 39 unfixed human cadaveric femur specimens under experimental modeling conditions using universal testing machine w+b (walter + bai ag) LFV-10-T50 (Switzerland). It was shown that in metadiaphysial and diaphysial femoral fractures fixation with modern intramedullar and external metal constructions not always met the requirements of biomechanical conception of fragments' fixation. Constructions that ensure the highest fixation stability in femoral fractures at different levels were defined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):11-19
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Use of Autologous Stem Cells for Prevention of Pyo-Inflammatory Complications at Surgical Interventions with Surgical Aggression in Traumatologic and Orthopaedic Patients
Mironov S.P., Kesyan G.A., Kondrat'eva I.E., Urazgil'deev R.Z., Berchenko G.N., Samkov A.S., Karapetyan G.S., Shulashov B.N., Mironov S.P., Kesyan G.A., Kondrat'eva I.E., Urazgil'deev R.Z., Berchenko G.N., Samkov A.S., Karapetyan G.S., Shulashov B.N.
Abstract
Study of the efficacy of in vitro cultivated autolymphocytes for homeostasis protection and pyo-inflammatory complications prevention at reconstructive operations performance. That technique was applied in 35 patients with comminuted fractures, femur pseudarthroses and coxarthrosis to whom extraosseous, intraosseous osteosynthesis and hip arthroplasty were performed. Control group included 30 patients with similar types of pathology who were treated by similar methods but without use of autolymphocytes. Post-operative use of autolymphocytes transfusion with regard for potential pyo-inflammatory complications enabled to achieve more favorable course of post-operative period, faster stabilization of patients' general condition, normalization of clinical and special indices as well as to decrease the rate of pyo-inflammatory complications.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):20-25
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Combined Application of Platelet-Rich Plasma and Biocomposite Material Collapan in Complex Treatment of Patients with Non-United Fractures and Pseudarthrosis of Extremity Long Bones
Kesyan G.A., Berchenko G.N., Urazgil'deev R.Z., Mikelaishvili D.S., Shulashov B.N., Kesyan G.A., Berchenko G.N., Urazgil'deev R.Z., Mikelaishvili D.S., Shulashоv B.N.
Abstract
Nanostructural biocomposite material Collapan and platelet-rich autoplasma (PRP) were applied for the treatment of 158 patients with non-consolidating fractures and pseudarthrosis of extremities' long bones. It was shown that combined application of Collapan and PRP was available, safe and effective measure for activization of reparative bone regeneration. Consolidation of fractures and healing of pseudarthroses was achieved in 97.8% of patients. In control group (traditional surgical treatment) positive results was achieved in 81.4% of patients. Terms of fracture consolidation reduced by 11.0±2.3 days, of pseudarthroses healing - by 20±4.3 days. Nanostructural Collapan is a perfect matrix for isolation of autologous growth factors from platelets that contribute to fracture healing activization.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):26-32
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First Experience in one-step Surgical Treatment of Distal Forearm Bones Fractures Complicated by Regional Pain Syndrome
Golubev I.O., Krupatkin A.I., Kutepov I.A., Bushuev O.M., Merkulov M.V., Shiryaeva G.N., Maksimov A.A., Golubev I.O., Krupatkin A.I., Kutepov I.A., Bushuev O.M., Merkulov M.V., Shiryaeva G.N., Maksimov A.A.
Abstract
Treatment results for 9 patients with distal forearm fractures complicated by sympathetically dependant type of complex regional pain syndrome were analyzed. After clinical, radiologic examination, laser Doppler flowmetry, computer thermography one-step open reposition of bone fragments with osteosynthesis and perivascular sympathectomy was performed in all patients. Follow-up period made up from 4 to 7 months. Excellent results was achieved in 1 (11%) patient, good - in 7 (78%), satisfactory - in 1 (11%) patient.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):32-37
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Treatment of Elbow Fractures in Children and Adolescents
Merkulov V.N., Dorokhin A.I., Stuzhina V.T., El'tsin A.G., Mininkov D.S., Merkulov V.N., Dorokhin A.I., Stuzhina V.T., El'tsin A.G., Mininkov D.S.
Abstract
Treatment results of 1353 children and adolescents with acute elbow injuries were performed. The main difficulties for diagnosis and treatment of those injuries were shown. Using stored experience the methods of diagnosis and treatment for all types of injuries were optimized. Potential complications and mistakes were described; the ways of their prevention were presented. Tactics of postoperative management of patients was elaborated. Differentiated approach to the treatment of every type of injuries enabled to obtain good and excellent results in 93.2% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):38-45
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Use of Autologous Stromal Marrow Cells for Surgical Treatment of Congenital Crus Bones Pseudoarthrosis in Children
Mironov S.P., Omel'yanenko N.P., Kozhevnikov O.V., Il'ina V.K., Ivanov A.V., Mironov S.P., Omel'yanenko N.P., Kozhevnikov O.V., Il'ina V.K., Ivanov A.V.
Abstract
First experience in application of cultivated autologous stromal marrow cells for the stimulation of reparative bone regeneration in zone of crus bones pseudoarthrosis resection was presented. There were 4 patients, aged 16 months - 9 years. Results obtained showed significant stimulated influence of autologous stromal marrow cells on activity of osteoreparation and healing of bone fragments. Signs of consolidation were noted 3 months after operation. Duration of apparatus fixation ranged from 5 to 7.5 months. At 5 years follow-up no consolidation of bone fragments without bone callus formation was detected in all patients. No recurrence of pseudoarthrosis and disturbance of medullar canal were noticed
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):46-52
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Twenty Years Experience in Large Joints Arthroplasty at specialized department of CITO named after N.N. Priorov
Zagorodniy N.V., Nuzhdin V.I., Kagramanov S.V., Khoranov Y.G., Kudinov O.A., Ayusheev D.B., Kuz'min F.A., Buravtsova M.E., Chragyan G.A., Bukhtin K.M., Erokhin P.A., Nikolaev I.A., Zagorodniy N.V., Nuzhdin V.I., Kagramanov S.V., Khora-nov Y.G., Kudinov O.A., Ayusheev D.B., Kuz'min F.A., Buravtsova M.E., Chragyan G.A., Bukhtin K.M., Erokhin P.A., Nikolaev I.A.
Abstract
Experience in hip and knee arthroplasty (primary and revision) accumulated at CITO department for large joints arthroplasty during the period from 1990 to 2010 is presented. Dynamic of the development of that direction in traumatology and orthopaedics, i.e. perfection of implants and surgical technique, is shown. Typical difficulties and complications in primary and revision operations are noted. Elaborated at the department technique for acetabulum reconstruction at revision hip arthroplasty in patients with significant deficit of bone mass and disturbance of mechanical bone strength is described.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):52-58
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Influence of Bisphosphonates within Biocomposites upon Bone Formation and Bone Mineralization
Rodionova S.S., Torgashin A.N., Lekishvili M.V., Semenova L.A., Morozov A.K., Rodionova S.S., Torgashin A.N., Lekishvili M.V., Semyonova L.A., Morozov A.K.
Abstract
Effect of various nitrogen containing bisphosphonates (ibandronic acid - Bonviva, zolendronic acid - Aklasta, alendronate sodium - Fosamax) within biocomposite materials upon the process of bone formation and bone mineral density in the zone of surgical intervention (bone defect formation) and segment as a whole (tibia) at local application was studied in animal experiment (60 rats). Morphologic study showed that bisphosphonates did not depress bone formation but even provided its higher intensity as compared to the control group (p=0.045). Analysis of the influence of study bisphosphonated upon bone formation showed reliable advantage (p<0.05) of zolendronic acid. Contrary to control group intensive bone formation was accompanied by reliable BMD increase both in zone of intervention and in segment as a whole. That confirmed the positive influence upon bone tissue remodeling
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):59-66
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Enoxaparin and Dabigatran Thromboprophylaxis after Total Hip Arthroplasty
Momot A.P., Merkulov I.V., Grigor'eva E.V., Panov M.Y., Momot A.P., Merkulov I.V., Grigor'eva E.V., Panov M.Y.
Abstract
Comparative assessment of the efficacy and safety of enoxaparin and dabigatran thromboprophylaxis after total hip arthroplasty was performed. Hemorrhagic and thrombotic complications as well as indices of laboratory tests after application of new oral thrombin inhibitor Dabigatran Etexilate were taken into account. Study included 161 patients who were randomized into two groups and operated on under spinal anesthesia. First group (81 patients) was on subcutaneous enoxaparin (40 mg/day), second group (80) was on dagibartan (200 mg/day). The day before surgery and on 5th and 10th days after arthroplasty duplex angioscanning of lower extremities and assessment of blood clotting parameters was performed. It was shown that in case of significant intraoperative blood loss thromboprophylaxis with both enoxaparin and dabigatran was similar to that with low-molecular-weight heparin. Postoperative thrombogenic risk by D-dimers level was higher with enoxaparin versus dabigatran application. Peroral use of anticoagulants is more acceptable due to its noninvasiveness, safety, low requirements in laboratory monitoring and convenience of application in out-patient conditions. In patients with low compliance testing of blood plasma thrombin can be used for the confirmation of dabigatran intake when necessary.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):67-70
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Peculiarities of Course and Surgical Treatment for Dysplastic Lumbar and Thoracolumbar Scoliosis in Children and Adults
Vetrile S.T., Kuleshov A.A., Shvets V.V., Vetrile M.S., Vetrile S.T., Kuleshov A.A., Shvets V.V., Vetrile M.S.
Abstract
Analysis of CITO outpatient department archives has shown that practically from 20 to 30% of patients with spine pathology are suffering from scoliosis. The most common types are lumbar and thoracolumbar scoliosis. Progression of lumbar scoliosis goes on after growth completion and is accompanied by formation of pronounced degenerative changes in the spine. Clinically the course of the disease is aggravated by marked persistent pain syndrome. Results of surgical treatment performed at CITO spine pathology department with application of ventral and dorsal instrumentation have been analyzed for 118 patients with lumbar and thoracolumbar scoliosis. Eighty of those patients were operated on in childhood and juvenile age, 38 patients at the age of 25 - 70 years. Use of ventral instrumentation enabled to achieve high degree of lumbar and thoracolumbar scoliosis correction - up to 72% of initial deformity, average derotation made up 12.9° or 44.3% of initial rotation. Use of dorsal instrumentation is also effective for surgical treatment of lumbar and thoracolumbar scoliosis (66.8% of lateral curvature). Screw fixation ensures higher degree of the lateral curvature (68.2%) and sagittal profile as well as rotation component (33.1% of initial value). Presence of focal neurologic symptomatology is the indication to decompressive operations followed by instrumental fixation and posterior fusion. Defor-mity correction is performed only within the limits of deformity mobility
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):71-80
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S.T. Vetrile
- -.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):80-80
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Low Back Pain Syndrome in Athletes and Ballet Dancers: Spinous Ligaments Pathology
Mironov S.P., Burmakova G.M., Saltykova V.G., Mironov S.P., Burmakova G.M., Saltykova V.G.
Abstract
Experience in diagnosis and treatment of 32 athletes, ballet dancers and circus actors aged from 15 to 25 years with lumbosacral spine spinous ligaments pathology is presented. In 12 cases pathology of subspinous and in 24 cases of interspinous ligaments was diagnosed. Acute injury of spinous ligaments and ligamentopathy was diagnosed in 6 and 26 patients, respectively. Complex diagnosis included clinical-neurologic examination, ultrasonography and thermography. All patients were on conservative treatment: therapeutic physical training using special individual complex, massage, curative-analgesic blockades, injections of platelet-rich plasma, injections of sclerosing solutions in Baastrup syndrome, injections of nitrogen-oxygen mixtures into paravertebral muscles, use of vascular drugs and stimulating therapy. Analysis of the obtained results confirmed high efficacy of the proposed methods for the diagnosis and treatment of lumbosacral spine spinous ligaments pathology in athletes and ballet dancers.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):81-88
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Errors in Graft Placement at Arthroscopic Reconstruction of Knee Anterior Cruciate Ligament
Mironov S.P., Lisitsyn M.P., Mironov S.P., Lisitsyn M.P.
Abstract
Study included 168 patients (31 women and 138 men, aged 17-47 years) to whom anterior cruciate ligament (ACL) autoplasty was performed during the period from 1996 to 2003. Kits of mechanical instruments with metric and calibration scales were used for ACL reconstruction. In 150 patients ACL reconstruction was performed using patellar ligament with 2 bone blocks, in 19 patients using tendons of semitendinous and gracilis muscles on the affected side. Formation of the axes for tibial and femoral channels was based on 5 criteria. Analysis of postoperative knee joint X-rays of 132 patients (73%) detected graft location disturbance in 46 patients (37%). Assessment by Lysholm scale showed 24.1% (27 patients) of satisfactory and poor results. By IKDC form 1995 the share of C and D groups increased up to 34.8% (39 patients).
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):89-94
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Modern Me-thods of Infectious Knee Joint Arthritis Treatment
Orletskiy A.K., Butkova L.L., Timchenko D.O., Orletskiy A.K., Butkova L.L., Timchenko D.O.
Abstract
New approach to the treatment of patients with infectious knee joint arthritis using arthroscopic technique has been elaborated at CITO department of sports and ballet injury. During the period from 2004 to 2010 total number of 23 patients (32 - 67 years) has been treated. Use of arthroscopic technique enabled to improve treatments results and to decrease the duration of hospitalization. The importance of early diagnosis and timely initiation of treatment has been shown. Delay of arthroscopic revision and knee joint sanitation may result in destructive changes in cartilage and other joint components. Evaluation of treatment results by Lysholm scale showed 28.6% of good and 71.4% of satisfactory outcomes.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):94-98
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Diagnosis and Surgical Treatment of Benign Pelvic Tumors and Tumor-Like Diseases in Children
Snetkov A.I., Frantov A.R., Morozov A.K., Berchenko G.N., Batrakov S.Y., Anisimov M.V., Snetkov A.I., Frantov A.R., Morozov A.K., Berchenko G.N., Batrakov S.Y., Anisimov M.V.
Abstract
Experience in diagnosis and treatment of benign pelvic tumors and tumor-like diseases in children was summarized. There were 104 patients, aged 2-18 years. Complex diagnosis included modern radiologic methods (CT, MRT, angiography). The treatment was performed taking into account the nosologic form and pathologic process volume. Vast resections of pelvic bones were performed in osteochondroma, fibrous dysplasia, chondromyxoid fibroma, solid form of aneurismal cyst as well as in aneurismal cysts in cases of failed paracentetic treatment. In tumors of small sized (osteoid-osteoma, osteoblastoma) surgical treatment was performed with computer navigation. Paracentetic treatment was applied in aneurismal cysts, eosinophilic granulema of bone as well as in residual cavities after failed previous interventions. In patients with aggressive aneurismal cysts roentgenendovascular embolization of pathologic vessels in combination with paracentetic treatment or endoscopic intervention were used. Follow-up ranged from 1 to 8 years. Recurrences were noted in 3 (6.4%) patients with aneurismal cyst.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):99-106
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Solution for the Problem of Difficult Respiratory Tract in Planned Orthopaedic Surgery
Arzhakova N.I., Efremov V.A., Bessonov S.V., Ukolov K.Y., Novosel'tseva V.A., Arzhakova N.I., Efremov V.A., Bessonov S.V., Ukolov K.Y., Novosel'tseva V.A.
Abstract
Methods to solve the situation of difficult intubation in planned orthopaedic surgery are presented. Total number of 101 patients with problematic conventional tracheal intubation due to various orthopaedic pathology (Bekhterev's disease, abnormality of development or posttraumatic instability of cervical spine, etc.) was studied. In 49 patients tracheal intubation was performed using laryngeal mask LMA C-Trach with videovisualization (main group), in 52 patients - using fiberoptic bronchoscope (control group). The results achieved showed high efficacy of LMA C-Trach technology for solving difficult intubation problem. Application of laryngeal mask was successfully performed even in patients with Hallo-apparatus fixed cervical spine. Unlike fiber bronchoscope insertion placing of laryngeal mask was atraumatic in relation to stomatopharynx and enabled to perform adequate pulmonary ventilation till tracheal intubation. Videovisualization ensured accurate localization of trachea and its intubation with atraumatic reinforced tube under visual control. Only in 2 patients use of that technology failed and it was related to the bleeding from tonsils after multiple unsuccessful attempts of trachea intubation using direct laryngoscopy. Above described technique is not only a highly effective method for solving the problem of difficult intubation but decreases psychologic strain of the anesthesiologic team.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):106-109
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Extracorporal Shock-Wave Therapy for Treatment of Lumbosacral Myofascial Pain Syndrome in Athletes and Ballet Dancers
Pokin'-Chereda G.D., Burmakova G.M., Krupatkin A.I., Pokin'-Chereda G.D., Burmakova G.M., Krupatkin A.I.
N.N. Priorov Journal of Traumatology and Orthopedics. 2011;18(2):110-111
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