Vol 18, No 2 (2011)

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.

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.

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.

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

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

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

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.

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.

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.