卷 17, 编号 3 (2010)

Outcomes of total hip arthroplasty performed using home-produced «Sfen-C», «Isko-Rudn» implants for cemented fixation and «Fenix», «Compomed» for non-cemented fixation were studied in 156 patients with degenerative-dystrophic joint lesions (174 operations). Dynamics of peri-implant bone mineral density (comparative standard computed roentgenodensitometry), roentgenologic parameters of the operated joint (computed roentgenometry), weight bearing function of the lower extremities after arthroplasty (stabilometric analysis) were evaluated. Reasonability of application of home-produced implants «Sfen-C», «Isko-Rudn» and «Compomed» was substantiated. Recommendations on implant Fenix use limitations were given.

Retrospective analysis of case histories of 125 patients (36-77 years) after total knee arthroplasty for III-IV stage of gonarthrosis was performed. On 4-5 day after operation deep vein thrombosis was diagnosed in 30 (23.6%) patients. It was stated that additional factors which trustworthily influenced the risk factors of thromboembolic complications development were the following: application of tourniquet to the femur for more than 1 hour; application of tourniquet to the patients with initial venous pathology (varicosis of vena saphena magna and vena saphena parva, consequences of thrombophlebitis); obesity of II-III degree in women. No reliable influence of various methods of anesthesia and infusion therapy upon the risk of thrombosis development was detected. Obtained data confirm the necessity to perform compulsory examination of lower extremities veins in patients prior to knee joint arthroplasty and take additional measures on thrombosis prevention in high risk groups. Observance of the proposed antithrombotic protocol in the postoperative period prevents vein thrombosis progression, thrombus fragmentation and floating as well as promotes accelerated recanalization of thrombotic veins.

The possibility of refractive introscopy use on synchronic radiation source (multitarget complex Mediana) and dual energetic X-ray absorptiometry for the prognosis of bone formation in bone implant remodelling was studied in experiment. Experimental study was performed on 93 samples of rats' tibia. It was shown that refractive introscopy on synchronic source enabled to detect correctly the margins of allograft and native rat's bone tissue. Using this technique and dual X-ray absortiometry it was possible with high probability to prognosticate both the presence and absence of bone formation in the zone of bone-plastic material implantation.

Osteoprotective effect of enalapril and losartan was studied using experimental model of osteoporosis and osteoporotic fractures (222 female Wistar rats). It was detected that in rats after ovariectomy endothelial vascular dysfunction of microcirculation in bone tissue bed developed. Those changes caused osteoporosis and delayed experimental fracture healing. Enalapril and losartan prevented the decrease of microcirculation level in bone tissue that promoted slowing-down of osseous trabecula thinning, prevented microfractures and increased the healing rate of experimental fractures.

Experience in treatment of 104 patients aged from 18 to 74 years with sequelae of femur and shin fractures (47 patients with ununited and improperly united fractures and 57 patients with noninfected pseudarthroses and bone defects) was presented. Analysis of the results showed that the main reasons for unfavorable consequences of fracture were osteosynthesis failure, inadequate appraisal of fracture pattern and localization, inadequate treatment-tactic measures (inobservance of optimum treatment terms, early abolition of external immobilization or groundless refusal of its application, discrepancy between osteosynthesis stability and early functional loads). Treatment outcome (assessment by N.A. Lyuboshits - E.R. Mattis and I.L. Shvarzberg systems) was recognized as good in 49%, satisfactory - in 42.3% and poor - in 8.7% of cases.

First experience in aplication of intraoperative epidural morphine analgesia with postoperative ropivacaine anesthesia at correction of III-IV degree scoliotic deformity in children (25 patients) is presented. It is shown that epidural morphine analgesia on lumbar level as a component of combined anesthesia provides an adequate analgesia in during operation and creates an analgesic background for postoperative anesthesia with local anesthetics. Intraoperative high catheterization of epidural space by the proposed technique enables to avoid neurologic complications and provides the possibility of effective postoperative anesthesia with ropivacaine infusion within 3 days on the background of prolonged action of epidurally injected morphine. First xperience in application of the suggested technique shows that it is effective enough and helps this group of patients to endure an invasive operation with greater comfort.

The basis of the lecture is complex analysis and systematization of various forms of degenerative-dystrophic lesions of shoulder joint. With regard for the principles of modern clinical and roentgenologic diagnosis six etiologic and morphofunctional groups of shoulder deforming arthrosis are distinguished and characterized. Accurate diagnosis of clinical-roentgenologic type of the pathology will enable a physician to choose a maximum effective treatment technique.