Vol 17, No 1 (2010)

Articles
Specialized Traumatologic and Orthopaedic Care for Outpatients with Injuries and Bone-Muscular Diseases
Mironov S.P., Es'kin N.A., Andreeva T.M.
Abstract
Dynamics of traumatism and bone-muscular pathology among various population groups for the last 10 years is presented. Certain stabilization of injury rate in adults as well as continuous increase of injury rate in children and adolescents is noted. Rate of bone-muscular diseases is constantly increasing in all population groups. Principal ways for the perfection of outpatient trauma and orthopaedic care are proposed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):3-8
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Surgical Treatment of Scoliosis during the Period of Uncompleted Spine Growth
Kuleshov A.A., Vetrile S.T., Zhestkov K.G., Guseinov V.G., Vetrile M.S.
Abstract
Outcomes of surgical treatment of 34 patients aged from 9 to 15 years (mean age 11.7 years) with basic curvature arch from 43 to 148° (99° average). In 9 patients dorsal correction and spine fixation by CD system without intervention on the vertebral bodies was performed (1st group). In 25 patients diskepiphysectomy (including thoracoscopic one in 7 patients) and interbody spondylodesis on the apex of the convex basic arch were performed prior to dorsal correction. Then halo-pelvic traction was performed for 7-10 days followed by dorsal fixation of the spine by CDI without posterior spondylodesis (2nd group). Subsequently depending on the degree of correction loss due to spine growth step-by-step corrections of the deformity were performed. After spine growth completion final instrumental correction and fixation of the spine with posterior spondylodesis were performed. In the 1st group step-by-step corrections were to be performed in 77% of cases, in 2nd group - in 28% only. It was shown that performance of diskepiphysectomy on the apex of the deformity with following correction and CD system fixation of the spine decreased the rate of postoperative spine deformity progression, eliminated asymmetric growth of vertebrae on the deformity and increased the achieved correction. In the process of patients' growth wedge shape of the vertebral bodies decreased in frontal and sagittal planes and no increase of their torsion-rotation changes occurred.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):9-16
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Сomparative Evaluation of Modern Radiologic Examination Methods in Intracanal Spinal Column Pathology
Morozov A.K., Kuleshov A.A., Karpov I.N., Nikitina I.V.
Abstract
Comparative evaluation of efficacy of magnetic resonance, multispiral computed tomography and multispiral computed myelography was performed basing on the results of complex examination of 180 patients with degenerative dystrophic changes of the spine, consequences of its complicated injury and disturbances of liquorodynamics of various genesis. Algorithm of examination using radiologic methods when suspecting intracanal pathology of spinal column is suggested.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):17-21
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Plasty with Pedicle Muscular Flaps at Treatment of Infectious Complications after Stabilizing Operations on the Spine
Lisitskiy I.Y., Boev M.V., Evsyukov A.A.
Abstract
Experience in use of transferred pedicle muscular flaps for the treatment of 7 patients with infectious complications after previously performed stabilizing operations on the spine is presented. Revision interventions showed failure of implanted transpedicular constructions on the background of osteomyelitis with vast infected cavities. To compensate for vast wound defects with soft tissue deficit that remained after removal of stabilizing systems and necrectomy plasty with transferred muscular flaps was performed. Primary wound healing was achieved in all cases. At follow up from 1 to 4 years relapse of pyo-inflammatory process in the zone of intervention was detected in no one case.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):22-24
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New Measures for Prevention of Intra- and Postoperative Complications at Total Hip Replacement
Akhtyamov I.F., Garifullov G.G., Kovalenko A.N., Kuz'min I.I., Rykov A.G.
Abstract
The reasons of intraoperative and early postoperative complications i.e. implant dislocation and periprosthetic fractures, after hip replacement were analyzed and ways of their surgical prevention were elaborated. After 497 operations dislocation of the femoral component was detected in 24 (4,8%) cases including 15 - in the early postoperative period. The main reason of complication was inobservance of the prescribed motion activity regimen in the first postoperative days. In primary joint replacement periprosthetic fractures occurred in19 (3,8%) cases: in 15 (3%) cases the fracture developed intraoperatively and in 4 (0,8%) cases - after patients' discharge from the hospital. Application of the elaborated techniques of surgical prevention enabled to minimize the risk of such complications.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):25-28
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Efficacy of Tranexamic Acid Application for Blood Loss Reduction in Total Hip Arthroplasty
Tikhilov R.M., Shubnyakov I.I., Mokhanna M.I., Pliev D.G., Myasoedov A.A., Tsybin A.V., Ambrosenko A.V., Bliznyukov V.V., Chiladze I.T., Shulepov D.A.
Abstract
Prospective study of tranexamic acid use results (native preparation Tranexam) in primary total hip arthroplasty was performed during the period from March to October 2009. The study involved 159 patients (55 men, 104 women) with various hip joint pathology (79 patients - main group, 80 patients - control group). Mean age of patients made up 55.7 years (17 - 80 years). In patients from the main group 15 mg/kg Tranexam was injected just prior to operation with reinjection of the same dose in 6 hours. In control group etamsylate (750 mg 30 minutes prior to incision with reintroduction in 4 - 6 hours, daily dose up to 1500 mg) was applied. The results of the analysis showed reliable (p<0.001) decrease of total blood loss in the main group (409±228 ml) as compared to the control group (638±437 ml). The reasonability of the use of tranexamic acid for reduction of blood loss in total hip arthroplasty was shown.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):29-34
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Prevention of Venous Thromboembolic Complications in Orthopaedic Surgery: New Possibilities
Kopyonkin S.S.
Abstract
The causes of significant rate of venous thromboembolic complications after orthopaedic operations were analyzed basing on literature review and author's experience. Importance of orthopaedic surgeons' education in modern standard for such complication prevention as well as necessity of modern drugs application was presented. Data on the efficacy of new direct per oral anticoagulant Dabigatran etexilate (Pradax) were given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):35-38
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Classification and Diagnosis of Surgical Site Infection in Total Hip Replacement
Prokhoranko V.M., Pavlov V.V., Petrova N.V., Gol'nik V.N.
Abstract
Experience in elaboration of common approaches to diagnosis of surgical site infection accumulated at Novosibirsk SRITO department of joint arthroplasty and endoscopic surgery is presented. It is shown that standardized approaches to the detection and recording of such complication provides for objective evaluation of its rate.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):39-43
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Tribochemical Component of Oxidizing Stress Development at Joint Replacement. Part I. Determination of Radical-Forming Ability of Wear Particles from Various Orthopaedic Materials
Bulgakov V.G., Gavryushenko N.S., Shal'nev A.N., Tsepalov V.F.
Abstract
Using the model reaction of cumene oxidation the radical-forming ability of wear particles of some orthopaedic alloys and corundum ceramics were studied. It was revealed that wear particles from different alloys catalyzed cumene oxidation whereas particles of corundum ceramics were inert. Cobalt alloy wear particles were much more active as compared with the titanium alloy and stainless steel particles. Production of cobalt alloy by laser sintering reduced the radical-forming ability of its wear particles. Activity of cobalt wear particles was preserved for a long time after their formation and could considerably strengthen the development of oxidizing stress at joint arthroplasty. Detection of catalytic activity of orthopaedic alloys' wear particles requires studying of the influence of free radicals generated by tribochemical reaction upon implant components and biological tissues.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):44-48
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Total Hip Arthroplasty in Adolescents
Snetkov A.I., Frantov A.R., Gorokhov V.Y., Batrakov S.Y., Kolyarov R.S.
Abstract
During the period from 1970 to 2009 at CITO Department of child bone pathology and adolescent orthopaedics total hip arthroplasty was performed in 36 patients aged 14-18 years including 7 patients with bilateral interventions. Main group consisted of patients with systemic hereditary skeleton pathology. Optimum implant designs with regard to anthropometrics and disease pattern were determined for adolescents. Algorithm of surgical interventions in patients with stable flexion-adduction contractures on the background of systemic skeleton pathology was elaborated. Treatment results were evaluated at terms from 1 to 20 years. Good and satisfactory results made up 91.6%
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):48-53
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Modern Technique for Proximal Femur Osteosynthesis at Reconstructive Operations on Hip Joint in Children
Mironov S.P., Kozhevnikov O.V., Ivanov A.V., Gavryushenko N.S., Zatona D.B., Kralina S.E., Azimov S.T.
Abstract
Set of instruments and metal fixatives for osteosynthesis in corrective operations on proximal femur in patients aged 1-15 years was elaborated at CITO. Comparative experimental strength tests showed the advantages of suggested metallic fixatives over existed analogs (fixatives from DON set and Blount plate). Cannulated system for angular metal fixatives application provided for proper setting of the construction, shortened the duration of surgical intervention and decreased operative trauma. That set was used for the treatment of 169 children with various types of hip joint pathology. Average duration of surgical intervention made up 45 min. (versus 95 min. at routine surgical technique). Bone fragments displacement, loss of correction, instabi-lity of osteosynthesis and other complications were not observed at follow up less than 1 year.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):54-59
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Closed Intramedullar Osteosynthesis in Surgical Treatment of Children with Diaphyseal Femur Fractures
Rozinov V.M., Yandiev S.I., Burkin I.A.
Abstract
Outcomes of surgical treatment for diaphyseal fractures of the femur were analyzed in 270 (278 interventions) out of 509 patients being admitted to the clinic since 1999. In overwhelming majority of patients (226 children) closed intramedullar fixation of bone fragments (231 operations) was performed. Closed intramedullar osteosynthesis was performed using flexible and rigid rods including the locking ones. Elastic-stable osteosynthesis is indicated for the treatment of under school age children with type A1, A2, A3, B1, B2, B3, C2 fractures as well as junior school age children with type A1, A2, B1, B3, C2 fractures. Presented technique can be considered as a gold standard in this group of patients. Closed intramedullary osteosynthesis by rigid rod without locking is the optimum technique for the treatment of junior and senior school age children in bearing injuries of types A3 and B2. Method of choice in senior school age children with A1, A2, B1, B3, C1, C2 and C3 fractures is closed intramedullar osteosynthesis with locking rod. Preliminary extrafocal fixation in multiple and open injuries creates optimum conditions for delayed intramedullar osteosynthesis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):60-65
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Hirudotherapy in Bone and Joint Pathology in Children and Adolescents
Maiorov A.N.
Abstract
Experience in hirudotherapy application was analyzed in 1049 patients aged 3-18 years with bone and joint pathology. Recommendations on technique of hirudotherapy use in certain pathology are presented. Study results showed that secretion of medicinal leech saliva reliably decreased oxyproline content in blood serum of patients with Perthes disease. Electromyography showed that hirudotherapy reliably improved electrophysiological state of muscles responsible principle hip joint movements. Side effects and complications resulted from hirudotherapy were carefully analyzed. The ways of their prevention are given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):65-69
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Mistakes and Complications at Treatment of Diaphyseal Shin Bones Fractures with "Repofix" Apparatus for External Transosseous Reposition and Fixation of Bone Fragments
Oganesyan O.V., Anisimov E.C.
Abstract
Data on 280 patients with diaphyseal fractures of shin bones been treated at CITO and other clinics using Oganesyan Repofix apparatus for external transosseous reposition and fixation of bone fragments were analyzed. It was shown that in 57 cases certain mistakes and related complications were detected at different treatment steps. Recommendations on the prevention of such complications were given. Awareness of potential mistakes and complications will help to avoid them and thus to increase the treatment efficacy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):70-74
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Intra- and Periarticular Fractures of the Distal Shin Bones Segment: Peculiarities of Osteosynthesis using Tightening Clamps with Shape Memory
Kaplun V.A., Kopysova V.A., Selivanov D.P., Remorenko A.V.
Abstract
Tightening clamps with shape memory effect were used for interfragmental compression and fixation of bone fragments in 93 patients with intraarticular, periarticular and bifocal fractures of shin bones. In 16 patients with bifocal fractures osteosynthesis of tibial diaphysis was performed using intramedullar rod and osseous plates. Following intramedullar osteosynthesis fixation of the injured extremity with plaster splint was performed in 47 cases. In 46 patients longitudinal splinting of shin bones was performed by transosseous apparatus. Within the rehabilitation period chondroprotectors were prescribed to all patients. Good result of complex treatment was achieved in 87.5% of cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):74-80
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Ultrasound Study of Radial Nerve Projective Anatomy Relative to Lateral Humerus Aspect
Zolotov A.S., Ovcharov P.A., Zolotova Y.A.
Abstract
Location of radial nerve relative to lateral humerus was studied using US scanner in 17 volunteers (7 men, 10 women) aged 19-54 years. Conditional humerus length (acromion-olecranon distance) ranged from 31 to 39 cm. Radial nerve transacted lateral humeral diaphysis 11.3±1.9 cm (from 8 to 15 cm) proximal to lateral humeral epicondyle. Distance between lateral humeral epicondyle to radial nerve made up 31.9% of humerus conditional length. Awareness of obtained data may be helpful at performance of surgical intervention on the humerus.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):81-83
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Pathogenetic Approach to Treatment of Conservatively Irreducible Anterior Shoulder Dislocation
Yarmolovich V.A., Kezlya O.P.
Abstract
Approaches to the treatment of conservatively irreducible fresh anterior shoulder dislocations were considered. Experience in treatment of 5 patients with such injuries was presented. In case of deep impression of humeral head with its inclination into the anterior edge of the scapular glenoid cavity the authors used elaborated by them extension method of reduction that enabled to refusing the conventional step-by-step technique of irreducible dislocation treatment, to perform successful closed reduction in 3 out of 5 patients and to shorten the duration of treatment considerably.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):84-87
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Treatment of Primary Stages of Coxarthrosis by Intraarticular Injections of Chondroprotectors under Roentgenologic Control
Cherkes-Zade D.D., Miti A.
Abstract
Technique of medicinal preparation (chondroprotectors Synvisc) injection into hip joint cavity under roentgenologic control is described. Technique has been applied in 12 patients (14 procedures) with primary stages of coxarthrosis. Positive effect has been achieved in all cases. In comparison with the performance of intraarticular injections using echography the presented technique is more accurate and simple for the procedure documenting. Duration of manipulation makes up 5-7 minutes.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):88-89
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Pelvic Psteotomies at Treatment of Dysplastic Hip Pathology
Kamosko M.M., Grigor'ev I.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(1):90-93
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