Vol 17, No 2 (2010)


Tactics and Technique of Treatment of Large Extremity Segment Avulsion in Polytrauma Patients

Sokolov V.A., Didenko O.A., Byalik E.I., Ivanov P.A., Smirnov K.S., Nevedrov A.V.


At department of concomitant and multiple trauma of Scientific Research Institute of Emergency Care named after N.V. Sklifisovskiy 177 patients with polytrauma were treated from 1999 to 2009. All patients had avulsions and crushes of large segments of extremity including crus (66 patients - 37%), thigh (44 patients - 25%), foot (41 patients - 23%), shoulder (14 patients - 8%) and forearm (12 patients - 7%). In 99 patients (control group) the treatment was performed according to routine protocol: amputation by the type of primary surgical treatment (PST), topical treatment of wounds using antiseptic and salve dressings, autodermoplasty after wound granulation. In 78 patients (test group) new tactics of treatment was applied. Terms of performance and volume of amputation were determined based on the principles of injury control. In stable condition of patients amputation within the limits of intact tissues with stump formation and suturing was performed. In avulsion of extremity at the superior third of crus the amputation by type of PST was applied for preservation of knee joint. Sawing tibia surface was covered by gastrocnemius muscle and local wound treatment was performed with hydrohelium dressings and vacuum systems. After wound preparation autodermaplasty was carried out. In severe condition of patients the amputation by type of PST was performed at any level of avulsion. After stabilization of patients state topical wound treatment or reamputation within the limits of intact tissues was performed. Use of new treatment tactics allows decreasing the rate lethality by 6% versus 11% in control group, shortening the terms for patients' preparation for injured bone osteosynthesis, decrease of hospital treatment duration and terms of preparation for prosthetics and significantly improving functional treatment results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):3-8
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Treatment of Patients with Bilateral Pelvic Fractures

Shlykov I.L., Kuznetsova N.L., Agalakov M.V.


Treatment results of 48 patients with bilateral pelvic injuries were analyzed. In all cases surgical treatment using combination of external and internal fixators was performed. That technique enabled to achieve excellent anatomic and functional results in 78-87% of cases with B2 and C3 injuries by OTA/AO classification. Authors consider that the main principle of operative treatment is the conversion of bilateral injuries to unilateral ones. Perspective method for the realization of this principle is application of module external fixation device with fixation of posterior pelvic segments. It enables to modify the location and construction of reposition angles during treatment. Elimination or diminution of the value of multidirectional pelvic deformity and additional fixation of the rotation component provides earlier functional restoration of patients with bilateral pelvic injuries. Taking into account the high risk of deformity recurrence in C3 injuries, after closed reposition by external fixation device transosseous osteosynthesis should be supplemented with internal fixation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):9-15
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Weight-Bearing Feet Reactions at Walking in Patients with Pelvic Bone Fractures during Treatment by Transosseous Osteosynthesis

Dolganova T.I., Martel I.I., Shevedov V.V., Dolganov D.V.


Quantitative assessment of weight-bearing feet reaction at walking (computer complex DiaSled-Scan, St.Petersberg) was performed in 6 patients with pelvic bone fractures treated by transosseous osteosynthesis using Ilizarov device. In stable fixation of pelvic bones by the device the forefoot was used as additional balance when walking without assistive devices. The decrease in anterior and posterior push range which is compensated by the increase in time during one cycle of gait and its' variability should be considered as a summarizing index of adaptive changes of gait. Compensatory increase up to 40% of stance phase variability on the less involved side is preserved by 1 year after surgery.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):16-20
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Diagnosis of Arthrosis by Morphologic Picture of Sy-novial Fluid

Shatokhina S.N., Zar V.V., Voloshin V.P., Shabalin V.N.


Authors have studied the peculiarities of morphologic picture and distribution of chemical elements in dehydrated synovial fluid of normal individuals and patients with arthrosis. It has been determined that in the morphologic picture of synovial fluid the basic arthrosis marker is presented by spindle structures within the intermediate facies zone. It has been shown that in dehydrated synovial fluid P content was 4 times and Ca content - 7 times higher in patients with arthrosis as compared with healthy individuals. That was an evidence of the articular osteo-cartilagenous tissue destruction and accumulation of degradation products which were neutralized by calcites and phosphates.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):20-24
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Intra-articular Therapy of Osteoarthritis Using Drugs on the Base of Blood Serum

Chernyakova Y.M., Pinchuk L.S.


Comparison of biochemical composition and biophysical properties showed the pathogenetic expediency of blood serum use as a corrector of synovial environment in joints affected by osteoarthritis. For serum modification the patients were preliminary given a single dose of drug only. Then patient's blood was collected in the period of its maximum saturation by preparation. Serum obtained was applied in patients with knee joint osteoarthritis of 2-3 stages using three intra-articular injections. The evaluation of treatment results 5-6 months after treatment completion showed a significantly better and more stable therapeutic effect in test group as compared with patients from control group. Positive effect was stipulated by pain decrease, normalization of articular tissue trophicity, depression of local inflammation and cartilage lubrication improvement.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):25-30
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Rehabilitation of Patients with Initial Coxarthrosis after Revascularizing Femur Osteotomy

Zorya V.I., Gur'ev V.V., Sklyanchuk E.D.


In 128 patients with early coxarthrosis after revacularizing femur osteotomy complex rehabilitation including 2 stages, hospital and out-patient, was performed. Complex rehabilitation consisted of drug therapy and modern restorative treatment. It enabled to decrease destructive articular process and restore joint function in 90% of cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):30-33
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Total Knee Replacement Using Computer Navigation in Severe Extremity Deformities

Kavalerskiy G.M., Murylev V.Y., Elizarov P.M., Zhuchkov A.G., Yakimov L.A., Rukin Y.A., Terent'ev D.I.


Experience in cement total knee arthroplasty using computer navigation is presented. There were 42 patients with severe deformities of knee, condyles as well as tibia and femur diaphyses. Five patients out of them had prior implanted hip endoprostheses on ipsilateral side in whom use of routine arthroplasty technique with guide was impossible. In such cases computer navigation allowed to achieve high-precise insertion of implant with provision of correct ligament balance and maintenance of all axes and angles. The terms of rehabilitation and functional results were similar to common cases of primary knee joint replacement using computer navigation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):34-40
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Ultrasound Ablation: New Possibilities for Treatment of Bone and Soft-Tissue Tumors

Nazarenko G.I., Chen V.S., Khitrova A.N.


Focused high intensity ultrasound (HIFU) with sighting influence on tumor enabled to cause its complete coagulative necrosis without damage to intact environmental tissues. The possibilities of ultrasound ablation as the method of local treatment of bone and soft-tissue tumor were considered. Physical principles of method, criteria for patient selection, treatment technique as well as clinical outcomes and their evaluation were presented. Advantages of method are non-invasiveness, less traumatization, less technical complexity and dependence on surgeon skill compared with other sparing operations and methods of ablation. When necessary HIFU may be repeated several times. Effect of HIFU is independent on tumor type. Possible complications (secondary infection in coagulative necrosis zone, peripheral nerves damage, pathological fractures) and measures of their prevention are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):41-49
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Neuro-Orthopedic Tactics for the Treatment of Vertebral Body Tumors Complica-ted by Spinal Cord Compression

Protsenko A.I., Karanadze A.N., Nikuradze V.K., Fazilov S.K., Gordeev G.G.


Treatment results were analyzed for 55 patients with primary and metastatic tumors complicated by paralysis and severe paresis. It was shown that in cervical spine tumors early decompression stabilization operations via anterior approach provided regression of neurologic deficits and significantly improved patients' quality of life. In thoracic spine tumors decompression laminectomy with posterior metalspondylodesis was performed. In the majority of cases (15 out of 20 patients) positive result was achieved in early postoperative period. Laminectomy with posterior spondylodesis was less effective as compared with operations via anterior approach: the later gives lower probability of regression of neurologic deficits as well as lower duration of life and worse life quality.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):50-54
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Use of Combined Corpodesis Technique in Degenerative Lumbar Spine Diseases

Dzhumabekov S.A., Zagorodniy N.V., Abakirov M.D., Sulaimanov Z.D.


Efficacy of combined anterior corpodesis method elaborated by the authors (100 patients - main group) versus routine anterior corpodesis (98 patients - control group) in degenerative lumbar spine diseases has been analyzed. Combined method includes the use of selective approach to every spine segment and insertion of combined (intercorporal and interbody) autografts. Application of selective approach significantly decreases the operative trauma. Intercorporal insertion of autograft accelerates bone ingrowth, provides spine canal unloading, and excludes autograft migration. Additional interbody insertion of autograft strengthen fixation. In main group mean duration of bed rest was 7 days, in control group - 28 days, mean duration of hospital treatment was 14 and 56 days, respectively. Mean duration of working capacity restoration was 4-8 and 10-12 months, respectively. In main group the rate of complications was twice lower and hypostatic complications occurred rarely as compared to the control group. In main group good results were achieved 64%, satisfactory - 27%, unsatisfactory - 9%, in control group - 49, 38 and 13%, respectively.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):55-60
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Age Peculiarities of Clinical Manifestation and Development Dynamics of Spine Deformity in Idiopathic Scoliosis

Tesakov D.K.


Age terms of spine deformity primary manifestation were studied in 2006 patients with idiopathic scoliosis of various severity degrees. It was determined that first clinical signs of idiopathic scoliosis were revealed in children under 10 years, i.e. before the beginning of puberty. Analysis of data obtained enabled to detect the real share of various types of scoliosis deformity development for different terms of its first manifestation. This gives the possibility to consider the age of initial scoliosis deformity sing as a prognostic factor for the assessment of further orthopedic pathology development in concrete patients with idiopathic scoliosis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):61-65
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Reconstructive Operations in Static Foot Deformity

Kopysova V.A., Kaplun V.A., Gorodilov V.Z., Tsyganov A.A., Ten V.B., Egorov A.G.


In 92 patients with static foot deformities of II-IV degrees 159 operations were performed. Surgical treatment had for an object to eliminate first ray adduction and stabilize of forefoot. Follow-up within 1-5 years after operation showed that in static platypodia of II degree the resection of exostosis in combination with subcapital wedge-shaped resection of first metatarsal did not prevent the recurrence of great toe valgus deviation. The more effective method was operation by Shede-Brandes and corrective osteotomies of first metatarsal methaphysis using bone graft or porous implant. Fixation of fragments was performed by S-shaped bow with shape memory. In static platypodia of III degree good long-term functional result was achieved after double osteotomy by Logroscino. In patients with static platypodia of IV degree good results were achieved in combination of Logroscino operation with synostosis of first-second or first-third metatarsals by tightening bow with shape memory foot.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):66-69
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Biomechanical Analysis of Digital Movement in Injured Hand as Method for Functional Diagnosis

Biryukova E.V., Frolov A.A., Grinyagin I.V., Korshunov V.F., Romanov S.Y., Smirnitskaya I.A.


New method for functional diagnostics of motion activity of fingers based on registration of digital movements and their biomechanical analysis is suggested. Kinematical and dynamical parameters of digital movement accounted by biomechanical model adequately reflect the patterns of motion disorders and give the objective numerical evaluation. The method includes: a) registration of digital movement in both intact and injured hands using electromagnetic system of MiniBirds type; b) calculation of individual biomechanical parameters of fingers - length of phalanges, position and alignment; c) calculation of kinematic parameters of movement - time-base of joint angles, angular velocities and accelerations, range of motion of separate joints, degree of coordination of changes in various joints angles (kinematic synergy); d) evalua-tion of dynamic parameters of motion - time-base of total muscular forces moment in joints (dynamic synergy); e) evaluation of functional state based on analysis of kinematic and dynamic parameters of motion before, during and after treatment.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):70-77
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Refraction Introscopy at Synchronized Radiation: Expansion of Possibilities for Visualization of Bone Tissue Remodeling

Pogorelyi D.K., Torgashin A.N., Podurets K.M., Rodionova S.S.


Method of refraction introscopy at synchronized radiation for visualization of bone structures and allografts in laboratory animals was described. The aim of study was adaptation of method for the study of alloigrafts in bones of laboratory anomals. Method was approved at 150 samples of rat tibia. It was shown that use of refraction introscopy at synchronized radiation enabled properly to visualize the borders of allografts and own bone tissue of rat. Method may be recommended for the study of bone remodeling dynamics in experimental animals during long term after operation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):78-82
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Methods of Visualization for Diagnosis of Brachiae Plexus Pathology

Matveeva N.Y., Esikin N.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):82-85
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Reminiscences of Nikolay N. Priorov

Cherkasova T.I.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):86-89
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Some Words of N.N. Priorov

Mitbreit I.M.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):89-90
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Marvellous school

Dobrovolskaya N.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2010;17(2):90-93
pages 90-93 views

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