Vol 16, No 4 (2009)

Articles
Modeling of Posttraumatic Changes in Knee Joint in Animal Experiments
Mironov S.P., Omel'yanenko N.P., Trotsenko V.V., Karpov I.N., Kurpyakov A.P., Mironov S.P., Omel'yanenko N.P., Trotsenko V.V., Karpov I.N., Kurpyakov A.P.
Abstract
The purpose of the work was to create the model of posttraumatic changes in the knee joint for the study of changes in the injured joint and elaboration of surgical and conservative methods acting on such changes. Experiments were conducted in three equal groups of animals (4 sheep in each group). Round injuries with 5 mm diameter and various depths were inflicted to the bearing surface of the medial femoral condyle. The animals were sacrificed in 1, 3 and 6 months after operation using narcosis overdosage. The obtained data were analyzed by anatomic- morphologic and histochemical methods. Formed posttraumatic structures in the articular cartilage and subchondral bone are constant and may be considered as signs of deforming arthrosis. According to the depth of injury and morphologic changes in the involved cartilaginous and bone articular tissues three degrees of osteoarthrosis are marked out. In every degree the injured joint may be used as a model for the choice of adequate therapy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):3-12
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Blood Saving Effect of Tranexame at Hip Joint Replacement
Arzhakova N.I., Bernakevich A.I., Shushpanova E.V., Arzhakova N.I., Bernakevich A.I., Shushpanova E.V.
Abstract
Study of the efficacy (by the results of blood saving action assessment) and application safety of tranexamic acid (home antifibrinolytic drug Tranexame) at hip arthroplasty was performed. Perioperative blood loss (intraoperative + postoperative blood loss by drainages during 24 hours), need in hemotransfusion, laboratory indices (hemoglobin, hematocrit, coagulograms) before and after operation were analyzed in 43 patients. Twenty patients received 4 g of Tranexame daily (main group) and 23 patients did not receive antifibrinolytic drugs. In the main group reliable decrease in blood loss as compared with control perioperative one, lower decrease of hemoglobin level and less need for donor plasma transfusion (in combination with autodonor blood and other blood savings methods) was noted. Safety of the drug was proved by the absence of thrombosis signs at ultrasonography of lower extremities vessels.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):13-18
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On Possibility of Optimization of Bone Stress Remodeling in Knee Joint Arthroplasty
Reznik L.B., Turushev M.A., Reznik L.B., Turushev M.A.
Abstract
Using standard photodensitometry bone remodeling was studied in proximal tibia and distal femur after total knee arthroplasty at terms up to 12 months. Out of 120 patients 60 patients (main group) received strontium ranelate (Bivalos) for 12 months after operation and in 60 patients (control group) drug correction was not performed. By the results of standard photodensitometry in both patient groups the density of radiographic image around the implant decreased by 22% at an average within the first 2 postoperative months and that was indicative of osteolysis activity. Later on during the period from 2 to 6 months after arthroplasty the increase of optic bone density was observed. By the end of 12 month in patients from the main group the optic bone density around the implant increased by 39.6% (to preoperative level) and by 25% in controls as compared with the level recorded in 2 months after surgery. Analysis of the total knee replacement by Lischolm scale showed that drug optimization of the processes of bone tissue remodeling enabled to shorten the terms of patients' rehabilitation and to decrease the rate of unsatisfactory results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):19-23
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Bone-Plastic Reconstruction of Proximal Femur in Patients with Femoral Neck Fractures and Pseudarthroses
Kopysova V.A., Kaplun V.A., Gorodilov V.Z., Kutkov A.A., Kaplun I.V., Nysanbaev S.Z., Kopysova V.A., Kaplun V.A., Gorodilov V.Z., Kutkov A.A., Kaplun I.V., Nysanbaev S.Z.
Abstract
Rehabilitation potential of medializing valgus osteotomy with formation of bone lock by Konforti-Ivanov and reconstructive bone-plastic operation by Luck was studied in 122 patients with femoral neck fractures and pseudarthroses. The guarantee of surgical intervention efficacy is differentiated approach to the choice of treatment technique with due regard for the peculiarities of proximal femur injuries, stable functional osteosynthesis in combination with dynamic compression of bone fragments by tightening bows with shape memory effect. Good treatment results with long lasting functional effect achieved in 104 (89.7%) patients allowed to recommend using organ saving reconstructive plastic operations as an alternative to joint replacement in patients without presence of coxarthrosis and pathologic femoral head transformation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):23-28
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Transosseous Osteosynthesis with External Fixation Devices in Intraarticular Fractures of Knee Joint Area
Pankov I.O., Emelin A.L., Pankov I.O., Emelin A.L.
Abstract
Peculiarities of transosseous osteosynthesis with pin-rod external fixation devices at treatment of various intraarticular fractures in the area of the knee joint are presented. Analysis of treatment outcomes for 108 patients with 110 fractures (18 fractures of femoral condyles and 92 fractures of tibial condyles) was performed. Excellent and good results were achieved in 83 (75.4%) cases. In polysegmental and impression-compression fractures of femoral and tibial condyles the treatment results were most often only satisfactory or unsatisfactory that was accounted for the severity of injury with massive destruction of the articular surfaces.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):29-34
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Intraosseous Osteosynthesis with Pin Distractor in Closed Diaphyseal Fractures of the Tibia
Litvinov I.I., Klyuchevskiy V.V., Dzhurko A.D., Razankov A.G., Litvinov I.I., Klyuchevskiy V.V., Dzhurko A.D., Razankov A.G.
Abstract
The model of pin distractor (pat. 75299 RF) that enables to perform intraoperative 3D correc-tion of fragments' displacement has been proposed. Twenty patients with closed fractures of the shin bones have been operated using this device and treatment results have been analyzed. In 4 patients slight (up to 3°) angular displacements have been noted. In 1 patient 0.5 cm shortening of the shin has been present as a result of the previous fracture. Treatment results have been considered as good in all cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):34-37
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Restoration of Foot Shape and Function in Calcaneous Deformities and Defects
Samusenko D.V., Neretin A.S., Samusenko D.V., Neretin A.S.
Abstract
Methods and outcomes of treatment of calcaneous deformities and defects (102 patients, 112 feet) of different etiology are presented. Treatment technique was extrafocal compression-distraction osteosynthesis by Ilizarov. Condition of the foot was monitored using radioisotopic, biomechanical and radiologic examinations. Anatomic and functional results of treatment depended upon the severity of the initial pathologic changes in bone and soft tissues, presence of concomitant osteomyelitis in the remission phase as well as on gait stereotype and biomechanical relation of the overlying segments. Preference of transosseous osteosynthesis by Ilizarov for the treatment of calcaneous defects and deformities accounted for the possibility of dosed correction and functional loads as well as by the favorable effect on bone tissue blood supply.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):37-41
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Application of Stabilometry at Orthopaedic Clinic in Lower Extremity Joints Pathology
Nazarov E.A., Seleznev A.V., Ryabova M.N., Nazarov E.A., Seleznyov A.V., Ryabova M.N.
Abstract
Weight bearing response in patients with degenerative-dystrophic diseases and sequelae of hip, knee and ankle injuries was studied using the elaborated hardware-software stabilometric comp-lex Appliance for Registration and Analysis of Distribution of Loads to Lower Extremities. Evaluation of the efficacy of conservative and surgical treatment was performed. New data on stabilometric status of patients after hip joint arthroplasty and ankle arthrodesis were obtained.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):42-48
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Experimental Morphologic Substantiation of Exogenous Nitric Monoxide Use for Gunshot Wounds Treatment
Berchenko G.N., Shal'nev A.N., Rykunov A.V., Tatarenkov V.I., Berchenko G.N., Shal'nev A.N., Rykunov A.V., Tatarenkov V.I.
Abstract
Influence of exogenous nitric monoxide (NO) on the process of reparative regeneration of gunshot wounds was evaluated during experimental morphologic study. Object of the study were 120 white rats. Use of NO-therapy for the treatment of experimental gunshot wounds normalized microcirculation, activated macrophages, increased proliferation and synthetic activity of fibroblasts, decreased dystrophic and necrotic changes in the wound tissues envirement. It also decreased secondary necrosis and, hence, promoted synthesis, maturation and remodeling of granulation tissue. The data obtained showed that NO-therapy could be recommended for clinical application to treat gunshot wounds in inflammatory and proliferative stages.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):49-54
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Experience in Clinical Application of Perftorane for Intensive Therapy in Patients with Severe Combined Injuries Resulted from Explosion in Coal-Mine
Mullov A.B., Mullov A.B.
Abstract
Twenty victims with severe combined injuries caused by explosion in the coal-mine were included into the study. The components of such injuries were barotrauma, mechanical injury, skin and inhalation burns, carbon oxide poisoning intensified by syndrome of mutual aggravation. The ultimate cause of death was the affection of oxygen transport system. Temporary substitution of affected blood - lung system with oxygenated perftorane enabled to decrease considerably the lethality rate in miners with negative and doubtful survival prognosis. Efficacy of perftorane inclusion into intensive therapy was stipulated by its chemical inertness owing to which it can transport oxygen under conditions of blood poisoning by carbon oxide and unfit for breathing atmosphere in the mine after explosion.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):55-57
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Plasty with Vascularized Flaps in Burn Hand Deformities
Shaltakova G.C., Mateev M.A., Shaltakova G.C., Mateev M.A.
Abstract
Experience in treatment of 108 patients with hand deformities resulted from burns is presented. Reconstructive operations with vascularized tissue flaps grafting have been performed in all cases. Full healing of the grafted flaps was achieved in 97.2% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):58-60
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Chondrosarcoma in Children
Ivanova N.M., Ivanova N.M.
Abstract
Treatment experience was analyzed in 77 patients (aged from 1 to 17 years) with chondrosarcoma. All patients were under treatment at the Scientific Research Institute of Pediatric Oncology and Hematology during the period from 1982 to 2008. In 36 patients including patients with second degree of malignancy (main group) new treatment protocol that provided application of polychemotherapy with regard to the risk group was used. Second degree of malignancy was determined by the degree of DNA ploidy and proliferative tumor cells activity by flow cytophotometry data. Forty one patients (control group) were treated according to the routine protocol. It has been shown that early application of polychemotherapy enabled to expand the indications to organ saving surgical interventions and to increase 5-years relapse-free survival at unfavo-rable forms of chondrosarcoma up to 75±7.8%.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):60-64
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Spontaneous Resorption of Bones in Children (12 cases)
Snetkov A.I., Frantov A.R., Morozov A.K., Berchenko G.N., Batrakov S.Y., Kotlyarov R.S., Anisimov M.V., Snetkov A.I., Frantov A.R., Morozov A.K., Berchenko G.N., Batrakov S.Y., Kotlyarov R.S., Anisimov M.V.
Abstract
Experience in observation and treatment of 12 patients aged 5-18 years with spontaneous bone resorption is presented. Clinical and roentgenologic picture, results of modern examination methods (computed tomography, angiography) and histologic examination are considered. Indications to the treatment of patients with spontaneous bone resorption are determined. Surgical treatment should be performed in the phase of process stabilization while surgical intervention in the active phase of the disease results in the process progression.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):64-69
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Surgical Treatment of Long Bones Deformities in Exostotic Chondrodysplasia in Children
Bakhteeva N.K., Rubashkin S.A., Tsareva E.E., Zotkin A.V., Bakhteeva N.K., Rubashkin S.A., Tsaryova E.E., Zotkin A.V.
Abstract
Surgical method for the treatment of children with shin bones deformities developed on the background of multiple osteocartilagenous exostoses has been proposed. The technique consisted of exostoses removal within normal tissues, performance of osteotomy on the deformity apex, formation of autograft followed by its insertion into zone of the defect for its closure by means of fixed rate distraction and correction of limb axis in the external fixation device. That technique was applied in 11 children. Good result was achieved in 87.2%, satisfactory - in 11.5%, poor - in 1.3% of cases. In control group (24 patients treated by conventional surgical methods) good results made up 62.5%, satisfactory - 25.0%, poor - 12.5%. Closure of the defect zone by formed cortical autograft enabled to shorten the bone consolidation terms in patients who were treated by the proposed technique by 12-14 days.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):70-73
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Choice of Antibacterial Agents for Prevention and Treatment of Infectious Complications in Traumatologic and Orthopaedic Patients by Microbiologic Monitoring
Pkhakadze T.Y., Okropiridze G.G., Malysheva E.S., Pkhakadze T.Y., Okropiridze G.G., Malysheva E.S.
Abstract
Etiologic structure of infectious complications in traumatologic and orthopaedic patients has been studied at CITO named after N.N. Priorov during the period from 2005 to 2007. Using modern agents and techniques 6799 samples from 3023 patients were studied. Resistance of pathogenic microorganisms to the wide spectrum of antibiotics including the drugs of last gene-ration was studied. Basing on the study results the protocols for the application of modern antibiotics including protected aminopeptides, cephalosporins of third-forth generation including the protected ones, glycopeptides, oxazolidinones, aminoglycosides, fluoroquinolones, carbape-nemones have been elaborated and introduced into clinical practice.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(4):73-78
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