Vol 16, No 3 (2009)

Articles
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Use of Mathematic Computer Modeling for Elaboration and Prognostication of Hip Implant Biomechanical Behavior
Il'in A.A., Mamonov A.M., Karpov V.N., Zagorodniy N.V., Balberkin A.V., Ilin A.A., Mamonov A.M., Karpov V.N., Zagorodniy N.V., Balberkin A.V.
Abstract
Reasonability and main principles of mathematic computer modeling application for elaboration and prognostication of biomechanical behavior of hip joint implants are substantiated and demonstrated. General requirements to modeling of biomechanical systems and choice of initial data to provide trustworthiness and informativeness of calculation results are given. Concrete examples of mathematic modeling use for optimization of constructions, choice of materials and prognostication of biomechanical behavior of implant components produced by group «Ilkom-BMSI» within the last 10 years are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):7-13
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Primary Hip Replacement with Cementless «ESI» Implants
Nuzhdin V.I., Kudinov O.A., Erokhin P.A., Shaternikov B.N., Nuzhdin V.I., Kudinov O.A., Erokhin P.A., Shaternikov B.N.
Abstract
Comparative analysis of the outcomes of cementless implantation of total metal-polymeric structurized hip implants «ESI» of various generations was performed. Results of 1095 implantations (876 patients) performed during the period from 1995 to 2008 were evaluated. Follow-up was from 6 months to 12 years (mean term 7.3 years). Comparison of the results was performed between four groups differed by the modification of applied «ESI» implant. Characteristics for every of four «ESI» implant generations were presented. In the first group (1st generation of implants) assessment of treatment outcomes by Harris showed no excellent and good results, satisfactory results made up 4%, poor results - 96%. In the second group (2nd generation) excellent results were achieved in 3% of cases, good one in 18%, satisfactory - in 36% and poor result was noted in 43% of cases. In the third group (3rd generation) the results made up 27, 63, 8 and 2%, respectively. In group four (4th generation) excellent results made up 32%, good - 64%, satisfactory - 4% with no poor results observed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):14-20
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Joint Replacement in Femoral Neck Fractures
Klyuchevskiy V.V., Gil'fanov S.I., Danilyak V.V., Belov M.V., Khudaybergenov M.A., Klyuchevskiy I.V., Klyuchevskiy V.V., Gilfanov S.I., Danilyak V.V., Belov M.V., Khudaibergenov M.A., Klyuchevskiy I.V.
Abstract
Results of joint replacement in femoral neck fractures have been analyzed. During the period from 1994 to 2003 total hip replacement was performed to 399 patients with subcapital fractures including 372 patients in whom the operation was performed as a primary intervention. From 2002 to 2004 the total number of 290 hemiarthroplasty operations with use of module native implant was performed in 286 patients aged 76-101 years. In total joint replacement group intrahospital lethality made up 2% due to the following causes: pulmonary thrombembolia - 3 cases, acute cardiac insufficiency - 1 case, deep decubitus ulcers resulting in sepsis - 2 cases, polyorganic insufficiency on the background of severe concomitant pathology - 1 case. In the early postoperative period the following complications were noted: implant dislocation (5.2% of cases), intraoperative femoral fracture (3.5%). Infectious complications developed in 2 patients and in both cases removal of the implant was required. With mean-term follow-up native implants showed mean-term survival of 92-94% in 272 patients. Mean evaluation by Harris was the following: biometric «Sinko» and «ESI» implants - 83.1 points, PF «Sinko» implants - 89.3 points, combination of «Mathys» friction pair with native femoral component - 91.2 points. «Mathys» implants showed 94.6 points. Results of ЯРТЕЗ joint replacement were evaluated during the period from 1 to 3 years in 183 patients. Intrahospital lethality made up 1.8%. Excellent and good results were achieved in 53.7% of patients. Revision was required in 1.5% of cases. As concluded total hip replacement in femoral neck fracture was the effective treatment technique. It was reasonable both cement and cementless fixation with various implants for the optimum choice of implant in every specific patient. Use of modern module implants enabled to expand the indications for application of arthroplasty in elderly patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):21-25
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Functional and Psychoemotional Rehabilitation of Senile Patients with Proximal Femus Fracture after Bipolar Hip Hemiarthroplasty
Akhtyamov I.F., Zakirov R.K., Moiseev M.Y., Zyatdinov B.G., Akhtyamov I.F., Zakirov R.K., Moiseev M.Y., Zyatdinov B.G.
Abstract
Ten years experience in treatment of senile patients with proximal femur fractures after hemiarthroplasty is presented. Data of clinical-functional and psychoemotional analysis show the efficacy of bipolar monoimplants application. Due to relatively high price bipolar hemiimplants are not widely used in native clinical practice however simplicity and low invasiveness of the intervention as well as good outcomes allow the authors to recommend more wide used of these implants.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):26-30
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Methods for Restoration of Acetabulum Integrity in Revision Hip Replacement
Kagramanov S.V., Kagramanov S.V.
Abstract
Method for revision acetabulum replacement in marked destruction of bone tissue is described. Technique of acetabulum integrity restoration with bone alloplasty of the walls and roof using additional enforcement either by metallic cup or ring (native company ESI) is presented. Results of treatment (84 patients, follow-up from 4 months to 8.5 years) that confirm the efficacy of the proposed technique are given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):31-35
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Use of Alendronate in Postoperative Period for Prevention of Hip Implant Aseptic Instability
Rodionova S.S., Turgumbaev T.N., Rodionova S.S., Turgumbaev T.N.
Abstract
Assessment of the alendronate influence upon the course of adaptive remodeling of bone tissue adjacent to the implant was performed. Dynamics of mineral bone density (BMD) changes in Gruen zones was compared for 2 groups of female patients. The groups were similar by age, nosology. All operations were performed by the same surgical team with application of one type of implant (Zweymuller). During the first post-operative year patients from the study group (n=38) were taken alendronate (Fosamax-70) once a week and at least 1200 mg of calcium carbonate daily (either as calcium containing food products or calcium carbonate preparations). Patients from control group (n=94) were taken only calcium carbonate by the same scheme within the first postoperative year. It was detected that although by 6th postoperative month alendronate did not decraese BMD loss as compared to controls, within the interval of 6-15 months it significantly increased bone tissue mass accretion. In group of alendronate patients monthly accretion of bone tissue in some Gruen zones (except for R4) was twice and more higher than in control group. Fifteen months later patients from the main group showed BMD deficit only in R4 zone. In the rest of zones bone tissue mass exceeded the basic values and in the majority of zones that increase was trustworthy. In control group BMD deficit was preserved in two proximal zones (R6 and R7) and in zone R6 it even increased as compared to the results of the previous study (12 months after operation).
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):36-44
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Treatment of Patients with Pyo-Inflammatory Complications after Hip Replacement
Pichkhadze I.M., Kuz'menkov K.A., Zhadin A.V., Tsiskarashvili A.V., Pichkhadze E.I., Daneliya L.M., Rekvava G.R., Shulashov B.N., Pichkhadze I.M., Kuzmenkov K.A., Zhadin A.V., Tsiskarashvili A.V., Pichkhadze E.I., Daneliya L.M., Rekvava G.R., Shulashov B.N.
Abstract
Treatment results were analyzed for 78 patients (2001-2008) with pyo-inflammatory complications after hip joint replacement. Implants were preserved in 7 patients. In the rest of patients implants were removed followed by sequestrnecrectomy of articular ends and neoarthrosis formation. Treatment tactics and principles of surgical intervention were described. Good and satisfactory results were achieved in 75.44% and 24.56% of cases, respectively. Presented methods enabled to achieve weight bearing ability of the extremity and contributed to the adequate rehabilitation of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):45-50
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Analysis of Implant Alignment and Early Functional Results of Total Knee Replacement Performed Using Computer Navigation System
Petukhov A.I., Kornilov N.N., Kulyaba T.A., Tikhilov R.M., Selin A.V., Kroitoru I.I., Ignatenko V.L., Saraev A.V., Petukhov A.I., Kornilov N.N., Kulyaba T.A., Tikhilov R.M., Selin A.V., Croitoru I.I., Ignatenko V.L., Saraev A.V.
Abstract
Knee implant alignment analysis and comparative assessment of functional results of 47 total joint replacements with computer navigation system (main group) versus 50 conventional arthroplasties (control group) were performed. Computer assisted system improved the accuracy of limb alignment after knee arthroplasty and reduced the rate of deviations. The position of femoral component in frontal plane and tibial component in sagittal plane showed statistically reliable differences between two groups (p<0.05). Within the first 6 months after surgery knee joint function (KSS and WOMAC score systems) in the main group was trustworthily better as compared to the control group. Later on those differences smoothed over.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):51-55
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Experience in Total Ankle Replacement at Russian Scientific-Research Institute of Traumatology and Orthopaedics Named After R.R. Vreden
Tikhilov R.M., Koryshkov N.A., Emel'yanov V.G., Stoyanov A.V., Zhuravlev A.V., Privalov A.M., Tikhilov R.M., Koryshkov N.A., Yemelyanov V.G., Stoyanov A.V., Zhuravlyov A.V., Privalov A.M.
Abstract
Results of 45 ankle joint replacements performed during the period from 1998 to 2008 have been analyzed. Cementless original implants were applied in 6 (13.3%), «Link S.T.A.R.» implants - in 26 (57.8%) and «DePuy Mobility TM» implants - in 13 (28.9%) cases. Mean follow-up made up 3 years (from several months to 10 years). For the evaluation of long-term outcomes the data from patients questionnaires (prior to, 6 months after operation and at the time of last examination) and X-ray results were used. Early complications, i.e. fracture of lateral malleolus, was noted in 4 patients. Long-term complications, i.e. dislocation of tibial component, were observed in 2 patients. In 2 patients the development of infectious complications required implant removal followed by arthrodesis. In 91% of cases the results were assessed as satisfactory and good by Kitaoka scale.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):56-60
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Elbow Arthroplasty using «Endoservice» Elbow Endoprosthesis
Prokhorenko V.M., Chorniy S.I., Shaternikov B.N., Prokhorenko V.M., Chorniy S.I., Shaternikov B.N.
Abstract
Taking into account anatomic and biomechanical peculiarities of elbow joint specialists of Novosibirsk SRITO with Endoservice Firm elaborated original elbow endoprosthesis and instruments for it implantation. The application of this endoprosthesis is permitted in Russian Federation. The implant characterizes higher reliability during functional load and rotative stability of elbow joint in provision with sufficient of motion volume. Indications and contra-indications to total elbow replacement, operative technique as well as protocol of postoperative management of patients are given. Treatment results of 18 patients at terms from 1 to 6 years are presented. Good result was achieved in 72%, satisfactory in 17% and unsatisfactory in 11% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):61-68
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Problems of Venous Thromboembolic Complications in Large Joints Rep-lacement
Kopenkin S.S., Skoroglyadov A.V., Kopenkin S.S., Skoroglyadov A.V.
Abstract
Basing on the literature data and personal experience the authors have analyzed venous thromboembolic complications after hip and knee replacements in patients with locomotor system injuries and pathology. System for prevention of such complications in traumatologic and orthopaedic clinical departments has been presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):69-73
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Internal Fixation for Unstable Pelvic Ring Injuries in Polytrauma Patients
Sokolov V.A., Byalik E.I., Fayn A.M., Evstigneev D.V., Sokolov V.A., Byalik E.I., Fain A.M., Evstigneev D.V.
Abstract
During the period from 1997 to 2008 three hundred twenty two polytrauma patients with unstable pelvic ring injuries were operated on at the department of concomitant and multiple injury of Sclifosovskiy Scientific-Research Institute for Emergency Care. External fixation of pelvic ring fragments was the basic part of antishock therapy. Avulsion of symphysis pubis was treated using original pelvic plate. In multiple pelvic fractures two specially designed reconstructive plates were applied via 2 endopelvic mini approaches. Elaborated treatment tactics enabled to achieve good anatomical and functional results in the majority of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):74-79
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Transcortical Combined Plasty of Pseudarthroses of Bones Extremities
Sklyanchuk E.D., Zorya V.I., Gur'ev V.V., Prosvirin A.A., Sklyanchuk E.D., Zopya V.I., Gurev V.V., Prosvirin A.A.
Abstract
Authors elaborated method for surgical treatment of bones extremity including endostal decortication of fragments after marginal corticotomy, forming of fenestrated access into pseudarthrosis, plasty endostal cavity by collagenic materials (collost, collapan) and autogenic chip from the local tissue obtained during endostal decortication. That method was used during the treatment of 40 pseudarthroses in 37 patients. There were pseudarthroses of crus in 15 patients, forearm - in 9, femur - in 6, shoulder - in 4 and clavicular - in 3 patients. Healing of pseudarthroses were achieved in all cases in time similar to terms of bone fracture healing. However duration and traumatization of surgical intervention was reliably lower than in traditional bone-plastic operations.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):80-85
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Dynamics of Traffic Injuries in Russian Federation
Leonov S.A., Ogryzko E.V., Andreeva T.M., Leonov S.A., Ogryzko E.V., Andreeva T.M.
Abstract
Dynamics of traffic injuries in Russian Federation over the period 2003 to 2007 was analyzed. In that period rate of traffic injuries was decrease by 8%. Comparison of traffic injury rates of different Russian regions was made. Structure of non-fatal traffic injuries was presented. Data on non-fatal traffic injuries and traffic mortality rates were compared. Main directions to prevent traffic injuries were suggested.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):86-91
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Expediency of Trauma Center System Development in Oblasts of Siberian Federal Region: Monitoring Results of Concomitant Injury
Apartsin K.A., Gaydarov G.M., Novozhilov A.V., Grigor'ev S.E., Kornilov D.N., Batekha V.I., Zaytsev A.P., Bondarenko A.V., Pelengachuk V.A., Plekhanov A.N., Tsybikov E.N., Budasheev V.P., Yugov K.M., Apartsin K.A., Gaydarov G.M., Novozhilov A.V., Grigorev S.E., Kornilov D.N., Batekha V.I., Zaytsev A.P., Bondarenko A.V., Peleganchuk V.A., Plekhanov A.N., Tsybikov E.N., Budashev V.P., Yugov K.M.
Abstract
Целью исследования была проверка гипотезы о том, что развертывание в регионе специализированной помощи пострадавшим с сочетанной травмой существенно улучшает результаты лечения по сравнению с таковыми при оказании квалифицированной помощи. В рамках разработанного ранее авторами протокола мониторинга сочетанной травмы (МОСТ) обследованы региональные центры Сибирского федерального округа - Барнаул (специализированная помощь пострадавшим), Иркутск и Улан-Удэ (оба - квалифицированная помощь). Проведен сравнительный анализ распределения пострадавших по полу, возрасту, механизму травмы, ведущему повреждению, тяжести повреждений, летальности. Исследованы эпидемиологические характеристики сочетанной травмы. Наибольшая заболеваемость отмечена в Иркутске - 165 на 100 000 населения, наибольшая смертность - также в Иркутске (58,6 на 100 000). Выявлено, что общая летальность при сочетанной травме, госпитальная летальность, а также летальность при крайне тяжелых повреждениях в Барнауле была статистически значимо ниже, чем в Иркутске и Улан-Уде. Таким образом, развертывание специализированной помощи пострадавшим позволило существенно снизить летальность, что является основным критерием эффективности оказываемой помощи.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(3):92-92
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