Vol 11, No 4 (2004)

Articles
Development and Perfection of Pediatric Traumatologic and Orthopaedic Service in Russia
Malakhov O.A., Pozdnikin Y.I., Solov'eva K., Malakhov O.A., Pozdnikin Y.I., Solov'eva K.S.
Abstract
Dynamics of the indices of injuries, congenital and acquired diseases of loco-motor system as well as invalidism rate in Russian children during the period from 1992 to 2002 are presented. The organization of specialized traumatologic and orthopaedic care at all medical institutions are analyzed, positive and negative aspects is detected. Perspective directions of activity of public health administrations, scientific as well as treatment-and prophylactic institutions are suggested.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):3-9
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Optimization of Tactics for the Treatment of Patients with Congenital Shortening of Lower Extremities
Malakhov O.A., Kozhevnikov O.V., Zatona D.B., Malakhov O.O., Malakhov O.A., Kozhevnikov O.V., Zatona D.B., Malakhov O.O.
Abstract
Forty-three patients, 2.5-18 years aged, with shortening of lower extremity from 4 to 25 cm caused by congenital femur abnormality were observed at the Department of Pediatric Orthopaedics of CITO. Two patients with pathology of class 1-2 by Papas underwent extremity prosthetics only. In 4 patients with significant (15-20 cm) extremity shortening due to proximal femur defect or disturbance of its continuity similar to pseudoarthrosis prosthetics was performed after surgical stabilization of the hip joint. In the other patients surgical correction of extremity length discrepancy was used. Good results were achieved in 34 (79.1%) patients, satisfactory - in 8 (18.6 %) and unsatisfactory - in 1 (2.3%) patient.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):12-19
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Treatment of Coxarthrosis with Functional Myoneurostimulation
Belen'kiy V.E., Grishin A.A., Krivosheina E.N., Belen'kiy V.E., Grishin A.A., Krivosheina E.N.
Abstract
In 19 patients with typical clinical picture of 1-II bilateral coxarthrosis method of functional myoneurostimulation was used as monotherapy. Treatment course consisted of 15 procedures, 30 minutes each. Treatment results were assessed clinically and bimechanically. After treatment the intensity of pain syndrome decreased significantly; strength of muscles surrounding hip joint increased; the limitation of joint movement due to adductive contracture decreased; walk pattern was normalized. As a rule clinical status of patients that was achieved during the treatment lasted for 6 months. After that mentioned positive changes gradually became less pronounced. Repeated courses of stimulation improved physical condition of patients. Authors believe that efficacy of myoneurostimulation is determined by two main factors, i.e. influence of electric current upon articular and periarticular structures (neuro-muscular and ligamentous system, particularly) at movement as well as significant improvement blood circulation in the pathologic region.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):20-24
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Complex Conservative Treatment of Patients with Osteoarthrosis of Low Extremity Large Joints
Korableva N.N., Dlinnykh N.I., Enikeev M.G., Shestikov D.Y., Pirozhenko S.V., Krasnogorskiy A.V., Khutyz T.K., Korableva N.N., Dlinnykh N.I., Enikeev M.G., Shestakov D.Y., Pirozhenko S.V., Krasnogorskiy A.V., Khutyz Т.К.
Abstract
Results of treatment of 39 patients with hip and knee I-III osteoarthrosis are presented. Treatment consisted of irradiation of bioactive arthrospecific points with high energy Nd-laser followed by injections of drug cocktail into those points. No steroid drugs were used. The method could be used both as independent technique for rehabilitation treatment and preoperative management. It is shown that suggested method provides longer non-medicine remission as well as repeated remission in comparison with traditional conservative treatment.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):25-28
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Possible Tactics Variants of Total Hip Replacement in Dysplastic Coxarthrosis
Akhtyamov I.F., Turenkov S.V., Taranenko A.D., Akhtyamov I.F., Turenkov S.V., Taranenko A.D.
Abstract
Conception for the choice of total hip replacement variant in adult patients with dysplastic coxarthrosis is presented. Criteria for the choice are interrelation of hip joint elements that is evaluated according to the femoral head coverage index elaborated by the authors. The conception was used in 126 patients (136 joints). Advantages of two-steps treatment of dysplastic coxarthrosis were detected: correction of joint elements correlation (pelvic osteotomy by Hiarу) at early stages of pathologic process and subsequent joint replacement at the terminal stage.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):29-34
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Assessment of Results of Total Hip Replacement Using SFEN Implants (preliminary report)
Lomtatidze E.S., Lomtatidze V.E., Potseluyko S.V., Groshev Y.V., Kim N.I., Volchenko D.V., Popov D.P., Lomtatidze E.S., Lomtatidze V.E., Posteluyko S.V., Groshev Y.V., Kim N.L., Volchenko D.V., Popov D.P.
Abstract
From January 1999 to August 2004 total hip replacement with cement SFEN-C implants was performed in 113 patients (128 joints). Average age of patients at surgery was 65.5 years (from 21 to 87). Results were evaluated 3, 6, 12 months after operation and then yearly. At control examination pelvic radiography, assessment of cement technique by Barrack, dynamics of radiographic density at the metal-cement borders, cement-bone of femoral component by Gruen as well as acetabular component by DeLee and Charnley were performed. Functional result was evaluated by Merle d'Aubigne and Postel systems in modification by Charnley and by Harris. Mean follow-up was 20.3+10.8 months (from 3 to 68 months). Long-term results were studied in 87 patients. No sings of polyethylene shell wear and acetabular and proximal femur osteolysis were detected. No clinical symptoms of instability requiring re-operation were noted.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):35-41
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Influence of Anesthesiologic Provision at Total Replacement of Lower Extremity Large Joints in Early Postoperative Period on State of Patients with Cardio-Vascular Pathology
Bessonov S.V., Orletskiy A.K., Kassil' V.L., Bessonov S.V., Orleztkiy A.K., Kassil' V.L.
Abstract
In patients with cardio-vascular diseases total replacement of lower extremity large joints possesses high risk of severe hemodynamic complications. Method of combined epidural and general intravenous anesthesia providing minimum depressing influence on myocardium and allowing adequately prevent the patient from operative trauma was elaborated. In early postoperative period prolonged epidural block in combination with nonsteroid anti-inflammatory drugs results in the best anesthesia and stabilizes hemodynamics in patients with concomitant cardio-vascular pathology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):42-47
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In Vitro Investigation of Resistance to Wear of Human Knee Cartilage during Reciprocating Slipping
Gavryushenko N.S., Kapranchuk V.A., Malygina M.A., Bulgakov V.G., Gavryushenko N.S., Kapranchuk V.A., Maligina M.A., Bulgakov V.G.
Abstract
The resistance to wear of human knee cartilage was studied in «cartilage-cartilage» friction block during reciprocating clipping under pressure to assess the decrease of its thickness after loading and work. The tests were performed using vibrotribometer «Optimol SRV». Sinovial fluid obtained from the patient with posttraumatic knee synovitis and distilled water was used as lubrication. Dependence of the cartilage thickness decrease due to abrasion and deformity on pressure value in friction block was detected. It was shown that total disappearance of cartilage with 1.8 mm thickness under spontaneous change pressure within the range from 1.4 to 0.28 MPa occurred after 1.6 mln oscillations. Under constant 1.4 MPa pressure that corresponding to 990 N load on knee joint the total loss of cartilage was noted after 290000 oscillations, but under constant 3 MPa - after 207000 oscillations.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):48-51
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Theoretical Idea of Dysplastic Hereditary Predisposed Scoliosis (Conception Model)
Korzh A.A., Simenach V.I., Korzh A.A., Simenach B.I.
Abstract
Theoretical idea of dysplastic hereditary predisposed scoliosis has been found on the basis of integration principles using the methodology of the systemic approach taking into account authors' model of scoliosis. This pathology is stipulated by genetically determinant abnormalities of vertebra structure. These abnormalities predispose to the spine deformity development. Manifestation of scoliosis is possible only under conditions of the expositive effect of the environment factors (even the normal ones). Under their additional influence scoliotic deformity with compensative antideformities and all resulting consequences (disturbance of spinal tissues, deformity and disorder of chest and inner organs, etc.).
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):52-57
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Efficacy Assessment of One-Step Surgical Correction of Scoliotic Spine Deformity Using Cotrel-Dubousset Instrumentation
Vetrile S.T., Kisel' A.A., Kuleshov A.A., Vetrile S.T., Kisel' A.A., Kuleshov A.A.
Abstract
In 50 patients with dysplastic scoliosis (mobile deformity of III-IV degree) that underwent dorsal correction and spine fixation using Cotrel-Dubousset the mean postoperative correction of primary arch was equal 59.8%. Instrumental correction exceeded natural spine mobility average by 1.5 times. No significant segmental vertebrae derotation after surgical treatment was obtained. Postoperatively correct anatomic correlations of body and disk height on convex and concave deformity sides were restored. In further it was the determinant factor in preserving of achieved correction. The score system for the assessment of surgical scoliotic deformity correction was suggested. It allows presenting complex standardized characteristic of surgical treatment quality.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):58-67
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Possibilities of Transpedicular Osteosynthesis in Treatment of Thoracic and Lumbar Spine Injuries
Afaunov A.A., Usikov V.D., Afaunov A.I., Afaunov A.A., Usikov V.D., Afaunov A.I.
Abstract
Results of surgical treatment of 84 patients with thoracic and lumbar spine injuries using transpedicular osteosynthesis are presented. The patients were operated on within the terms from 2 days to 3.5 years after trauma. Different types of surgical reposition were used depending on the terms after injury and value of deformity. In 51 patients anterior corporodesis was performed. Average correction of local kyphosis was from 7.4° to 17.7° in different groups of patients. Vertical size of inured segments was restored up to 63.8-92%. Suggested method of intraoperative spine reposition enabled to increase the correction volume 1.7-2 times in late terms after injury. In severe deformities preliminary stage, i.e. transpedicular osteosynthesis using external fixation device with gradual correction over 35° was used. Complications - fracture of longitudinal rod (3 cases), partial destabilization of spine column in osteoporosis (2 cases), as well as loss of correction by 2-3° (9 cases) and 6-15° (3 cases) did not influence the outcomes significantly. In 48 patients the follow-up period was over 1 year. In 44 patients good results were achieved and satisfactory result was noted in 4 patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):68-74
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Use of «Lit-Ar» Material for the Substitution Long Bone Postosteomyelitic Defects
Krasnov A.F., Glukhov V.F., Liteynov S.D., Kapishnikov A.V., Krasnov A.F., Glukhov V.F., Litvinov S.D., Kapishnikov A.V.
Abstract
n 31 patients biodegradable collagen-apatite «Lit-Ar» was used for the substitution of 3-8 cm lone bone defects resulted from osteomyelitic resection. Roentgenologic control followed by computer analysis of roentgenograms was applied to evaluate the processes of material biodeg-radation and bone formation. Good results were achieved in 22 (71%) patients, satisfactory - in 4 (12.9%) and unsatisfactory - in 5 (16,1%) patients. It was shown that the recurrence of purulent-inflammatory process in the implant zone did not require «Lit-Ar» removal. Antibacterial therapy (general and local) was used without repeated surgical intervention and did not cause the rejection of implant. The study allows to conclude that taking into account both medical and economic indices composite material «Lit-Ar» could be used for the treatment of long bone defects
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):75-74
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Clinical and Roentgenologic Semiotics of Long Bone Pathologic Fractures
Demichev N.P., Tarasov A.N., Demichev N.P., Tarasov A.N.
Abstract
During 1965-2002 one thousand two hundred thirty patients with bone tumors and tumor-like diseases were treated at Astrakhan Medical Academy, Clinic of Traumatology and Orthopaedics. Out of them 163 (13.3%) patients had pathologic fractures. One hundred eight fractures were localized within long bones: humerus (61), femur (37), tibia (29), fibula (6), radius (5). Long bones fractures were commonly resulted from destructive lesions: solitary bone cyst - 48 cases, fibrous dysplasia - 26, giant cell tumor - 24, aneurismal bone cyst - 18, metaphyseal fibrous defect -11. Clinical and roentgenologic semiotics was studied and complex of roentgenologic signs of long bone pathologic fractures was systematized. Peculiarities of fractures (injury mechanism, typical localization of pathologic process, pattern of destruction focus) in various nosologic forms of primary disease were detected. The data obtained simplify diagnosis and allow trustworthy making prehistologic diagnosis as well as to choose optimum treatment tactics.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):79-84
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Experimental Substantiation of the Study of Fascial Grafts for the Extremity Reconstruction
Fedotov E.Y., Golubev V.G., Natsvlishvili Z.G., Khokhrikov G.I., Fedotov E.Y., Golubev V.G., Natsvlishvili Z.G., Khokhrikov G.I.
Abstract
The results of the anatomic and angiographic study of the radial and anterior serratus muscle fascial grafts on 30 cadavers are presented. Basing on the results of the work it is possible to conclude that potential introduction of this plastic material into clinical practice for the extremity reconstruction is desired, ft is the first time that the technique of the radial fascial graft harvesting is described in details. Angiographic results showed good blood supply of the isolated fascial grafts.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):85-88
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Biomaterials in Bone Reconstruction after Resection for Tumors
Vyrva O.E., Kladchenko L.A., Malyshkina S.V., Burlaka V.V., Vyrva O.E., Kladchenko L.A., Malyshkina S.V., Burlaka V.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):89-91
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Booke Review. Oganesyan O.V. «Principles of External Transosseous Fixation
Trotsenko V.V., Trotsenko V.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):92-92
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Index of Articles published in 1-4, 2004
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(4):95-97
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