Vol 11, No 2 (2004)

Articles
Peculiarities of Total Replacement in Hip Joint Severe Pathology
Nikolenko V.K., Buryachenko B.P., Nicolenko V.K., Buryachenko В.P.
Abstract
During the period from 1991 to 2003 the total number of 189 hip replacements in 168 patients aged 17-65 years (mean age 48.7) with severe joint pathology were performed at the traumatology and orthopaedics center of the Military Clinical Hospital named after NN. Burdenko. Six main groups of patients with severe pathologic changes in hip joint and surrounding tissues were detected, i.e. with posttraumatic and gunshot bone defects, dysplastic III- IV stage coxarthrosis, postosteotomic deformities of the extremity, specific inflammatory hip patology metastatic lesions of proximal femur, as well as patients who required single-step bilateral hip replacement. In 18 patients surgical treatment was performed in two steps by authors' technique. «Spotomo» and «Zweymuller» implants, Wagner revision stems and Muller strengthening rings were used most commonly. Excellent and good results were achieved in 157 cases (83.1%), satisfactory in 28 (14.8%). In 4 cases (2.1%) postoperative joint function was unsatisfactory.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):3-12
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Total Hip Replacement in Severe Sequelae of Its Injury
Buachidze O.S., Voloshin V.P., Zubikov B.C., Onoprienko G.A., Martynenko D.V., Buachidze O.S., Voloshin V.P., Zubikov V.S., Onoprienko G.A., Martynenko D.V.
Abstract
Experience of the orthopaedic and trauma clinic of the Moscow Regional Scientific Research Clinical Institute in large joints replacement is presented. Hip replacement was performed to 458 patients with sequelae of the joint injury. Depending on the severity of hip joint injury all patients were subdivided into 2 groups. In the first group of patients joint replacement was performed by standard technique, in the second group of patients certain technical modifications were required. Use of special implant constructions and methods to supplement standard techniques was considered in relation to concrete anatomic and functional changes. The results of large joints replacement were successful in 96% of cases with maximum observation period of 21 years.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):13-17
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Reduction of Toxic Effect of Methyl Methacrylate on Human Cells in Culture Containing Sodium Hypochlorit
Eropkina E.M., Mamaeva E.G., Eropkin M.Y., Mashkov V.M., Eropkina E.M., Mamaeva E.G., Eropkin M.Y., Mashkov V.M.
Abstract
The effect of sodium hypochlorite (SH) upon toxic response of cultured human fibroblasts to methyl methacrylate (MMA) which is a part of bone cement «Polacris» has been studied. Toxic effect of MMA in clinically adequate concentrations demonstrated dose-dependant suppression of total activity of mitochondrial enzymes and that was one of the showings of stress at the cellular level. MMA:SH mixture in volume ratio 1:1 and 10:1 caused reliable reduction of toxic effect on cultured cells as compared with pure MMA of the similar concentration. On the contrary, MMA: SH mixture in volume ratio 1:10 resulted in true decrease of fibroblasts viability as compared with the state of cells in presence of pure MMA. Thus it was shown that chemical experimental in vitro inactivation of MMA could be achieved only when MMA concentration was either higher or equal to SA concentration. That provided the reduction of metabolic disturbances in cells.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):18-21
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Method for Evaluation of Hip Joint State Indices Before and After Surgical Treatment in Dysplastic Coxarthrosis
Abel'tsev V.P., Abel'tsev V.P.
Abstract
System for the evaluation of the main clinical indices of the hip joint condition in dysplastic coxarthrosis has been worked out. The system is based on the objective and subjective signs of the pathologic process and for that the author introduces a concept of «conditional pain». Maximum total score of the objective and subjective signs is the same - 44 points. Depending on the conditions of examination performance and physician's experience, 12 more points have been assigned to the signs that can be both objective and subjective. For the accurate evaluation of the «conditional pain» trustworthiness coefficient has been introduced. This coefficient takes into account the age of patient and possible concomitant diseases. Examples of this coefficient application are given. For the automated processing of clinical data a computer program «Automated methods for the evaluation of pre- and postoperative observation results and stages of dysplastic coxarthrosis development.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):22-26
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Efficacy of Rehabilitation After Total Knee Replacement in Gonarthrosis
Golubev V.G., Goncharov N.G., Rimashevskiy D.V., Khutyz T.K., Pirozhenko S.V., Golubev V.G., Goncharov N.G., Rimashevskiy D.V., Khutyz Т.К., Pirozhenko S.V.
Abstract
The evaluation of the efficacy of rehabilitation program in patients with unilateral gonarthrosis after total knee replacement was performed at the orthopaedic department, Central Clinical Hospital of the Russian Academy of Science. The study included 44 patients who underwent primary total knee replacement with cement implants Osteonics 7000, USA, during the period from 1996 to 2000. After discharge all patients were recommended to take an outpatient rehabilitation course. Due to various reasons 26 patients refused and 18 patients completed the rehabilitation program. The results were assessed after the rehabilitation course completion (3 months after surgery), one year after surgery and at final examination ( 45,2 months average), In the post-rehabilitation group of patients statistically trustworthy improvement of knee joint function and strength of extensors were noted directly after completion of the rehabilitation program and 1 year after surgical intervention. Final examination did not show significant difference between the two groups.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):27-31
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Immune Status of Patients with Polytrauma During the Period of Acute Reaction and Early Clinical Manifestations of the Traumatic Disease
Agadzhanyan V.V., Mendelenko M.M., Semenikhina M.V., Bikbaeva E.F., Ivlev E.V., Kravtsov S.A., Pronskikh A.A., Milyukov A.Y., Agadzhanyan V.V., Mendelenko M.M., Semenikhina M.V., Bikbaeva E.F., Ivlev E.V., Kravtsov S.A., Pronskikh A.A., Milyukov A.Y.
Abstract
The dynamics of immunologic indices in the acute and early periods of the traumatic disease was analyzed in 30 patients (25-60 years) with polytrauma. Even during the period of early manifestations of the traumatic disease the signs of immune deficiency are already determined as a disturbance of T-lymphocytes differentiation, T-helpers in particular. The changes in the system of cellular immunity coincide by time with the occurrence of clinical signs of secondary posttraumatic immune deficiency, i.e. pneumonias, pleurities, purulent endobronchites. The obtained data are indicative of the fact that patients with polytrauma already require immunostimulation during the period of early manifestations of the traumatic disease.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):32-36
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Single-Step Reconstruction of Anterior and Posterior Crucial Ligaments after Their Traumatic Injury
Mironov S.P., Orletskiy A.K., Avdeev A.E., Mironov S.P., Orletskiy A.K., Avdeev A.E.
Abstract
Simultaneous injury of anterior and posterior crucial ligaments is a rare pathology (2-3%) and as rule results from application of force in several planes. This type of injury is one of the most severe traumata of knee joint and could be a block for sports activity on a high level. In athletes with knee ligaments injuries obligatory single-step reconstruction of all injured elements is required. Diagnosis, surgical technique and postoperative rehabilitation course are described.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):37-40
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Destruction of Implants after Extraosseous Osteosynthesis of Long Bones Fractures
Bondarenko A.V., Peleganchuk V.A., Pacnonova E.A., Pechenin S.A., Bondarenko A.V., Peleganchuk V.A., Raspopova E.A., Pechenin S.A.
Abstract
The results of treatment of 337 patients, aged from 15 to 75 years, with femur (175 patients), shin (41), arm (76) and forearm (45) fractures were analyzed. Open injuries were present in 42 (12,5%) and closed ones in 295 (87,5%) patients. According to AO classification type A fractures were diagnosed in 146 (43,3%), type В - in 103 (30,6%), type С - in 88 (26,1%) patients. In all patients osteosynthesis with plates and fixing screws was performed. In 37(11%) patients destruction of the implant took place. The dependence of that complication on the pattern of injury and type of fracture is detected: in open and comminuted fractures the rate of implant destruction was reliably higher. Mechanical destruction of the internal fixation system was presented by two variants: either break of a plate in the zone of the most intensive stress and a screw, or bone destruction in the site of screw insertion. In all cases of implant destruction the nonunion of fractures due to devitalization or absence of intermediate fragments was observed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):41-43
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New Method for Posttraumatic Elbow Contracture Correction
Mironov S.P., Tsykunov M.B., Oganesyan O.V., Seleznev N.V., Eremushkin M.A., Kuroles V.K., Mironov S.P., Tsykunov M.B., Seleznev N.V., Eremushkin M.A., Kuroles V.K.
Abstract
New method for elbow function restoration in posttraumatic contracture using apparatus complex «Raduga-CITO» is suggested. This complex enables to set, control and monitor the indicators of motion. Elaborated computer program provides accurate determination of articular angle values, the rate of articular ends movement, forces of articular surfaces interrelation by 6 main vectors and monitoring of these kinesiologic and dynamic patterns in real time. The program allows to determine adequate algorithm movement in elbow joint and thus to optimize the conditions for elbow function restoration in posttraumatic contractures. The method has been used in 17 patients with posttraumatic elbow contractures and good short term results have been achieved in all patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):44-48
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Use of "Material for Osteoplasty» in Pediatric Orthopaedics: Assessment of the Efficacy and Study of Biologic Processes
Malakhov O.L., Belykh S.I., Berchenko G.N., Kozhevnikov O.V., Saltykova V.G., Ivanov A.V., Malakhov O.O., Krasnoyarov G.A., Malakhov O.A., Belykh S.I., Berchenko G.N., Kozhevnikov O.V., Saltykova V.G., Ivanov A.V., Malakhov O.O., Krasnoyarov G.A.
Abstract
New composite «material for osteoplasty» was used for the treatment of 70 children, aged from 1.5 to 15 years, with various orthopaedic pathology. "Material" consists of defatted spongy and cortical-spongy bone matrix soaked with copolymer containing bioactive drugs as well as fetal bone tissue. Preliminary testing showed that the suggested implants were of high firmness. To assess the stimulating effect of "material for osteoplasty" upon the process of bone tissue reparative regeneration, monitoring of regional microcirculation by ultrasound Doppler mapping was used in complex with other methods. Osteoconductive and osteoinductive characteristics of the implants were observed in 76% of cases. The results of ultrasound Doppler mapping showed good correlation with the morphologic picture.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):49-53
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Use of «LitAr» Material for Substitution of Fingers and Forearm Bone Defects
Krasnov A.F., Litvinov S.D., Tseytlin M.D., Kapishnikov A.V., Krasnov A.F., Litvinov S.D., Tseitlin M.D., Kapishnikov A.V.
Abstract
Plastic hydroxyapatite collagenic material «LitAr» was used for the treatment of wrist and fingers bone defects in 23 patients. In 11 patients the defects resulted from degenerative dystrophic lesions and benign tumors, in 12 patients - posttraumatic genesis. Biotransformation of plastic material was controlled by X-ray and objective assessment was performed using computer analysis of X-ray films a posteriori. It was detected that lysis of composite «LitAr» took place within twenty days followed by substitution bone defect with newly formed bone structures. Newly formed bone met functional requirements of wrist and fingers.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):54-57
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Questionnaire for the Evaluation of Daily Life Activity in Patients with Wrist Pathology
Novikov A.V., Belova A.N., Shchedrina M.A., Donchenko E.V., Novikov A.V., Belova A.N., Chshedrina M.A., Donchenko E.V.
Abstract
The questionnaire for the evaluation of daily life activity in patients with wrist pathology is presented. This questionnaire has been elaborated taking into account social and cultural peculiarities of Russians life and includes 33 questions reflecting the possibilities of carrying out of personal every day activities (hygiene, dressing, putting on shoes, cooking, eating etc.). The functional activity of patients with various wrist pathology ( bone fractures, traumatic wrist and fingers avulsion, multicomponent wrist injuries, tendon injuries, Dupuytren's contracture) was assessed by that questionnaire. Analysis of data obtained showed the conformity of questionnaire to modern requirements of psychometry - high validity, sensitivity and reliability. This questionnaire should be used for the evaluation of rehabilitation efficacy of patients with wrist pathology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):58-62
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Long-Term Results of Surgical Treatment for Benign Thoracic and Lumbar Spine Tumors in Adults
Balberkin A.V., Morozov A.K., Shavyrin D.A., Balberkin A.V., Morozov A.K., Shavyrin D.A.
Abstract
Oncologic and orthopaedics results of surgical treatment of 32 patients with benign tumors of the thoracic and lumbar spine were analyzed. Tumors were manifested by the following nosologic forms: hemangioma, giant cell tumor, osteoid osteoma, osteoblastoma. Follow up period was from 2 to 16 years, at the time of results evaluation all patients were alive. It was shown that the following factors were responsible for the impairment of treatment results: late diagnosis, surgical treatment at nonspecialized clinics, widely spread tumor, severe neurologic disorders, spine deformity in the postoperative period.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):63-66
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Reconstruction of Chest in Metastatic Lesion of Sternum
Burlakov A.S., Makhson A.N., Burlakov A.S., Makhson A.N.
Abstract
Technique of chest reconstruction after sternum resection in its metastatic lesion is presented. This technique includes three methods of reconstructive surgery. For pleura defect closure greater omentum on a vascular pedicle is used. Bony frame is reconstructed using special fast hardening plastic plates. These plates are produced during surgical intervention. Whole construction is covered by vascularized thoraco-dorsal muscular-cutaneous flap. The application of that technique enabled to successfully perform radical operation in 3 with severe metastatic lesions.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):67-68
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Scintigraphy Peculiarities of Bone Solitary Cyst in Children and Adolescents
Bergaliev A.P., Pozdeev A.P., Bergaliev A.N., Pozdeev A.P.
Abstract
Study of blood circulation intensity and bone tissue functional activity was performed in 81 children bone cysts (including 10 children with cyst recurrence) using polyphasic scintigraphy. Most typical picture in presence or absence of pathologic fracture as well as in pathologic recurrence is described. Interrelation between the fracture and rate of cyst recurrence is detected. Scintigraphic criterion for prognosing of solitary bone cyst recurrence is suggested.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):69-73
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Neurovascular Interrelations and Tissue Microcirculation in Posttraumatic Reflex Sympathetic Dystrophy
Krupatkin A.I., Berglezov M.A., Kolosov V.A., Krupatkin A.I., Berglezov M.A., Kolosov V.A.
Abstract
Thirty eight patients with posttraumatic reflex sympathetic dystrophy (RSD) of upper extremities and 28 healthy individuals of the same age (control group) were examined using computer laser doppler flowmetry (LDF) and wavelet-analysis of amplitude-frequency spectrum of fluctuations of microvascular circulation. RDS prevailed in patients with primary warm forms, increase ofportion of shunt circulation, decrease of sympathetic activity and its breakdown at activation. Patients with primary cold forms were characterized by inconstant increase of neurogenic tonus of microvessels at rest. Prolong activation of peptidergenic function of sensory fibres supporting neurogenic inflammation, edema and pain syndrome were typical. One could not exclude that sympathetic vasomotor function and sympathetic support of pain may innervated by different groups of sympathetic neurons. Objective assessment of perivascular innervation and tissue microcirculation is of great clinical importance for individual RSD treatment protocol. Use of LDF is reasonable for early diagnosis of RSD, determination the role of sympathetic and peptidergenic mechanisms in RSD pathogenesis and indications for sympathetic blockades and capsaicin.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):74-77
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Technique of Working of Roentgenograms for the Planning of Orthopaedic Operations
Zolotov A.S., Zolotov A.S.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):78-79
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Rare Case of Acute Traumatic Injury of Femoral Artery by Femur Exostosis
Bogachanov A.N., Slukhay L.F., Bogachanov A.N., Slukhai L.F.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):80-81
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Efficacy of Fingers Reconstruction in Sequelae of Various Injuries
Azolov V.V., Aleksandrov N.M., Azolov V.V., Aleksandrov N.M.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):82-88
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In commemoration of the 100 anniversary of A.V. Kaplan
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):89-89
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Essay about Medical Treatment
KAPLAN A.V., Kaplan A.V.
N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):89-92
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A.F. Krasnov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):93-93
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A.P. Chernov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):94-94
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Yu. I. Ezhov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):94-95
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G.D. Nikitin
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N.N. Priorov Journal of Traumatology and Orthopedics. 2004;11(2):26-26
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