Vol 10, No 1 (2003)

Original study articles

Modern concept of early detection and treatment of idiopathic scoliosis

Mikhaylovskiy M.N., Novikov V.V., Vasyura A.S., Sarnadskiy V.N., Kuz'mishcheva L.G.


Concept of early detection and treatment of patients with idiopathic scoliosis is presented. That concept has been elaborated at Novosibirsk Institute of Traumatology and Orthpaedics (Republican Center of spine pathology) and includes the following stages. 1. Screening of large groups of children for early diagnosis of spine deformities using computer optic tomography. 2. Follow up of children from the “risk groups”. 3. Conservative treatment of children with deformities within 20-40° by Cobb using jacket elaborated at Novosibirsk. 4. Surgical treatment of progressive deformities with individual approach to the following groups of patients: children under 10 years; intermediate group (11-13 years, skeleton growth not completed); adolescents (14-20 years); patients with neglected deformities over 90°. 5. Postoperative rehabilitation using segmental instrumentation of CDI type takes several weeks.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):3-10
pages 3-10 views

Possibilities of computed tomography in the complex assessment of scoliotic spinal deformity

Vetrile S.T., Morozov A.K., Kisel A.A., Kuleshov A.A., Kosova I.A.


Complex evaluation of scoliotic deformity was performed using CT. Fifty patients with displastic scoliosis of III—IV degree were examined before and after surgical intervention — dorsal correction and spine fixation with Cotrel-Dubousset instrumentation. No marked derotation of spine at the deformity apex was noted postoperatively. Changes of thorax in the plane of apical vertebra were studied and quantitatively evaluated: postoperatively thorax became of more correct oval shape in all cases. Density of trabecular bone of apical and neutral vertebrae coincided with the understanding about asymmetry of deformed vertebrae bone density. No marked immediate postoperative changes were noted. Combination of CT and myelography showed the dislocation of dural sac to the side opposite to the deformity convexity; either partial (up to 60—70% in patients with deformity of III and early IV degree) or complete (in patients with severe deformity) disturbance of contrast distribution in subarachnoidal space from concave side and compensatory widening of subarachnoidal space from the opposite side with maximum changes at the apex of scoliotic deformity.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):11-20
pages 11-20 views

State of the cardiorespiratory system in patients with grade IV thoracic scoliosis before and after surgical treatment

Avtandilov A.G., Vetrile S.T., Nemanova D.I., Kuleshov A.A.


Cardiorespiratory system was examined in 33 patients with thoracic scoliosis of degree TV ( 15 — nonsurgical, 18 — surgical treatment). Eighteen surgically treatment patients were operated using Cotrel—Dubousset instrumentation and were examined within 1—3 years after surgery. Examination included evaluation of external respiration function, echocardiography (ECG), bicycle ergometer test (BEMT). It was shown that postsurgically the function of external respiration was better than in nonsurgically treated patients. ECG showed reliably lower size and thickness of the right ventricular wall as well as considerably lower level of pulmonary hypertension. Tolerance to physical load at BEMT, level of working capacity and the term of restoration was reliably better in surgically treated patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):21-23
pages 21-23 views

Experience in the use of composite biocompatible implants in the clinic of pediatric and adolescent orthopedics

Malakhov O.A., Krasnoyarov G.A., Belykh S.I., Kozhevnikov O.V., Ivanov A.V., Tatarenkov V.I.


Specialists from Children Orthopedic Clinic (CITO) and Institute of Medical Technology elaborated therapeutically active implants on the base of N-vinilpirrolidone and methylmethacrylate with different additives. Those implants were successfully applied in clinical practice. Experimental study on rabbits showed the possibility of implants to stimulate osteogenesis. Various types and shapes of implants were elaborated using different combinations of additives. Minimum invasive surgical intervention and indications to implants’ application were worked out. From 1987 to 2001 one hundred thirteen patients with various pathology (obstetrical paresis, clubfoot, juvenile femur head ephiphysiolysis, congenital hip dislocation, funnel-shaped deformity of thorax, dystrophic varus deformity of femur head, osteochondropathy of lower limbs) were treated surgically using new implants. At 3—5 years follow up good and excellent anatomic and functional results were noted in 89% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):78-83
pages 78-83 views

Diagnostic possibilities of sonography in lumbosacral pain

Mironov S.P., Burmakova G.M., Saltykova V.G., Eskin N.A.


Ultrasound examination results of 83 athletes and ballet dancers with lumbar-sacral pain syndrome caused by osteochondrosis, spondylolysis of lower lumbar vertebrae, pathology of lumbar-sacral spine ligaments are presented. Technique of ultrasonography of the lumbar spine from anterior and posterior accesses is given. Pathological changes in various structures lumbar spine (intervertebral disks, ligamentous system) at overloading are described. The advantages of ultrasonography, i.e. informativeness, low invasiveness, possibility of the repeated examination during the treatment are noted.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):24-31
pages 24-31 views

Features of the clinic, diagnosis and treatment of diseases of the thoracic and lumbar spine in pregnant women

Skryabin E.G.


Examination of 325 pregnants with spinal pain at different terms of gestation was performed. The nature, rate and main clinical manifestations of vertebral pathology are detected. Taking into account impossibility of radiologic examination the shady moire topography of posterior surface of trunk , which exerted no negative influence on fetus, was used for the diagnosis of spine deformity. Complex treatment with nondrug therapy allowed to eliminate or significantly decrease the spinal pain syndrome. Specially elaborated devices for the diagnosis and treatment of spinal diseases in pregnants were used.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):31-35
pages 31-35 views

Segmental spinal dysgenesis

Mushkin A.Y., Ulrich E.V., Elyakin D.V.


Segmental spine dysgeusia is a rare variant of vertebral abnormality that is characterized by severe stenosis of spinal canal, severe spine deformity, spine instability accompanied by congenital isolated spine malformation. Optimum method for the treatment is an early operation directed to simultaneous elimination of spine cord stenosis, deformity correction and restoration of spine stability. The results of examination, technique and surgical outcome are presented for a 2 years and 7 months child with segmental spine dysgeusia.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):35-38
pages 35-38 views

Biological osteosynthesis in fractures of the trochanteric region of the femur

Rublenik I.M., Vasyuk V.L., Shayko-Shaykovskiy A.G.


New interlocking metal-polymeric fixative of the seventh generation for closed osteosynthesis in trochanteric fractures is elaborated and introduced into practice. The strength of the «bonefixative» system is calculated. The suggested fixative and the technique of its use meet the criteria of biologic (low invasive) osteosynthesis, provides the possibility to perform surgery via small skin incisions and thus minimizes the risk of intra- and post-operative complications.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):38-41
pages 38-41 views

Treatment of fractures of the distal tibial metaepiphysis

Babovnikov V.G., Babovnikov A.V., Tsypurskiy I.B.


The experience in treatment of 58 patients with distal tibia metaepiphysis fractures is summarized. Two-staged treatment tactics was used. Preoperatively (first stage) skeletal traction was performed. Surgical treatment was applied at the second stage. Depending on injury mechanism five variants of compressive fractures were differentiated, i.e. axial compression and axial compression in extension, flexion, abduction, adduction of foot position. Subdivision of patients by the injury mechanism enabled to detect accurately the fracture zone and to choose the surgical approach. Osteosynthesis by plate was the method of choice. Postoperatively complex rehabilitation treatment was performed. Excellent results were achieved in 30% of patients, good results in 50%, satisfactory in 15%, poor results in 5%o of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):42-45
pages 42-45 views

Features of the treatment of injuries of the talus

Koryshkov N.A., Zaytsev O.V.


The experience in diagnosis and treatment of 52 talus injuries (50 patients) is presented. Inclusion of computer tomography into examination complex allowed to improve the diagnosis accuracy, especially in fractures of talus body and talus blocking in sagittal plane. Eight (16%) patients underwent conservative treatment and 42 (84%) were operated on. Surgical dissection of medial malleolus provides anatomic (preservation of artery deltoideus) and vast approach for the revision of fracture zone. Reposition performed at the early terms as well as stable fixation of talus fragments by sunken metal-devices are the means for the compensation of vascular disturbances (aseptic necrosis). In case of moderate pain syndrome, development of small aseptic necrosis zones and absence of talus prolapse active vascular therapy and delayed tactics are indicated. In marked pain syndrome, vascular disturbances, significant aseptic necrosis of talus with its prolapse the indications to the resection astragalectomy should be considered. Long term results were observed in 43 patients. Good results were achieved in 36 (83.7%) and satisfactory results — in 7 (16.3%) patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):46-50
pages 46-50 views

Surgical treatment of lateral instability of the metacarpophalangeal joint of the first finger

Korshunov V.F., Skvortsova M.A.


Examination and treatment results of 27 patients with lateral instability of metacarpal-phalanx thumb joint were presented. The indication to operation and technique of surgical intervention in dependence on the terms from injury moment, presence or absence of instability, value of passive lateral deviation angle were detected. Surgical technique for the treatment of complete tears of collateral ligaments of metacarpal-phalanx thumb joint was petfected. In 22 patients follow up period ranged from 6 to 12 months. Excellent results were achieved in 13 (59%o), good — in 7 (32%)), satisfactory — in 2 (9%) patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):50-53
pages 50-53 views

Morphological characteristics of the anterior cruciate ligament of the knee joint in case of its damage (experimental study)

Taylashev M.M., Benemanskiy V.V.


The changes in ACL after its detachment from the external femur condylar were studied in a rabbit model. It was shown that changes were of phase nature, ligament stumps with wound contraction gradually retracted and atrophied by 45 post-injury day. In isolated ACL injuries with developed joint instability menisci are easily damaged. That confirmed the critical role of ACL in provision of knee stability and testified the necessity of early ligament suturing. Posttraumatic hemosynovitis spontaneously stopped during the first 2 weeks (acute period). Morphologically that period showed marked fibroplastic process that signified the transition of acute period to subacute one (within 2 following weeks). Four weeks after injury the process got into chronic phase with morphologic picture of marked destruction and degeneration of collagen fibers of ACL stump.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):54-59
pages 54-59 views

Stimulation of the therapeutic effect of chondroprotectors in the treatment of deforming arthrosis of the knee joint

Dubrovin G.M.


Method for stimulation of therapeutic action of chondroprotectors using polarization light and vibrotherapeutics was suggested for the treatment of deforming arthrosis. The main drug was alphlutop — chondroprotector out of glucosaminoglycanes group. Ninety patients with deforming knee arthrosis of I—III degree in sub- and decompensated forms were treated. Control group (without stimulation) consisted of 20 patients. In 70 patients different variants of stimulation were used. Long term results were evaluated in terms up to 2—3 years. It was detected that combined use of polarization light, chondroprotectors, vibrotherapeutics allowed to achieve higher clinical outcomes and prolonged remission.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):60-62
pages 60-62 views

The induced bioelectrical activity of the muscles of the lower extremities in patients with gonarthrosis

Shein A.P., Sizova T.V., Chikorina N.K., Makushin V.D., Chegurov O.K.


Comparative evaluation of functional lower limb muscle status depending on gonarthrosis severity and technique of surgical intervention was performed using the results of stimulation electromyography (M-responses). Data obtained showed that the changes of evoked bioelectrical activity in lower limb muscles depend to a great degree on the initial status (gonarthrosis grade) than on the technique of surgical intervention.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):63-66
pages 63-66 views

Surgical treatment of patients with transverse flat feet, hallux valgus: medical process design

Kuzmin V.I.


On the base of great clinical experience (over 1600 patients) medical technology for the surgical treatment of patients with transverse platypodia and technologic cards for its practical application have been worked out. These cards include ambulatory diagnostic, hospitalization and rehabilitation periods. Technologic card for hospitalization period which was applied during the treatment of 50 patients is presented. Use of elaborated technology allowed to choose the adequate volume of surgical intervention, accelerate patient’s activization that gave the possibility to shorten the hospitalization period without decrease of treatment quality.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):67-72
pages 67-72 views

The study of autoantibodies to collagen of various types in the blood serum of patients with degenerative-dystrophic diseases of the hip joints

Buylova T.V., Puchenkina E.V., Lebedev M.Y.


The level of autoantibody (AAB) to collagen was studied in serum of patients with degenerative dystrophic hip joint diseases: deforming coxarthrosis of I, II, III degree, aseptic necrosis of femur head of III, TV degree and cystic remodeling of articular ends of II, III degree. In 123 patients level of AAB to general determinants of collagens was detected using reaction of passive hemagglutination. In 24% of patients high diagnostically significant of AAB titers to collagen were determined. Correlation of AAB level and general determinants of various collagen types as well as the type of articular pathology were studied. In 62 patients AAB level to collagen of I, II, III and IV types was detected using solid phase immunoenzyme analysis. High level of AAB to collagen of I, II types was shown. In patients with aseptic necrosis reliable increase of AAB level to collagen of I (osseous) type and marked tendency to the increase of AAB level to collagen of II (cartilagenous) type was detected. In patients with cystic remodeling reliable increase of AAB level to collagen of II type and tendency to the increase of AAB level to collagen of I type was observed. Strong correlation between AAB level to collagen of II type and clinical manifestations of pathology was determined.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):73-77
pages 73-77 views

Short communications

Restorative treatment for pathological fracture of the acetabulum in a patient with neurofibromatosis

Afaunov A.A., Afaunov A.I., Akhtem Y.D., Mishagin A.V.


Skeletal pathology as a manifestation of type I neurofibromatosis is relatively rare — in 15–20% of patients, and each case of neurofibromatosis “bears the stamp of individual uniqueness” [1, 2]. Among the indications of the involvement of bone structures in the destructive process, we did not find a description of a pathological fracture of the acetabulum and methods for restoring the support ability of the pelvis and hip in this disease.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):83-84
pages 83-84 views


Complex regional pain syndrome of the extremities (literature review and own data)

Krupatkin A.I., Berglezov M.A., Kolosov V.A.


Complex regional pain syndrome (CRPS) of the extremities is a combination of chronic pain, local autonomic disorders, trophic changes in the tissues of the extremity and impaired motor function. Unsatisfactory outcomes in the treatment of patients with CRPS are largely due to a lack of understanding of the fundamental foundations of the ongoing disorders, which, in turn, is associated with the interdisciplinary nature and complexity of the problem under discussion. The present work aims to fill this gap to some extent.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):84-90
pages 84-90 views

Intraosseous blood pressure

Nazarov E.A., Seleznev A.V.


The study of the etiology and pathogenesis of many bone diseases, restoration of its integrity after injuries in terms of the state of bone circulation is still relevant. In the complex mechanism of bone nutrition, not only its blood supply is important, but also increased interstitial (intraosseous) pressure compared to other tissues, the slightest deviations from the norm can lead to trophic disorders [16].

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(1):91-95
pages 91-95 views

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