Vol 10, No 1 (2003)

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.

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.

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.

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.

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.

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.

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.

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.

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].