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Vol 27, No 4 (2020)

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Original studies

Step-up approach for surgical treatment of the spinal canal stenosis in a patient with mucopolysaccharidosis type VI (Maroto–Lami syndrome)

Kolesov S.V., Pereverzev V.S., Shvets V.V., Kazmin A.I., Sazhnev M.L., Panteleev A.A., Kruglikov I.A.

Abstract

The article presents a clinical case of step-up surgical treatment of spinal canal stenosis at the craniovertebral and thoracolumbar level in a patient with mucopolysaccharidosis (MPS) type VI. The treatment method gives an opportunity to achieve a satisfactory result at the background of severe metabolic disease.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):5-10
pages 5-10 views

Screw fixation failure after 360° fusion at the lumbar level

Leonova O.N., Baykov E.S., Krutko A.V.

Abstract

Aim: to identify possible predictors of screw loosening (SL) in patients after decompression and fusion at the lumbar level for degenerative spinal diseases.

Methods. The data of patients with degenerative lumbar diseases who underwent primary decompression and fusion and who were re-hospitalized were analyzed. Clinical data (demography, characteristics of primary surgical procedures and characteristics of the perioperative period), results of radiological methods (presence and characteristics of resorption around screws, bone density (BMD) by densitometry and CT, intervertebral fusion grade and implant subsidence) were evaluated.

Results. The study included 19 patients with SL and 37 patients without resorption, median age 59.1 [51.4; 63.1] years, men 20 (35.7%). When comparing patients with and without SL, there was no significant difference in gender, age, method of surgery, length of the fixation (p > 0.05). According to CT scans, the bone density of the vertebrae between the groups did not differ significantly (p > 0.05). In the group with SL, fusion failure was more common than in the group without SL (22.6% versus 20.7%), but the differences are not significant (p > 0.05). In the intergroup comparison, it was determined that, in general, there were more complications in the group with SL than in the group without SL (p = 0.00015) due to the greater number of infectious complications (p = 0.00044). Also, patients with SL had a significantly longer duration of primary hospital stay (p = 0.000021).

Conclusion. Patients with SL after primary surgery have a significantly longer hospital stay duration, mainly (45.8%) due to infectious complications. Patients with SL have comparable bone density in both the vertebral bodies and pedicles compared to patients without SL.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):11-18
pages 11-18 views

Early and medium-term results of total joint arthroplasty of first carpo-metacarpal joint

Simonova E.N., Aleksandrov T.I., Prokhorenko V.M.

Abstract

Introduction. Reviews dedicated to surgical treatment of the first carpo-metacarpal joint repeatedly state that the evaluation of arthroplasty results is difficult. This is due to the small clinical study groups and the lack of description of all types of outcomes.

The aim of the study is to analyze obtained early and midterm results of ceramic CMC-arthroplasty. The endoprosthesis are represented with unbound proximal and distal components made of ceramic material. The interaction of the head and cup is represented with no intersecting forces that impede on the multi-axial movement. The surgical technique of CMC-1 joint arthroplasty prescribes the installation of components by the press-fit fixation. There is a brief emphasis on the features of the joint and contributing factors for the development of risarthrosis. Early results are described. Cases of unsatisfactory outcomes are described separately.

Materials and methods. The study group included patients from 33 to 72 years. The total number of observers was 28 people. We performed revision endoprosthetics in 2 cases (7%), which were associated with aseptic instability of the proximal component according to the osteoporosis. It obvious that endoprosthetics is the only method of orthopedic care that allows maintain mobility and achieve stability of the destroyed CMC joint. Evaluation of the results was carried out by clinical and instrumental methods.

Results. It cannot be denied that the CMC arthroplasty is the only method of orthopedic care that allows to preserve mobility and achieve stability of the broken joint.

Conclusion. Arthroplasty of the carpo-metacarpal joint with ceramic implants is a promising method of orthopedic care, that allows to restore the function of the hand.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):19-27
pages 19-27 views

Biomechanical evidence-based transosseous osteosynthesis in treatment of humerus fractures complicated by chronic osteomyelitis and consequences

Tsiskarashvili A.V., Melikova R.E., Zhadin A.V., Kuzmenkov K.A.

Abstract

Aim. To study the results of treatment of patients with fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, by the method of biomechanically grounded transosseous osteosynthesis.

Materials and methods. A retrospective analysis of the results of treatment of fractures and pseudarthrosis of the humerus, including those complicated by chronic osteomyelitis, was carried out by the method of biomechanically substantiated transosseous osteosynthesis in 74 patients who were in the N.I. N.N. Priorov in the period from 2011 to 2019. Osteosynthesis with a rod-based apparatus was performed in 36 (48.6%) patients, with a spoke-rod — in 38 (51.4%) patients.

Results. Complete consolidation of bone fragments of the humerus and relief of the purulent-inflammatory process were achieved in all cases studied. Excellent treatment results were achieved in 25 (34%) cases, good results were obtained in 44 (60%) patients, satisfactory results were stated in 4 (6%) patients. No unsatisfactory outcomes were registered.

Conclusion. The use of biomechanically based transosseous osteosynthesis in the treatment of fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, provided up to 94% of excellent and good results.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):28-40
pages 28-40 views

Neuropathy of the peroneal nerve as a complication after total knee arthroplasty: characteristics of rehabilitation

Novikov A.V., Antonova V.A.

Abstract

Knee arthroplasty is recognized as the “gold standard” in the treatment of stage III–IV degenerative diseases and the consequences of traumatic injuries. The number of surgeries is growing, and the number of complications after considered interventions is growing as well. Frequency of peripheral nerve neuropathies is not high, but damage to the peroneal nerve after total arthroplasty of the knee joint can lead to severe dysfunction of the lower limb, decrease in daily activity and the patient’s quality of life. The article analyzes the treatment results of 254 patients after primary and secondary knee arthroplasty. Signs of damage to the peroneal nerve upon admission to the second stage of rehabilitation were identified in 3.9% of cases. The clinical and functional examination performed in dynamics showed that the presence of neuropathy of the peroneal nerve aggravated the severity of the existing functional disorders in patients after knee arthroplasty. It has been established that complex intensive rehabilitation treatment, which should begin immediately after the diagnosis is made and be carried out intermittently for at least six months, restore the function of the affected nerve in 75% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):41-45
pages 41-45 views

Structural features of non-cellular tissues of the human body during ochronosis

Shatokhina S.N., Zar V.V., Zar M.V., Shabalin V.N.

Abstract

With the help of special methods of dehydration, the features of the structural organization of the solid phase of biological fluids of a patient with a rare genetic disease — ochronosis were revealed. Three biological fluids were taken as material for the study: urine, blood serum, and synovial fluid. For the transfer of biological fluids into a solid phase, the methods of cuneiform and marginal dehydration (technology “Litos-System”) were used. The structure of the solid phase of biological fluids was studied using stereomicroscopy in white and polarized light, as well as in a dark field. It was found that the structures of the solid phase of biological fluids reflect the main clinical signs of ochronosis, and also contains information about concomitant pathological processes. Specific structures of the solid phase of patients with ochronosis can be used as diagnostic markers of this disease.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):46-52
pages 46-52 views

Dynamics of bone tissue metabolism in the complex treatment of chronic posttraumatic osteomyelitis of long bones

Tsiskarashvili A.V., Rodionova S.S., Mironov S.P., Gorbatyuk D.S., Taraskin A.Y.

Abstract

Introduction: Chronic post-traumatic osteomyelitis is a complex problem of modern traumatology and orthopedics, affecting, in addition to medical, social and economic aspects of healthcare. When planning treatment, it is necessary to take into account the metabolic state of the bone tissue, since the effect of an infectious pathogen goes far beyond the “classical” lytic process, disrupting the balance of bone formation and bone resorption in various ways. The study is devoted to the study of the dynamics of parameters reflecting the metabolism of bone tissue in patients receiving complex therapy for chronic post-traumatic osteomyelitis of long bones.

Aim: To study the dynamics of metabolic disorders of bone tissue in patients with orthopedic infection of long bones and large joints under conditions of ongoing complex etiotropic and compensatory therapy for 6 months, the timing of bone tissue consolidation — within 2 years from the moment of surgery.

Materials and methods: The study was prospective, observational, comparative, exploratory, involving 138 patients with post-traumatic chronic osteomyelitis of the long bones. Complex therapy included a combination of surgical treatment with antibacterial, anti-inflammatory therapy and drug correction of the revealed disorders of bone metabolism. The timing of the consolidation of bone defects after treatment and the dynamics of indicators of bone metabolism were studied.

Results: The similarity of the periods of consolidation of different segments in the conditions of the described therapy was shown; the time period corresponding to the most pronounced dynamics of changes (correction) of violations was determined (3 months from the beginning of treatment); shows the effectiveness of metabolic therapy for the treatment of osteoarticular infections in various anatomical segments of the extremities. The results corresponds both to the results of the previous study and to the pathophysiological aspects of bone metabolism described in the literature.

Conclusion: the timing of consolidation in the treatment of metabolic disorders is generally similar; the greatest changes in the parameters of bone metabolism are recorded within 3 months after the start of therapy. Also, the metabolic therapy regimen can be considered as universal for all segments.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):53-64
pages 53-64 views

Distal interosseous membrane of the forearm: anatomy, biomechanics, diagnostics

Golubev I.O., Matveeva N.Y., Maksarov M.L.

Abstract

Relevance. Recent studies show that even with damage to the structures of the triangular fibrocartilaginous complex (primary stabilizer), instability of the distal ray-elbow joint does not develop in some cases. Studies carried out by a number of authors prove that the distal interosseous membrane of the forearm can influence the stability of the joint and be a secondary stabilizer for it.

Aim of the study. To study the variability in the structure of the distal interosseous membrane of the forearm using anatomical material and determine the effect of the distal interosseous membrane on the stability of the distal ray-elbow joint. Using ultrasound to determine the variability of the structure of the distal interosseous membrane of the forearm.

Materials and methods. Material for our study was 10 pairs of anatomical specimens of the upper extremities. The functional viability was assessed by passive rotation of the anatomical material of the forearm. Changes in the tension of the distal interosseous membrane, its additional formations and the capsule of the distal ray-elbow joint were observed. Ultrasound was chosen as an instrumental method for visualizing the distal interosseous membrane of the forearm and its structures. In the course of this work, 30 volunteers of both sexes and different ages were examined. The study was carried out: maximum pronation (position of the sensor back) and maximum supination (position of the sensor palmar).

Results. In the course of the anatomical study, we determined that in 6 pairs of anatomical material, the distal interosseous membrane is a thin transparent connective tissue structure. No additional formations in the form of thickening were found. In 4 pairs of preparations, which amounted to 40% of the total amount in the distal interosseous membrane, there were additional formations in the form of thickening of the membrane — this is the distal oblique bundle and the distal ray-the ulnar tract. During the functional study, it was revealed that during pronation of the forearm, the distal membrane and dorsal capsule are stretched, which in turn holds the head of the ulna in the sigmoid notch of the radius. After conducting ultrasound, we determined the variability in the structure of the distal interosseous membrane of the forearm. The distal oblique bundle is visualized as a linear hyperechoic formation. Of the 30 surveyed, this formation was identified in 13 women (92.8%) and 1 man (7.1%), which in percentage terms was 43%.

Conclusion. After conducting anatomical examination, we determined the variability in the structure of the distal interosseous membrane of the forearm in the form of the presence of thickenings — the distal oblique bundle and the distal ray-ulnar tract, and determined the effect of these structures on the stability of the distal ray-elbow joint. An ultrasound scan also identified the features in the structure of the distal interosseous membrane in the form of — hyperechoic formation.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):65-72
pages 65-72 views

Reviews

Modern concepts of treatment of complicated diaphyseal forearm fractures (literature review)

Chernyaev S.N., Neverov V.A.

Abstract

The analysis of modern domestic and foreign literature on the issues of surgical treatment of patients with diaphyseal forearm fractures is presented in the article, the main problems at these injuries are noted. The analysis has been carried out on the basis of databases of medical publications of CyberLeninka, eLibrary, PubMed and biliary databases. The treatment of complicated diaphyseal forearm fractures in the form of nonunions, pseudoarthrosis, defects and malunion is serious problem in traumatology and orthopaedics, because according to the literature data, unsatisfactory results in the treatment of this pathology reach 20–47%. This problem requires the development and implementation of modern functional methods of treatment, which would allow to combine the period of restoration of segment integrity with the period of rehabilitation without risk of osteosynthesis instability and nonunion. The problem of choosing the optimal tactics and methods of surgical fixation of these lesions remains a subject for discussion, which is the basis for scientific research on optimization of tactics and methods of surgical treatment of patients with consequences of diaphyseal forearm fractures.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):73-79
pages 73-79 views

Obituary

In memory of Karina Surenovna Solovieva

Abstract

The staff of the Federal State Budgetary Institution “National Medical Research Center of Pediatric Traumatology and Orthopedics named after G.I. Turner ”, the Russian Ministry of Health expresses condolences to the family and colleagues of Karina Surenovna. The bright memory of her will remain in our hearts, and her work will continue.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(4):80-80
pages 80-80 views

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