Vol 8, No 2 (2001)


Results of the implementation of scientific research within the framework of the industry program "Topical Issues of Traumatology and Orthopedics" (1996-2000)

Mironov S.P., Trotsenko V.V., Popova M.M., Andreeva T.M.


The paper used materials from reports of specialized research institutes and departments of traumatology, orthopedics and military and surgical medical universities. The industry program was carried out by 10 NIITO, as well as MONIKI them. M.F. Vladimirsky, St. Petersburg Research Institute of Prosthetics and 5 departments of traumatology and orthopedics of medical universities - RSMU, St. Petersburg, Samara, Ivanovo and Izhevsk. More than 740 researchers took part in scientific research. Completed 40 contracts.

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):3-4
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The role of computed tomography in the development and implementation of minimally invasive surgery methods in the clinic of bone pathology

Morozov A.K., Snetkov A.I., Balberkin A.V., Belyaeva A.A., Kosov I.A., Frantov A.R.


The evaluation of the CT efficacy for the elaboration and realization of low invasive diagnosis and treatment in bone pathology was performed. Sixty two patients, aged from 6 to 80, were examined. The method of stereotaxic determination of pathologic locus localization with CT controlled manipulation (target biopsy, «anchor» navigation in disorder focus, injection of contrast matter and introduction of plastic materials into the focus) was used. The efficacy of those method made up 89.6% for target biopsy corresponding to the high degree accuracy of pathological process identification and 100%) for the preoperative marking. New elaborated method is accurate and safe for the patients.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):5-10
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Clinic, diagnosis and treatment of chondroblastoma in children

Snetkov A.I., Morozov A.K., Verchenko G.N., Frantov A.R., Belyaeva A.A., Pavlov R.N., Kotov V.L., Batrakov S.Y.


It is for the first time that the clinical picture, diagnosis and outcomes of surgical treatment of bone chondroblastoma in children (85 patients, aged 8—16) are described in native literature. Pathological focus was localized in the epiphysis and metaepiphysis of long bone predominantly. Clinical manifestations were pain syndrome, restriction of movement and development of contracture in the adjacent joint. Typical radiological signs included excentrically located osteolytic locus of destruction with speckled inclusions and clear contour. The locus was separated by sclerosis line and periostal stratums were present in the distance from the locus. CT, MRT and angiographic examination enabled to determine the destructive locus at early stages of its development and to differentiate with other tumors, inflammatory diseases and dystrophic processes. In all cases diagnosis was verified morphologically. All patients underwent surgery. In the majority of cases periarticular subchondral resection with cavity electrocoagulation and alloplasty of the defect was performed. In case of articular cartilage destruction intracapsular marginal or segmental resection followed by allo- or autoplasty of the defect was carried out. Recurrences were observed in 8,2%) of cases. In 8 patients shortening or deformity of limb developed as a result of growth zone damaged caused by pathological process and surgical intervention. Those problems were eliminated by additional surgery.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):10-16
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Problems of lengthening of the lower limbs in children and stimulation of reparative processes in the area of distraction regenerates

Malakhov O.A., Kozhevnikov O.V., Omelianenko N.P., Belyaeva A.A., Krupatkin A.I., Kosovo I.S.


During the period from 1988 to 2000 the compensation lower limb shortening was performed in 285 patients, aged 2.5-18 years, at CITO Pediatric Orthopaedic Clinik. In 5 patients with severe extremity malformation and severe vascular pathology surgical interventions aimed at facilitation of subsequent prosthesis and orthesis. The other patients were subjected to surgical correction using rod distraction device of original design. Complex rehabilitation treatment including functional biocontrol was started in the early postoperative period. The condition of distraction regenerate was evaluated by X-ray, CT and Doppler Laser Flowmetry data. In 63 patients with congenital lower extremity pathology in whom insufficient regeneration was observed the implants containing fetal bone tissue were inserted into the regenerate zone resulting in marked osteogenic effect. Suggested treatment allowed to improve the outcomes and shorten the terms of treatment.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):17-22
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Psychophysiological bases of efficiency of restoration of muscle function by the method of functional biofeedback

Kosovo I.S.


Scheme of the development of pathologic motor analyser changes in locomotor system injuries which are manifested by the formation of vicious circle of disturbance of muscular motor function. In this the main initiating factor is the deficit of sensor information. The place of artificially created biological feedback is showed and its role in the restoration of muscular motor function is described.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):22-24
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Principles of treatment of polystructural injuries of limbs in children

Merkulov V.N., Sokolov O.G., Dorokhin A.I., Stuzhina V.T.


Authors suggest to use a term «polystrusctural injuries» when two or more anatomic structures within either one segment or extremity are injured and reconstructive treatment is required. Experience in treatment of 256 patients with polystructural limb injuries is summarized. The consequence of reconstructive operations on skin, bones, muscular-ligamentous elements, vessels and peripheral nerves. Main techniques for the reconstruction of injured anatomic structures depending on their nature and combinations are presented. Using elaborated principles of treatment for polystructural limb injuries positive results are achieved in 93.5% of cases.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):25-29
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Pathogenetic treatment of gunshot wounds of extremities

Kesyan G.A., Lazarev A.F., Kondratiev I.E., Verchenko G.N., Urazgildeev R.Z., Chelyapov V.N.


Various unknown appropriateness to the development of gunshot wound process were determined on the base of systemic approach. The causes and mechanisms of complication development were detected as well. Several new treatment methods were elaborated, evaluated in experiment and implemented into clinical practice. Addition of antioxydants to the treatment protocol decreased genotoxic effect and the use of elaborated prognosis for the complication development enabled to decrease the rate of purulent complications up to 5.6%.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):30-33
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Medico-biological aspects of experimental studies of armored contusion injury

Crazier A.N., Kamenev Y.F.


Experiments with armoured vest on mongrel dogs and mini-pigs showed that the most significant indices of contusion trauma is the volume of injury. When the shock impulse affects the cardiac zone the inner organs injuries are distributed in the following way: right lung - 29%o, right lung + liver - 29%o, left lung + liver -14%o, right lung + heart - 14%o, heart + liver - 14%o, and cardiorrhexis occurs only in 32%o of cases. When the shock impulse is aimed at the pulmonary zone the isolated liver injury is observed in 54%o and combined injury of the right lung and liver in 46%> of cases. The severity of the contusion trauma resulting in liver and spleen injuries may be of different degree. In such cases the outcome depends on the type and severity of these organs injury and inner bleeding may be asymptomatic for a long time. The results of our study show that even the first 6 hours after the spleen injury the volume of blood within the abdomen could be from 500 to 1000 ml. At the same time the ruptures and fissures of the hepatic capsule do not result in such massive hemorrhage.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):33-36
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Modified apparatus for reposition and fixation of bone fragments

Oganesyan O.V.


The modified device was used for the treatment of 817 patients with fractures and pseudoarthrosis, correction of bone deformities and limb lengthening in hospitals of Russia and abroad. Perfection of the construction in comparison with previous designs enabled to simplify the application of the device, shorten the operation time and to increase the efficacy of its use. Graduate dozed reduction of bone fragments in all planes as well as elimination of angular displacement is performed using special device and anterior distracter without additional unit. Sagittal and frontal compression of bone fragments is carried out both longitudinally and transversely by the device itself due to its peculiarities. Stable fixation of fragments within the device does not prevent movements in the adjacent joint and provides the possibility of early limb loading.

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):36-39
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Some new directions in the treatment of fractures of long bones and their consequences

Pichkhadze I.M.


Elaborated biomechanical classification of long bone fractures and biomechanical conception of fragments fixation are showed to allow the choice of both the fixation mode and the type of fixatives for every specific case. Essentially new splint for the traction is presented. System (set of fixatives) for transosseous osteosynthesis providing stable joining of the plate and the screw is suggested. New device (III variant) for mono- and poly polar fixation of bone fragments using pins, rods and their combinations is created. It is possible to perform the fragments reduction in all directions of three- dimensional space.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):40-44
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Tactics of treatment of severe spinal injuries using modern technologies

Vetrila S.T., Kolesov S.V., Borisov A.A., Kuleshov A.A., Shvets V.V.


The experience in treatment of 139 patients with cervical (71 patients) and thoracolumbar (68 patients) spine injuries is reviewed. The treatment of cervical spine injuries was performed with halo apparatus which was more effective in injuries of upper cervical zone. In 14 patients with lower cervical spine injuries the surgery with «Orion» system was carried out. All patients with fractures or posttraumatic deformities of the thoracic and lumbar spine underwent operative treatment. Eight patients had systemic osteoporosis. Reduction-stabilization operations with decompression and different spondylodesis were also performed. Steffee system was used in 33 cases, Cotrel-Dubousset in 22, Tenor in 7, and Luque in 6 cases. Operative stabilization allowed to achieve primary rigid fixation of the mobile injured lumbar segments for early activization of patients. For the achievement of good outcome the different choice of curative tactics is required. Concomitant osteoporosis significantly influences the long term results. Long term preservation of stability depends on the proper choice and the length of a fixation device as well as on the method of spondylodesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):45-50
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Surgical treatment of cruciate ligament injuries of the knee joint (retrospective analysis)

Mironov S.P., Mironova Z.S., Orletsky A.K.


Clinical analysis of operative treatment of cruciate ligament ruptures based on forty years experience is presented. During the period from 1962 to 1982 lavsan prosthetic material for the plastic reconstruction of cruciate ligaments was widely used at Sports and Ballet Injury Clinic. Histologic, morphologic, clinical and roentgenologic investigations were performed and data on readaptation of lavsan prosthesis within intrasynovial medium were obtained. Starting from 1983 autoplasty for the restoration of joint stability has been elaborated and introduced into practice. Active dynamic stabilizing operation for chronic posttraumatic knee instability is worked out. Principles of static stabilizing operation on the knee are elaborated. Detailed description of various modifications for knee surgery is presented. The disadvantages of certain surgical techniques and the ways of their avoidance are given. Special attention is paid to arthroscopic intervention. Specific protocol and preventive measures to improve the efficacy of treatment are noted.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):51-55
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Ultrasonographic diagnosis of hand tendon injuries

Eskin N.A., Kuzmenko V.V., Korshunov V.F., Magdiev D.A., Chulovskaya I.G.


Ultrasonographic examination was performed in 106 patients with clinical manifestations of wrist tendon injuries and their sequelae (in 54 patients prior to specialized treatment, in 90 - in the postoperative period and in conservative treatment). In 63 patients flexor tendons, in 36 extensor tendons, in 5 both flexors and extensors were examined. In 106 patients 139 tendons (445 ultrasonographies) were examined. Real-time «Sonoline SL-1» scanner («Siemens») with 5 and 7.5 MHz linear and sector transducers was used. The examination was performed in transverse and longitudinal planes both at rest and dynamics. In 75 patients (70.8%) scan allowed to correct the preoperative protocol, tactics of conservative treatment and postoperative management as well as to choose the adequate individual duration of immobilization. Techniques of ultrasonographic examination of the wrist soft tissues in tendon injuries is elaborated. Indications for ultrasonographic examination are determined and sonographic picture of fresh and old tendon injuries and their sequelae is described.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):56-60
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Plasty of extensive defects of long bones with vascularized peroneal grafts

Grishin I.T., Golubev V.T., Kroshkin M.M., Bogdashevsky D.R., Golubev V.V., Polotnyanko V.N.


The experience in treatment of 130 patients with vast long bone defects using microsurgical plasty with vascularized fibular autogtarfts is generalized. The defects mainly resulted from severe open mechanical and gunshot injuries as well as congenital pseudoarthroses. Long term results were evaluated in 102 patients in terms from 2 to 15 years. Good results were achieved in 89.2%) of patients. In treatment of congenital pseudoarthroses no failed outcomes were detected, while the use of routine method of bone plasty gave up to 80% of unsatisfactory results.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):61-65
pages 61-65 views

Revision hip arthroplasty

Nuzhdin V.I., Trotsenko V.V., Popova T.P., Kagramanov S.V.


From 1990 to 2000 238 revision hip joint replacements were performed at Joint Replacement Department of CITO. Both cement and cementless implants as well as in case of need allografts in the form of bone chips and spongeous bone were used. Technique peculiarities of revision operations for Sivash and «Compomed» implants replacement are described. The working time for «Com- pomed» implants was detected to be up to 5 у ears, for Gerchev implants up to 7 years and for Sivash implants 10 years and more. In revision replacement the following complications occurred: lethal outcome — 2 cases, acute myocardial infarction in early postoperative period — 1 case (recovery), deep suppuration — 1 case (implant was removed), thromboembolia of small branches of a. pulmonalis — 3 cases (recovery), paresis of fibular portion of n. ischiadicus — 5 cases (complete function restoration), dysbacteriosis during antibacterial therapy — 2 cases (recovery). Results of treatment were evaluated in 140 patients in the periods from 3 months to 10 years. In 139 cases complete or almost complete restoration of operated limb function was clinically noted. In 37 out of 139 patients signs of bone resorption around the cup and stem of implant were detected roentgeno- logically.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):66-69
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Identification and evaluation of the role of the arthro-medullary connection in the functioning of human joints (experimental study)

Gavryushenko N.S., Bulgakov V.G.


New components of synovial tissue which provide unusually lower friction in joints were detected. Data on previously unknown ability of capsular-ligamentous tissues to be a conductor of oiling substances into joint cavity were obtained. Composition and significance of osseous fat were determined. Osseous fat was both a oiling substance consists of triglycerides, cholesterine ether and depot of fat-soluble antioxidants. High content of antioxidants was revealed in capsula and bones adjacent to articular cartilage

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):72-75
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The value of mineral density and quality indicators of bone tissue in ensuring its strength in osteoporosis

Rodionova S.S., Makarov M.A., Kolondaev A.F., Gavryushenko N.S., Morozov A.K.


The purpose of that investigation was to study the factors influencing the strength of femoral neck and its endurance to loads in osteoporosis. In experiment 24 samples of proximal femur obtained in autopsy from patients older than 60 years who died from different diseases without disturbance of bone metabolism were investigated. Mineral density of cortical and cancellous bones was assessed in standard zones using dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). For the imitation of soft tissues the samples were placed in water and that allowed to compare the data obtained with norm measurement used for diagnosis of osteoporosis. Strength of femoral neck and its cortical layer as well as limit of elastic deformities, deformity value of femoral neck were evaluated in gradually increasing load. High correlation was showed between neck strength and BMD (r=0.86, p<0.001). Osteoporotic qualitative state of bone and structural peculiarities of femoral neck influenced the bone strength independently of BMD value. The main role of cortical bone in providence the strength offemoral neck was confirmed in experiment.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):76-80
pages 76-80 views

Treatment system for myoneurogenic foot deformities in adults

Istomin I.S., Oganesyan O.V., Levin A.N.


Surgical management for the myoneurogenetic foot deformities is suggested. It is based on the differenciated approach to the elimination of all components of the deformity as possibile. The treatment includes 4 complex operations: 1) surgical intervention on soft tussies in combination with osteotomy of the first metatarsal bone; 2) wedge resection and three-articular arthrodesis of foot joints; 3) wedge resection and four-articular arthrodesis of foot and ankle joints; 4) closed correction of the deformity using hinge-distraction device. Results of the treatment (126 patients, 155 feet) confirmed the efficacy of the suggested methods. In 87%) of cases long-term results were good, in 8.4%) — satisfactory and in 4.5% of cases -unsatisfactory.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):81-86
pages 81-86 views

Diagnosis of giant cell reparative granuloma of the bones of the hands and feet

Berchenko G.N., Morozov A.K., Semenov L.A., Frantov A.R.


Clinical, roentgenologic and morphologic features of giant cell reparative granuloma in wrist and foot bones are presented. Analysis of 2 cases and literature review shows that giant cell reparative granuloma is a rare benign fibrous osseous proliferative process of unknown etiology. No clinical symptoms and roentgenologic signs have specifical features and do not differ a lot from chondroma, giant cell tumor of bone, aneurysmal cyst, «brown tumor» in hyper- parathyroidism. Correct diagnosis could be made on the base of histologic study taking into account Ca, P and alkaline phosphatase content in blood. The main histologic signs of giant cell reparative granuloma are the following: presence offibroblasts, histiocytes, multinuclear osteoclast-like cells, microbloodstrokes, microcysts, osseous bridges of different maturity degree and not numerous mitoses in connective tissue stroma. Surgical treatment using currettage results in high local recurrence rate (mean 33— 39%). The most adequate treatment is surgical intervention with observance of oncologic principles: marginal resection, electrocoagulation and auto- or alloplasty of none defects; in case of severe bone lesions - segmental resection or bone extirpation.

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):87-92
pages 87-92 views

Modern approaches to the rational use of disinfectants and antiseptics in order to prevent hospital infectious complications

Pkhakadze T.Y., Okropiridze G.G., Savostyanova O.V., Loktionova N.V.


Rational use of modem antiseptics, disinfectants and sterilization agents is one of the important factors to prevent the intrahospital infection. Approaches of principles to the detection of optimum agents are presented. It has been determined that the base of the choice is complex assessment of agent's properties which provide efficacy, safety and profitability of its use as well as the type of disinfected object. One of the most important criteria of aseptic and antiseptics quantity are the results of bacteriologic control.


N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):93-95
pages 93-95 views

Osteoarthritis: current state of the problem (analytical review)

Mironov S.P., Omelianenko N.P., Orletsky A.K., Markov Y.A., Karpov I.N.


Joint diseases are widespread throughout the world. Up to 55% of the structure of articular pathology is due to osteoarthritis (deforming arthrosis) [8]. Many foreign authors define this pathological process as osteoarthritis [9, 36]. According to most researchers, osteoarthritis (OA) is a polyetiological disease of the joints, characterized by impaired function, pain, deformity, and degenerative-destructive changes in tissue components [15]. In the United States, OA is considered one of the most common forms of joint disease [27]. In the period 1990-2020. the number of cases in the age group over 50 years is expected to double [46]. The problem of OA is of great social importance: the disease leads to disability and disability, mainly due to limited range of motion, in 20–30% of patients [33].

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):96-99
pages 96-99 views

Nervous trophism and neurodystrophic syndromes of tissues of the musculoskeletal system (literature review and own data)

Krupatkin A.I.


“The concept of a living organ presupposes the concept of its nervous trophism. Any violation of the latter is ... a violation of the integrity or even loss of the organ itself ”A.D. Speransky

N.N. Priorov Journal of Traumatology and Orthopedics. 2001;8(2):100-104
pages 100-104 views

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