Vol 6, No 1 (1999)

Original study articles

Total hipjoint replacement

Nuzhdin V.I., Popova T.P., Kudinov О.А.


During 1990-1998 at CITO total hipjoint replacement was performed in 1668 patients. 1599 patients were followed from 1 to 8 years. In 1100 patients (68.8%) good results (passively flex the hipupto 90 degrees without pain, walk without additional support) were achieved. 399 patients (25%) had satisfactory results (passively flex the hipupto 60 degrees, transient pain, walk with additional support). 100 patients (6.2%) underwent revision hiparthroplasty due to prosthesis loosening. Outcomes were improved when the modern implants with structural surface and high-firm polyethylene - chirulen (Biomet, ESI, Plus Endoprothetik AG) were used.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):5-7
pages 5-7 views

Diagnosis and treatment tactics for aseptic implant loosening and osteomyelitis in hiparthroplasty

Sherepo K.M.


On the base of retrospective analysis of 673 hiparthroplasties with Sivash implant clinical and X-ray signs of aseptic prosthesis loosening (early, marked and severe) as well as osteomyelitis are systematized. Possibility of early radiologic osteomyelitis diagnosis is shown. It is noted that periosteal excrescences in aseptic implant loosening developslower and later in compare with osteomyelitic periostitis. The former are characterized by great spreading along diaphysis, have uniform density and clear counter, while periostites have uneven density and fringed counter. Tactics of treatment including the possibility of implant preservation, revision arthroplasty and prosthesis removal with palliative operation is given.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):7-11
pages 7-11 views

Treatment of infection after hipand knee arthroplasty

Urazgildeev Z.I., Malovichko V.V.


Analysis of clinical and X-ray data as well as treatment experience of 128 patients with infection followed by hip(110) and knee (18) arthroplasty was performed. Two types of complications that determined treatment management were distinguished: 1) infection in stable prosthesis; 2) infection in loosening of implants. In the first type revision of periprosthetic region with radical debridement, antibiotic therapy and drainage during 2-3 weeks was carried out. In the second type the hipimplant was removed and early rehabilitation was started to developneoarthrosis. In knee implant loosening compression arthrodesis was performed followed by implant removal. When proximal femur osteomyelitis was detected during revision due to stable implant the scheme of treatment as in case of implant loosening was preferred because of extremely high risk of instability and recurrence of infection.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):11-16
pages 11-16 views

The alignment of components in total hiparthroplasty

Malzer U., Schuler P., Shaposhnikov Y.G.


The alignment of components is one of the most important topics in total knee arthroplasty. The resections should be performed according to anatomical landmarks, such as the epicondylar line, the anterior-posterior axis and the tibial tubercle. Some important anatomical properties of the human knee joint and their significance for surgical technique are described.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):16-21
pages 16-21 views

Poly-tension-band osteosynthesis of femur neck fractures in elderly and senile patients

Lazarev A.F., Nikolaev А.P., Solod Е.I.


Most of femur neck fractures in elderly and senile patients result from osteoporosis so it is necessary to apply sparing bone mass osteosynthesis. Authors elaborated poly-tension-band osteosynthesis with V-shape tense pins for fragment fixation. The method gives minimum traumatic effect. 64 patients were treated with those fixation. No lethal outcomes and hypostatic complications were observed. 14-20 days after operation the patients were discharged for ambulatory treatment. All patients could walk with crutches or wheeled cart. In 70% of cases clinical and X-ray signs of fracture healing were noted. According obtained elastic characteristics of V-shaped pins system of bone-fixator are considered to be dynamically tense and total value of elastic effect on the bone is equal to 64 H.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):21-26
pages 21-26 views

Application of extracorporeal shock waved therapy in chronic degenerative dystrophic diseases of loco-motor system

Mironov S.P., Basil’ev D.O., Burmakova G.M.


In 87 patients with chronic degenerative dystrophic diseases of loco-motor system extracorporeal shock waved therapy was applied. Procedure of extracorporeal shock waved is given. Early and longterm results show high efficacy of this method. In 72 cases (82.76%) good results were obtained. 11 patients (12.64%) had satisfactory results and the remaining 4 patients (4.6%) had unsatisfactory ones.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):26-29
pages 26-29 views

Experimental and theoretical substantiation of the mechanism of the trophic influence of a function on the structural organization of the bone. Physiological restructuring

Brusco A.T., Omelchuk V.P.


In biomechanical experiments on isolated fresh and wet long bones of dogs, the features of the distribution of compressive and tensile mechanical stresses were studied, the hydrodynamic effects of elastic deformations were visualized, and their dependence on the nature, magnitude and frequency of variable loads was established. The conditions for adaptation of long bones to persistent changes in the functional load have been clarified. Based on the data obtained, it was established that the influence of the mechanical factor is realized through the hydrodynamic effects of elastic deformations, which are considered as an important physiological mechanism for the regulation of intraosseous microcirculation, and, consequently, bone tissue trophism. From these positions, the significance of the functional factor in the physiological restructuring of the bone, the occurrence of certain types of orthopedic pathology, and its role in the rehabilitation of patients with diseases and injuries of the musculoskeletal system are explained.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):29-35
pages 29-35 views

Solid type of aneurysmal bone cyst

Berezhniy A.P., Burdygin V.N., Snetkov А.I., Verchenko G.N., Nechvolodova О.L., Frantov А.R.


Clinical manifestations, diagnosis, surgical management was analyzed during prospective study of 42 patients, aged 3-54, with solid type of aneurysmal bone cyst. Pathologic focus was localized in metaphysis, metaepiphysis of long bones, pelvic bones, vertebral bodies, into bone cyst and giant cell foot tumor. Morphologic examination was determinant factor for diagnosis. All patients underwent surgical treatment with oncologic approach taking into account aggressive osteolytic pattern of process. In children with solid aneurysmal bone cyst saving operation (margin and segmental bone resection) with auto- and alloplasty was performed. In adult patients segmental resection of articular bone end followed by defect substitution by Sivash endoprosthesis with long stem was performed. In 11 patients recurrent disease was detected in the period of 3-24 months after operation. Some patients had decreased function of operated limb: shortening of extremity, contractures, loosening of implant, that demanded additional orthopaedic treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):35-45
pages 35-45 views

Various limb-saving operations in children with primary malignant tumors of long bones

Kovalev V.I., Strykov V.A., Starostina А.Y., Borodachev А.V., Kovalev D.V., Lebedev K.V., Yasonov A.V., Bystrov A.V., Rykunov A.E.


Treatment results of 83 children, aged 5-15, with primary malignant tumors of long bones are analysed. Efficacy of combined and selective pre- and postoperative chemotherapy are shown. Criteria of conservative treatment subjective and objective evaluation are determined as a factor to perform limb-saving operation. In children over 12 the tumor removal and hip/knee total joint replacement has been carried out simultaneously. Three types of limb-saving operations, i.e. free bone autoplasty, Gana’s operation and bone microsurgical autoplasty are described. These operations can be performed in children of any aged group. Adverse reactions and complications are presented. All positions are confirmed by clinical observations.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):45-52
pages 45-52 views

Combined treatment of malignant medullar spine tumors

Bizer V.A., Kudryavtseva G.T., Zubarev А.L.


Twenty four patients with malignant medullar spine tumors were reviewed. Sacrum was involved in 67% of cases. Combined methods including chemotherapy and radiation therapy as well as complex methods including distant gamma-therapy, surgical management and chemotherapy were used. After chemotherapy and radiation therapy 58.3% of patients survived for at least 1 year, 41.7% of patients - 3 years and 33.3% - 5 years. In the most of those patients radical operation was impossible to perform, so chemotherapy and radiation therapy to decrease compression of spinal cord and increase of life time should be considered as an adequate method.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):53-55
pages 53-55 views

Theoretical aspects of readaptation of children with hereditary skeleton diseases

Mikhailova L.K., Tsykunov М.B., Kosov I.S., Eryemushkin М.А.


Theoretical ground of a new approach to the treatment tactics of patients with hereditary skeleton diseases, named readaptation is given. Pathophysiologic, anatomic as well as functional bases for readaptation are considered in point of the compensatory mechanisms development of pathologically changed motor stereotypes in these patients. Main principles of readaptation are formulated. Algorithm for the diagnosis and treatment of readaptation programs is suggested.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):55-58
pages 55-58 views

Report on the symposium "Arthroplasty of large joints"

Popova T.P., Chesnokov А.A.


Orthopedists from Russia, CIS countries, Switzerland, Germany, Austria took part in the work of the symposium, which took place on November 12-14, 1998 at CITO. Issues of total hip and knee arthroplasty, indications for arthroplasty, surgical technique, long-term results, complications, as well as prospects for the development of the problem were discussed. Demonstrative operations were performed on the hip and knee joints using modern endoprosthesis designs from Plus Endoprothetik AG.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):68-69
pages 68-69 views


Experience in using the original repositioning apparatus

Simakov V.I., Zelyanin А.S.


The problem of accurate reposition of fragments is relevant in the treatment of both fresh and improperly fused, non-united fractures and false joints. Transosseous osteosynthesis with Ilizarov-type devices is today an everyday, common method of treating fresh and old bone fractures of metadiaphyseal localization. Its advantages are widely known - first of all, good stability, high functionality and the possibility of influencing reparative bone regeneration.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):58-60
pages 58-60 views

Reviews, literature review

Clinical use of bisphosphonates

Rodionova S.S., Yuryeva E.A., Kolondaev А.F., Mashkovskaya T.А.


In the treatment of bone tissue pathology associated with a violation of its metabolism, drugs belonging to the class of bisphosphonates have been increasingly used in the last decade. Bisphosphonates are synthetic analogs of pyrophosphoric acid containing, instead of the chemical bond [P-O-P], which undergoes rapid decay in the body, a non-hydrolyzable bond [P-C-P]. This prevents the drugs from breaking down when taken per os, but since they are chelators, it is recommended to take them on an empty stomach to prevent binding to divalent ions.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):61-65
pages 61-65 views


Konstantin Mitrofanovich Sivash

Sherepo K.M.


On February 23, 1999, Professor K.M. Sivash. He hasn't been with us for 10 years. It is known that often even the most significant scientific achievements receive a true assessment only after a long time, sometimes after the death of a scientist. Konstantin Mitrofanovich won wide recognition and fame during his lifetime. However, over time, his contribution to science seems to be more significant.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):3-4
pages 3-4 views

Georgy Stepanovich Yumashev


April marks the 80th anniversary of the birth of G.S. Yumashev - one of the glorious galaxy of scientists who are the pride of domestic medicine.

From the institute's bench, Georgy Stepanovich went to the front, where he went through the harsh school of a military surgeon. After the war, along with practical work, he engaged in scientific activities, showing himself not only as an experienced doctor, a virtuoso surgeon, but also as a promising scientist. The first steps in the field of science were made by him at CITO under the guidance of N.N. Priorov.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):66-66
pages 66-66 views

Vladimir Pavlovich Okhotsky


75 years have passed since the birth of the Head of the Department of Traumatology of the Moscow Institute of Emergency Medicine. N.V. Sklifosovsky, Chief Traumatologist of Moscow, Honored Scientist of the Russian Federation, Professor, full member of the Russian Academy of Medical and Technical Sciences V.P. Okhotsky.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(1):67-67
pages 67-67 views

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