Vol 6, No 1 (1999)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.