Vol 9, No 3 (2002)


High-tech methods of surgical treatment of degenerative diseases of the lumbar spine

Nazarenko G.I., Cherkashov A.M.


In 1908, Krause described a case of removal of a damaged intervertebral disc. After making a median skin incision, detaching the paravertebral muscles from the spinous processes and arches, and removing half of the arch, he discovered a dural sac protruding posteriorly. After dissecting the dura mater, the surgeon removed a tumor-like formation of the intervertebral disc (which he called the echondroma). This case can be considered the first attempt to remove a prolapsed disc [60]. In 1929, Dandy discovered that the cartilaginous tissues of the intervertebral disc, migrating into the spinal canal, can compress the nerves and cause pain in the leg. The removal of these "cartilaginous nodules" helped to eliminate the pain syndrome.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):90-94
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Meeting of the main pediatric orthopedic traumatologists of Russia: "Actual issues of pediatric traumatology and orthopedics"

Malakhov O.A., Pozdnykin Y.I., Solovyov K.S.


In accordance with the Plan of the main organizational measures of the Ministry of Health of Russia for 2002 (paragraph 7.46) and the Directive of the Ministry of Health of Russia No. 594-U dated 15.04.02, on May 29-30, 2002 in Svetlogorsk (Kaliningrad Region) a meeting of the main pediatric orthopedists-traumatologists on topic "Actual issues of pediatric traumatology and orthopedics". It was organized by the State Research Institute for Children's Orthopedics. G.I. Turner (Director - Prof. Yu.I. Pozdnikin), GUN Central Research Institute of Traumatology and Orthopedics. N.N. Priorov (Director - Academician of the Russian Academy of Medical Sciences S.P. Mironov) and the Health Department of the Kaliningrad Region (Head - E.M. Krepak). The meeting was held under the patronage of the Governor of the Kaliningrad Region V.G. Egorov, who addressed the participants with a welcome address.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):94-95
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Congratulations to the hero of the day


June 12, 2002 was the 60th anniversary of the Honored Inventor of the Russian Federation, Doctor of Medical Sciences, Professor VASILY IOSIFOVICH ZORA.V.I. Zorya was born in Ukraine in the village of Maly Chernyatin, Vinnitsa region, into a peasant family. After graduating from high school, he entered the Vinnitsa railway technical school. After completing his studies, he was drafted into the ranks of the Soviet Army. After demobilization, he worked as a foreman on the railway.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):75-75
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Tactics of surgical treatment of spondylolisthesis

Mironov S.P., Vetrila S.T., Kuleshov A.A., Vetrila M.S.


The results of surgical treatment of 133 patients with spondylolisthesis are analysed. In 60 patients I—II degree, in 69 — III—IV degree, in 4 patients V degree (spondyloptosis) was diagnosed. Preoperative management included traditional and functional roentgenography of lumbosacral spine, myelography, CT and MRT. Tactics of surgical treatment depended on the degree of spondylolisthesis and clinical-roentgenologic manifestations of the disease. In 32 patients bone plasty was performed (posterior and anterior spondylodesis) without additional metal fixation, in 101 patients bone plastic operations were combined with the metal fixation of the lumbosacral spine. Various types of fixatives were used: external fixation device by Byzov (6 cases), Wilson plates (23), Kazmin distractors (20) and different types of transpedicular constructions (52). Vertebral canal revision was performed only in case of persistent neurologic symptomatology. In patients with III-IV degree of spondylolisthesis either interlaminectomy or laminectomy (in marked spondylolisthesis) was performed under the visual control of the dural sac and roots at the moment of reduction. In cases of high degree of dislocation the surgical treatment was performed in two steps — posterior metal fixation was supplemented with the anterior spondylodesis. It is concluded that transpedicular fixation in combination with bone plasty is the method of choice for the surgical treatment of spondylolisthesis. In Ш-IV degree of spondylolisthesis transpedicular fixation is to be combined with the anterior spondylodesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):3-12
pages 3-12 views

Передний мини-инвазивный экстраперитон бальный доступ к позвоночнику на уровне t12-s1

Lazennec J.Y., Pouzet В., Ameltchenko М., Mora N., Saillant G.


Anterior mini-invasive approach to the spine that enables to achieve all levels from T12 to SI is described. This approach can be used both in injuries and in degenerative pathology of the spine. Surgical results were studied roentgenologically and that gave us the possibility to assess the performed osteosynthesis and the equilibrium in the sagittal plane. The suggested approach is the continuation of classical anterior approaches and it provides significant advantages for the performance of various surgical interventions at all levels of the lumbar spine without damaging the muscles. Theoretically it possesses neither neurologic risk nor the problem of blood loss which occur when intervertebral transplantation is performed via the posterior approach. Anterior extraperitoneal mini-approach enables to adjust the size of the graft and to perform the correction of sizable deformities using either rigid or semirigid graft. It can also be the only choice in case of considerable loss of posterior bone mass, weakness of the posterior graft and infection in the zone of the posterior approach.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):13-21
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A decade of experience with microsurgical discectomy

Aganesov A.G., Musalatov H.A.


Ten years experience in microdiskectomy for the treatment of degenerative spine diseases (about 900 patients) is presented. Seven hundred and seventeen patients have been operated on by traditional W.Caspar technique and 21.4%) out of them required not only diskectomy but radiculolysis, resection of the arch margins and posterior longitudinal ligament. In some patients side by side with microdiskectomy, spondylodesis via interarch approach using CAC system combined with transpedicular system USS (AO) was performed. The same technique was used in patients with lumbar vertebra spondylolisthesis. Positive results were achieved in 88.2% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):21-25
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Syndrome of the intervertebral and sacroiliac joints ("facet syndrome") in the pathology of the lumbosacral spine

Musalatov K.A., Chensky A.D., Makirov S.K., Slinyakov L.Y.


The purpose of the work was to detection of facet syndrome of lower lumbar intervertebral and sacro-iliac joints in various types of spine pathology. In 1044 patients with facet syndrome the examination and treatment results were analysed. Manual therapy was shown to be one of the main methods for the treatment of facet syndrome with functional block. The application of that method enabled to achieve good and satisfactory results in 97,5% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):25-30
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The use of computer thermography in the diagnosis of diseases of the lumbosacral spine in athletes and ballet dancers

Mironov S.P., Krupatkin A.I., Burmakova G.M.


The experience in thermographic examination of 108 patients (athlets and ballet dancers) with lumbar-sacral spine diseases is presented. All patients have been treated at the CITO Department of Sports and Ballet Injury during the period from 1987 to 2002. Various thermograms typical of osteochondrosis, spondyloarthrosis, spondylolysis and ligamentous pathology of lumbar-sacral spine are given and described. Thermography is shown to be a nonspecific examination method which only defines more precisely the clinical and radiologic data. The main value of thermography is the possibility to detect the activity of the pathologic process and to retrace the dynamics of the disease development during follow up and treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):31-35
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Evolution of structural and functional changes in the lumbar segment in dysplastic diseases of the spine

Prodan A.I., Kolesnichenko V.A.


Structural and functional changes of the lumbar segments in dysplastic spine diseases are considered as a continuous dysplastic dystrophic process. The background of this process is a structural abnormality of the spine segment. Destructive effect of external factors (e.c. loading) results in the adaptative remodeling, development of compensatory accommodative reactions followed by their exhaustion and decompensation with corresponding clinical manifestations.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):36-41
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Surgical treatment of juvenile progressive scoliosis (staged message)

Mikhailovsky M.V., Novikov V.V., Vasyura A.S., Udalova I.G., Rusinova V.T., Lebedev M.N.


At the Department of Child and Adolescent Vertebrology of Novosibirsk SRI TO a multi-step technique was used for the surgical treatment of 21 patients with progressive juvenile scoliosis. That technique included epiphysiospondylodesis on the convex side of curvature, step by step distraction with endocorrector from the Cotrel-Dubousset instrumentation set and completely posterior spondylodesis at the age of sexual maturation. Six out of 21 patients completed treatment; the deformity was decreased from 74.6 to 41.5° and the achieved correction has been almost completely preserved. That surgical technique did not disturb the growth of patients trunk (mean growth rate was 6 cm per year). Torsion component of the deformity did not increase confirming the efficacy of epiphysiospondylodesis. Mean follow up made up 27 months. In spite of the significant number of complications the obtained results testified the prospectiveness of that direction.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):42-46
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Complex orthopedic-surgical treatment of scoliotic disease

Jalilov Y.R.


Treatment results of 271 patients with scoliosis are analysed. All patients have been treated according to the system which was worked out by the author and introduced into practice in Azerbaijan. Within this system the conservative and treatment are considered as the components of a single complex of curative measures. Long course of outpatient treatment included the use of corrective deep plaster beds, dynamic corsets of Lion and Charleston type, kineso- therapy, electrostimulation of muscles, drug therapy for metabolism disturbances. Spine deformity stabilization has been noted in 72.3%) of patients including 21.4%) of those in whom the curvature correction was within 12—18°. In 75 patients (27.7%>) the progression of the deformity continued. 46 out of them have been operated on. Plate correctors of the author’s design (23 patients), combination of Harrington instrumentation and plate correctors (5 patients), modified Harrington technique (18 patients) were used. The use of plate endocorrectors in patients with the deformities up to 65° enabled to achieve 35° correction. The combination of two endocorrectors was effective in patients with rigid scoliosis and allowed to decrease the loss of the correction. Systemic pre- and postoperative treatment contributed to the preservation of the achieved correction.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):47-52
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The immune status of patients with scoliosis

Kosmiadi G.A., Vetrila S.T., Kuleshov A.A.


In 37patients with scoliosis, aged 7—29, immunologic status was studied in pre- and postoperative periods. Material for the study was blood, cerebrospinal fluid, intervertebral disk tissue (tissues of nucleus pulposus and fibrous ring removed intraoperatively). Content of blood lymphocytes; percentage of main lymphocyte subpopulations possessing CD3, CD4, CD8 (T-cells including chelpers and cytotoxic effectors), CD 16 (natural killers) and CD20 (В-cells) markers; lymphocyte activation and proliferation capacity stimulated by activator (mitogen). Analysis of data obtained allowed to define 2 groups of patients. In the 1st group including the majority of patients (n=29) preoperative indices were not significantly different as compared to mean normal ones and postoperative ly those indices restored rapidly. Second group of patients showed preoperative change of at least one index of immunologic status. It allowed to consider that group of patients as a risk group. That group was characterized by the following: patients' age was under 13 years, scoliosis of IV degree, tendency to decrease of CD3+, CD4+ cell content and reduce their functional activity, tendency to increase of CD 16+ cell content. Study of cerebrospinal fluid and intervertebral disk tissue on the top of deformity did not reveal intratissue lymphocytes. It testified that the processes causing the development of scoliotic spine deformity proceeded without direct participation of immune system.


N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):53-58
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Predicting the outcomes of surgical treatment in patients with chronic disability due to pain in the lumbar spine

Watkins IV R.G., Cairns D.M., Williams L.A., Yeung C.A., Watkins III R.G.


Patients qualifying for spinal fusion to relieve chronic lumbar disability completed several instruments that use personality inventory data, demographic data, and medical history in predicting the clinical success of such surgery. Pre-surgical evaluation was effective in identifying patients who were likely to report «роог/fair» outcomes regarding pain and function, and patients who were more likely to return to work.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):58-66
pages 58-66 views

Evaluation of the results of treatment of patients with pelvic trauma

Aghajanyan V.V., Milyukov A.Y., Pronsky A.A., Mikhailov V.P., Petushenko K.V.


Retrospective analysis was performed to evaluate the long-term results associated with the use of various methods for the treatment of pelvic injury. There were 210 patients who were evaluated using 2 methods: subjective assessment according to Majeed score and objective assessment using optic topography (45 patients). Data obtained showed that in the group of patients in which treatment methods were chosen depending on both the severity of pelvic injury and severity of patient’s condition the reliably higher percentage of good and excellent results were achieved by the time of discharge as well as at 1 year follow up. Complex evaluation offunctional treatment results optic topography examination of pelvis allowed to define the degree of adaptive capacity of loco-motor system and possibility of correction of the revealed disturbances.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):67-69
pages 67-69 views

Development of the hip joint in children and adolescents (experimental anatomical and radiological study)

Malakhov O.A., Morozov A.K., Ogarev E.V., Kosovo I.A.


Forty1 eight cadaveric hip joints from humans aged 0 to 18 years were examined to study the process of the joint formation. Polypositional radiologic and CT examinations with and without application of various techniques of artificial contrast were conducted as the first step of the study. Data obtained enabled to define more precisely the dynamics of anatomical changes during the hip joint growth, to detect the method of choice for their diagnosis and the alternative method of radiologic examination. All that is of great importance for the early detection of the pathologic changes as well as for the elaboration of diagnostic and curative management.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):70-75
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High corrective osteotomy of the tibia using a pedicle graft for varus deformity of the knee joint

Dubrovin G.M.


The method of valgus revascularizating tibia osteotomy using autoplasty of the clinoid defect by a pedicle graft is proposed for the treatment of patients with varus gonarthrosis. Nine patients with varus deforming arthrosis, decompensated form, stages 2 and 3, were operated on. Varus changes in the tibiofemoral angle ranged from 5 to 15°. The mean consolidation term in the region of osteotomy was about 10 weeks. Follow up period was at least 2 years. The patients were clinically observed using screening monitoring system to control the disease severity and treatment efficacy. Draining effect and normalization of microcirculation were estimated by the measure of intraosseous pressure in subchondral zone. Dispersion analysis of the observation results has shown stable reduction of the average number ofpatient's condition severity from 27. 7 to 17 and the reduction of intraosseous pressure from 2.4 kPa to 0.9 kPa.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):76-78
pages 76-78 views

Russian Medical Academy of Postgraduate Education, Moscow

Golubev V.G., Golubev V.G., Ondar V.S.


Examination and treatment results of 120 patients with closed injuries of the ankle joint are presented. In 76 patients with various patterns and severity of closed injuries duplex crus veins examination using color Doppler to evaluate the venous blood circulation was performed within the first 24 hours. Mural deep vein thrombus of the crus was diagnosed in 26 (34.2%)) patients. Deep vein occlusion (posterior tibial vein) was detected in type B2 injuries — 14 (45.2%) out of 31 examined patients, in type B3 — 11 (36. 7%)) out of 30 patients and in type C2 — 1 (9.1%)) out of 11 patients. Elaborated diagnostic — curative scheme gave a two times decrease of the ratio of chronic venous circulation disturbance as compared to control and in 34.2%) of patients the development of postthrombophlebitic syndrome was prevented.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):79-82
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The use of a modified hinge-distraction apparatus for chronic injuries of the ankle and foot

Oganesyan O.V., Korshunov A.V.


The experience (126 patients) in the use of the suggested by O.V. Oganesyan modified hingedistraction device for the treatment of old foot dislocations and fractures of the ankle joint articular ends is presented. Perfection of the construction enabled to simplify the application of the device as well as makes it possible to put together the articular ends and their fragments either in one step or gradually, to maintain the width of the articular slit along the articular surface, to perform active and passive motions in the unloaded joint. When the apparatus is used the volume of open surgical interventions is reduced to the required minimum. Due to the device construction it is also possible to eliminate all types of ankle joint and foot deformities (varus, valgus, equinus, adduction, excavation). In 109 patients the follow up period ranged from 1 to 17 years: the overwhelming majority of cases (82%) showed the restoration of the ankle joint function.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):83-87
pages 83-87 views

Thermometry in the diagnosis of ankle injuries

Raspopov E.A., Udartsev E.Y.


Examination results on 12 patients with closed injuries of the ankle joint capsular-ligamentous system are presented. Together with the traditional clinical and roentgenologic methods, ultrasonography and thermometry were used for the assessment of the injury severity. It is shown that thermometry is the informative method for the determination of the early postinjury reactive inflammation severity in the zone of injury. The elaborated monitoring of the skin temperature changes in the symmetric points of the injured and intact extremities enabled to evaluate the markedness of metabolic disturbances, the pattern and rate of reparative processes in the zone of injury, as well as to determine the time of their completion.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(3):87-89
pages 87-89 views

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