Vol 8, No 4 (2001)

It is shown that radio-frequency denervation (RFD) is one of the most economical and effective methods for the treatment of pain syndrome in degenerative spine diseases. Innervation of different elements of spine segments as well as theoretical grounding of RFD application is given. The first experience of RFD use is summarized and analyzed. The technique of RFD for the treatment of discogenic and arthrogenic spine pathology at different levels is described (41 patients). It is shown that RFD can be considered as a palliative treatment method. Stability of RFD effect, possibility of repeated course make this method attractive to both the physicians and patients. RFD differs from all known noninvasive methods by its high efficacy and by its safety when compared with the invasive ones.

The experience in examination and treatment of 21 patients with low back pain resulted in ligamentum iliolumbale pathology is presented. Clinical neurologic examination takes significant place in diagnosis of ligamentopathy. Correct interpretation of provocated testing data and pseudoradicular syndrome allows to avoid the diagnostic mistakes and inadequate treatment.

There were 45 adolescent patients with scoliosis of III-IV degree who underwent operative correction of the spine deformity by Cotrel-Dubousset system. Intraoperatively 26 patients received autologous shed blood reinfusion collected from wound drainage (mean 17.3+5.6 ml/kg), no donor erythrocytic mass was transfused. In 19 patients presurgical normovolemic hemodilution with 500 ml blood donation was performed. Reinfusion of that blood as well as the transfusion of donor washed off erythrocytes (mean 13.8+1.3 ml/kg) were performed at the peak of blood loss. Marked differences in patients’ condition were noted neither during surgical intervention nor in the postoperative period. It was concluded that normovolemic hemodilution in combination with transfusion of donor washed off erythrocytes may be the alternative to reinfusion of autologous shed blood if the later could not be performed.

The method of minimum invasive internal rod fixation of the pelvic ring elaborated at the Chair of Military Traumatology and Orthopaedics, Military Medical Academy, is presented. Suggested method allowed to perform anatomically precise fragment reposition and internal functional stable fixation of the pelvic ring by small surgical intervention and low intraoperative blood loss when fixation was performed at early terms after trauma. In 16 patients with unstable pelvic injuries treated by that method neither unsatisfactory anatomic outcomes nor secondary dis­placement of pelvic bones under the functional load were noted. In uncomplicated pelvic injuries the duration of hospital treatment and medical rehabilitation was 31.5 and 51.2 days, respec­tively. In syndrome of vertical instability of the anterior semi-ring was 27.8 and 43.4 days, respectively.

Possibility of osteogenon application as monotherapy in osteoporosis and medicine to normalize adaptive processes in isolated fractures and polytrauma was studied. It was showen that osteog­enon (2 tabi, x 3 times a day) not only provided Ca supply to the organism but also activited the remodeling of bone tissue. Uptake of osteogenon decreased the terms of fracture healing and following rehabilitation. The drug has good tolerance. The results showed that osteogenon should be recommended for clinical practice in children and adults.

The potentialities of early diagnosis of Legg-Kalve-Perthes disease were studied using infrared computer thermography according to the examination results of 60 patients, aged 3-10 years. It was determined that hyperthermia registered prior to roentgenologic stage of the disease was changed by hypothermia with the progression of aseptic necrosis. Combination of minimum clinical manifesta­tions of Legg-Kalve-Perthes disease in absence of roentgenologic signs and hyperthermia of the hip joint involving 1/4 or more of the anterior hip diameter with thermoasymmetry exceeding 0.3° in comparison with analogic zone of contralateral extremity had sensitivity of 75%), specificity of 88.8%), prognosis of positive outcome of 75%), prognosis of negative outcome of 88.8%) and diagnostic efficacy of 84.6%o to consider a patient to be a member of the necrosis development risk group.

Clinics and diagnosis of a rare form of genetically grounded heterotopic ossification, i.e. progres­sive ossificating fibrodysplasia are presented on the basis of literature review and the authors’ experience. The authors described one patient, age 4,5 years, with heterotopic issificates on occipitocervical, subscapular and axillary zones. The patient had anomaly of great toes, flattened cervical vertebrae and deformity of the the fingers. The diagnosis of this syndrome is based on following clinical and roentgenologic criteria: presence of congenital deformity, shortening of toes and heterotopic ossification of soft tissues. Effective method of treatment does not exist.

Transmission and scanner electronic microscopy was used to study the influence of laser radiation upon the articular cartilage and subchondral bone. Laser radiation with maximum power (up to 70 W) was generated using surgical laser plant «Lamin-1» with 1.06 m wave length in air environment. Data obtained showed that zone of thermal lesion surrounding the defect ranged from 0.8 to 1.0 mm. Articular cartilage and subchondral bone outside the thermal lesion zone preserved specific ultrastructural architectonics. Those data gave evidence of a little traumatic effect of laser using «Lamin—1» and the possibilities of laser application for surgical interventions in traumatology and orthopaedics.

Blood loss during traumatological and orthopedic operations causes so many diverse changes in the body that in the framework of this report we have the opportunity to dwell in some detail only on the most significant of them.

From September 6 to 8, 2001, the 5th International Conference was held in Oxford (Great Britain) dedicated to the problems of classification, prevalence, diagnosis and treatment of skeletal dysplasia. It is worth recalling that the 1st international forum on skeletal dysplasia (organized by A. Poznanski) was held in 1993 in Chicago, 2nd (R. Maroteaux) -in 1995 in Versailles, 3rd (D. Rimoin and R. Lachman) -in 1997 in Los Angeles and 4th (J. Spranger) -in 1999 in Baden-Baden.

On November 3, 2001, the honored inventor and honored worker of science of the Republic of Tatarstan, laureate of the State Prize of the Republic of Tatarstan in the field of science and technology, laureate of the Prize of the Fund named after. acad. G.A. Ilizarov, Corresponding Member of the Academy of Sciences of the Republic of Tatarstan, Doctor of Medical Sciences, Professor Kh.Z. Gafarov.

On August 24, 2001, Valeria Dmitrievna Dedova died. As a person, a doctor, a scientist, she will remain in the memory not only of her friends and colleagues, but above all of hundreds of patients -children and adolescents who have become adults today, whom she helped to find the happiness of a full life. Until the very last days, her patients of the 50s and 60s called her to once again say kind words of gratitude and express deep respect for her selfless devotion to the noble cause of treating children.