Vol 5, No 1 (1998)

One hundred fifty patients, age 16-77, were examined. Forty five out of them had malignant tumors or metastatic lesions of sacrum; 105 patients had benign tumors, tumor-like diseases and inflammatory processes (3). All patients were operated on. Diagnosis was verified morphologically. Analysis of clinical-radiological symptomatology and of the results of special radiation diagnostic methods (CT, MRT) were performed. Clinical manifestations of sacrum tumors have no specific features, careful examination of a patient and anamnesis study give the possibility to detect the process pattern, but not the nosologic form. In 75,8% of patients radiologic and especially CT and MRT data allowed to determine nosologic form preoperatively. Authors emphasized that CT and MRT was the method of choice for examination of patients with sacrum tumors. The attention was directed to the necessity of the increase oncologic alertness among neurologists and orthopaedic surgeons. If sacrum tumor is suspected the patient must be referred to special medical institute which are equipped with modern radiation diagnosis systems.

Author speaks an active supporter of the wide application of plastic surgery methods in clinical oncology. The experience of Department of Plastic and reconstructive Surgery at Moscow Municipal Clinical Oncologic Hospital has showed that application of different microsurgical technique of autotransplantation allowed to significantly widen the indications to organsaving operations in malignant tumors of loco-motor system, considerably improve both oncologic and functional results of treatment.

The experience of operative treatment of 31 patients with total and subtotal tumor and tumor-like lesions of humerus for the period from 1967 to 1997 is presented. The perfection of total humerus replacement is reflected in chronological order on the materials of the Clinic of Bone Pathology, CITO, Moscow. The indications to extirpation are given. The peculiarities of operative technique and the elaboration of design of endoprosthesis to reduce the duration of operation and to improve the functional results are described. In 31 patients results of total replacement of humerus are given. In spite of high percentage of postoperative complications (infection - 6.5%, postoperative neuritis - 3,2, dislocation of endoprosthesis - 6.5%, relapse of the disease - 22.6%) endoprosthesis is an adequate operation improving the quality of life of patients.

The first description in Russian literature of osteofibrous dysplasy in children is presented. It is grounded on the analysis of diagnostic peculiarities and treatment of 24 patients in the period from 1966 to 1996 The main diagnostic criteria by clinical, radiologic and pathomorphologic features are given. Osteofibrous dysplasy is a rare and insufficiently studied disease affecting mainly tibia in children of the first ten years. It has dysplastic congenital nature and is similar to the biastomatosis process. Saber-like deformity of the affected segment prevails in clinical picture. This deformity may be of different degree of manifestation and accompanied by painless. Eccentric intracortical location of pathologic focus is typical of radiologic picture. Morphologic examination is the main diagnostic method. Histologic study shows architectonics «zone» of the pathologic focus which consists of fibrous tissue with bone trabeculae inclusion (bone trabeculae with laminar structure) mainly surrounded by active osteoblasts.

The experience in diagnosis (52 patients) and treatment (35 patients) of chronic recurrent multifocal osteomyelitis in children is presented. In 17 patients conservative treatment was accompanied by surgical intervention. Eighteen patients received the conservative treatment only. Analysis covering medical documentation and authors’ observation showed that antibacterial therapy that was performed both before hospitalization of patients to CITO (20 patients) and at the institute (21 patients) was ineffective. Original scheme of conservative treatment with application of hormonal, nonsteroid antiinflammatory and metabolic therapy is given. Long term complex therapy proved sufficiently high efficacy of that treatment method and allowed to overcome the pessimism in prognosis of that disease.

The aim of the study was to determine the significance of extrafocal osteosynthesis in the treatment of patients with dischondroplasy as well as the affect of distraction on chondromatosis foci. In 59 patients, age 6-17, extrafocal osteosynthesis was applied for correction of shortening and deformity of forearm (11), humerus (12), lower extremities (36). Three forms of dischondroplasy were distinguished: dysplastic, tumorlike, mixed. The technique of distraction osteosynthesis was changed depending upon the dischondroplasy form. Good results were achieved in 89% of patients. Histologic examination of dischondroplastic foci was performed at the different stages of surgical treatment. It revealed that no distraction neither led to ossification of chondromatosis focus nor stimulated its growth. By authors’ opinion the extrafocal compression-distraction osteosynthesis is the method of choice in treatment of patients with dischondroplasy.

Two hundred eighty six patients with clubfoot were examined to detect the rational tactics and method of treatment. It is showed that radiographic or MRT examination of foot is necessary for objective estimation of total bone-articular correction of the deformity. Absence of improvement during conservative treatment is the indication to operative treatment. Traditional method of conservative correction of varus gives efficacy at every stage of treatment during the first 6 changes of plaster bandage only. Equine correction should be performed surgically. Choice of operative tactics depends on the degree of residual foot deformity. If equine and varus is preserved talus reposition with internal fixation is indicated; when equine is preserved the posterior or posteromedial tenoligamentocapsulotomy is indicated.

According to the WHO histological classification of tumors (1972), chondroblastoma of bone belongs to benign cartilage-forming tumors. However, later literature data indicate the possibility of its malignancy. T.P. Vinogradova mentions its malignant form along with benign chondroblastoma, noting that "each benign form of tumor, as a rule, has its malignant analogue". There are 20 cases of malignant chondroblastoma described in the world literature and there are brief mentions of another 8 such cases. The work of V.N. Burdygin, A.K. Morozov and S.I. Lipkin [1] reports 6 own observations, A.K. Morozov reports 8 malignant chondroblastomas out of 113 studied, the publication of S.I. Lipkin - about 13 malignant chondroblastomas and 3 clear cell chondrosarcomas, which probably arose on the basis of chondroblastoma malignancy; according to V.L. Kotov and S.I. Lipkin, in 13 of 225 patients with chondroblastoma the tumor was verified as malignant.

At the beginning of the twentieth century, industrial injuries began to grow simultaneously with the intensive development of industry. In 1904 the Russian government was forced to introduce a law on insurance of workers against accidents. This entailed a significant increase in expenses of plant and factory owners for the payment of life annuities to the injured, which forced them to reconsider their attitude to the prevention of injuries and treatment of patients with injuries of the musculoskeletal system received at work, which in most cases led to disabling injuries.

January 2, 1998 was the fiftieth anniversary of the birth of Professor Vladimir Nikolaevich Merkulov, Head of the Children's Traumatology Clinic at CITO.