Vol 7, No 3 (2000)

At present the constant increase of the cost of medical service is observed all over the world but with no adequate improvement of its quality as well as with no adequate safeties of patients. To overcome this tendency it is necessary either to neglect the quality of medical care or to work out the special care which will enable to decrease the cost without the quality loss. The system should be based on the modern technology which quarantees minimum sufficient and maximum effective level of patients treatment. Authors suggest a concrete way for the improvement of medical care on the example of examination and treatment of patients with low back pain. For this purpose the «Technologic chart for diagnosis and treatment of patients with spondylogenous low back pain» is elaborated. This chart can be used both in out- and inpatients and it regulates the steps of patient's examination and treatment.

Twenty-year experience in application of anterior approaches for spine surgery is analyzed. There were 826 patients with acute spinal injuries and their sequlae, spinal tumors, infectious and degenerative spinal lesions as well as spinal deformities. Using the anerior approaches 839 operations were performed. Results of surgical treatment were evaluated by dynamics of neurologic deficit, term and pattern of anterior osseous block development, value of spine correction, rate of postoperative complications, dynamics of functional spine state during rehabilitation period. Data obtained testify the high efficacy of anterior approaches in spine interventions for the treatment of patients with spine injuries and diseases.

The experience in diagnosis, morphologic study and surgical treatment of 363 patients with spine tumors was summarized. In 178 patients benign tumors, in 95 patients primary malignant tumors and in 90 patients the metastatic ones were diagnosed. Benign tumors were of the following nature: osteochondroma (18.6%)), osteoblastoclastoma (15.2%)), chondroma and hemagioma. In the group of malignant tumors plasmocytoma and myeloma prevailed (53.7%); chondrosarcoma and malignant lymphoma were diagnosed too. Metastatic tumors originated from nephroma (20%)), breast cancer (14.%) and lung cancer (12.3%)). In 23.3% of cases primary locus was undetected. The peculiarities of spine tumor process development and course were determined. New approaches to complex treatment of patients with malignant tumors were elaborated in which radical interventions were completed by the stable spondylodesis with titanium transpedicular or universal fixators. Those fixators elaborated by the specialists of Belarus Research Institute of Traumatology and Orthopaedics in cooperation with «Medbiotech» company allowed to perform the radio- and chemotherapy.

The criteria for the evaluation of a separate vertebra statics were distinguished. Those criteria were taken as a principle for systemic analysis of spine radiograms. Structural shape and spatial position disturbances of the separate vertebrae, mobile motor spinal segments as well as the whole spine were reflected in algorythmic description and diagrams. 452 patients, aged 6- 76 years, were examined using that method. Degenerative dystrophic diseases were detected in 79% of patients, statics disturbances in 17-21.9%), different malformations in 0.9-20.4% of cases. On the base of examination data a computer model of «normal» spine was created and the influence of sacrum position and thoracic kyphosis peculiarities on the level, rate and direction of cervical and lumbar spondylolisthesis was studied.

Article by V.N. Petukhov is likely to be of interest to the readers of the journal, since the problem that is considered in it is of undoubted scientific and practical interest. Vertebrogenic pain syndrome occurs daily in the practice of an orthopedist. For several decades, various methods of spinal traction have been used to stop it. Traction therapy is highly effective, but only with strict adherence to the indications for it and the correct procedure for performing the procedure.

In some cases of coxarthrosis (dysplastic, rheumatoid, coxarthrosis as a result of the prior head femur epiphysiolysis, Legg-Calve-Perthes disease and 4-5th stage ) the external rotation in combination with flexion-adducting contracture of hip joint is noted. Long-lasting pathologic process results in gradual increase of external hip rotation. Thus the anterior lever of the hip joint and the anterior segment of the capsule are elongated significantly. Simultaneously the shortening of the posterior lever of the joint and posterior segment of the capsule takes place. Uncorrected disturbance between two levers makes difficulties when the implant head is to be correctly placed in the acetabulum and also results in recurrent external rotation, redistribution of friction forces between the head and the cup of the implant and finally the rapid.

The bone skeleton is extremely susceptible to hereditary diseases, among which the most severe group is generalized bone dysplasia, or hereditary systemic diseases of the skeleton. Despite their relative rarity, they cause significant damage to the family and society, leading to early and severe disability of patients.

Osteomyelitis of the spine (OP) is a relatively rare disease. The acute form of OP was first described by Lannelongue in 1897, the chronic form by Wohlgemuth in 1898 [cit. 33]. According to V.F. Voyno-Yasenetsky [12], in 1910 Grisel collected only 85 cases of this disease in the literature. Of subsequent early publications, Wilensky [161] and Kulowsky [108] should be noted. By 1964, about 450 patients with OP treated with surgical and conservative methods were described in the literature [46]. In the future, reports of OP are much more common [3,15,16,23,35,39,96].

The conference took place on May 25-27, 2000 in Staraya Russa. It was attended by 153 specialists from leading specialized centers, as well as pediatric traumatologists and orthopedists from different regions of the country.

Professor O.L. Nechvolodova is one of those radiologists who are well known to orthopedic traumatologists. In 1954, Olga Leonidovna graduated with honors from the II Moscow Medical Institute, then clinical residency and postgraduate studies in bone tuberculosis in the clinic named after. T.P. Krasnobaev Institute of Tuberculosis of the USSR Academy of Medical Sciences. In 1961 she defended her thesis on the topic "Non-specific changes in the hip joint in tuberculous osteitis".