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Vol 29, No 2 (2022)

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Original study articles

Idiopathic scolioosis: long-term results of treatment of patients with the method of transpedicular fixation. Retrospective longitudinal study

Zeynalov Y.L., Burtsev A.V.


BACKGROUND: Тhe study of the treatment results of patients with idiopathic scoliosis should include both objective assessment methods, such as radiography and multispiral computed tomography, and subjective methods related to the response of the patient or his/her parents to treatment. A set of indicators will only allow an objective assessment of the long-term treatment outcomes.

AIM: To examine long-term treatment results of posterior transpedicular fixation in patients with idiopathic scoliosis of varying severity.

MATERIALS AND METHODS: Long-term treatment results by posterior transpedicular fixation were studied in 300 patients with idiopathic scoliosis of varying severity. To assess the effectiveness of treatment, clinical and radiological diagnostic methods and SRS30 and SRS22 questionnaires were used.

RESULTS: Treatment results in 1 year were studied in all patients and in 2 years in 225 patients (75%). In 150 patients (50%), the long-term treatment results was studied in 5, and in 15 of them (10%) in 10–12 years. The achieved correction value was maintained with a slight loss depending on the magnitude of the initial deformity and correction achieved after the operation. The SRS22 questionnaire 2 years after treatment of grade II deformity (according to Chaklin) showed that the indicators of postoperative function and remained practically unchanged, and the scores on self-esteem, appearance, and attitude were higher (p <0.05). In grade IV deformity, the scores on the appearance and attitude of others were high without significant differences.

CONCLUSION: Dorsal correction of the spine using transpedicular implants in patients with idiopathic scoliosis allows obtaining good treatment outcomes, which was confirmed by the preservation of correction during dynamic X-ray examination and assessment using the SRS22 questionnaire.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):117-128
pages 117-128 views

Mycoplasma as a possible trigger for the development of idiopathic avascular necrosis of the femoral head

Mikhaylov A.S., Prishchepa N.P., Kovalev D.V., Efimov A.V., Fedotov P.V., Ivanov M.I., Kryuchkov N.A.


BACKGROUND: The death of bone tissue cells with impaired blood supply, followed by the development of secondary arthrosis/arthritis of the adjacent joint, is most characteristic of osteonecrosis of the femoral head. This condition is common in young patients — mainly in men of working age. Hip arthroplasty at a young age has a high risk of loosening of the endoprosthesis components, which can lead to many repeated surgical interventions. In recent years, hypotheses about the possible role of infectious agents in articular pathology have been discussed, as evidenced by the detection of specific antibodies and antigens of pathogens in the joint fluid and periarticular tissues. Mycoplasmas can trigger the development of osteonecrosis because the bone marrow is the main depot and source of endogenous reinfection (when immunity is weakened).

АIM: This study aimed to identify signs of the presence of mycoplasmas in the soft tissues of the hip joint and bone marrow of the femur during hip arthroplasty in patients with idiopathic avascular necrosis of the femoral head.

MATERIALS AND METHODS: Clinical and laboratory data of 36 patients with idiopathic aseptic necrosis of the femoral head who underwent total hip arthroplasty were analyzed, and 11.1% of the patients had a history of sexually transmitted diseases. The tissues of the synovium and bone marrow were examined by polymerase chain reaction for the presence of DNA to sexually transmitted infections.

RESULTS: The average age of the patients was 42.7 years, and the average period from disease onset to the time of surgery was 46.2 months. Bilateral joint damage was found in 78% of cases, and 91.7% of the patients had stage 4 femoral head disease (ARCO). The preoperative Harris score was 33.7 points on average. In history, 4 (11.1%) patients had sexually transmitted diseases. During the study, when analyzing tissue samples of the synovial membrane and bone marrow, DNA fragments of Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma spp., and M. hominis were not isolated in any case, including in patients with previous mycoplasma and chlamydial infection.

CONCLUSION: The absence of mycoplasma suggests that a history of sexually transmitted diseases does not significantly affect the outcomes of hip arthroplasty in aseptic necrosis of the femoral head.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):129-138
pages 129-138 views

Universal reposition and fixation ring for surgical treatment of acetabulum fractures: preliminary results of laboratory static tests

Kolesnik A.I., Gavryushenko N.S., Fomin L.V., Donchenko S.V., Solodilov I.M., Ivanov D.A., Ovcharenko A.V., Surikov V.V., Tarasov E.P.


BACKGROUND: Several structures are widely used in the surgical treatment of long-standing fractures of the BB, such as support rings of M. Muller, Burch–Schneider, rings of PROTEK (Switzerland) implanted in the BB. In traumatology practice, rings are used to strengthen fractured walls. However, these rings are not functionally designed for open reposition and fixation of columns and fractures, followed by TBS endoprosthetics with cement fixation of the components of the endoprosthesis. Recently, primary endoprosthetics of EP TBS became the trend for displaced fractures of the BB, which is considered the best option for surgical treatment of BB fractures. In the literature, no analogs of our ring were available, which provides CHP in the treatment of BB fractures.

AIM: To study the deformation properties of a repositional fixation ring with an outer diameter of 52 mm with a stiffening rib.

MATERIALS AND METHODS: A ring has been developed for the surgical treatment of acetabulum fractures (Patent for Invention No. 2692526 dated 26.06.2019 under Application No. 2018133671 dated 25.09.2018.; Bul. No. 18 dated 26.06.2019). For mechanical testing, a ring with an outer diameter of 52 mm with a stiffening rib was manufactured by sequential sintering using additive technologies by Konmet LLC (Moscow). Laboratory mechanical tests were conducted by the Testing Laboratory of Medical Devices and Materials of the FSBI “NMIC TO named after N.N. Priorov” (Moscow).

RESULTS: A static testing of a ring with a stiffener for compression, stretching, torsion, joint stretching, and twisting of the edges of the ring connector was performed, and its deformation properties and reaction to external loads during static tests were examined. The load corresponded to the deformation of 2 mm, kN; compression, 0.209; tension, 0.082; torsion (angle of rotation of 5 degrees, Nm), 9.422; and joint stretching with twisting of the edges of the ring connector (load corresponding to the deformation of 10 mm, kN), 0.060.

CONCLUSION: The results of the initial study of the deformation behaviors of the new ring design clearly show the elastic nature and deformation properties of the ring, which were attributed to the stiffening rib. The positive primary results of studying the deformation behaviors of the ring reinforced with a stiffening rib indicate the possibility for clinical trials and the direction of further refinement of the design..

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):139-149
pages 139-149 views

Clinical case reports

Endoprosthesis replacement of the sternum handle in G1 chondrosarcoma: clinical case

Snetkov A.A., Khaspekov D.V., Snetkov A.I., Machak G.N.


BACKGROUND: Malignant neoplasms with lesions of the chest are quite rare in the sternum and range from 0.5 to 3.1% of the total number of patients with bone tumors of all localizations. In this connection, there are few publications describing the tactics of surgical treatment and methods of prosthetics of the formed defect. The present article describes a clinical case of successful application of an individual prosthesis of the manubrium of the sternum in G1 chondrosarcoma.

CLINICAL CASE DESCRIPTION: to present a clinical observation of the surgical treatment of an 18-year-old patient with G1 chondrosarcoma of the manubrium of the sternum, with individual prosthetics.

CONCLUSION: The use of modern 3D technologies based on the results of CT modeling allows, not only to plan the volume of necessary bone resection, but also to manufacture high-tech prostheses by using 3D printing to replace the defect with planning sufficient support capacity and function.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):151-159
pages 151-159 views

The use of the apparatus of an intelligent system with biofeedback in the evaluation of preoperative preparation of a patient with type I diastematomyelia: clinical case

Kolesov S.V., Tsykunov M.B., Bagirov S.B., Semenduev S.V., Morozova N.S.


BACKGROUND: Diastematomyelia is a rare congenital anomaly of the spinal cord, characterized by its cleavage in the spinal canal, which can be combined with spinal deformity. When correcting scoliotic deformity, patients with this anomaly have a high risk of developing neurological disorders due to its fixation. Therefore, its preliminary mobilization surgically is necessary. In the upcoming corrective surgery, an important role is also played by preoperative halo-traction training in combination with therapeutic physical culture.

CLINICAL CASE DESCRIPTION: A clinical case of the use of the «Tergumed 3D» intelligent biofeedback system in assessing the effectiveness of preoperative halo-gravity traction in combination with mobilizing therapeutic physical culture in a patient with complex spinal deformity against the background of congenital malformation (type I diastematomyelia) to prepare for surgical correction is presented.

CONCLUSION: The results of this study suggest that the combination of physical therapy and halo-traction can be effectively used for preoperative preparation of patients with rigid scoliotic deformities and spinal anomalies. It help analyze preoperative preparation in patients with congenital spinal deformities.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):161-172
pages 161-172 views

One-stage ventral correction of the secondary thoracolumbar kyphosis in a patient with failed transpedicular fixation of Th12 fracture

Ostrovskij V.V., Shulga A.E., Zaretskov V.V., Bazhanov S.P., Likhachov S.V., Smolkin A.A.


The main surgical treatment technique of thoracic and lumbar spine acute injuries is transpedicular fixation, the failure of which, according to the literature data, occurs in 10–15% of cases. There are no common views on tactics and the surgical technique used to deal with the consequences of unstable transpedicular spondylosynthesis. And the publications devoted to the use of isolated anterior interventions are the least common.

We present a case study of the surgical management of the 71 years old patient with secondary thoracolumbar kyphosis that progressed after failed transpedicular fixation of Th12 fracture. The deformity was corrected with one-stage anterior approach and ventral crew system.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):173-180
pages 173-180 views


Epidemiology of fractures of the proximal femur in people older than 50 years: what has changed in the last 30 years?

Samarin M.A., Asi Habiballah Z.A., Krivova A.V., Rodionova S.S., Solomyannik I.A.


The analysis of works devoted to the issues of the epidemiology of fractures of the proximal femur confirms the relevance of these studies, which is associated with both the aging of the population and the increase in cases of osteoporosis and the number of fractures against this background. The review presents data on the hospitalization of patients in Russia and the CIS countries with PPBP. It is shown that «selective» hospitalization of patients with PPBP does not allow obtaining objective data on their prevalence, while this information is an important component of planning and organizing medical care, including at the stage of providing specialized trauma and orthopedic care. As for treatment, in Russia and the countries there is a low level of surgical and high — conservative treatment using outdated techniques. This approach reduces the possibility of almost 70% of patients returning to the quality of life they had before the fracture. At the same time, monitoring the situation can be the first step in organizing organizational measures in a particular country or region to improve the detection of fractures and their treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):181-191
pages 181-191 views

Non-vascularized toe phalanges transplantation in congenital hand malformations

Matveev P.A., Shvedovchenko I.V., Koltsov A.A.


According to the world literature, congenital malformations of the upper limb are found in 2.3–7.9 per 10 thousand live births, while anomalies in the development of the hand occur in 65–95% of patients, the most common are reduction anomalies (brachydactyly, ectrodactyly, adactyly, hypoplasia). Various methods of reconstructive plastic surgery are known in the world literature, including microsurgery, compression-distraction osteosynthesis, various types of skin, tendon-muscle and bone plasty, as well as prosthetics. Non-vascularized toe phalanges transplantation is a less common method, which is effective and technically accessible in case of reduction anomalies of the hand. This study is aimed at studying the relevance of the application of the presented method based on the analysis of world literature.

The aim of the review is the analysis of the world experience of using non-vascularized toe phalanges transplantation in case of congenital hand malformations. A search was made for literature sources in the open electronic databases PubMed and eLibrary for the last 110 years. The publications devoted to the study of the effectiveness of transplanting the phalanges of the toes into defects of the fingers in clinical practice are analyzed. This method has a number of advantages: low morbidity for the donor foot, minimal risk of resorption of the transplanted graft, restoration of the anatomy of the formed finger, preservation of blood supply and sensitivity in the formed finger, the possibility of phalanx growth while maintaining the growth zone, the functionality of the fingers. At the same time, such issues as the detailed functioning of the growth zone of the non-perfusion phalanx after its transplantation, the reasons for the continuation or cessation of growth in the short term after surgery, the resorption of displaced phalanges, and the dependence of the mobility of the reconstructed fingers on the technology of interventions are not indicated anywhere.

Conducting further research on the role of transplantation of non-vascularized toe phalanges in the pathology of the hand in children seems to be an actual task.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):193-204
pages 193-204 views

Posterior pelvic ring injuries: classification, diagnosis, methods of treatment

Aganesov N.A., Lazarev A.F., Kuleshov A.A., Vetrile M.S., Lisyansky I.N., Makarov S.N., Zakharin V.R.


This article aimed to familiarize the reader with the features of classification, diagnosis, and treatment methods of posterior pelvic ring injuries. It presents a review of literatures from PubMed (MEDLINE) and eLibrary investigating posterior pelvic ring injuries. A total of 67 scientific papers were covered. Modern aspects of classification, diagnostics, and surgical methods of treatment of the posterior pelvic ring injuries were analyzed. However, the classification of posterior pelvic injuries remains a difficult problem. Currently, various classifications of sacral fractures have been proposed, but sacral fractures cannot be considered separately from the entire pelvic ring because it is not only a part of the spine but also of the pelvis. The gold standard diagnostic modality of a patient with suspected pelvic ring damage is computed tomography, which reduces the frequency of missed or delayed diagnosis of pelvic injuries. Spino-pelvic fixation in combination with iliosacral screws or plate (triangular osteosynthesis) is the most stable technique for the stabilization of the dorsal pelvic ring. However, the higher risks of failure of the postoperative wound and the risks of deep infection with subsequent removal of the metal fixator should be considered. In the absence of clinically significant displacement, but in the presence of pelvic ring instability, minimally invasive methods of the stabilization of the posterior pelvic ring are preferred.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(2):205-220
pages 205-220 views

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