


卷 31, 编号 4 (2024)
- 年: 2024
- ##issue.datePublished##: 25.12.2024
- 文章: 22
- URL: https://journals.eco-vector.com/0869-8678/issue/view/8434
- DOI: https://doi.org/10.17816/vto.2024314
Original study articles
Information technologies for supporting prevention, diagnosis and management of surgical site infections in trauma and orthopedic patients
摘要
BACKGROUND: Surgical site infections (SSIs) are one of the most common preventable healthcare-associated infections, with a significant socioeconomic burden. Information technology, particularly clinical decision support systems, has been shown to improve patient safety. However, there have been few publications on the use of these systems for the prevention and treatment of SSIs.
AIM: To develop a multifunctional patient safety information system (PSIS) for the prevention, diagnosis, and treatment of SSIs in traumatic and orthopedic surgery.
MATERIALS AND METHODS: A PSIS for traumatic and orthopedic surgeons was developed and implemented in the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics in late 2023 to early 2024. The PSIS includes two user systems: 1) an analytical and authoring system (PSIS-Manager) for subject matter experts who develop scenarios; 2) a medical system for patient data entry and access to guidelines.
RESULTS: A PSIS prevention scenario was developed based on the guidelines of the National Association of Infectious and Non-Infectious Disease Control Professionals. It includes 11 recommendations for the preoperative stage, 30 for the perioperative and intraoperative stages, 33 for SSI prevention during surgery, and 7 for the postoperative stage. A surgical antibiotic prophylaxis scenario includes 24 recommendations. Decision-making algorithms for the treatment of SSIs are based on the guidelines of the American Academy of Orthopaedic Surgeons (AAOS). Decision-making involves 6 factors providing 264 various clinical scenarios, with 9 decision options.
CONCLUSION: Scenario-based protocols can be used to support decision-making on patient management strategy, as well to control compliance with SSI prevention and treatment guidelines. Further perspectives on PSIS development in terms of SSI diagnosis and treatment include the use of artificial intelligence technologies to aid in the diagnosis of wound infections and the selection of treatment options.



Use of negative pressure wound therapy in patients with early deep implant-associated spine infection
摘要
BACKGROUND: Implantable metal fixators are widely used in modern spine surgery for surgical treatment of a wide spectrum of pathologies: degenerative pathology, neoplasms, spinal deformities, traumas. The increasing number of operations entails an increase in the number of complications, including implant-associated infection (IAI). The rate of IAI, according to the literature, accounts for up to 20% of cases. The treatment of such complications represents a significant burden on the healthcare system, since patients require multiple revision interventions, antibacterial therapy and other treatment measures requiring a comprehensive interdisciplinary approach. A single, generally accepted algorithm for treatment of deep spinal IAI has not yet been developed, but the use of negative pressure treatment systems (vacuum therapy) is becoming increasingly widespread. Despite the good results of the method reflected in the literature, the evidence base for treating deep IAI remains limited.
AIM: To evaluate the results of negative pressure wound therapy (NPWT) treatment of early deep implant-associated spine infection.
MATERIALS AND METHODS: An observational retrospective study included 28 patients with early deep implant-associated spine infection treated with surgical debridement combined with NPWT method in 2019–2023, among them 16 (57.1%) female and 12 (42.9%) male. Obtained data are presented as mean and standard deviation. Comparison of laboratory blood parameters at different time points was made using Wilcoxon W-test. Differences were considered significant at p <0.05.
RESULTS: In all patients, the remission of infection was achieved. The fixator was retained in 18 (64.3% of total) cases, partially removed in 1 case (3.6%), completely removed in 8 cases (28.6%), and replaced in 1 case (3.6%). On average 5.7±2.83 NPWT dressings were required to achieve the clinical cure. In 27 cases (96.4% of total) the wound was closed with the help of secondary sutures, in 1 case (3.6%) plastic surgery was provided. The average duration of antibiotic therapy was 38.2±18.1 days, the number of hospital days was 42.1±23.31. Relapse was noted in 1 (3.6%) patient with preserved metal structure one month after discharge. During microbiological tests, positive results (growth of microflora) were recorded in 26 (92.9% of total) patients, negative — in 2 casеs (7.1%). Among these, in 19 (67.9%) cases, a change of leading pathogen occurred during treatment period.
CONCLUSION: NPWT is an effective and safe method that can be characterized by good clinical results.



Middle-term two-stage treatment results of fistulous and non-fistulous form of chronic hip periprosthetic joint infection
摘要
BACKGROUND: Chronic deep periprosthetic infections (PPIs) of the hip joint are a major concern in modern orthopedic surgery. Numerous risk factors are being studied to reduce the recurrence rate; however, the role of functional fistulous tracts remains unclear.
AIM: To compare the physical status of patients, infection etiology, efficacy of chronic periprosthetic hip joint infection therapy, and treatment outcomes depending on the presence of a fistulous tract.
MATERIALS AND METHODS: The retrospective analysis included 218 patients, with two study groups. Group 1 had 80 PPI patients without fistulas, while Group 2 had 138 PPI patients with fistulas. Treatment outcomes were assessed in 202 patients; the median duration of follow-up was 26 months.
RESULTS: Patients with fistulas were younger than those without fistulas: 58 and 63 years, respectively (p = 0.006). There were no significant intergroup differences in the total comorbidity score, duration of surgery, and blood loss. Patients with fistulas had a three-day shorter average hospital stay than those without fistulas (p=0.03). Monobacterial PPIs were the most common in both groups, with Staphylococcus epidermidis predominating in the group without fistulas and Staphylococcus aureus in the group with fistulas (p <0.001). These findings had no significant impact on the recurrence rate. The efficacy of the first debridement was 82% and 76% in the groups without fistulas and with fistulas, respectively; the efficacy of the second debridement was 69% and 58%, respectively (p >0.05). The presence of a fistulous tracts significantly increased the risk of PPI recurrence (p=0.048).
CONCLUSION: PPIs of the hip joint with fistulas have no significant impact on the first PPI relapse; however, fistulas may significantly increase the risk of the second relapse. This must be taken into account when planning relapsing PPI treatment stages.



Surgical debridement of wounds using local negative pressure in the treatment of patients with periprosthetic infection of the hip joint
摘要
BACKGROUND: Topical negative pressure systems are an effective modern technique for treating patients with infected and purulent wounds, including after joint replacement surgeries.
AIM: To assess the efficacy of negative pressure wound therapy (NPWT) systems in surgical debridement of infected periprosthetic wounds during the first stage of revision hip replacement surgery.
MATERIALS AND METHODS: A prospective case study was performed in 96 patients with deep periprosthetic hip joint infections who received treatment between 2015 and 2020. Inclusion criteria: patients with Tsukayama (1996) type I–IV deep periprosthetic infections, with no possibility of implant preservation (80 cases). These patients had a two-stage revision hip replacement surgery. Exclusion criteria: clinical cases with preserved implant components (16 cases). The study included two groups. In the treatment group, NPWT systems were used for surgical debridement of periprosthetic tissues following implant removal, prior to cement spacer placement (15 patients). In the control group, immediate surgical debridement was performed prior to cement spacer placement (65 patients). In the treatment group, if there were uncertainties about the efficacy of surgical debridement of the periprosthetic wound prior to spacer placement, surgical wound debridement was performed and NPWT systems were applied for 48–72 hours. If the wound showed an improvement, a spacer was placed. If the effect was insufficient, surgical debridement was repeated, and an NPWT system was used again. The second stage of revision join replacement surgery was performed after 2–3 months, providing that the infection did not return.
RESULTS: In 67 (83.75%) of 80 patients, postoperative wounds healed by primary intention. Postoperative wounds were initially closed without skin damage in all cases. In the treatment group, the mean Harris hip score was 54.6±12.2 at baseline and 61.5±8.8 two months after surgery (p <0.05). In the control group, the mean Harris hip score was 56.3±14.2 and 62.1±10.9, respectively (p <0.05). Intergroup differences between Harris hip scores at baseline and after surgery were not significant (p <0.05). There were no significant intergroup differences in the frequency of second-stage revision joint replacement surgery: 14 (86.7%) and 54 (83.1%), respectively (p <0.2).
CONCLUSION: NPWT systems are effective in surgical debridement during the first stage of revision hip replacement surgery, following the removal of implant components. In apparently more complex circumstances of wound infection, this technique provides outcomes comparable to those of immediate surgical debridement of periprosthetic wounds with cement spacer placement.



Bactericidal activity of experimental samples of titanium alloy implants with a calcium phosphate coating and an antibacterial component against gram-negative pathogens (experimental study)
摘要
BACKGROUND: Gram-negative bacteria, specifically P. aeruginosa, Acinetobacter spp., Klebsiella spp., and Enterobacter spp., can cause osteomyelitis. Two-stage treatment according to the Masquelet technique is considered effective; however, single-stage surgical treatment options are also being investigated. Submerged implants with bioactive antimicrobial calcium phosphate coating may prevent infectious complications, reduce the incidence of osteomyelitis relapses, and accelerate osteogenesis.
AIM: To assess bactericidal properties of experimental titanium implants with antimicrobial calcium phosphate coating against gram-negative bacteria.
MATERIALS AND METHODS: A single-center, continuous, prospective, open-label experimental in vitro study was performed. The disk diffusion test was used. BT6 titanium disks with calcium phosphate coating, impregnated with amikacin, cefepime, and cefotaxime (2.5/5.0/7.5 µg), were tested. Reference cultures: archival strains of Pseudomonas aeruginosa (АТСС 27853), Acinetobacter baumannii (АТСС 19606), and Klebsiella pneumoniae (АТСС 700603). The results were assessed by the inhibition zone diameter around a disk.
RESULTS: The study found that impregnating a bioactive metal base with amikacin and cefotaxime at a dose of ≥2.5 µg or cefepime at a dose of ≥7.5 µg results in bactericidal activity against Klebsiella pneumoniae. Amikacin at a dose of ≥5 µg and cefepime at a dose of ≥7.5 µg provide bactericidal activity against Pseudomonas aeruginosa. Antibiotic doses used in the study had no bactericidal effect against Acinetobacter baumannii. The bactericidal effect was only investigated in relation to archival gram-negative bacteria strains, which is a limitation of this study. Using clinical strains may yield different results.
CONCLUSION: Commonly used antibiotics may provide bactericidal properties of the surface of submerged implants designed for traumatic and orthopedic surgery, notably against gram-negative bacteria. However, the efficacy of implants depends on the selected antibiotic and its concentration.



Application of additive technologies in the treatment of patients with gunshot wounds of the elbow joint
摘要
BACKGROUND: Management of patients with upper extremity gunshot wounds that have destroyed the elbow joint is a major challenge in modern traumatic and orthopedic surgery.
AIM: To assess medium-term surgical outcomes in patients with upper extremity gunshot wounds that have destroyed the elbow joint who received combination treatment using additive technology.
MATERIALS AND METHODS: Between 2022 and 2024, 25 patients with upper extremity gunshot wounds that have destroyed the elbow were treated using additive technology in the Center for Traumatology and Orthopedics of the Burdenko Main Military Clinical Hospital of the Ministry of Defense of Russia. All patients were male, with a mean age of 34.5±7.82 years. The mean time from injury to elbow replacement surgery was 193±39 days. The range of motion in the elbow joint was assessed. The QuickDASH and the Oxford Elbow Score were used to subjectively assess treatment outcomes after 3 and 6 months. CT examinations were performed at each stage.
RESULTS: A follow-up examination after 6 months showed an improvement in the range of motion in the majority of patients. The following criteria indicated a positive outcome: range of motion without limitations (Table 4, RF Government Decree No. 565 of July 4, 2013, On Approval of the Regulation on Military Medical Examination), QuickDASH score <45, and Oxford Elbow Score >70. The outcome was good in 17 (68%) patients and satisfactory in 5 (20%) patients. Three (12%) patients had postoperative complications (one patient’s elbow implant component was destroyed, and two patients developed deep periprosthetic infections), resulting in poor outcomes. Thus, the elbow joint function was successfully restored using additive technology in 22 (88%) patients.
CONCLUSION: In patients with upper extremity gunshot wounds that have destroyed the elbow joint, additive technology rapidly and completely restores the upper extremity function. However, the long-term outcomes of this treatment need to be investigated further.



Features of radiography of the scaphoid bone of the wrist
摘要
BACKGROUND: Scaphoid bone fractures are quite common. Difficulties and inaccuracies in the diagnosis of damages may significantly delay the treatment and reduce its efficacy. Routine X-ray imaging of the wrist joint is insufficiently informative, leaving some fractures undetected. The scaphoid bone has a distinctive shape and position in the wrist joint; thus, when using conventional positioning during X-ray imaging, the fracture line is not always visible, and the scaphoid bone appears shorter. W.R. Stecher, an American surgeon, proposed specific positioning options to examine the entire scaphoid bone, thus improving the diagnosis of scaphoid bone pathology.
AIM: To compare conventional positioning with three Stecher positioning options; to determine the option that best eliminates the distortion (shortening) of scaphoid bone images.
MATERIALS AND METHODS: The study included 13 volunteers aged 23 to 65 years. X-ray imaging of the wrist joint was performed in all volunteers using conventional positioning and three Stecher positioning options. The scaphoid bone length was measured. The results were processed using the MS Excel Analysis ToolPak (descriptive statistics); the Friedman test was used for repeated measurements.
RESULTS: The scaphoid bone length varied when using different positioning options. All volunteers had the shortest scaphoid bone length when using conventional positioning and the longest when using modified Stecher positioning. The difference in measurements between these positioning options was 2 to 8 mm, which is significant for a small anatomical structure.
CONCLUSION: In this study, the option “fingers clenched + elbow deviation” was found to be the best for frontal X-rays of the scaphoid bone. This approach (modified Stecher positioning) produces scaphoid bone images with minimal distortion, which is crucial for diagnosis, preoperative planning, treatment, and outcome assessment.



Long-term results of primary and revision oncological endoprosthetics
摘要
BACKGROUND: Increased overall survival leads to a significant increase in the service life of implants. Currently, no joint replacement systems are failure-free, which reduces the service life.
AIM: To assess and systematize the main complications of primary and revision joint replacement surgery, identify the main causes of these complications at various stages of joint replacement based on literature data and analysis of own findings in a large patient population, and develop treatment approaches.
MATERIALS AND METHODS: The study included 1,292 patients with primary bone and soft tissue sarcomas, as well as metastatic and benign bone tumors, with 1,671 primary and revision joint replacement surgeries of varying extent performed between January 1992 and January 2020. The proportion of males and females who underwent joint replacement surgery was approximately equal. Joint replacement surgery was performed in 886 (68.6%) patients with primary cancer, 144 (11.1%) patients with metastases to long bones, and 262 (20.3%) patients with benign tumors.
RESULTS: During the study period, the overall incidence of complications was 1.4 times higher in the revision joint replacement surgery group (38.1%) compared to the primary joint replacement surgery group (26.6%). The most common type I–IV complications included unstable implants two and more years post-surgery (type IIB) and broken implants (type IIIA). As a result of innovative modifications, the overall incidence of type I–IV complications in primary and revision joint replacement surgery decreased to 16.5% and 24.3%, respectively. The most common cancer-related complication of primary joint replacement surgery was tumor recurrence (type V), accounting for 9.5% of cases. Tapered and cylindrical stems were the best shapes for primary and revision joint replacement surgery. The best stability was observed for 60–100 mm long stems in upper extremity joint replacement and 110–150 mm long stems in lower extremity joint replacement. Stems longer than 160 mm can only be used in revision joint replacement surgery. Adequate perioperative antibiotic prophylaxis reduced the risk of implant site infections.
CONCLUSION: High-quality cement mantle formation, stems that match the diameter and shape of the medullary canal, and optimal stem length decrease the incidence of early aseptic instability. The study used a set of preventive measures, including strict compliance with standardized antibiotic therapy regimens during and after surgery, surgical technique modifications, perioperative patient management, and informing patients about the risks of infectious complications. These measures decreased the incidence of early implant site infections after primary and revision joint replacement surgery for a period of 28 years. The efficacy of combination treatment for these diseases has a direct impact on the incidence of local tumor recurrence. Surgical technique modifications based on tumor grade significantly increased treatment efficacy.



Diagnostics aspects of benign tumors of soft tissues of hand
摘要
BACKGROUND: Benign soft tissue masses of the hand are defined by the lack of a generally accepted global classification, consistent terminology, and histological identification criteria, as well as a wide range of forms and frequent recurrences. During preoperative preparation in routine clinical practice, imaging and comprehensive clinical examinations are frequently not performed in patients with soft tissue masses of the hand. In the event of a later recurrence, the selection of treatment approach can be challenging due to limited clinical and imaging findings.
AIM: To assess the prevalence of benign soft tissue masses of the hand among all neoplasms of the hand, based on the histological structure, as well as the characteristics of clinical diagnosis and the efficacy of specialized examination methods.
MATERIALS AND METHODS: A retrospective study was performed in 1.355 patients with benign soft tissue masses of the hand and tumor-like lesions for a 10-year period between 2010 and 2020. The diagnosis was based on clinical, X-ray, and ultrasound findings, with a mandatory histological examination of the excised tumor in all patients. To clarify the diagnosis, additional magnetic resonance imaging was used in 53 patients, computed tomography in 15 patients, angiography in 13 patients, and thermographic and radionuclide studies in 28 patients.
RESULTS: Of the 1,355 cases of tumor-like lesions on the hand, 563 (41.5%) were benign soft tissue masses. The most prevalent were benign synoviomas (263 cases; 46.8%), hemangiomas (94 cases; 16.8%), lipomas (62 cases; 11.2%), fibromas (35 cases; 6.2%), glomangiomas (28 cases; 5%), and fibrolipomas (26 cases; 4.6%). Angiofibromyomas, hemangiopericytomas, and lymphangiomas had the lowest prevalence (3 cases each; 0.5%).
CONCLUSION: The study found that benign soft tissue masses of the hand accounted for 41.5% of all tumor-like lesions on the hand, with benign synoviomas being the most prevalent. The diagnostic significance of mandatory X-ray and ultrasound examinations before surgery was confirmed. Only 884 of 1,355 cases (62.5%) had a preliminary diagnosis made prior to imaging studies that matched the final diagnosis based on histomorphological examination of the excised tumor. The feasibility of widespread use of high-resolution MRI for the differential diagnosis of hand neoplasms was determined. The diagnostic significance of angiography, computed tomography, and thermographic and radionuclide studies in detecting benign hand neoplasms was confirmed. It is incorrect to perform surgery without preliminary clinical and imaging examinations. A histomorphological examination of the excised tumor is mandatory in all cases.



Effect of ultra-low content of graphite nanoplatelets on tribological properties of composites based on ultra-high molecular weight polyethylene
摘要
BACKGROUND: Improving ultra-high-molecular-weight polyethylene (UHMW PE) production techniques continues to be a top priority in medical engineering. This is due to the fact that liners are the weakest components of artificial joints, causing the majority of their damage or destruction. Filler reinforcement of UHMW PE improves the durability of UHMW PE products by decreasing the wear rate and coefficient of friction for various friction pairs.
AIM: To assess the effect of ultra-low graphite nanoplate content (0.006–0.307 mass%) on the tribological properties and wear resistance of UHMW PE-based composites.
MATERIALS AND METHODS: UHMW PE synthesized using various technologies was compared to commercial-grade UHMW PE produced by Ticona. The tribological properties were examined using the Nanovea Tribometer, and the wear resistance was assessed according to ISO 15527.
RESULTS: The study identified the range of graphite nanoplate concentrations with the lowest coefficient of friction. The coefficient of friction of UHMW PE without a filler corresponds to that of commercial-grade products GUR 1020 and GUR 1050 of the Chirulen brand, and composites made from it have a lower coefficient of friction. The optimal filler concentration was determined based on tribological and wear test findings.
CONCLUSION: Graphite nanoplates increase wear resistance when exposed to a water-sand suspension.



A comparative study of the data of intraoperative neurophysiological monitoring in the surgical correction of severe scoliosis with and without preoperative halo-traction
摘要
BACKGROUND: Intraoperative neurophysiological monitoring (IONM) in remedial spine surgery is currently a gold standard, and protecting the nervous system during surgery is a major concern for both surgeons and patients. Moreover, we use various types of preoperative halo traction in patients with severe scoliosis to reduce the risk of neurological complications. Thus, we performed a comparative study of changes in IONM findings during scoliosis surgery in patients with and without preoperative halo-gravity traction.
AIM: To compare IONM findings during scoliosis surgery with and without preoperative halo-gravity traction.
MATERIALS AND METHODS: An observational, single-center, retrospective, single-arm study of IONM findings was performed in 88 patients with severe scoliosis who underwent scoliosis surgery with halo traction between 2019 and 2023. The study included two groups. Group 1 (52 patients) had preoperative halo-gravity traction while standing or sitting. Group 2 (36 patients) had intraoperative halo traction. A comparative analysis was performed, which included the following: risk criteria for neurological deficit in the lower extremities during surgery, deformation angles, mobility parameters, postoperative deformation, blood loss, and surgery duration.
RESULTS: The intergroup comparison of changes in deformation angles and IONM findings revealed that Group 1 had more severe deformation based on primary and compensatory curve angles, more severe stiffness, and a lower number of patients with normal motor evoked potential (MEP) levels. The differences were significant (p <0.05). Risk criteria for neurological deficit were reported in 12 patients: seven in Group 1 and five in Group 2. In two patients in Group 2, MEP values of the lower extremities were not restored, resulting in permanent neurological deficit.
CONCLUSION: Preoperative halo traction prepares the nervous structures for the treatment of severe deformations and minimizes the intraoperative impact on the nervous system, reducing the risk of neurological complications in patients with severe spinal deformities compared to immediate treatment with intraoperative traction.



Clinical case reports
Spinal epidural abscess
摘要
INTRODUCTION: Spinal epidural abscess (SEA) is a rare but severe infectious disease, characterized by the accumulation of pus in the epidural space of the spine. This condition may cause spinal cord and spinal root compression, resulting in a persistent neurological deficit or even death in the event of a delayed or incorrect diagnosis. The prevalence of SEA has increased in the recent decade, which is attributed to increased life expectancy, extensive use of invasive procedures, and an increase in risk factors such as diabetes mellitus, obesity, and intravenous drug abuse. SEA is difficult to diagnose because of its non-specific symptoms. However, clinicians’ awareness and early use of magnetic resonance imaging (MRI) allow timely disease detection and therapy initiation.
CLINICAL CASE DESCRIPTION: Patient (55 years old), presented with complaints of weakness in all extremities and neck pain. The medical history started roughly 4 months ago, beginning with strep throat, after which the patient developed increasing weakness in the extremities. Based on the MRI and CT findings, the following diagnosis was made: SEA at the C4–C5 level, causing spinal cord compression. The following procedures were performed: C4 and C5 corporectomy, epidural abscess excision and drainage, and stabilization with a cervical plate and autograft. A significant improvement was observed in the postoperative period, with a notable decrease of neurological deficit at discharge.
CONCLUSION: This case report highlights the need to improve awareness of SEA among healthcare professionals for early diagnosis and treatment initiation, particularly in high-risk patients. Despite advances in treatment, mortality rates and the incidence of neurological complications remain high, necessitating further research to improve treatment strategies and outcomes in SAE patients.



Bacterial spondylitis of the thoracic spine
摘要
INTRODUCTION: Spinal osteomyelitis, also known as spondylitis, is characterized by inflammation of the vertebral column structures caused by various factors, such as injuries, autoimmune diseases, and infectious diseases. Bacterial spondylitis, the most severe form of spondylitis, is frequently caused by hematogenous infection spread and can lead to major complications such as neurological disorders, spinal deformities, sepsis, and death. Bacterial spondylitis is more prevalent in patients over the age of 50 with risk factors such as systemic diseases and immunosuppression. The paper discusses the routes of infection transmission, modern diagnosis tools (CT, MRI, bacteriological and genetic methods), and therapeutic approaches with a focus on surgical treatment.
CLINICAL CASE DESCRIPTION: The paper presents a clinical case of bacterial osteomyelitis of the upper thoracic spine in a 65-year-old female patient with a history of infectious nonspecific polyarthritis. The medical history, clinical presentation, and MRI findings are provided. The transmanubrial approach for optimal corpectomy followed by stabilization with a titanium plate is described.
CONCLUSION: Spinal osteomyelitis remains a major concern, necessitating high-quality surgical intervention. Modern diagnosis tools and individualized therapy are expected to decrease the incidence of complications in patients with infectious spinal lesions.



Experience of successful treatment of an infected soft tissue defect of the lumbar spine region with a perforating skin flap
摘要
INTRODUCTION: Surgical site infections following spinal surgery are a major concern. According to the literature, the incidence of surgical site infections is 2.0%–2.5%. These complications are sometimes accompanied by soft tissue defects, which require special treatment, including skin grafting.
CLINICAL CASE DESCRIPTION: The paper presents a clinical case of postoperative wound infection in the lumbar region. Complication management resulted in a 12×6 cm tissue defect. The wound included previously implanted metal screws and pins. To address this issue, the defect was repaired using a perforator lumbar flap. The implants were not removed. The postoperative wound healed properly, the implants were preserved, and the patient has been followed up since 2014.
CONCLUSION: Skin grafting using a perforator flap is an option in soft tissue defect repair due to infectious complications of spinal surgery.



Вone marrow edema in the differential diagnosis of deases of the knee
摘要
INTRODUCTION: Bone marrow edema (a radiological term used in MR diagnosis) is characterized by low-intensity infiltration on T1-weighted sequences and high-intensity signal on T2-weighted short-tau inversion recovery (T2w-STIR) images.
CLINICAL CASE DESCRIPTION: The paper presents a case series in patients with knee pain, with subchondral bone lesions on MRI, characterized by bone marrow edema with no previous injury. The following diagnoses were made based on the type of bone edema and medical history: aseptic necrosis of the condyle, subchondral fracture, osteochondritis, secondary osteonecrosis, osteoarthritis, septic arthritis, and others. The paper describes the approach to differential diagnosis based on MRI findings.
CONCLUSION: An assessment of bone marrow edema found on MRI in patients with knee pain allows for timely diagnosis clarification and treatment initiation in some cases.



Endoprosthetics of the head of the talus for deforming arthrosis of the talonavicular joint
摘要
INTRODUCTION: Idiopathic osteoarthritis of the rearfoot joints most commonly affects the talonavicular joint. Currently, talonavicular osteoarthritis is commonly treated using double and triple arthrodesis, as well as isolated talonavicular arthrodesis. However, restricting functionally significant joints of the foot results in increased load on adjacent joints, causing degenerative changes.
CLINICAL CASE DESCRIPTION: The paper presents a clinical case of surgical treatment in a patient with avascular necrosis of the talar head, deforming arthrosis, and fibrous ankylosis of the talonavicular joint by talar head replacement with an original ceramic implant. The presented case is the first to describe a novel treatment method for gross talonavicular joint pathology using a ceramic implant to replace the talar head.
CONCLUSION: Based on the medium-term outcomes of surgical treatment in a patient with stage III deforming arthrosis and fibrous ankylosis of the talonavicular joint, talar head replacement is a promising treatment option for this condition. The initial findings showed that the proposed implant and its placement method can be used as an option of choice to preserve the mobility of the talonavicular joint.



SCIENTIFIC REVIEWS
Local antibacterial depot systems in the treatment of bone and joint infection (review)
摘要
Local depot systems with high antibiotic content are an essential component of combination therapy in osteoarticular infections. These systems are effective against microbial biofilms by providing drug concentrations that surpass the requirements of planktonic bacteria. Currently, there are numerous support matrixes with various properties. Only a few of them are sufficiently studied and actively used in clinical practice. These include polymethylmethacrylate-based bone cement, calcium sulfate, collagen, allografts, etc. However, the vast majority of local systems have only been studied in vitro and in vivo. This review describes currently available depot systems, including their primary properties, advantages, and disadvantages, as well as potential for future use of a specific matrix both for the treatment and prevention of diseases.



Modern ideas about the expediency of antibiotic prophylaxis in arthroscopic knee surgery: literature review
摘要
Despite advances in aseptic, antiseptic, and surgical techniques, the risk of infectious complications persists. Antibiotics have long been used to prevent these complications, particularly during surgeries involving prosthetic materials, implants, or transplants. However, their use prior to minimally invasive surgeries, such as knee arthroscopy, remains controversial. We reviewed international literature to summarize modern approaches to antibiotic prophylaxis in knee arthroscopy, as well as to determine the prospects of improving rational antibiotic prophylaxis regimens during these surgeries. The search was performed in PubMed/MedLine and eLIBRARY databases. The following search terms were used: “antibiotic prophylaxis in knee arthroscopy,” “antibiotic prophylaxis in ACL reconstruction,” “antibiotics in knee arthroscopy,” and “septic arthritis after knee arthroscopy.” The search yielded 567 studies published between 1986 and 2024. Following screening, 57 eligible studies were selected. All studies were conditionally divided into two groups. The first group included studies addressing routine arthroscopy without grafting. The second group included studies addressing infectious complications and antibiotic use during knee arthroscopy, using tendon allografts and autografts, with anterior cruciate ligament repair as an example. The literature review found that there is no consensus on the feasibility of antibiotic prophylaxis in routine knee arthroscopy. There were no significant differences in the incidence of deep infectious complications between groups of patients with and without preoperative antibiotic prophylaxis. During knee arthroscopy with the use of tendon grafts, antibiotic prophylaxis was performed in all identified studies. There are two commonly used regimens: a conventional regimen that exclusively uses intravenous antibiotics and a combination regimen that includes additional graft exposure to vancomycin solution. The incidence of deep infectious complications was considerably lower in the group where antibiotic prophylaxis was supplemented by graft exposure to vancomycin solution.



Chronic recurrent multifocal osteomyelitis: aspects of epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment: literature review
摘要
The paper presents a literature review on chronic recurrent multifocal osteomyelitis. This orphan disease, which primarily affects children and adolescents, has a wide range of clinical manifestations and presents various diagnostic, pathological, and therapeutic problems. An analytical review was performed using medical literature databases and PubMed (MEDLINE), Google Scholar, and eLibrary search systems. The review addresses the following: epidemiology, clinical presentation, pathogenesis, diagnosis, treatment, and genetic factors in the pathophysiology of chronic recurrent multifocal osteomyelitis in humans. The review aimed to improve clinicians' understanding of this disease, allowing for timely diagnosis and appropriate treatment initiation.



Treatment of post-traumatic instability of the shoulder joint in athletes: literature review
摘要
According to the World Health Organization, the incidence of shoulder injuries is 17.2 cases per 100,000 population. Sports injuries account for approximately 7% of all shoulder injuries, which frequently results in sports career termination if medical attention is not received on time. Over the last decade, arthroscopic surgery has evolved from a diagnostic procedure to an effective therapy method for post-traumatic shoulder instability. Compared to open surgery, arthroscopic surgery is associated with a lower incidence of postoperative complications, shorter surgery duration, lower pain intensity, and early initiation of rehabilitation therapy. The use of both metal and biodegradable anchors reduced the incidence of relapses to <7%, which is a positive outcome. Advances in surgical treatment, particularly the use of arthroscopic techniques, allow for the minimally invasive restoration of shoulder joint function in athletes in a short period of time. Moreover, the postoperative period is characterized by a low incidence of complications and relapses. With each passing year, arthroscopic surgery allows for a broader spectrum of procedures with minimal tissue damage.



Arthroscopy of the hip joint: literature review
摘要
As recently as the middle of the 20th century, arthroscope insertion in a ball-and-socket hip joint was thought to be almost impossible. Hip arthroscopy has evolved greatly since then, and its current development rate is closely related to the detection rate of hip joint disorders. Athletes and other young patients with hip joint injuries are increasingly being diagnosed with constantly evolving disorders. Many of these conditions were previously undiagnosed and hence remained untreated. Hip arthroscopy, like any other procedure, has its risks. This procedure is not widely available, as it requires special equipment and extensive training.



The influence of CNN architecture, image size and quality to object detection model on histological specimens
摘要
Improving convolutional neural network (CNN) quality for object search in histology scans is a long-standing problem that essentially involves selecting the best CNN architecture and creating a high-quality dataset. The efficacy of object detection algorithms is determined by numerous factors, including image quality, image size, and the search object. The primary aim of this study was to identify published studies on the impact of various image characteristics in a training sample and CNN architecture on the quality of a created model. Literature published in the last 5 years was reviewed, which addressed data pre-processing, methodology, requirements to images included in datasets, image preparation for CNN model development, and architecture selection. At the time of the study, there were no requirements to image size, and there was no data on the ratio of object size to image size for the best model performance. Moreover, the selection of neural network architecture is lacking in transparency and algorithmization. In the majority of cases, researchers recommend architectures that they have developed or used themselves, without explaining the reasons and selection criteria or comparing them to alternative options. All these factors significantly complicate the development of CNN models for medical image processing. This paper presents a brief overview of publications that address image preparation for datasets, as well as a potential approach to CNN architecture selection.


