Vol 19, No 3 (2012)

Long-term results (up to 40 years) of surgical treatment using different types of correction osteotomy in 51 children with Blount disease showed that the operation was necessary but a delayed measure. The authors showed that when deformity achieved the degrees requiring surgical intervention with bone transaction the deforming gonarthrosis inevitably developed at terms up to 10 years after operation. The main causes of varus deformity recurrence were determined, i.e. presence of active but disturbed growth and ossification processes, distal osteotomy level, absence of intraoperative hypercorrection, inobservance of postoperative orthopedic regimen. The only way to achieve good results is early operative intervention directed to growth normalization and formation of proximal tibia with spontaneous deformity correction during the period of child's growth.

Surgical treatment results for 53 patients with III—IV stage of scoliosis are presented. In all patients original endocorrector has been applied. Endocorrector is based on the application of cross-section corrective («translation effect») forces that enable to shift the vertebrae of the main scoliotic arch to the median line of the trunk. Endocorrector was the most effective in curvature arch under 75° and provided 35—45° correction. Mathematic modeling of a situation «endocor- rector—curved spine» was performed as well as the pattern of forces created by endocorrector and participated in the scoliotic deformity correction was studied. Surgical intervention enabled to achieve stable fixation of the spine with its sagittal contours preservation. At long-term follow up (1—6 years) loss of correction did not exceed 8—10°. In scoliosis with arch over 75° step-by- step corrections were performed and loss of correction could make up 15°.

Clinical, roentgenologic and pododynamographic data were analyzed for 195 patients after 207 total hip arthroplasties performed via modified minimum invasive anteroexternal approach by Watson-Jones during the period from 2004 to 2006. Clinical results showed reduction of rehabilitation period and significant relief of postoperative pain syndrome. The rate of complications corresponded to that at conventional technique application. Despite slight varus position of the femoral component roentgenologic examination results were also comparable. Analysis of gait showed its considerable improvement and decrease in preoperative asymmetry between healthy and operated sides already in 4 months after operation. Residual differences were almost not observed in 6 months after intervention. Obtained clinical results confirmed the advantages of the applied technique.

Comparative study of clinical efficacy and safety of dabigatran etexilate (DE) and other widely used anticoagulants (AC) in primary thromboprophylaxis after orthopedic interventions was performed. Retrospectively 828 patients from 13 hospitals located in 10 different Russian towns were evaluated. Seven hundred sixty one patients (91,9%) underwent total arthroplasty of either knee or hip joints and 67 patients — other orthopedic operations. Clinical efficacy of AC was evaluated by the rate of postoperative vein thrombosis, safety of AC — by the rate of postoperative bleedings. No statistically significant difference in the incidence of venous thromboembolism at DE and other AC intake after total arthroplasty (distal thrombosis — 4% [2%, 7%] and 4% [2%, 6%] in DE and other AC subgroups, respectively; proximal thrombosis — 0% [0%, 1%>] in both subgroups and after other orthopaedic interventions (distal thrombosis — 4% [0%, 18%] and 3% [0%, 13%]; proximal thrombosis — 4% [0%, 18%] and [0%, 9%] in DE and other AC subgroups, respectively) was detected. The incidence of bleeding after arthroplasty also showed no significant difference between DE and other AC (minimum postoperative bleeding was 1% and 1% in DE and other AC subgroups, respectively; massive bleeding — 0% in both subgroups. No postoperative bleeding was observed after other orthopaedic interventions. Thus clinical efficacy and safety of DE is comparable to other widely used AC for thrombosis prevention.

Study on the assessment of influence of sympatectomy upon the regeneration of human upper extremity nerves is presented. During the period from 2008 to 2012 ninety patients (83 men, 7 women) aged 12 — 60 years were treated for the defects of median, radial, ulnar and musculocutaneous nerves. The length of defects was from 2.5 to 20.0 cm . In 46 patients from the main group autoneuroplasty was combined with sympatectomy (thoracoscopic clipping of sympathetic trunk at Th3 — Th4 level). In 44 patients from the control group sympatectomy was not performed. During the period from 1.5 to 2 years after operation increase in reinnervated muscles force up to M3 — M4 was registered in 47.7% of patients from the main group versus 10.9% of patients from the control one and restoration of sensation up to S3 — S3+ in 65.9 and 13.04% of patients respectively (p <0.05). Earlier and more effective restoration of blood flow and pressure in microcirculatory bed in the denervated segment of the extremity was noted as compared with the control group.

Results of comparative study of the efficacy and safety of intraoperative application of tranexam versus autoplasma in patients with planned surgical blood loss and high risk of venous thrombosis development has been presented. One hundred seven patients admitted for total knee replacement were divided into 2 groups. In the main group (55 patients) intraoperative intravenous infusion of 10 mg/kg tranexam were used. In the control group (52 patients) intraoperative hemodilution with autoplasma was performed. Hemostasis indices (APTT, INR, SFMC, D- dimer) and lysis index were studied before surgery and in postoperative period. Ultrasound scanning of lower extremity veins was performed before surgery and in 4—5 days after intervention. The volume of intraoperative blood loss in two groups did not differ. In the postoperative period the drainage blood loss in the main group was more than twice lower as compared to the control group (p=0,037). In postoperative period statistically significant increase in SFMC and D-dimer indices was noted in both groups. However after tranexam application the increase in fibrin lysis products content was reliably less marked than in control group. US investigation of lower extremities showed distal veins thrombosis in 2 patients from control group and no cases of thrombosis in the main group.

A special device assembled from standard details of Ilizarov apparatus is described. The device enables not only to perform the reduction of navicular bone fragments but provides their stable fixation as well. Conditions for walking on the first days after transosseous osteosynthesis with gradually increasing loads upon the operated extremity are created. Clinical case is presented.