Vol 18, No 3 (2011)

Results of operative treatment using radical thoracoplasty in 31 patients with funnel breast were analyzed. Mean age of patients was 14.98±4.36 years. All patients had concomitant spine deformity. For purpose of cosmetic effect improvement the mini-invasive submammary accesses were used. Fixatives of sternocostal complex from nickel-titanium with shape-memory were worked out. The shape memory effect was achieved by cooling of the implant that resulted in implant plasticity. After being inserted the implant restored its original shape. That technique allowed achieving full correction of the deformity and positive cosmetic effect in all patients. No complications associated with plate migration were revealed. Radical thoracoplasty with thoracocostal complex stabilization by plate with shape-memory effect is pathogenetically justified and allows correcting the funnel chest of any degree and form and is indicated to patients of any age groups.

Tactics of surgical treatment of spondyloptosis including use of transpedicular external fixation device is presented. There were 4 patients with L5 spondyloptosis. The tactics is characterized by minor traumatization of lumbosacral spine with external fixation device, decrease of neurologic complications rate owing to gradual L5 reduction, possibility of spine deformity elimination, significant technical simplification of internal transpedicular osteosynthesis performance. Clinical results showed normalization of anatomic interrelation in lumbosacral spine, elimination of vertebroradicular conflict, restoration of trunk balance and anthropometric proportion as well as stabilization of L5-S1 segment by osteo-metalic block.

Treatment results were analyzed for 22 patients, aged 5-27 years, with long bone cysts. Combined treatment (transosseous osteosynthesis and drug punctures) was used in all cases. Activity of alkaline and acid phosphatase total proteolytic activity, total protein content in blood serum and cyst contents was determined in dynamics. Biochemical examination of solitary bone cysts contents showed that their qualitative composition was identical to chemical contents of blood serum. During treatment osteolytic activity of cyst contents decreased considerably with reduction of low molecular and rise of high molecular components that evidenced of «structurization» cyst cavity.

Comparative analysis of treatment results for 152 children who underwent acute hematogenic osteomyelitis at age under 3 years is presented. Introduction of individual preventive measures during the course of acute hematogenic osteomyelitis treatment and follow up period resulted in 1.32 time decrease of potential orthopaedic complications in the area of hip joint.

Primary knee arthroplasty under combined spinal epidural anesthesia (CSEA) was performed to 30 patients with III stage of gonarthrosis. Anticoagulant prophylaxis of venous thromboembolism was started 12 hours prior to surgery - subcutaneous injections of 40 mg enoxaparine sodium (Clexane®). Postoperatively all patients were taken direct inhibitor of thrombin - dabigatran etexilate (Pradaxa®) by standard scheme: 110 mg in 3 hours after operation and than 220 mg once a day for 14 days. Deep vein thrombosis (DVT) was diagnosed in 2 cases (6.7% of patients). This rate was not higher than in case of prophylaxis with low molecular weight heparins. No hemorrhagic complications were noted. Maximum growth of total coagulation index was observed on 3 - 7 days after surgery that was manifested by raise of fibrinogen concentration, soluble fibrin-monomer complexes (SFMC) and increased activity of coagulation enzymic link. Indices returned to norm by 14th postoperative day. Use of dabigatran etexilate in knee arthroplasty provides an adequate prophylaxis of venous thromboembolism and does not increase the risk of hemorrhagic complications.

Algorithm for the choice of surgical techniques for the treatment of first metetarsophalangeal joint arthrosis is presented. New aspects of etiopathogenesis are determined. It is shown that syndrome of progressing flat valgus foot causes overloading of dorsal articular surfaces of first metatarsophalangeal joint resulting in fast progression of arthrosis in this joint. Schemes of various types of operations, their correlation by frequency of use and efficacy depending on the degree of pathology severity are presented.

Morphometric indices of mononuclear hepatocytes (volumes of cells and nuclei, nucleo-cytoplasmic index, percentage of parenchymal cells of different classes) in peripheral and central zones of hepatic lobules were determined 3 days after experimental fracture of shin bones in CBA mice. Increase of hepatocyte nuclei size within the range of K3, K4 and K5 classes was revealed. This is indicative of the involvement of hepatic parenchymal cells into the process of adaptive reorganization of the organism in loco-motor system injury.