Vol 17, No 1 (2010)

Outcomes of surgical treatment of 34 patients aged from 9 to 15 years (mean age 11.7 years) with basic curvature arch from 43 to 148° (99° average). In 9 patients dorsal correction and spine fixation by CD system without intervention on the vertebral bodies was performed (1st group). In 25 patients diskepiphysectomy (including thoracoscopic one in 7 patients) and interbody spondylodesis on the apex of the convex basic arch were performed prior to dorsal correction. Then halo-pelvic traction was performed for 7-10 days followed by dorsal fixation of the spine by CDI without posterior spondylodesis (2nd group). Subsequently depending on the degree of correction loss due to spine growth step-by-step corrections of the deformity were performed. After spine growth completion final instrumental correction and fixation of the spine with posterior spondylodesis were performed. In the 1st group step-by-step corrections were to be performed in 77% of cases, in 2nd group - in 28% only. It was shown that performance of diskepiphysectomy on the apex of the deformity with following correction and CD system fixation of the spine decreased the rate of postoperative spine deformity progression, eliminated asymmetric growth of vertebrae on the deformity and increased the achieved correction. In the process of patients' growth wedge shape of the vertebral bodies decreased in frontal and sagittal planes and no increase of their torsion-rotation changes occurred.

Experience in use of transferred pedicle muscular flaps for the treatment of 7 patients with infectious complications after previously performed stabilizing operations on the spine is presented. Revision interventions showed failure of implanted transpedicular constructions on the background of osteomyelitis with vast infected cavities. To compensate for vast wound defects with soft tissue deficit that remained after removal of stabilizing systems and necrectomy plasty with transferred muscular flaps was performed. Primary wound healing was achieved in all cases. At follow up from 1 to 4 years relapse of pyo-inflammatory process in the zone of intervention was detected in no one case.

Prospective study of tranexamic acid use results (native preparation Tranexam) in primary total hip arthroplasty was performed during the period from March to October 2009. The study involved 159 patients (55 men, 104 women) with various hip joint pathology (79 patients - main group, 80 patients - control group). Mean age of patients made up 55.7 years (17 - 80 years). In patients from the main group 15 mg/kg Tranexam was injected just prior to operation with reinjection of the same dose in 6 hours. In control group etamsylate (750 mg 30 minutes prior to incision with reintroduction in 4 - 6 hours, daily dose up to 1500 mg) was applied. The results of the analysis showed reliable (p<0.001) decrease of total blood loss in the main group (409±228 ml) as compared to the control group (638±437 ml). The reasonability of the use of tranexamic acid for reduction of blood loss in total hip arthroplasty was shown.

Experience in elaboration of common approaches to diagnosis of surgical site infection accumulated at Novosibirsk SRITO department of joint arthroplasty and endoscopic surgery is presented. It is shown that standardized approaches to the detection and recording of such complication provides for objective evaluation of its rate.

During the period from 1970 to 2009 at CITO Department of child bone pathology and adolescent orthopaedics total hip arthroplasty was performed in 36 patients aged 14-18 years including 7 patients with bilateral interventions. Main group consisted of patients with systemic hereditary skeleton pathology. Optimum implant designs with regard to anthropometrics and disease pattern were determined for adolescents. Algorithm of surgical interventions in patients with stable flexion-adduction contractures on the background of systemic skeleton pathology was elaborated. Treatment results were evaluated at terms from 1 to 20 years. Good and satisfactory results made up 91.6%

Outcomes of surgical treatment for diaphyseal fractures of the femur were analyzed in 270 (278 interventions) out of 509 patients being admitted to the clinic since 1999. In overwhelming majority of patients (226 children) closed intramedullar fixation of bone fragments (231 operations) was performed. Closed intramedullar osteosynthesis was performed using flexible and rigid rods including the locking ones. Elastic-stable osteosynthesis is indicated for the treatment of under school age children with type A1, A2, A3, B1, B2, B3, C2 fractures as well as junior school age children with type A1, A2, B1, B3, C2 fractures. Presented technique can be considered as a gold standard in this group of patients. Closed intramedullary osteosynthesis by rigid rod without locking is the optimum technique for the treatment of junior and senior school age children in bearing injuries of types A3 and B2. Method of choice in senior school age children with A1, A2, B1, B3, C1, C2 and C3 fractures is closed intramedullar osteosynthesis with locking rod. Preliminary extrafocal fixation in multiple and open injuries creates optimum conditions for delayed intramedullar osteosynthesis.

Data on 280 patients with diaphyseal fractures of shin bones been treated at CITO and other clinics using Oganesyan Repofix apparatus for external transosseous reposition and fixation of bone fragments were analyzed. It was shown that in 57 cases certain mistakes and related complications were detected at different treatment steps. Recommendations on the prevention of such complications were given. Awareness of potential mistakes and complications will help to avoid them and thus to increase the treatment efficacy.

Location of radial nerve relative to lateral humerus was studied using US scanner in 17 volunteers (7 men, 10 women) aged 19-54 years. Conditional humerus length (acromion-olecranon distance) ranged from 31 to 39 cm. Radial nerve transacted lateral humeral diaphysis 11.3±1.9 cm (from 8 to 15 cm) proximal to lateral humeral epicondyle. Distance between lateral humeral epicondyle to radial nerve made up 31.9% of humerus conditional length. Awareness of obtained data may be helpful at performance of surgical intervention on the humerus.

Technique of medicinal preparation (chondroprotectors Synvisc) injection into hip joint cavity under roentgenologic control is described. Technique has been applied in 12 patients (14 procedures) with primary stages of coxarthrosis. Positive effect has been achieved in all cases. In comparison with the performance of intraarticular injections using echography the presented technique is more accurate and simple for the procedure documenting. Duration of manipulation makes up 5-7 minutes.