Vol 17, No 2 (2010)

At department of concomitant and multiple trauma of Scientific Research Institute of Emergency Care named after N.V. Sklifisovskiy 177 patients with polytrauma were treated from 1999 to 2009. All patients had avulsions and crushes of large segments of extremity including crus (66 patients - 37%), thigh (44 patients - 25%), foot (41 patients - 23%), shoulder (14 patients - 8%) and forearm (12 patients - 7%). In 99 patients (control group) the treatment was performed according to routine protocol: amputation by the type of primary surgical treatment (PST), topical treatment of wounds using antiseptic and salve dressings, autodermoplasty after wound granulation. In 78 patients (test group) new tactics of treatment was applied. Terms of performance and volume of amputation were determined based on the principles of injury control. In stable condition of patients amputation within the limits of intact tissues with stump formation and suturing was performed. In avulsion of extremity at the superior third of crus the amputation by type of PST was applied for preservation of knee joint. Sawing tibia surface was covered by gastrocnemius muscle and local wound treatment was performed with hydrohelium dressings and vacuum systems. After wound preparation autodermaplasty was carried out. In severe condition of patients the amputation by type of PST was performed at any level of avulsion. After stabilization of patients state topical wound treatment or reamputation within the limits of intact tissues was performed. Use of new treatment tactics allows decreasing the rate lethality by 6% versus 11% in control group, shortening the terms for patients' preparation for injured bone osteosynthesis, decrease of hospital treatment duration and terms of preparation for prosthetics and significantly improving functional treatment results.

Quantitative assessment of weight-bearing feet reaction at walking (computer complex DiaSled-Scan, St.Petersberg) was performed in 6 patients with pelvic bone fractures treated by transosseous osteosynthesis using Ilizarov device. In stable fixation of pelvic bones by the device the forefoot was used as additional balance when walking without assistive devices. The decrease in anterior and posterior push range which is compensated by the increase in time during one cycle of gait and its' variability should be considered as a summarizing index of adaptive changes of gait. Compensatory increase up to 40% of stance phase variability on the less involved side is preserved by 1 year after surgery.

Comparison of biochemical composition and biophysical properties showed the pathogenetic expediency of blood serum use as a corrector of synovial environment in joints affected by osteoarthritis. For serum modification the patients were preliminary given a single dose of drug only. Then patient's blood was collected in the period of its maximum saturation by preparation. Serum obtained was applied in patients with knee joint osteoarthritis of 2-3 stages using three intra-articular injections. The evaluation of treatment results 5-6 months after treatment completion showed a significantly better and more stable therapeutic effect in test group as compared with patients from control group. Positive effect was stipulated by pain decrease, normalization of articular tissue trophicity, depression of local inflammation and cartilage lubrication improvement.

Experience in cement total knee arthroplasty using computer navigation is presented. There were 42 patients with severe deformities of knee, condyles as well as tibia and femur diaphyses. Five patients out of them had prior implanted hip endoprostheses on ipsilateral side in whom use of routine arthroplasty technique with guide was impossible. In such cases computer navigation allowed to achieve high-precise insertion of implant with provision of correct ligament balance and maintenance of all axes and angles. The terms of rehabilitation and functional results were similar to common cases of primary knee joint replacement using computer navigation.

Treatment results were analyzed for 55 patients with primary and metastatic tumors complicated by paralysis and severe paresis. It was shown that in cervical spine tumors early decompression stabilization operations via anterior approach provided regression of neurologic deficits and significantly improved patients' quality of life. In thoracic spine tumors decompression laminectomy with posterior metalspondylodesis was performed. In the majority of cases (15 out of 20 patients) positive result was achieved in early postoperative period. Laminectomy with posterior spondylodesis was less effective as compared with operations via anterior approach: the later gives lower probability of regression of neurologic deficits as well as lower duration of life and worse life quality.

Age terms of spine deformity primary manifestation were studied in 2006 patients with idiopathic scoliosis of various severity degrees. It was determined that first clinical signs of idiopathic scoliosis were revealed in children under 10 years, i.e. before the beginning of puberty. Analysis of data obtained enabled to detect the real share of various types of scoliosis deformity development for different terms of its first manifestation. This gives the possibility to consider the age of initial scoliosis deformity sing as a prognostic factor for the assessment of further orthopedic pathology development in concrete patients with idiopathic scoliosis.

New method for functional diagnostics of motion activity of fingers based on registration of digital movements and their biomechanical analysis is suggested. Kinematical and dynamical parameters of digital movement accounted by biomechanical model adequately reflect the patterns of motion disorders and give the objective numerical evaluation. The method includes: a) registration of digital movement in both intact and injured hands using electromagnetic system of MiniBirds type; b) calculation of individual biomechanical parameters of fingers - length of phalanges, position and alignment; c) calculation of kinematic parameters of movement - time-base of joint angles, angular velocities and accelerations, range of motion of separate joints, degree of coordination of changes in various joints angles (kinematic synergy); d) evalua-tion of dynamic parameters of motion - time-base of total muscular forces moment in joints (dynamic synergy); e) evaluation of functional state based on analysis of kinematic and dynamic parameters of motion before, during and after treatment.