Vol 8, No 2 (2001)

The paper used materials from reports of specialized research institutes and departments of traumatology, orthopedics and military and surgical medical universities. The industry program was carried out by 10 NIITO, as well as MONIKI them. M.F. Vladimirsky, St. Petersburg Research Institute of Prosthetics and 5 departments of traumatology and orthopedics of medical universities - RSMU, St. Petersburg, Samara, Ivanovo and Izhevsk. More than 740 researchers took part in scientific research. Completed 40 contracts.

It is for the first time that the clinical picture, diagnosis and outcomes of surgical treatment of bone chondroblastoma in children (85 patients, aged 8—16) are described in native literature. Pathological focus was localized in the epiphysis and metaepiphysis of long bone predominantly. Clinical manifestations were pain syndrome, restriction of movement and development of contracture in the adjacent joint. Typical radiological signs included excentrically located osteolytic locus of destruction with speckled inclusions and clear contour. The locus was separated by sclerosis line and periostal stratums were present in the distance from the locus. CT, MRT and angiographic examination enabled to determine the destructive locus at early stages of its development and to differentiate with other tumors, inflammatory diseases and dystrophic processes. In all cases diagnosis was verified morphologically. All patients underwent surgery. In the majority of cases periarticular subchondral resection with cavity electrocoagulation and alloplasty of the defect was performed. In case of articular cartilage destruction intracapsular marginal or segmental resection followed by allo- or autoplasty of the defect was carried out. Recurrences were observed in 8,2%) of cases. In 8 patients shortening or deformity of limb developed as a result of growth zone damaged caused by pathological process and surgical intervention. Those problems were eliminated by additional surgery.

Scheme of the development of pathologic motor analyser changes in locomotor system injuries which are manifested by the formation of vicious circle of disturbance of muscular motor function. In this the main initiating factor is the deficit of sensor information. The place of artificially created biological feedback is showed and its role in the restoration of muscular motor function is described.

Various unknown appropriateness to the development of gunshot wound process were determined on the base of systemic approach. The causes and mechanisms of complication development were detected as well. Several new treatment methods were elaborated, evaluated in experiment and implemented into clinical practice. Addition of antioxydants to the treatment protocol decreased genotoxic effect and the use of elaborated prognosis for the complication development enabled to decrease the rate of purulent complications up to 5.6%.

The modified device was used for the treatment of 817 patients with fractures and pseudoarthrosis, correction of bone deformities and limb lengthening in hospitals of Russia and abroad. Perfection of the construction in comparison with previous designs enabled to simplify the application of the device, shorten the operation time and to increase the efficacy of its use. Graduate dozed reduction of bone fragments in all planes as well as elimination of angular displacement is performed using special device and anterior distracter without additional unit. Sagittal and frontal compression of bone fragments is carried out both longitudinally and transversely by the device itself due to its peculiarities. Stable fixation of fragments within the device does not prevent movements in the adjacent joint and provides the possibility of early limb loading.

The experience in treatment of 139 patients with cervical (71 patients) and thoracolumbar (68 patients) spine injuries is reviewed. The treatment of cervical spine injuries was performed with halo apparatus which was more effective in injuries of upper cervical zone. In 14 patients with lower cervical spine injuries the surgery with «Orion» system was carried out. All patients with fractures or posttraumatic deformities of the thoracic and lumbar spine underwent operative treatment. Eight patients had systemic osteoporosis. Reduction-stabilization operations with decompression and different spondylodesis were also performed. Steffee system was used in 33 cases, Cotrel-Dubousset in 22, Tenor in 7, and Luque in 6 cases. Operative stabilization allowed to achieve primary rigid fixation of the mobile injured lumbar segments for early activization of patients. For the achievement of good outcome the different choice of curative tactics is required. Concomitant osteoporosis significantly influences the long term results. Long term preservation of stability depends on the proper choice and the length of a fixation device as well as on the method of spondylodesis.

Ultrasonographic examination was performed in 106 patients with clinical manifestations of wrist tendon injuries and their sequelae (in 54 patients prior to specialized treatment, in 90 - in the postoperative period and in conservative treatment). In 63 patients flexor tendons, in 36 extensor tendons, in 5 both flexors and extensors were examined. In 106 patients 139 tendons (445 ultrasonographies) were examined. Real-time «Sonoline SL-1» scanner («Siemens») with 5 and 7.5 MHz linear and sector transducers was used. The examination was performed in transverse and longitudinal planes both at rest and dynamics. In 75 patients (70.8%) scan allowed to correct the preoperative protocol, tactics of conservative treatment and postoperative management as well as to choose the adequate individual duration of immobilization. Techniques of ultrasonographic examination of the wrist soft tissues in tendon injuries is elaborated. Indications for ultrasonographic examination are determined and sonographic picture of fresh and old tendon injuries and their sequelae is described.

From 1990 to 2000 238 revision hip joint replacements were performed at Joint Replacement Department of CITO. Both cement and cementless implants as well as in case of need allografts in the form of bone chips and spongeous bone were used. Technique peculiarities of revision operations for Sivash and «Compomed» implants replacement are described. The working time for «Com- pomed» implants was detected to be up to 5 у ears, for Gerchev implants up to 7 years and for Sivash implants 10 years and more. In revision replacement the following complications occurred: lethal outcome — 2 cases, acute myocardial infarction in early postoperative period — 1 case (recovery), deep suppuration — 1 case (implant was removed), thromboembolia of small branches of a. pulmonalis — 3 cases (recovery), paresis of fibular portion of n. ischiadicus — 5 cases (complete function restoration), dysbacteriosis during antibacterial therapy — 2 cases (recovery). Results of treatment were evaluated in 140 patients in the periods from 3 months to 10 years. In 139 cases complete or almost complete restoration of operated limb function was clinically noted. In 37 out of 139 patients signs of bone resorption around the cup and stem of implant were detected roentgeno- logically.

The purpose of that investigation was to study the factors influencing the strength of femoral neck and its endurance to loads in osteoporosis. In experiment 24 samples of proximal femur obtained in autopsy from patients older than 60 years who died from different diseases without disturbance of bone metabolism were investigated. Mineral density of cortical and cancellous bones was assessed in standard zones using dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). For the imitation of soft tissues the samples were placed in water and that allowed to compare the data obtained with norm measurement used for diagnosis of osteoporosis. Strength of femoral neck and its cortical layer as well as limit of elastic deformities, deformity value of femoral neck were evaluated in gradually increasing load. High correlation was showed between neck strength and BMD (r=0.86, p<0.001). Osteoporotic qualitative state of bone and structural peculiarities of femoral neck influenced the bone strength independently of BMD value. The main role of cortical bone in providence the strength offemoral neck was confirmed in experiment.

Clinical, roentgenologic and morphologic features of giant cell reparative granuloma in wrist and foot bones are presented. Analysis of 2 cases and literature review shows that giant cell reparative granuloma is a rare benign fibrous osseous proliferative process of unknown etiology. No clinical symptoms and roentgenologic signs have specifical features and do not differ a lot from chondroma, giant cell tumor of bone, aneurysmal cyst, «brown tumor» in hyper- parathyroidism. Correct diagnosis could be made on the base of histologic study taking into account Ca, P and alkaline phosphatase content in blood. The main histologic signs of giant cell reparative granuloma are the following: presence offibroblasts, histiocytes, multinuclear osteoclast-like cells, microbloodstrokes, microcysts, osseous bridges of different maturity degree and not numerous mitoses in connective tissue stroma. Surgical treatment using currettage results in high local recurrence rate (mean 33— 39%). The most adequate treatment is surgical intervention with observance of oncologic principles: marginal resection, electrocoagulation and auto- or alloplasty of none defects; in case of severe bone lesions - segmental resection or bone extirpation.

Joint diseases are widespread throughout the world. Up to 55% of the structure of articular pathology is due to osteoarthritis (deforming arthrosis) [8]. Many foreign authors define this pathological process as osteoarthritis [9, 36]. According to most researchers, osteoarthritis (OA) is a polyetiological disease of the joints, characterized by impaired function, pain, deformity, and degenerative-destructive changes in tissue components [15]. In the United States, OA is considered one of the most common forms of joint disease [27]. In the period 1990-2020. the number of cases in the age group over 50 years is expected to double [46]. The problem of OA is of great social importance: the disease leads to disability and disability, mainly due to limited range of motion, in 20–30% of patients [33].