Vol 27, No 3 (2020)

Objective. To study the effectiveness of using implants with a bioactive calcium-phosphate coating on the example of treating a patient with combined fractures of the acetabulum and the neck of the femur.

Materials and methods. A 52-year-old patient, injured as a result of a traffic accident with multicomponent damage to the right hip joint (transcervical fracture of the femoral neck and a high two-column fracture of the acetabulum). Osteosynthesis of the femoral neck fracture is made by three cannulated screws with a calcium-phosphate coating (patent of the RU No. 81427). For the osteosynthesis of the acetabular fracture, a reconstructive plate with a calcium-phosphate coating was used (patent of the RU No. 113945).

Results. Despite the heavy, multi-component destruction of the hip joint, consolidation of the fractures ensued. The remote result is tracked for 10 years. On the score scale of the functional results Harris 89 points, the result is rated as good.

The conclusion. The use of imantates with bioactive calcium-phosphate coatings from hydroxyapatite promotes activation of reparative processes in the region of fractures.

Relevance. Koenig’s disease, or osteochondritis dissecans of the knee joint, has been known since the end of the 16th century. The incidence is high (18-30 cases per 100 thousand of the population), while there is no common opinion on the management tactics and the treatment method for this pathology. Incorrect treatment choice as well as the lack of active management tactics provokes inevitably the transformation of primary pathology in early deforming arthrosis, followed by a pronounced decrease in joint function and the working capacity of an adult patient.

Material and methods: electronic scientific library PubMed, SciVerse (Science Direct), and Scopus were the open Internet tools we searched for literature sources. For data search we used following keywords: dissecting osteochondritis, Koenig’s disease, osteochondritis dissecans. The article presents the main results in the publications of domestic and foreign experts with an emphasis on the diagnosis and treatment of dissecting osteochondritis. In some cases, their own comments about the diagnosis and treatment are made.

Conclusion. In our opinion, the surgical objectives are to restore the congruency of the articular surfaces by improving vascularization of the affected area, tight fixation of the unstable fragment and protecting the supporting part of the loaded condyle section in the postoperative period. Due to the rarity of such a pathology and the lack of research with a high level of evidence base, further development of treatment methods is actual.

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine.

Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later.

Results. Postoperative hospitalization in group I — 32.5 ± 7.4 days, 27.1 ± 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 ± 55.6 minutes, in group II 526.0 ± 116.2 minutes (p = 0.001124); blood loss 1862.5 ± 454.3 ml versus 1096.0 ± 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p < 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II — in 13 (43.3%) patients (p = 0.001).

Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

Introduction. To date, there is no single approach to the surgical treatment of hallux rigidus. In turn, it is known that in the presence of bone-cartilaginous defects in knee, hip and ankle joints, the autologous matrix-induced chondrogenesis is quite successfully used. In this regard, we have proposed to use this technique in patients with hallux rigidus.

The aim of the study was to evaluate the clinical efficacy of the 1^st MTP joint chondroplasty using the induced chondrogenesis technique in patients with HR, to analyze the immediate and medium-term results of the operations in terms of pain and function.

Materials and methods. The 1^st MTP joint chondroplasty has been performed in 21 patients with hallux rigidus. Before the surgery the range of motion (ROM) in 1^st MTP joint was measured; the foot condition was evaluated using such scales as VAS of pain, AOFAS, VAS FA. The 1^st MTP joint chondroplasty was performed using the technique of the induced chondrogenesis with collagen matrix. The results of surgical treatment were evaluated within 3, 6 and 12 months after surgery.

Results: 3 months after the operation, a significant decrease in pain, an increase in ROM in 1^st MTP joint and an improvement in the foot function were observed. Subsequently, a moderate positive dynamic was observed.

Conclusion: the results of the operations showed that the 1^st MTP joint chondroplasty can be an effective method of surgical treatment, which allows to relieve pain and significantly improve the quality of life of patients with hallux rigidus, both young and elderly. Also, this technique can be used in the treatment of patients with rheumatic diseases of the low activity or remission.

Aim of the study. The development of the method of octacalcium phosphate (OCP) and mineral-polymer composite material functionalization with biological agents (human platelet lysate (PL) growth factors and antibiotic vancomycin) by the biomimetic coprecipitation principle technique.

Materials and methods. The OCP and the mineral-polymer composite matrices (sodium alginate / gelatin / OCP) functionalization was obtained by biomimetic coprecipitation of calcium phosphates and the bioactive molecules on their surface. The materials structure was examined by electron microscopy. The functionalization efficiency was determined by measurement of the incorporated compounds in solution, as well as by analysis of their release over the 8 days. The antimicrobial activity of vancomycin functionalized samples was evaluated by in vitro disk diffusion method against the Staphylococcus aureus strain.

Results. The evaluation of incorporated molecules release showed that the OCP functionalization with vancomycin is more effective than PL. The antibiotic release had continued for three days, while PL growth factors — only for 30 minutes. The incorporated into a composite matrix vancomycin was completely released within 24 h. In vitro study of the functionalized composite samples showed growth delay of the Staphylococcus aureus strain in dependence on antibiotic content.

Conclusion. The developed method of drug incorporation during biomimetic precipitation allowed to create target delivery system which transfer antibiotic to the bone defect.