Vol 24, No 4 (2017)

Injuries and musculoskeletal disorders are the most widely spread diseases. It is shown that the majority of injured patients and patients with orthopedic pathology require an outpatient care. The state of specialized outpatient care is analyzed and the ways of its perfection are proposed.

Purpose: to evaluate the condition of adjacent intervertebral discs (IVD) after single level rigid lumbosacral stabilization and total arthroplasty by calculating IVD height index and apparent diffusion coefficient (ADC). Patients and methods. The study included 117 patients (64 women and 53 men) after rigid lumbosacral stabilization or total arthroplasty of the degenerative IVD at L5-S1 level. Values of ADC and height of the adjacent IVD were assessed prior to surgery, at discharge and in 6, 12, 24 and 36 months after surgical intervention. Results. The value of the height of the adjacent IVD in patients after rigid stabilization in the early postoperative period averaged 0.58±0.046, in 6 months - 0.58±0.044 and 0.52±0.037 in 36 months after surgery. In patients after total arthroplasty it made up 0.59±0.041, 0.60±0.038 and 0.56±0.02, respectively. Comparison of the adjacent IVD height indices showed significant difference starting from the 12th observation months (p<0.05). In group of patients after rigid stabilization the value of ADC made up 1547.7±231.4 mm2/s in the early postoperative period, 1314.5±117.9 mm2/s in 6 months and 1189.3±117.9 mm2/s in 36 months after surgery. In patients after total arthroplasty it was 1539.7±228.9 mm2/s, 1477.3±245.1 mm2/s and 1334.5±217.6 mm2/s, respectively. Statistically significant difference in ADC values between 2 groups of patients was noted in 6 months after surgery and later (p<0.05). Conclusion. Diffusion weighted MRI with ADC calculation is a modern noninvasive diagnostic method for early stages of adjacent IVD degeneration. In contrast to rigid lumbosacral stabilization, total IVD arthro- plasty enables to delay slightly the degeneration of segments adjacent to the operated level.

Purposes are to determine 1) what frequency and what degree is of custom acetabular implants malposition in comparison with planned position, 2) what the reason of malposition is and 3) what the malposition consequences we can wait for. Patients and methods. The observation group included 20 patients (18 women and 2 men) with severe acetabular defects. Mean age of patients made up 53 (22-72) years. Position of the implants was compared with the parameters of preoperative planning using 5 postoperative CT indices (inclination, anteversion of semi- spherical part of the implant, spatial location of the rotation center in three axes). More than 10° deviation for inclination or anteversion and 5° dislocation of the rotation center in any axis was considered as a malposition of the component. Results. Only 5 of 20 constructions matched conditionally permissible limits by all the parameters. Most often excessive dislocation of the rotation center in lateral direction (10 cases) and excessive anteversion (9 cases) were observed. During 6 weeks follow up no complications related to the acetabular component position were recorded. Conclusion. It was shown that at revision arthroplasty with custom-made implants the probability of implant malposition as compared to the preoperative plan. The main reason could be the complexity of intraoperative orientation under conditions of abnormal hip anatomy. Malposition of the implants beyond the stated values did not result in complications within the early postoperative period. The longer follow up is required for the assessment of the long-term results.

Evaluation of the bone regenerate maturation in 21 patients, aged 27 - 66 years, with closed shoulder fractures was performed in the course of treatment by Ilizarov technique according to the rate of blood supply velocity at functional load and by the value of that load. Examination was performed in 1 and 2 weeks as well as in 1 and 2 months after fixation. Within the first 2 weeks the bone fragments micro mobility at 10 kgF axial load on the extremity made up 194±42 µm. Subsequently as the regenerate became compact the bone fragments micro mobility decreased up to 53±13 µm (p≤0.02). During the fixation period the load tolerance increased from 5 to 15 kgF. The threshold of load tolerance was detected by the occurrence of unpleasant feel- ings the regenerate zone and increased rate of blood circulation in the vessels. At the end of fixation period the rate of blood circulation was decreased by 2 times and practically did not change at increasing loads confirming the formation of the protection system for circulatory bed in the bone regenerate.

Typical errors in rendering specialized care to patients with chronic periprosthetic infection after total hip arthroplasty are demonstrated on the example of one patient. The role of patient examination with due regard for the complication risk factors, insufficient alertness in respect to postoperative infectious complications, absence of continuity at the steps of surgical treatment, complexity of eradication of infectious agent and need of multidisciplinary approach for rendering care to this group of patients is specially emphasized.

The review gives the characteristics of the general status of the problem of infection in the zone of surgical intervention including the field of traumatology and orthopaedics. The shortcomings of antibiotic use and methods of their local delivery for surgical and orthopaedic needs are considered. The conception of local use of antibacterial agents and the requirements for the current “ideal” antibacterial agent are given. Classification of the local antibiotic delivery systems on the basis of their physicochemical properties is presented as well as the number of prospective methods for the prevention of microorganisms’ adhesion on the surface of the implanted devices and systems that could be used in traumatology and orthopaedics are examined.

Since the 50th of the last century a great number of different systems for the evaluation of both short- and long term outcomes of total hip arthroplasty have been developed. The present paper covers different views and current trends towards the evaluation of arthroplasty outcomes.