Vol 21, No 4 (2014)

Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.

Basing on the anatomic examination results the main principles of safe bone tunnels formation at arthroscopic plasty of posterior cruciate ligament (PCL) were formulated. Additional instrumentation of original design and original surgical technique directed to minimization of the risk of popliteal artery injury at tibial bone tunnel formation were proposed. During the period from 2010 through 2013 twenty one patients with PCL injuries were operated on at endoscopic surgery department. In 20 n patients treatment results were assessed in 6 and 12 months after intervention. Evaluation was performed by clinical results, IKDC forms, Lysholm - Gillquist score and visual pain scale. Preoperatively mean point by IKDC questionnaires was 46.80±18.07, by Lysholm - Gillquist score - 51.62±20.34 and in 6 months postoperatively - 68.64±10.13 and 73.84±11.16, respectively, that was statistically significant higher than prior to operation (p<0.05). One year after intervention positive dynamics was present (p<0.01): mean point by IKDC made up 77.23±8.03, by Lysholm - Gillquist - 81.08±8.64. Evaluation result by IKDC form was recognized in 11 (55%) patients as good (group A), in 6 (30%) - as close to good (group B), in 2 (10%) - as satisfactory (group C) and in 1 patient - as poor (group D). The use of perfected technique enabled to decrease the duration of surgical intervention by 27 minutes at average but the long-term treatment results were as good as after standard surgical intervention.

Seventy two patients, aged 39 - 84 years, with degenerative lumbar scoliosis were operated on. In 30 patients (1 st group) nitinol rods 5.5 mm in diameter and standard transpedicular screws were used. In 20 patients fixation at L1 - S1 and in 10 patients at L1 - L5 level was performed. In presence of spinal canal stenosis additional decompression was performed. Spinal fusion was not performed. Forty two patients (2 nd group) were treated by standard methods using titanium rods in combination with lumbosacral spinal fusion. Out of them in 20 patients fixation at L1 - S1 and in 22 patients at L1 - L5 level was performed. Results were followed up in 1.5 years after intervention at minimum. Correction of the deformity in two groups was almost equal and averaged 25° (from 10° to 38°). No one case of implant instability, bone tissue resorption around the screws and adjacent level involvement was recorded. Functional X-rays showed 21° of lumbar spine mobility (from 15° to30°) at average. In 2 nd group mobility in fixed segment was absent; pseudarthrosis was diagnosed in 3 and proximal kyphosis - in 1 patient. Revision intervention was required in 2 cases.

One hundred seventeen patients with hemihypoplasia and discrepancy of lower limbs length of 1 - 3 cm were examined during the period from 2008 through 2013. Series of functional tests to evaluate conditional and coordination skills as well as stabilometry in European and American variants were performed. All patients demonstrated frontal postural disorders, marked weakness of the abdominal muscles and muscles of the back that resulted caused postural imbalance that resulted in formation of myofascial trigger points and development specific pain syndrome. Stabilometry and coordination tests results showed the predominance of proprioceptive body balance control over the visual one.

Rendering of high-tech medical care (HTMC) is one of the priority directions of the Ministry of Health of the Russian Federation. Search of new organizational approaches, elaboration and perfection of medical technologies, introduction of new materials continue. The purpose of the study was to evaluate the expediency of biodegradable constructions use at rendering HTMC to traumatologic and orthopaedic patients. Treatment results for 56 patients with various feet pathology (calcaneus fractures, feet joints deforming arthrosis, Hallus valgus) were analyzed retrospectively. In control group ( n =28) metal constructions and in the main group (n=28) biodegradable constructions were used for bone fragments fixation. In two groups surgical treatment results were comparable, however treatment of patients from the main group was accompanied by significant social and economic effect due to more effective work of the bed as no construction removal was performed and no expenditures for patient’s stay at the hospital and intensive care unit were required. All that contributed to the improvement of patients’ life quality.

Arthroscopic treatment results for 6 elderly patients (mean age 64 years) with massive (over 5 cm) nonreconstructable rotator cuff tear are presented. In all cases fatty degeneration of the rotator cuff tendon above 3 rd degree by Goutallier classification was present. In all patients elbow arthroscopy with implantation of InSpace Balloon into subacromial space was performed. Mean score by UCLA scale made up 14 (12-15) preoperatively and over 30 in 6 months after intervention that corresponded to a good and excellent result. Preliminary results indicate that applied technique is a simple, mini-invasive and effective intervention enabling to reduce pain and increase range of movements in this group of patients.

Bone tissue deficit can be filled by various methods but all such methods increase the complicacy of surgical intervention and its volume that raises the risk of complications development. Experience in treatment of 77 years old patient with pains after revision hip arthroplasty is presented. Examination revealed wrong position of the stable acetabular component. Intraoperatively a decision was made to implant cemented cup without removing previously implanted one. That surgical technique enabled to eliminate pain syndrome, restore joint rotation center and biomechanics, to decrease intraoperative trauma, avoid use of allograft and conduct patient’s rehabilitation at terms common to primary joint replacement

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.