Vol 22, No 1 (2015)

Analysis of literature data dedicated to the study of distraction osteosynthesis is presented. In accordance with the ideas of the mechanisms of reparative regeneration in distraction osteosynthesis, the main factors responsible for the triggering of reparative regeneration are artificially created tissue “deficit” and tension-stress effect on the vascular network that was formed during the latent period. Consecutive local effect of growth factors and other peptide regulators provides sufficient level of reparative osteogenesis within the whole distraction period. The volume and quality of newly formed bone tissue depend upon the spatial and temporal characteristics of distraction as well as on the potentialities of concrete individual.

The purpose of the work was to elaborate experimental model for transverse tenotomy with intersection of facial membranes and mesenteric vessels as well as to study the process of connective tissue reparative regeneration under created conditions. Experiment was performed on 25 chinchilla rabbits of both sexes, aged 1 month with weight 1376 ± 124.8 g. Processes of Achilles tendon reparative regeneration was studied on days 15, 21, 30, 60 and 90 after operation. Histomorphologic study showed that within 30 days after tenotomy the substitution of defect zone with friable, reach in cells and gradually maturating fibrous tissue took place. By the end of day 60 a considerable part of the defect was substituted by dense fibrous connective tissue assumed a scar pattern. On day 90 after tenotomy a reverse development of the defect zone with focal substitution of dense fibrous tissue by friable unformed connective tissue containing histiocytes, lymphoid cells and inclusions of fatty tissue foci was observed. At that term histologic structure of the specimen showed its relatively low mechanical strength. The achieved data enabled to demonstrate that performance of tenotomy with traumatization of peritendinous tissues adversely affected the dynamics and pattern of reparative processes in the tendinosus defect zone.

Porous granular composite biomaterials based on sodium alginate and calcium phosphate component: 1% sodium alginate; sodium alginate with gelatin (80/20); calcium phosphate ceramics (CHA, TCP and OCP) and composite materials alginate/CHA, alginate/TCP, alginate/OCP, alginate/gelatin (80/20)/TCP and alginate/TCP/CHA/OCP were investigated for cytotoxicity and matrix (for cells) properties in dynamics of cultivation (up to 21 days). Two adhesive cell lines - immortalized human fibroblasts (HF, strain 1608 hTERT) and human osteosarcoma (MG-63) were used for in vitro MTT assay. OCP material showed its cytotoxicity while all its composites possessed weak matrix properties. For further research on the development of prototyping technologies 3 samples of composite materials were selected: alginate/CHA, alginate/TCP and alginate/gelatin (80/20)/TCP that are characterized by cytocompatibity and the presence of either expressed or moderate matrix properties of the surface for cells.

Long term results of revision arthroplasty with hip joint reconstruction using demineralized allograft based on cranial vault flat bones are presented. Since 2005 nine patients (14 substitutions) aged from 46 to 67 years were operated on. Control of implanted material remodeling was performed in 12 months after surgery and then annually up to 8 years. No one case of implanted material suppuration was observed. Roentgenologic control showed relatively early remodeling of allografts in 1.5-2 years after intervention. Remodeling process was characterized by the increase of roentgenologic density in plasty site. Positive results were achieved 8 patients (13 substitutions) that made up 93%.

Experimental and clinical studies of osteoplastic materials of various groups were performed. IT was shown that implantation of osteoplastic materials stipulated the development of chronic productive inflammation by the type of foreign body response while the process of bone formation in the regenerate containing osteoplastic material entailed resorption of newly formed bone tissue on its surface. Analysis of the reasons of low biocompatibility of the materials was performed and scheme for osteoplastic material safety and efficacy study planning was proposed.

The study involved 47 young people aged 18 to 20 years. Among them, 11 people with previously diagnosed idiopathic scoliosis of the 1 st and 2 nd levels were the group "scoliosis", 36 persons without orthopedic and neurological disorders were the group "norm." A method of computed stabilometry was used. We obtained functional dependences that characterized the distribution of movement rate of foot pressure center on support surfaces in the frontal plane, which differed parametrically in both groups. Diagnostic feature, namely the number of movement intervals with the constant velocity of 0.02 seconds was identified, which allowed to include the subject in the scoliosis risk group. Clinical testing method was carried out in two groups of children aged 7-8 years. The first group, "scoliosis control", had 12 children with clinically confirmed diagnosis of the 1 st and 2 nd degrees idiopathic scoliosis. In the second group of "normal control" 12 children were without orthopedic and neurological disorders. The sensitivity of this method was 92%.

Results of first Russian local prospective multicenter observational study with participation of 2293 patients who received rivaroxaban for prevention of thromboembolism after major joints arthroplasty are presented. The study was performed under conditions of “real clinical practice”, i.e. without any changes in postoperative management. Demographic indices, prevalence of aggravating anamnestic factors that determined the risk of thromboembolism development, and adverse effects (AE) against the background of drug intake were studied. Interruptions of rivaroxaban intake were noted in 5% of patients. The number of AE made up 52 in 45 patients and only in 11 cases AE were associated with rivaroxaban intake. Drug efficacy and tolerance was assessed by physicians as excellent and good in 97.9% and 98.8% of patients, respectively. The overwhelming majority (98.4%) of patients appreciated the convenience of oral anticoagulant intake. It was stated that under conditions of the organizational peculiarities of medical care in Russia the efficacy of rivaroxaban was comparable to that, demonstrated in foreign studies.