Vol 17, No 4 (2010)

First experience in performance of spinal segments' stabilization using robotic assistance (SpineAssist, MAZOR Surgical Technologies, Caesarea, Israel) in Russia is presented. Between August 2009 and August 2010 twenty six surgical interventions using that technique were performed at Spinal Department of RAMS Institute of Neurosurgery named after N.N. Burdenko. Preoperative neuro-visualization included spondylography, MRI, CT with sections <1 mm that was essential for preoperative planning using computed work station SpineAssist. The robot was used for automated navigation of instruments in operative wound according to preoperatively planned path. New system of transcorporal stabilization of spinal segments Go-Lif required only two screws for fixation was compatible with fusion technique and was of special interest. Robotic assistance enabled to obtain optimum location of implants in all cases even in presence of anatomical peculiarities of the operated segments (thin vertebral arch roots, rotative deformity of vertebrae. Basing on the results of control CT examination and comparison of obtained CT data with preoperative planning data it was shown that with robotic assistance clinical accuracy of implant location was within 1 mm). No complications related to implant insertion were observed.

Data on experimental evaluation of osteoinduction of recombinant bone morphogenic protein of native production fixative on xenogenic demineralizated bone matrix or collagen-calcium-phosphate biocomposite material. Evaluation was performed using experimental model of end-to-end osteosynthesis of diaphyseal femur fragments by external fixative device in Wistar rats. Roentgenologic examination, study of autopsy material and evaluation of bone consolidation strength using biomechanical twisting test showed high osteoinduction of rhBMP-2 containing biocomposites.

Diagnostic value of contrast radiologic examination of hip joint was analyzed in 49 children aged from 1 to 12 years with high congenital hip dislocation. Informativeness of 38 standard hip joint arthrograms was studied for the choice of treatment technique and preoperative planning. It was stated that arthrography did not provide sufficient information on the changes in soft tissue and cartilaginous structures of the joint. Experience in joint pathologic changes diagnosis using contrast computed tomography (11 patients) was presented. Potentialities of that examination technique were determined. It was shown that in high dislocation of femoral head it provided real picture of interrelation of all articular structures. That enabled to take objectively substantiated decision on open or closed correction of dislocation and perform an adequate preoperative planning.

Treatment results of 59 patients with femoral bone defects and diaphyseal pseudarthroses were analyzed. To substitute bone defects of more than 6 cm permeable porous endoprostheses were used. In patients with normotrophic and hypertrophic pseudarthrosis stable osteosynthesis with interfragmental compression of bone fragments by shape-memory-effect tightening bows was performed. In patients with atrophic pseudarthrosis bone plasty with autograft was applied. In all patients the weight-bearing ability of the affected limb was restored. Total restoration of function was achieved in 75.6% of patients.

The experience in treatment of hallux valgus is presented. There were 90 patients, aged 19-77, 199 feet. Seven patients had first degree of deformity, 24 patients - second degree and 59 patients - third degree. Surgical treatment was performed in the period from 2004 to 2009. Depending on the deformity degree various types of osteotomy were applied followed by biomechanically stipulated fixation of bone fragments with small-sized rod and pin-rod external fixation devices. In all patients stable elimination of valgus deformity was achieved. Excellent long-term results were obtained in 67,5% of cases (112 feet), good results in 29,5% (45 feet) and satisfactory results in 3% (5 feet). Neither long-term failed results nor complications were observed. Advantages of surgical treatment of forefoot deformity with external fixation device are the restoration of foot anatomical shape and function in stable fixation of osteotomic fragments without limitations of active functional load on the operated foot.