Vol 16, No 4 (2009)

The purpose of the work was to create the model of posttraumatic changes in the knee joint for the study of changes in the injured joint and elaboration of surgical and conservative methods acting on such changes. Experiments were conducted in three equal groups of animals (4 sheep in each group). Round injuries with 5 mm diameter and various depths were inflicted to the bearing surface of the medial femoral condyle. The animals were sacrificed in 1, 3 and 6 months after operation using narcosis overdosage. The obtained data were analyzed by anatomic- morphologic and histochemical methods. Formed posttraumatic structures in the articular cartilage and subchondral bone are constant and may be considered as signs of deforming arthrosis. According to the depth of injury and morphologic changes in the involved cartilaginous and bone articular tissues three degrees of osteoarthrosis are marked out. In every degree the injured joint may be used as a model for the choice of adequate therapy.

Using standard photodensitometry bone remodeling was studied in proximal tibia and distal femur after total knee arthroplasty at terms up to 12 months. Out of 120 patients 60 patients (main group) received strontium ranelate (Bivalos) for 12 months after operation and in 60 patients (control group) drug correction was not performed. By the results of standard photodensitometry in both patient groups the density of radiographic image around the implant decreased by 22% at an average within the first 2 postoperative months and that was indicative of osteolysis activity. Later on during the period from 2 to 6 months after arthroplasty the increase of optic bone density was observed. By the end of 12 month in patients from the main group the optic bone density around the implant increased by 39.6% (to preoperative level) and by 25% in controls as compared with the level recorded in 2 months after surgery. Analysis of the total knee replacement by Lischolm scale showed that drug optimization of the processes of bone tissue remodeling enabled to shorten the terms of patients' rehabilitation and to decrease the rate of unsatisfactory results.

Peculiarities of transosseous osteosynthesis with pin-rod external fixation devices at treatment of various intraarticular fractures in the area of the knee joint are presented. Analysis of treatment outcomes for 108 patients with 110 fractures (18 fractures of femoral condyles and 92 fractures of tibial condyles) was performed. Excellent and good results were achieved in 83 (75.4%) cases. In polysegmental and impression-compression fractures of femoral and tibial condyles the treatment results were most often only satisfactory or unsatisfactory that was accounted for the severity of injury with massive destruction of the articular surfaces.

Methods and outcomes of treatment of calcaneous deformities and defects (102 patients, 112 feet) of different etiology are presented. Treatment technique was extrafocal compression-distraction osteosynthesis by Ilizarov. Condition of the foot was monitored using radioisotopic, biomechanical and radiologic examinations. Anatomic and functional results of treatment depended upon the severity of the initial pathologic changes in bone and soft tissues, presence of concomitant osteomyelitis in the remission phase as well as on gait stereotype and biomechanical relation of the overlying segments. Preference of transosseous osteosynthesis by Ilizarov for the treatment of calcaneous defects and deformities accounted for the possibility of dosed correction and functional loads as well as by the favorable effect on bone tissue blood supply.

Influence of exogenous nitric monoxide (NO) on the process of reparative regeneration of gunshot wounds was evaluated during experimental morphologic study. Object of the study were 120 white rats. Use of NO-therapy for the treatment of experimental gunshot wounds normalized microcirculation, activated macrophages, increased proliferation and synthetic activity of fibroblasts, decreased dystrophic and necrotic changes in the wound tissues envirement. It also decreased secondary necrosis and, hence, promoted synthesis, maturation and remodeling of granulation tissue. The data obtained showed that NO-therapy could be recommended for clinical application to treat gunshot wounds in inflammatory and proliferative stages.

Experience in treatment of 108 patients with hand deformities resulted from burns is presented. Reconstructive operations with vascularized tissue flaps grafting have been performed in all cases. Full healing of the grafted flaps was achieved in 97.2% of patients.

Experience in observation and treatment of 12 patients aged 5-18 years with spontaneous bone resorption is presented. Clinical and roentgenologic picture, results of modern examination methods (computed tomography, angiography) and histologic examination are considered. Indications to the treatment of patients with spontaneous bone resorption are determined. Surgical treatment should be performed in the phase of process stabilization while surgical intervention in the active phase of the disease results in the process progression.

Etiologic structure of infectious complications in traumatologic and orthopaedic patients has been studied at CITO named after N.N. Priorov during the period from 2005 to 2007. Using modern agents and techniques 6799 samples from 3023 patients were studied. Resistance of pathogenic microorganisms to the wide spectrum of antibiotics including the drugs of last gene-ration was studied. Basing on the study results the protocols for the application of modern antibiotics including protected aminopeptides, cephalosporins of third-forth generation including the protected ones, glycopeptides, oxazolidinones, aminoglycosides, fluoroquinolones, carbape-nemones have been elaborated and introduced into clinical practice.