Vol 11, No 1 (2004)

The peculiarities of cervical spinal cord blood supply were studied on 34 autopsied specimens. It was detected that both a. anterior spinalis, gone away from intracerebral zone of a. vertebralis and a. anterior radiculo-medullaris approaching the a. anterior spinalis system with C2-8 radicis played an equally important role in blood supply of the cervical spinal cord. The most significant importance had C5 left and C7 right a. radiculo-medullaris, that were noted in 65% of specimens. For cervical spinal cord the branching type of blood supply was more characteristic (67,7% of cases). In that type the number of a. radiculo-medullaris ranged from 2 to 8 (mean 4,4). That peculiarity significantly increases the probability of restoration of blood circulation in injury or other pathology of a. anterior spinalis.

On the base of experience in treatment of 114 patients with concomitant and multiple injury (1996-2003) the indications, terms and tactics of operative intervention in complicated comminuted fractures of distal femur were determined. During resuscitation period in open fractures primary debridment and stabilization with external fixation devices was performed. In closed fractures immobilization by skeletal traction; in movement irritation - by external fixation device was used. At 10-21 day after trauma deep osteosynthesis with fixatives (angular plate - 51 fractures, condylar plate - 30 fractures, DCS - 6 fractures, DCP - 18 fractures) was carried out. In presence of other fractures of ipsilateral and contralateral limb the modem fixatives (DFN - 4 cases, UFN - 3 cases) were used. Application of low invasive technique allowed to perform the osteosynthesis of all fractures simultaneously. Long term results were evaluated in 53 patients (59 distal femurfractures) atfollow up 1-6 years. Excellent results were achieved in 30 (50,8%), good - in 14 (23,7%), satisfactory - in 7(11,9%) and unsatisfactory - in 8 (13,6%) cases.

Comparative analysis of the efficacy of transosseous compression osteosynthesis (110 patients --test group) and deep osteosynthesis with routine fixatives, i.e. screws, pins, plates, fighting bolts, etc. (206patients - control group) was performed. Technique of dynamic compression osteosynthesis (test group) provided firmness of fragment fixation in minimum operative trauma and preserved the movement in joint. In test group positive results were achieved in 94,3% of patients; in control group positive results were noted in 72,1% of cases.

At the Scientific Research Institute of Emergency Care named after N.V. Sklifosovskiy the modern cruciate ligament implants (France) have been successfully used since 1994. Physical mechanical and deformed characteristics of ligaments of human knee joint and synthetic prostheses of ligaments were tested by machine «Zwick-1464». New original endoprostheses of knee joint ligaments as well as instruments for optimization of the points of entrance and exit within condyles were elaborated. The methods for elimination of different types of knee joint instability in cruciate ligament injury using authors' endoprostheses were worked out. Authors proved that it could improve the functional results of treatment.

Twenty eight volunteers and 46patients (18 with old complete anatomic rupture of n. medianus (CARN), 14 with intratrancal neuroma after failed priamary suture, 14 with partial anatomic nerve lesion (PANL)) were examined using laser doppler flowmetry (LDF) of fingers skin in red (R) and infrared (IR) diaposons and wavelet-analysis of oscillations of microvascular blood flow. Formulae for calculation of indicis of local volumetric total (VTBF), nutritious (NVBF), shunting (VSBF) microvascular cutaneous blood flow, resistence to blood inflow anf outflow, microvascular pressure were suggested. Reliable positive correlation of temperature with NVBF and VTBF in red diapason was shown. The advantages of volumetric LDF parameters in old CARN were demonstrated. In old CARH and In intratrancal neuroma the decrease of VTBF with deficit of NVBF was noted. Correlation between VTBF in red and infrared diaposons enabled to assess the distribution of cutaneous blood flow in vertical plane. This methods allows to detect the causes of nutritious blood flow disturbance and to choose the correction tecnique. The advantages of LDF-indicis are its uninvasiveness, innocuity, possibilities to perform dynamic control and obtain information.

Spongiosotomy with implantation of the marginal portion of the m. tibialis anterior into the zone of trepanation foramen was suggested for the treatment of deforming arthrosis with hypertensive endosteal syndrome. To study revascularising and decompressive effect of the surgery experimental study in 28 dogs was performed. There three groups of animals, 8 dogs in each group: two first groups were control, third group - test one. Deforming gonarthrosis was reproduced in all animals. Animals from group II were subjected to subchondral spongiosotomy, dogs from group III - spongiosotomy with muscle implantation. The study of the intraosseous pressure dynamica and morphologic examination of microsamples confirmed the efficacy of the suggested method and allowed to recommend its use in clinical practice.

The experience in treatment of 369 patients with stumps, shortenings and defects of finger phalanges and metacarpal bones is presented. Distraction method alone and distraction with combination of bone autoplasty were used. Thirty patients (8,1%) with amputated stumps, 77 patients (20,9%) with ununited and 93 patients (25,2%) with malunited fractures were treated using distraction only. In 42 patients (11,4%) with amputation stumps, 29 patients (7,9%) with pseudoarthroses, 31 patients (8,4%) with ununited, 28 patients (7,6%) with malunited fractures and in 39 patients (10,6%) with the defects of articular ends and metacarpal bones the distraction in combination with bone autoplasty was performed. Long term results were evaluated in 281 patients (76,1%). Good results were achieved in 163 patients (58%), satisfactory - in 111 (39,5%) and unsatisfactory - in 7 patients (2,5%).

Ten patients with electrical injury (over 3000 V) of the forearm and hand were operated on during the period of 11.6±3.1 months after accident. Soft tissue plasty with free microsurgical flap and simultaneous tendon and nerve plasty with nonvascularized autograft was performed in eight patients. In two patients with extensive soft tissue defects microsurgical flap included musculus latissimus dorsi that was reinnervated using the anastomoses with anterior interosseous nerve. For the restoration of sensation along the palmar surface of the hand, transposition of ulnar nerve segment on a vascular pedicle from the arm to the forearm was performed. Although no severe postoperative complications developed all patients required tendolysis and transposition of tendons for the restoration of tendon function. Those additional interventions provided the restoration of the wrist grip and social rehabilitation of all patients.

During the period from 1972 to 2002 six hundred ninety three patients with primary and metastatic tumors have been operated on at Moscow oncologic hospital # 62. Preserving operations have been performed in 86% of patients with 11% recurrence rate. After amputation and exarticulation tumor relapses were recorded in 18% of patients. At strict observance of the ablation principles the recurrence rate did not exceed 2%. It has been shown that the use of modern plastic and reconstructive surgical techniques, including the microsurgical ones, significantly increases the potentialities of the performance of adequate (radical and ablastic) preserving operations in patients with loco-motor system tumors and thus improves the quality of life in this group of patients.