Vol 10, No 2 (2003)

Biomechanic conception of implant choice for primary total hip replacement in osteoporotic femur neck fractures is presented. Criterion for the choice is a localization of load-bearing surface of dense structure in acetabulum roof zone, i.e. sursile. Absolute indications to total hip replacement, use of bipolar and unipolar hemiprostheses are determined depending on the direction and deviation degree of sursile from horizontal axis of pelvis. Based on suggested conception the retrospective analysis of joint replacement results in 58 patients has been performed. The causes of protrusion and loosing of implants were studied.

Experience in knee arthroscopy in children with acute knee trauma and sequelae of knee injuries is presented. There were 417 patients, aged 4—18, who were under treatment at the clinic in the period from 1994 to 2002. One hundred forty four patients (34.5%) had injury of articular cartilage. In 12 cases diagnostic and in 132 cases diagnostic and curative arthroscopy was performed. Evident advantages of arthroscopy in diagnosis of intraarticular knee structures injuries, especially cartilagenous tissue were emphasized. Protocol of diagnostic examination including clinical, roentgenologic, ultrasonographic methods as well as CT and MRT (as indicated) is suggested. Indications to knee arthroscopy in children and adolescents are determined. Clinical-arthroscopic classification of knee articular cartilage injuries is given. Due to exact diagnosis and adequate curative tactics total restoration of knee function was achieved in 75% of patients with articular cartilage injuries.

The aim of the study was to assess the rate of proximal femur fractures in citizens, aged 50 years and over, from two towns of Samara region (Zhigulevsk and Novokujbyshevsk). In Novokujbyshevsk mean rate of proximal femur fractures for males and females was equal to 67.9 and for 72.7 per 100 000, respectively. In Zhigulevsk the same index for males and females was 93.4 and 104.5 per 100 000, respectively. The difference between rate of proximal femur fractures in female relative to male was insignificant. Increase of incidence of proximal femur fractures was detected in women over 65 years and in men over 70 years.

The system of evaluation of treatment outcomes of finger flexor tendons are presented. The system is based on the restoration of total range of active movement only in intrafalangeous joints taking into account the contractures in functionally disadvantageous position. Using this system it is possible to evaluate the treatment outcomes in case of simultaneous injury of superficial and deep flexor tendons, isolated injury of deep flexor tendons of II— V fingers as well as long flexor tendon of the thumb.

The remodeling of irradiated bone re-implant placed into simultaneously irradiated bed was studied by scintigraphy method using 99Tc-labeled drug (TcLD) (perfoteh). The data obtained were compared with data of radiologic control. The study included 11 patients with osteogenic sarcoma who were operated on after chemo-radiotherapy course. The peculiarities of operation were as follows. Resected bone with tumor was irradiated by single 60 G dose, after that the bone was re-implanted. It was revealed that 1 month postoperatively TcLD retention in contact zone of bone fragments was 2—2.5 times higher as compared with the symmetric zone of healthy bone. Remodeling peak was observed 1.5—2 months after operation. Over that interval TcLD retention decreased gradually and by 18 months the contact zone was not detected on scintigrams. According to the data of radiologic control the peak of remodeling took place at 6—8 months after operation. The study showed that irradiated re-implant preserved mechanical stiffness and worked as a biologic prosthesis while substituting the newly formed bone. Scintigraphy is an additional method the earlier assessment of reparative processes in extracorporal irradiated reimplant as compared to the assessment of radiologic control.

The new direction in study of spine osteochondropathy pathogenesis was worked out from the point of systemic approach. The disease is considered as continuous dysplastic-dystrophic process. The base of this process is a structural anomaly of the end-plates of vertebral body that changes morphogenesis of the vertebral segment. Subsequent clinical course is determined by anatomic-biomechanic characteristics of the affected zone, peculiarities of spine configuration in the saggital plane as well as by the variants of disorders in vertebral body shape formation.

In 52 patients with lumbar intravertebral disk hernia the examination of muscle lower extremity force was performed. Maximum force moment of crus flexor and extensor as well as plantar and dorsal foot flexors was registered using dynamometry. It was shown that patients with lumbar intravertebral disk hernia had a decrease of maximum force moment not only in the indicator group but other muscles on both affected and contralateral extremity as well. It was detected that maximum level of contractive ability of indicator muscles was expressively influenced by the severity of pain syndrome and microcirculation of compressed spinal radices.

The experience in treatment and rehabilitation of 100 patients with suppuration following total hip replacement and 60 patients with chronic osteomyelitis of proximal femur and acetabulum is presented. Patients’ age ranged from 10 to 84 years. Removal of unstable metallic constructions (implant or fixator) and radical resection fistulosequestrnecrectomia by Girdlestone were performed in all patients. In postoperative period the complex program for the elimination of purulent process and rehabilitation measures were carried out. That program foresaw active and expedient control for compensation of the affected joint function. In all patients purulent inflammatory process was eliminated, weight-bearing hip joint neoarthosis with satisfactory function was formed. According to authors’ opinion the formation of weight-bearing neoarthrosis is an adequate alternative to both revision joint replacement and arthrodesis in purulent process in proximal femur and acetabulum.

Aneurysmal bone cyst refers to tumor-like lesions with an etiology not fully elucidated [10, 13, 14]. Until recently, bone cysts in children were classified as tumor processes [4]. A.P. Berezhny [1], based on a clinical and radiological study and analysis of a large number of observations, came to the conclusion that primary cysts in children, including aneurysmal ones, are a dystrophic process, usually affecting one bone without damaging the growth zone and adjacent bones. The same opinion is shared by some foreign authors [6]. However, at present, the point of view is more widespread, according to which an aneurysmal bone cyst is a reactive process that develops in response to bone damage [3, 5, 9, 10, 14].

Among the readers of the magazine, there is hardly anyone who would not be familiar with the name of Zoya Sergeevna Mironova - the most famous specialist in the field of sports traumatology, a person who enjoys unquestioned authority both among colleagues and patients - athletes, ballet dancers and circus. She, like no one else, understands, "feels" her patients, knows how to find a common language with each of them. Probably, Zoya Sergeevna's sports past is of no small importance here - she is an honored master of sports, a two-time champion of the USSR in speed skating. But the main thing is her highest professionalism. Zoya Sergeevna has a great merit in the formation and development of domestic sports traumatology, in the creation of her favorite brainchild - the unique department of sports and ballet trauma CITO. Honored Worker of Science of Russia, Professor Z.S. Mironova was awarded the Order of Lenin, two Orders of the Badge of Honor, the medal "For Valiant Labor", and two Olympic Orders. In the days of the anniversary, the list of her awards was replenished with the Order of Merit for the Fatherland, IV degree, and the Church Order of St. Sergius of Radonezh. The editors turned to Zoya Sergeevna with a request to tell readers about her life. She got a story not so much about herself, but about those who worked next to her. As for the title of the article (you must agree, not every woman, and not every man would dare to put such a “round” date in the title of the publication), here one can only quote A.S. Griboyedova: "... everyone lies calendars!" - Zoya Sergeevna's energy, optimism, efficiency would be envied by many young people.

In recent years, the activity of conducting clinical and fundamental research has noticeably decreased, including in the field of autonomic regulation and microcirculation disorders of the tissues of the musculoskeletal system. Therefore, the publication of a monograph, which for the first time summarizes modern aspects of the clinical physiology of perivascular innervation and neurovascular interconnections of the extremities, should be welcomed in every possible way.

On November 20, 2002 Professor I.I. Con. He died in Italy, in the city of his youth, Bologna. But his homeland was and always has been Russia. Here he spent his entire working life. Here remains the work of his life.