Vol 14, No 3 (2015)

Within the period of 2003-2014, we performed 195 arthroscopic surgery of knee joint in the 9th Department of Central Institute of Traumatology and Orthopeadics with ACL injuries within the age group of 5-18 years. The treatment after rupture of the anterior cruciate ligament (ACL) may be operative or conservative. In both cases, the goal is to reach the best functional level for the patient without risking new injuries or degenerative changes in the knee. Return to high level of athletic activity has been an indicator of treatment success. Rehabilitation is an important part of the treatment. Knowledge of healing processes and biomechanics in the knee joint after injury and reconstruction, together with physiological aspects on training effects is important for the construction of rehabilitation programmes. Current rehabilitation programmes use immediate training of range of motion. Weight bearing is encouraged within the first week after an ACL reconstruction. Commonly, the patients are allowed to return to light sporting activities such as running at 2-3 months after surgery and to contact sports, including cutting and jumping, after 6 months. In this article, some criteria that should be fulfilled in order to allow the patient to return to sports are presented. Surgery together with completed rehabilitation and sport-specific exercises should result in functional stability of the knee joint. In addition, adequate muscle strength and performance should be used as a critical criterion. Other factors, such as associated injuries and social and psychological hindrances may also influence the return to sports and must be taken into consideration, both during the rehabilitation and at the evaluation of the treatment.

Vertebral fractures in osteoporosis causes chronic pain and lead to a reduction in the quality of life of patients. The purpose of this study was to evaluate the effect of dynamic electric (DENS) the intensity of back pain and quality of life of patients with osteoporotic vertebral fractures. This study was a double-blind, randomized, placebo-controlled trials. The study included 60 women older than 50 years with chronic pain in the back and osteoporotic fractures of the vertebrae confirmed by X-ray. Patients of the main group a course of low-frequency DENS on the area of pain in the thoracic or lumbar spine. For the control group was created imitation of DENS-influence DiaDENS PC placebo. Efficacy was assessed using the Quality of Life Questionnaire QUALEFFO-41 visual analog scale (VAS) of pain and patient diary, reflecting the taking pain medications. After the DENS course patients of the main group showed a statistically significant reduction in pain VAS., improve the quality of life in the domains of "pain", "daily activity", "mobility", "state of mind" and for total score, as well as reducing the need for additional analgesia. Thus, DENS reduces pain and improves the quality of life of patients with OP fractures of the vertebrae and can be included in a comprehensive treatment program for these patients.

The main objective of treatment of patients with osteoarthritis consists in restriction of progressing of a disease, and rehabilitation in which all patients practically after each next aggravation of pathological process need reduction of a pain syndrome, of restoration lost, during an aggravation, functional ability of joints and, eventually, improvement of quality of life of patients with constantly progressing degenerate process in the musculoskeletal device, a t.a criteria of an assessment of efficiency are based on estimates of dynamics of pain, functional activity and the general condition of the patient. It is necessary to consider that patients with osteoarthritis generally people of advanced age who have an accompanying pathology also demanding carrying out therapy that increases danger of a polipragmaziya and interaction of medicines. Therefore one of the important directions is scientific justification for wide use of not medicinal technologies of physical therapy, remedial gymnastics and massage, for knocking over of an aggravation of secondary aseptic inflammatory process at osteoarthritis and the subsequent rehabilitation for restoration of the lost locomotors stereotype and quality of life of patients. One of effective methods of physical therapy used in treatment and rehabilitation of patients with osteoarthritis is hyperbaric gas cryotherapy. This method is based on assignment of heat from an organism, in response to what, compensation and/or reflex, processes of heat production in fabrics as a result of stimulation of metabolic processes, vascular, neuroendocrine and immune systems of regulation of a homeostasis are activated, leading to therapeutic effect in the form of knocking over of a secondary aseptic inflammation and progressing of degenerate process at osteoarthritis. In this regard, the purpose of the real research consisted in scientific justification of hyperbaric gas cryotherapy in complex recovery treatment of patients with gonosteoarthritis and a coxosteoarthritis. Results of complex recovery treatment (110 patients (22 men and 88 women) with gonarthritis and a coxarthritis of the II-III stage (on classification of Kellgren) aged from 40 till 75 years which were divided by method of randomization into two groups (on 55 patients) -the main and control (group of comparison) are presented. In the main group, unlike control, along with hardware physical therapy, a balneoterapiya, gymnastics and massage, hyperbaric gas cryotherapy with an assessment of results on the basis of the international indexes Lequesne, WOMAC., Likert was used. It allowed to define predictors of use of hyperbaric gas cryotherapy and to raise, in comparison with control, for 33% efficiency of recovery treatment of patients with osteoarthritis of large joints. The greatest clinical efficiency in 90% at a gonosteoarthritis is proved and 64% at a coxosteoarthritis.

The article presents the results of research aimed at improving the results of surgical treatment of patients with fresh ankle fractures through the development and introduction of new technologies minimally invasive osteosynthesis. In the midst of trauma and orthopaedics at 32 1 patient group operated by the methodology of AO/ASIF (outer ankle-plate, Interior ankle-on Weber). 39 patients operated for core group developed minimally invasive technique using V-shaped spokes for inner ankles and needles with thread for osteosynthesis of the lower third of the fibula. The average duration of treatment in hospital patients 1 group amounted to 16 days, using minimally invasive technologies-10 days. In the comparison group 1 edge skin necrosis developed at 8 patients (11%), inflammatory complications had 5 (7%) 32 patients operated in the deferred order. Function ankle recovered through 6 weeks. Metallofiksatora migration observed from 1 patient (1.4%), does not allow for fractures in 4 patients (5.5%) patients of Group 2 inflammatory complications and necroses of the edges of the wounds have been identified, the term of function recovery of the ankle joint was 2 weeks. Do not allow fractures in the monitoring group 2 not identified. Do not allow fractures in the monitoring group 2 not identified. Based on the results of this study, the proposed method of minimally invasive osteosynthesis promotes better ankle function in the postoperative period, allows to execute the operational allowance regardless of the swelling in the ankle, reduces operational access not exposing the fracture zone, thus minimizing the risk of inflammatory and infectious complications.

The actuality of the study model of patients’ rehabilitation after various injuries and ankle injuries is due to the fact that, despite the use of modern methods of both conservative and surgical treatment, the number of poor results is 4-12%, and the primary disability is 10%. This trend continued for decades, makes us look for new methods of patients’ recovery. And in relation to the development of rehabilitation after fracture treatment focused only on the normalization of the damaged segment ’s functions and do not include deliberate action to restore the body’s functionality. The study proved that the best in recovering from fractures is the comprehensive use of resources, providing for the simultaneous recovery of the damaged segment (hydrotherapy) and overall health (exercise bike). In developing the methodology Therapeutic exercises we took into account the fact that the mechanism of the exercise effect is exactly the same in athletes and people with mobility impairments. For this reason, we decided to build a system to focus on training mesocycle consisting of three weekly microcycle. This is due to the length of the duration of hospital stay and the muscle activity energy supply. The first microcycle suggested an aerobic mode and included the use of only mechanotherapy devices with minimum weight. The second microcycle - anaerobic-aerobic treatment to work on a stationary exercise bike in the regime "B" from 15 to 20 minutes and the increase in weight mehatoapparate up to 3 kg. The third microcycle is anaerobic treatment, with primary use of exercise bikes in the regime "A", then work on Mechano machine with a weight of 6 to 9 kg.

Разработаны клинические рекомендации по проведению реабилитационных мероприятий больным после вывихов плеча

Разработаны клинические рекомендации по проведению реабилитационных мероприятий больным при эндопротезировании коленного сустава. Описаны основные этапы реабилитации данной категории пациентов. Указаны конкретные сроки назначения физических упражнений в раннем послеоперационном периоде. Даны рекомендации при выписке из стационара. Приведены критерии оценки эффективности реабилитационных мероприятий после эндопротезирования коленного сустава.