Vol 2, No 3 (2017)

Articles
50th anniversary of the department of traumatology, ORTHOPAEDICS AND EXTREME SURGERY N.A. RAS ACADEMICIAN KRASNOV AF
Lartcev Y.V., Chernov A.P., Povelikhin A.K.
Abstract
The article presents a report about the work that has been done by the Department of Traumatology, Orthopaedics and Extreme Surgery named after the Academician of the Russian Academy of Sciences Krasnov AF for the years of its existence, and also about the plans for the further development. The stages of formation and development of the department are described. Present state of educational, medical and scientific activities of the team is presented. The article shows what we have achieved during this period. The emphasis is placed on scientific and innovative work, experimental scientific research, and publications.
Science and Innovations in Medicine. 2017;2(3):6-12
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REVIEW OF MATERIALS AND TECHNOLOGICAL METHODS USED IN THE MANUFACTURE OF ENDOPROSTHESIS IN TRAUMATOLOGY AND ORTHOPAEDICS
Kolsanov A.V., Nikolaenko A.N., Ivanov V.V., Prichodko S.A., Platonov P.V.
Abstract
Traumas and diseases of the musculoskeletal system are the second among the causes of temporary disability of the population, and the third among the causes of disability and mortality. An effective method of treatment is endoprosthetics. ; Every year across the globe 500-1000 patients per 1 million of population require prosthetics. The development of endoprostheses is progressing in various spheres: design of the implant parts, methods of fixation, use of various materials, different types of surface finish of implants. Endoprostheses that are currently produced and used in traumatology and orthopaedics are unified, i.e. ; standardized - all of them have different size, but their shape is the same. This imposes serious limitations on the use of implantation in difficult clinical cases. The way out can be the use of personified implants, designed and manufactured with the use of modern rapid prototyping technologies. In this case, the use of titanium will fully implement the most important advantages of this direction: the best biocompatibility, high corrosion resistance, low modulus of elasticity, high specific strength and endurance.
Science and Innovations in Medicine. 2017;2(3):13-17
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DETERMINATION OF BIOCOMPATIBILITY AND CYTOTOXICITY OF POROUS TITANIUM-BASED MATERIALS IN EXPERIMENT
Kolsanov A.V., Nikolaenko A.N., Ivanov V.V., Prikhodko S.A., Platonov P.V.
Abstract
Aim - to evaluate the proliferative activity of dermal fibroblast cultures in the presence of composite materials based on titanium silicides in vitro. Materials and methods. To assess the proliferative activity of dermal fibroblasts in vitro, the following materials were used: titanium silicide, titanium carbosilicide oxidized in vacuum and without vacuum, titanium VT-00 (comparison group). Testing of proliferative activity was carried out by the direct contact method. The proliferation index, the doubling time and the number of culture doubling during the cultivation period were calculated. Attachment of dermal fibroblasts to the surface of the test materials and their presence on it during cultivation was assessed by scanning electron microscopy. Results. The study of the morphofunctional characteristics of dermal fibroblasts cultured in the presence of the test samples of material showed that during the entire experiment no major changes occurred in any of the series, the cells retained the monolayer growth characteristic of fibroblasts, preferably spindleshaped with 2-4 shoots. Moreover, all cultures of dermal fibroblasts underwent the same number of doublings during the experiment and reached saturation density 7 days after sowing, which indicates good proliferative activity of cells in the presence of test materials. The results of scanning electron microscopy demonstrate the high affinity of human dermal fibroblasts for both titanium silicide and titanium carbosilicides. Conclusion. Absence of morphofunctional changes in dermal fibroblasts and active proliferation testify to the absence of cytotoxicity of the investigated alloys, and the ability of cells to adhere to the surface of materials indicates their good biocompatibility.
Science and Innovations in Medicine. 2017;2(3):18-22
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PERSONIFIED APPROACH IN SURGICAL TREATMENT OF BENIGN BONE TUMORS WITH THE USE OF PRE-OPERATIVE COMPUTER PLANNING AND NAVIGATION
Kolsanov A.V., Nikolaenko A.N., Ivanov V.V., Prikhodko S.A., Platonov P.V.
Abstract
Aim - to analyze the results of the use of 3D modeling and computer navigation in the treatment of benign tumors and tumor-like diseases of long bones. Materials and methods. The study included 19 patients with benign tumors and tumor-like diseases. The main group consisted of 10 patients. In the preoperative planning stage, in addition to X-ray and computed tomography these patients had 3D-models of the affected bone segment constructed. Surgical treatment was carried out with the use of the navigation system. The control group consisted of 9 patients who underwent radiography and computed tomography of the affected bone segment in the preoperative planning stage. Results. The application of the new method made possible to reduce the operation time by 40 min, intraoperative blood loss by 350 ml, and the intensity of pain on a visual analog scale by more than 2 points. This result was achieved by intuitively simple for the operator dimensional orientation in the operative field in real time, the possibility of more accurate surgical procedures due to a more precise calculation of the level of necessary transplant. It minimizes the trauma of the donor area, exerting a positive influence on the reduction of postoperative pain. Conclusion. The use of 3D modeling and computer navigation for the treatment of patients with benign tumors and tumor-like diseases of long bones managed to improve noticeably the results of surgical treatment, and consequently, to speed up social and functional adaptation of patients and to enhance social and economic outcome.
Science and Innovations in Medicine. 2017;2(3):23-27
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FEATURES OF THE APPLICATION OF THE NEW METAL FIXATOR FOR OSTEOSYNTHESIS IN OSTEOPENIA IN POST-MORTEM EXAMINATION
Lartcev Y.V., Shereshovets A.A.
Abstract
Aim - to study the peculiarities of osteosynthesis in osteopenia with the application of the new metal fixator in post-mortem studies. Material and methods. New metal fixator for osteosynthesis in osteopenia has been developed. Measurements of the mechanical strength of osteosynthesis, and biomechanical tests of osteosynthesis stability with the application of this fixator were studied in 16 corpses (32 cases). Results. Biomechanical tests indicate that the new metal fixator is able to maintain the optimal position of anatomical reduction in 15 cases out of 16, while using a sponge screw AO type shows this result only in 6 cases out of 10. The mechanical strength of osteosynthesis with the use of the new metal fixator is 2,77 times greater than when using a sponge screw AO type. Conclusion. The carried out post-mortem examination testifies to the advantage of using the new metal fixator compared to the traditionally used sponge screw AO type for osteosynthesis in osteopenia.
Science and Innovations in Medicine. 2017;2(3):28-31
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NEW APPROACH TO SOLVING THE PROBLEM OF COMPLEX REGIONAL PAIN SYNDROME
Pankratov A.S., Ardatov S.V., Ogurtsov D.A., Kim Y.D., Shitikov D.S.
Abstract
Aim - to improve the results of treatment of patients with complex regional pain syndrome (CRPS) in bone fractures of the lower extremities by applying a new integrated approach. Methods. A new approach to solving the problem of complex regional pain syndrome in fractures of lower limb bones is proposed, including the use of modern minimally invasive methods for surgical treatment of fractures of the lower limb bones, such as blocked osteosynthesis, Fixion technology, use of angular stability plates, metal structures for osteosynthesis of the proximal femur. All these measures help to minimize the negative effect that is produced on the bone by such factors as prolonged immobilization and absence of early movements of the joints, which will make it possible to perform CRPS prophylaxis in bone fractures of the lower limbs more effectively. If it is not possible to prevent the development of CRPS, then it is necessary to administer complex therapy, including psychoemotional correction, adherence to the regime, proper immobilization, rehabilitation exercises, physiotherapy, medical treatment, hyperbaric oxygenation, and gravitational therapy. Results. Clinical tests, radiography, densitometry, method of statistical analysis and mathematical modeling with elements of evidencebased medicine objectively confirmed the activation of the restorative processes in altered tissues of the lower limbs due to the use of the new complex. Conclusion. The analysis of the obtained data of clinical and functional methods of research has proved that the total value of positive results is 80%.
Science and Innovations in Medicine. 2017;2(3):32-38
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COMBINED IMPACTION AUTOPLASTY OF THE FEMORAL HEAD IN THE TREATMENT OF PATIENTS WITH EARLY STAGES OF ASEPTIC NECROSIS
Kudashev D.S., Zuev-Ratnikov S.D., Shorin I.S.
Abstract
Aseptic necrosis of the femoral head refers to the number of severe, rapidly progressing destructive-dystrophic hip joint lesions. In the overwhelming majority of cases, the disease develops in young and most active age group. In the absence of necessary treatment, the result of the disease is the early disability retirement with the need for radical reconstructive interventions on the joint. The use of modern diagnostic methods makes it possible to detect the beginning of the pathological process in the femoral head in the early stages and to conduct the most effective treatment of patients of this category. Aim - to improve the results of treatment of patients with early stages of aseptic necrosis of the femoral head due to the development and introduction into clinical practice of a new method of combined impaction autoplasty of the femoral head. Materials and methods. A new method of combined impaction autoplasty of the femoral head was used, including decompression, intraosseous resection and excision of the focus of osteonecrosis followed by combined autoplasty of the postresection defect (RF patent No. 2583577 dated 13.04.2016). Intraosseous resection of the focus of destruction of the femoral head was performed with the help of a specially developed device - milling cutters for bone tissue resection (RF patent for utility model No. 171951 dated 21.06.2017). Evaluation of the effectiveness of the treatment was carried out on the basis of the severity of the pain syndrome and functional capabilities of patients defined by the Harris scale (Harris Hip Score). Results. The analysis of the medium-term results of the conducted treatment showed that good results were obtained in 67.4% of cases in which the proposed method was used.
Science and Innovations in Medicine. 2017;2(3):39-44
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NEW METHOD OF AUTOPLASTY OF KNEE ARTICULAR SURFACE DEFECTS IN PATIENTS WITH DESTRUCTIVE-DYSTROPHIC DISEASES
Kudashev D.S., Zuev-Ratnikov S.D.
Abstract
Aim - to evaluate the results of the treatment of patients with destructive-dystrophic diseases of the knee using a new method of autoplasty of articular surfaces. Materials and methods. The results of surgical treatment of 42 patients with destructive-dystrophic diseases of the knee were studied. All patients underwent surgical treatment with the use of a new method of autoplasty of articular surfaces. The operation is based on the technique of "classical" mosaic chondroplasty, but in addition we form a non-free muscle flap and pass it under the basis of osteo-cartilaginous autografts in the defect zone through a specially created canal. Comparative evaluation of surgical treatment results of the indicated clinical group of patients was carried out 3, 6 and 36 months after the operation. Treatment response was assessed according to the following indicators: WOMAC-index, Lequesne index, parameters of the rheovasography, functional electromyography and podometry. These indices allowed us to calculate integral indicators Хвц with the use of which we managed to develop mathematical models of clinical and functional state of the lower limb and analyze them. Results. Comparative analysis of the mathematical models (clinical and functional state of the lower limb) demonstrated that the use of the proposed method of autoplasty provided more expressed clinical remission and functional recovery of the lower limb after 12 months after the operation. The dynamics of changes in the integral index value in the early postoperative period clearly shows its tendency towards the normal value; this tendency is even more pronounced in the late postoperative period. This shows the positive progress of the ongoing reparative processes in the knee joint and better quality of restoration of the functional state of the lower limb. Conclusion. The proposed method of autoplasty of articular surfaces of the knee joint provides significantly greater clinical and functional recovery of the knee and may be recommended for clinical use.
Science and Innovations in Medicine. 2017;2(3):45-49
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PREOPERATIVE EXAMINATION OF PATIENTS WITH ANTERIOR-INFERIOR AND INFERIOR HABITUAL SHOULDER DISLOCATION
Larteev Y.V., Kobzarev V.V.
Abstract
Aim - to determine a rational method for the treatment of patients with anterior-inferior and inferior habitual shoulder dislocation based on the results of examination of patients. Material and methods. The study involved analysis of the treatment results of 98 patients with anterior-inferior and inferior chronic instability of the shoulder joint. Patients were divided into two clinical groups. The first group consisted of 52 patients, and the choice of treatment was based only on the diagnosis and did not take into account the peculiarities of pathology in each particular patient, which led to unsatisfactory results. To improve the results of treatment of patients with anterior-inferior and inferior chronic instability of the shoulder joint, a set of diagnostic measures was proposed, which made it possible to choose the proper method and volume of intervention taking into account the direction of the dislocation and the plane ofjoint displacement. The second clinical group consisted of 46 patients who underwent examination and treatment according to the proposed complex. A detailed description of the proposed diagnostic complex is presented, including a number of clinical and instrumental methods for examining patients, and a self-administered questionnaire for the patients. Based on the results of the survey, taking into account the direction of the dislocation, the patients underwent surgical intervention, which made it possible to achieve stability of the joint and restore the function of the limb. Conclusion. The choice of optimal diagnostic complex with regard to the direction of dislocation and the plane of shoulder head displacement in habitual shoulder dislocation helps to choose pathogenically justified surgical method and contributes to the full functional restoration of the limb.
Science and Innovations in Medicine. 2017;2(3):50-54
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SURGICAL TREATMENT AND POSTOPERATIVE MANAGEMENT OF PATIENTS WITH BROAD FOREFOOT
Rasputin D.A.
Abstract
The article considers the problem of broad forefoot, which is one of the most frequent deformities of the musculoskeletal system. Aim - to improve the results of treatment of patients with transverse platypodia by the use of new methods of surgical interventions, and to improve the tactics of postoperative management of such patients. Material and methods. The study involved analysis of the results of treatment of 375 patients. For evaluating the long-term outcomes of treatment, methods of evidence-based medicine were used, reflecting a reduction in the relative risk of interventions and an increase in their relative benefit. Results. The study of the long-term results of treatment showed that there were good and satisfactory outcomes in 92.7% cases (267 patients) and only 7.3% of unsatisfactory results (21 patients) in the main group; in comparison group - 74.7% (65 patients) and 25.3% (22 patients) respectively. The evaluation of the adequacy of anesthesia on the first day after the operation revealed good and satisfactory quality of anesthesia in the first group in 89.9% patients (259), in the second - only in 55.2% patients (48). Conclusion. The use of the above mentioned methods of surgical treatment and enhancement of tactics of postoperative management improve outcomes of patients with transverse flatfoot, and, consequently, are recommended for widespread use in clinical practice.
Science and Innovations in Medicine. 2017;2(3):55-57
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APPLICATION OF THE METHOD OF TEMPORARY BLOCKING OF GROWTH ZONES IN THE TREATMENT OF DEFORMITIES OF THE LOWER EXTREMITIES IN CHILDREN
Ryzhov P.V., Pirogova N.V., Shmelkov A.V.
Abstract
Aim - to evaluate the effectiveness of surgical correction of shortening and axial deformities of the lower extremities in children by temporary blocking of the growth zones. Materials and methods. The article presents five-year experience (2011-2016) in the treatment of 45 children (59 knees) with deformities of the lower extremities of different etiology. These cases included such congenital and acquired deformities as post-traumatic deformities, Blount's disease, metaphyseal dysplasia, after-effects of osteomyelitis, exostotic chondrodysplasia. Shortening or elongation of the limbs were found in 13 patients, the angular deformity - in 29 patients, combined deformity - in 3 patients. Results. In our practice, the timing of the correction of deformity ranged from 10 to 32 months. The degree and time of correction of the deformation directly depend on its severity and age of patients. The analysis of the results of the treatment of children with the use of this methodology showed the following results: good outcomes were observed in 37 patients (82.2%), satisfactory - in 8 patients (17.8%), unsatisfactory outcomes were not observed. Complications occurred in 3 patients (6.6%). Irreversible complications were not observed. Conclusions. Method of temporary blocking of the growth zones of long bones (method of controlled growth, temporary epiphysiodesis) is a good alternative to corrective osteotomies due to sufficient efficacy, minimal invasiveness, and little risk of complications.
Science and Innovations in Medicine. 2017;2(3):58-62
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APPROACH TO PROXIMAL FEMUR FRACTURES TREATMENT
Ardatov S.V., Pankratov A.S., Ogurtsov D.A., Shitikov D.S., Kim Y.D., Tatarenko I.E.
Abstract
Aim - to describe the approach to proximal femur fractures treatment in geriatric (elderly and senile) group of patients. Materials and methods. The article presents the analysis of 16 years’ experience of using both classic and author’s technologies according to the developed classification of patient’s functional state. Conclusion. The decision on therapeutic approach for geriatric patients was optimized.
Science and Innovations in Medicine. 2017;2(3):63-68
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ANALYSIS OF SURGICAL TREATMENT OF SUBCUTANEOUS RUPTURES OF ACHILLES TENDON (LITERATURE REVIEW)
Kim Y.D., Chernov A.P., Ardatov S.V., Shitikov D.S., Bardovskaya Y.I.
Abstract
In our opinion, the treatment of patients with subcutaneous ruptures of the Achilles tendon is poorly covered in special literature, and in many cases the information is biased. These preconditions are the cause of the lack of awareness of surgeons, traumatologists, orthopaedic surgeons, rehabilitation therapists about the real complexity of treatment of this category of patients. In this context, this paper focuses on the literature review of recent works on surgical treatment of patients with subcutaneous Achilles tendon rupture, summarizing the data of foreign and Russian researchers.
Science and Innovations in Medicine. 2017;2(3):69-72
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