Статьи журнала - Гений ортопедии

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"Hip-spine" синдром - взгляд на проблему с точки зрения биомеханики

"Hip-spine" синдром - взгляд на проблему с точки зрения биомеханики

Котельников Александр Олегович, Рябых Сергей Олегович, Бурцев Александр Владимирович

Статья научная

Актуальность. Реализация компенсаторных механизмов пояснично-тазового комплекса при сочетанных дегенеративно-дистрофических изменениях остается малоизученной проблемой. В многочисленных публикациях, как правило, есть изолированные данные либо с позиции патологии позвоночника, либо с позиции поражения тазобедренного сустава. Цель. Оценка изменений параметров позвоночно-тазового сагиттального баланса у пациентов с «Hip-spine» синдромом. Материалы и методы. Проанализированы 2 группы пациентов с «Hip-spine» синдромом: 1) «Hip-spine» группа - (n = 54) и 2) «Spine-hip» группа (n = 66). Всем пациентам производилось лучевое обследование: рентгенограммы позвоночника с захватом головы и тазобедренных суставов в передне-задней и боковой проекциях в положении стоя. Результаты. В первой группе - Hip-Spine (54) - отмечалось положение таза в пределах нормальной антеверзии либо присутствовала гиперантеверзия таза. Во второй группе - Spine-Hip (66) - выявлено наличие ретроверзии таза и лишь в единичных случаях сохранение нормального положения таза (без компенсаторного его отклонения)...

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"Ловушки" магнитно-резонансной томографии в диагностике повреждений менисков коленного сустава

"Ловушки" магнитно-резонансной томографии в диагностике повреждений менисков коленного сустава

Стулов Андрей Сергеевич, Тарасов Алексей Николаевич

Статья научная

На основе сравнительного анализа магнитно-резонансных томограмм коленного сустава представлена визуализация нормальных анатомических внутрисуставных структур, симулирующих повреждения менисков, от истинных патологических состояний.

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"Многоликий" хронический остеомиелит: лучевая диагностика

"Многоликий" хронический остеомиелит: лучевая диагностика

Дьячкова Галина Викторовна, Дьячков Константин Александрович, Клюшин Николай Михайлович, Ларионова Татьяна Адиславовна, Шастов Александр Леонидович

Статья научная

Введение. Анализ литературы и собственные данные свидетельствуют о разнообразных по протяженности и степени выраженности изменений структуры кости при хроническом остеомиелите, определение границ которых представляет значительные сложности. Цель. Провести анализ протяженности очага и глубины нарушения структуры кости методом МСКТ при различных типах остеомиелита и вариантах его локализации. Материалы и методы. Исследование ретроспективное, одноцентровое. У 235 больных хроническим остеомиелитом методом полипозиционной рентгенографии и мультисрезовой компьютерной томографии (МСКТ) изучены особенности рентгеноморфологии бедренной и большеберцовой костей с количественной оценкой плотности различных участков кости. Результаты. Наиболее частой локализацией хронического остеомиелита был диафиз бедренной (33) и большеберцовой костей (52). Причиной остеомиелита во всех случаях была травма или операция. У 14 больных в результате длительно протекающего заболевания сформировался ложный сустав или дефект кости. Анализ данных МСКТ показал, что анатомические изменения бедренной и большеберцовой костей при хроническом остеомиелите были индивидуальны у всех пациентов. Что касается рентгеноморфологических проявлений, то они складывались из общих симптомов (остеопороз, остеосклероз, нарушение архитектоники), однако выраженность, протяженность и характер изменения структуры были крайне разнообразны, так же как и изменение плотности кости с большим отклонением. Заключение. Полученные данные свидетельствуют о том, что «визуальная реальность» в диагностике хронического остеомиелита связана с компьютерной томографией, позволяющей определять протяженность и характер изменений кости, детализировать разнообразные изменения анатомии и архитектоники, свидетельствующие о «многоликости» хронического остеомиелита.

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30 лет лаборатории радионуклидной диагностики

30 лет лаборатории радионуклидной диагностики

Свешников А.А.

Персоналии

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35 лет на пути к совершенству и качеству к юбилею РНЦ «ВТО»

35 лет на пути к совершенству и качеству к юбилею РНЦ «ВТО»

Шевцов В.И., Марченкова Л.О.

Статья

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85-й конгресс SOFCOT

85-й конгресс SOFCOT

Щурова Е.Н., Мишина Н.И., Солдатов Ю.П., Неретин А.С.

Краткое сообщение

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A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

Al-Rousan Fadi Mohammad

Статья научная

Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision without any attempts to approximate the retracted ends of the nerves, this was followed by reconstruction of the gaps by cable grafts from the sural nerves using fibrin glue. Conversely, in group (B) we took measurements of the defects after using 1 or 2 bridging stay sutures through the posterior aspect of the epineurium just to overcome the retracted distance without any further tension on the nerve. This also was followed by reconstruction of the gaps by cable nerve grafts with the aid of fibrin glue. Results: in group (B), the cable grafts length can be shortened from (29.6mm to 14.2 mm) with average of (15.4 mm). The number of cables per graft increase from 2.2 to 3.2. The number of grafts used in reconstruction of the brachial plexus were more in group B than in group A. Conclusions: A simple bridging stay suture can prevent retraction of the nerve ends after repair with fibrin glue, working as an internal splintage to the repair site, decrease the length of the cable graft, increase the number of cables per graft, gives more opportunity to make more nerve grafts and the surgeon feel that his repair is more secure.

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A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

Firas Ahmad Suleiman, Fadi Mohammad Al-Rousan

Статья научная

Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision without any attempts to approximate the retracted ends of the nerves, this was followed by reconstruction of the gaps by cable grafts from the sural nerves using fibrin glue. Conversely, in group (B) we took measurements of the defects after using 1 or 2 bridging stay sutures through the posterior aspect of the epineurium just to overcome the retracted distance without any further tension on the nerve. This also was followed by reconstruction of the gaps by cable nerve grafts with the aid of fibrin glue. Results: in group (B), the cable grafts length can be shortened from (29.6mm to 14.2 mm) with average of (15.4 mm). The number of cables per graft increase from 2.2 to 3.2. The number of grafts used in reconstruction of the brachial plexus were more in group B than in group A. Conclusions: A simple bridging stay suture can prevent retraction of the nerve ends after repair with fibrin glue, working as an internal splintage to the repair site, decrease the length of the cable graft, increase the number of cables per graft, gives more opportunity to make more nerve grafts and the surgeon feel that his repair is more secure.

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Autologous blood injection versus corticosteroid for tennis elbow

Autologous blood injection versus corticosteroid for tennis elbow

Bari Mofakhkharul, Shahidul Islam, Shetu Nazmul Huda, Mahfuzer Rahman

Статья научная

Goal. Compare the effectiveness of injections of autologous blood and injections of corticosteroids in the treatment of "tennis elbow." MATERIALS AND METHODS. 25 men and 35 women (mean age 35.2 years) with a "tennis elbow" were randomized for injections or autologous blood (2 ml of autologous venous blood mixed with 1 ml of 2% xylocaine hydrochloride) or a steroidal preparation of triamcinolone acetonide (1 ml - 40 mg, mixed with 1 ml of 2% xylocaine hydrochloride), which one surgeon did. We evaluated before (0 day) and after (after 15, 30, 60 days) treatment for the presence of pain in the elbow, the function and strength of flexion in the joint. The presence of pain in the elbow joint was evaluated after one year. Results. Infections, tendon ruptures and neurovascular damage were not identified. Five patients reported pain for up to three days after the injection of autologous blood. In both groups, the flexion force improved dramatically after treatment, but the recovery process was different. Compared with injections of autologous blood during the injection of a corticosteroid drug, the recovery occurred more quickly in the first 15 days, and then slightly slowed down to the 60th day. After the introduction of autologous blood, pain relief, function and flexion strength were steadily improved and eventually became more sophisticated. The conclusion. In comparison with injections of a corticosteroid drug, injections of autologous blood were more effective with a long period of control in terms of relief of pain, restoration of function and flexion strength. This is how we recommend this first-order injection technique, because it is simple enough, inexpensive and more effective.

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Bleeding diseases in orthopedic clinical approach

Bleeding diseases in orthopedic clinical approach

Yildiz Kadri, Yildiz Vahit

Статья научная

Aim Bleeding diseases are rarely studied as complications of an orthopedic surgical procedure with postsurgical bleeding. This study aims to present a retrospective cohort-study about the approach to bleeding disorders in an ordinary orthopedic clinic. Material and Methods 344 patients were recorded for our study group between November 2017 and September 2019. These patients were monitored for bleeding disorders, both primary or secondary. Results 27 (7.84 %) patients with bleeding diseases [1 (0.29 %) patient with VWD, 1 (0.29 %) patient with hemophilia, 1 (0.29 %) patient with ITP, 15 (4.36 %) patients with drug use, 5 (1.45 %) patients with vascular disorders, 4 (1.16 %) patients with herbal agent use] were detected in all traumatic cases which were admitted to our clinic in this time period . These patients were divided in 6 groups. Patient with VWD was Group 1, patient with hemophilia was Group 2, patient with ITP was Group 3, patients with drug use formed Group 4, patients with vascular disorders - Group 5, patients with herbal agent use - Group 6. Conclusion We advise to have a careful preoperative control for postsurgical bleeding risks according to three criteria: i) patient anamnesis should be studied carefully (diathesis/hemophilia searching), ii) platelet counts must be checked (twice is guaranteed), iii) coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT) and International Normalized Ratio (INR)] must be studied.

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Cervical spine tropism CII-CIII anomaly

Cervical spine tropism CII-CIII anomaly

Gubin Aleksandr Vadimovich, Drozd Vadim Anatolevich, Burtsev Aleksandr Vladimirovich, Riabykh Sergei Olegovich

Статья научная

Study Design. 3 patients with CII-CIII tropism anomaly and unilateral subluxation were investigated and treated. Objectives. To demonstrate clinical and CT findings in children with the new anomaly in CII-CIII junction. Summary of Background data. A thorough in vivo research of CII-CIII junction became possible only after introduction of modern CT scanning technologies. We have not managed to find other clinical observations of this segment pathology in children in contemporary medical literature. Methods. We determined not typical cases of acute wryneck from the group of 262 children hospitalized in our clinic. X-ray and CT scans were used for evaluation of the problem. Results. From the group of patients with acute stiff-neck we selected three with the following symptoms: neck blocked and movement not possible; head advanced forward. On the lateral X-ray scans there were a cervical lordosis straightening and the pars interarticulares of the CII were overridden by the processus articularis superior of the CIII. The CT-scan of the cervical spine showed a unilateral subluxation of the CII segment in the forward direction. The articulation planes of the CII-CIII facets had different orientation on the left and right sides. Conclusion. We propose the hypothesis that non-symmetrical orientation of the articulation facet planes in the CII-CIII segment can cause a stiff-neck syndrome in children. In the described cases, the sole detected source of the pain syndrome and blocked neck was the tropism anomaly in the CII-CIII segment accompanied by a subluxation of the joint.

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Chronic Сhopart's joint dislocation and its treatment with the Ilizarov external fixator: a case report and literature review

Chronic Сhopart's joint dislocation and its treatment with the Ilizarov external fixator: a case report and literature review

Barawi Omer A.R., Raoof Soran S., Muhsin Abd Ali

Статья научная

Background Chronic Chopart dislocation is one of the causes of acquired painful flat foot, which is treated by midtarsal arthrodesis causing limitation of movement and smaller-sized foot. Gradual reduction based on the principles of аrthrodiastasis using the Ilizarov external fixator is used for treating chronic Chopart dislocation. The case and method Twenty-two year-old male presented with painful right flat foot fourteen months after a motor vehicle accident. Gradual reduction was used for the chronically dislocated Chopart’s joint by arthrodiastasis using the Ilizarov external fixator. Result The follow-up result after four years is presented. The longitudinal arch of the foot recovered and the foot is painless with full range of movements; the size of the foot is preserved. Conclusion Treatment of chronic Chopart dislocation by arthrodiastasis using the Ilizarov external fixator is a preferred method of treatment as the size of the foot will be preserved , movement of the joint will not be restricted, the joint will be painless. There is no need for thromboprophylaxis, no chance of compartment syndrome and less operation time in comparison to arthrodesis.

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Clinical and radiographic outcomes of medial open wedge high tibial osteotomy (MOWHTO) with Ilizarov technique in OA knee

Clinical and radiographic outcomes of medial open wedge high tibial osteotomy (MOWHTO) with Ilizarov technique in OA knee

Bari Mofakhkharul Bari, Islam Shahidul, Shetu Nazmul Huda, Rahman Mahfuzer

Статья

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Clinical assessment difference between patellar resurfacing and retention groups with grade IV osteoarthritis in total knee arthroplasty

Clinical assessment difference between patellar resurfacing and retention groups with grade IV osteoarthritis in total knee arthroplasty

Kamolhuja Eshnazarov, Jong Keun Seon, Eun Kyoo Song

Статья научная

Introduction. Despite the excellent clinical success with total knee arthroplasty (TKA), there is disagreement about whether or not to replace the patellar articular surface. This led to randomized controlled trials. Such studies are the most reliable source of evidence of the effectiveness of potential interventions. But most of these studies include the study of results at all degrees of osteoarthritis of the patellofemoral joint. Therefore, the authors conducted a prospective study to compare the clinical and radiological outcomes after TKA with the replacement of the patellar articular surface in patients with osteoarthritis of the patellofemoral joint of the fourth degree. Materials and methods. The study included 123 patients with Kellgren-Lawrence patellofemoral joint osteoarthritis. Patients were randomly assigned to groups, in one of which the patellar joint surface was replaced (62 cases), in the other case, they were not performed, i.e. retained the patella (61 cases). Among them were 114 patients who were observed for more than two years (group with replacement of the articular surface - 59 cases, the group without replacement - 55 cases). Preoperative and postoperative clinical data were evaluated and evaluated on the scale of the Hospital for Special Surgery Patellar (HSSP) (total score of 100, presence of pain in the anterior part of the knee, functional limitations, tenderness in palpation or pressure, crepitation , Q-force). Scales developed at the Special Surgery Hospital (HSS), and the WOMAC scale, as well as the volume of movements (ROM), were also used. Results. The mean HSSP score in the group with replacement of the patellar articular surface was 85 points and 83 points in the group without replacement, which showed no significant differences between the groups (p = 0.75). When assessing the presence of pain in the anterior part of the knee, there were also no significant differences between the groups (40 in the group with articular replacement, 36 in the group without replacement, p = 0.52). HSS scores improved to 94 points in the group with articular replacement and up to 95 in the group without replacement, which also indicated no significant difference (p = 0.92). The WOMAC score and the volume of movements were 32 and 128 ° ± 10.5 ° in the replacement group and 29 points and 126 ° ± 11.5 ° - in the group without replacement, there was no significant difference between the groups (p> 05) . The conclusion. Thus, identical good clinical outcomes without significant differences were achieved after TKA with and without replacing the patellar articular surface in patients with a high degree of osteoarthritis of the patellofemoral joint. TKA without replacing the articular patella surface is a good option in patients with a high degree of osteoarthritis of the patellofemoral joint.

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Comparison between strontium administration and ibandronate injection effects on bone density of post-ovariectomy Wistar rat

Comparison between strontium administration and ibandronate injection effects on bone density of post-ovariectomy Wistar rat

Bastian D., Martiana I.K.

Статья научная

Introduction Osteoporosis is a disease causing high morbidity with increasing prevalence. It is one of chronic diseases caused by reduced bone mass that subsequently decreases bone strength and increases fracture risks. Pharmacologic treatments for osteoporosis include antiresorptive agent (bisphosphonate) and bone-forming agent (strontium ranelate), so further research is needed to compare these two medications. Objectives We aimed to histopathologically compare bone density in post-menopause white rats after being treated with strontium and ibandronate. Material and methods 45 ovariectomized female rats were divided into three groups. The subjects in the first group were only ovariectomized (control). The strontium group was given daily oral strontium at a dose of 625 mg/kg BW/day for 60 days. The ibandronate group was given one subcutaneous ibandronate injection at a dose of 1 μg/kg BW/day for 60 days. We measured osteoclasts, osteoblasts, trabecula area and cortical thickness. Results The animals in ibandronate and strontium groups showed a significant increase.

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Congenital pseudoarthrosis of the tibia and treatment using the Ilizarov technique

Congenital pseudoarthrosis of the tibia and treatment using the Ilizarov technique

Al-Neqresh Hamdy, Ozbi Assia

Статья научная

Background: Congenital pseudoarthrosis of the tibia (CPT) is one of the most difficult problems in paediatric orthopaedic surgery. This is a rare condition, which is mostly associated with neurofibromatosis. Treatment options have varied greatly. Successful surgical treatment of tibial pseudoarthrosis is possible by the Ilizarov method. Patients and methods: 7 patients with CPT treated using the Ilizarov technique within the period from 1998 to 2008. RESULTS: Bone healing was achieved in all cases except one. (Union rate - 85,7 %). Conclsion: The Ilizarov technique is a comprehensive approach to all CPT aspects. Its use can end with very good results

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Damage control orthopaedics

Damage control orthopaedics

Bari Mofakhkharul, Islam Shahidul, Shetu Nazmul Huda, Rahman Mahfuzer

Статья научная

Emergency procedures aimed at rapid reduction and fixation and spanning of periarticular fractures has been termed “damage control orthopaedics”. In severely injured patients, early definitive fixation of fractures may not be appropriate. Recent studies showed that in multiple trauma, DCO is the best option for management of patients who are unstable and in extremis. The paper presents a case of such a control in a 34-year-old patient who sustained polytrauma on 20.10.2016. Primary medical care was conducted at a local hospital. Ten hours after the injury, the patient was transported to the Bari-Ilizarov orthopaedic centre for further management. On admission, he was in a traumatic shock. Radiographic study showed a comminuted fracture of the left femur, medial condylar fracture of the ipsilateral femur, comminuted fractures of both bones of the shin, left wrist sprain, and contusion of the head. Osteosynthesis of the left femoral shaft was performed with a Kuntscher nail and additionally with the Ilizarov fixator. When patient’s condition stabilized on the next day, osteosynthesis of the tibia was performed with the Ilizarov apparatus and the wrist was fixed with a plaster cast.

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Distraction osteogenesis techniques in treatment of acquired and congenital shortening of the hand bones using a modified external mini-fixator

Distraction osteogenesis techniques in treatment of acquired and congenital shortening of the hand bones using a modified external mini-fixator

Danilkin Mikhail Iurevich

Статья научная

Distraction osteogenesis according to Ilizarov is the most common method of bone lengthening and deformity correction including the hand and foot bones. This method forms the basis of the main techniques used for the hand bone lengthening. The author described the technical specifications of the mini-fixator developed for short tubular bones, demonstrated the diagrams of its application to finger phalanges and metacarpal bones, as well as he presented the illustrative clinical cases. The hand bone lengthening performed in 394 patients (566 segments of the hand) at the Center within the period of 1999 and 2012. The performed lengthening procedure improved the hand appearance and functions.

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Drainage versus non-drainage in primary total knee replacement: a comparative study

Drainage versus non-drainage in primary total knee replacement: a comparative study

Zaid Al-Eyadah

Статья научная

Goal. Compare the results in 80 patients who underwent total knee replacement, find out the advantages of using closed suction drainage and compare the results with those in the group where drainage was not used. Methods. A randomized prospective study was conducted in 2011 in group A (40 patients) without drainage and in group B (40 patients) with drainage. Total blood loss was significantly greater in patients who were drained (400 ml) compared to 200 ml in the group without drainage, although the latent amount of blood loss can not be accurately determined. Results. The statistical difference in terms of postoperative pain, ecchymosis or the frequency of cases of infection in the postoperative period in both groups was not. Conclusions. There were no clear evidence to support the use of drainage with total arthroplasty of the knee, despite this many surgeons prefer to use them.

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Hallux valgus: рентгенометрия костей стопы до и после хирургической коррекции

Hallux valgus: рентгенометрия костей стопы до и после хирургической коррекции

Алинагиев Бабек Джебраил Оглы, Теймурханлы Ф.А.

Статья научная

Результаты лечения 63 больных Hallux valgus изучены методом полипозиционной рентгенографии, которую выполняли до, после операции и на различных этапах фиксации аппаратом, а также в отдаленном периоде. У всех больных проводили рентгенометрические исследования. В зависимости от степени деформации первого луча больным производили различные виды остеотомий с фиксацией остеотомированных фрагментов устройством наружной фиксации. После устранения деформации отмечался длительный процесс перестройки в первой плюсневой кости, который можно разделить на два периода: ближайшие два месяца и год после окончания лечения. У 48 больных через год после окончания лечения процесс перестройки первой плюсневой кости был близок к завершению, были сформированы хорошо выраженные кортикальные пластинки, в области основания кости прослеживалась ячеистая структура, форма первой плюсневой кости приближалась к нормальной. У остальных больных процесс перестройки был незавершен, отмечались участки уплотнения в зонах остеотомий, кортикальная пластинка имела различную толщину и плотность, в области головки и основания кости ячеистая структура чередовалась с участками уплотнения и разрежения.

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