2018, volume 14

Aim: retrospective analysis of surgical treatment results of patients with the consequences of humerus fractures by locking intramedullary constructions. Material and Methods. 69 patients with ununited fractures and false joints of humerus diaphysis (39 females, 56.7±11.5 yrs (56.5%) and 30 males, 52.3±9.8 yrs (43.5%)) comprised observation group. In the course of surgical intervention they were treated by locking intramedullary rods to perform fragment anchorage, this including 12 patients (17%) with ununited humerus diaphysis fractures after conservative treatment, and 57 (83%) with false humerus joints. Clinical (limb functional restoration) and X-ray (integrity signs) methods were applied for the diagnostics and control of integrity restoration in bone structures; for the assessment of treatment outcomes we used standardized system of outcomes of locomotor fractures and their consequences (SOI-1). Results. Consolidation of the fracture up to 6 months postoperatively was observed in all patients with ununited humerus fractures, treatment outcomes by SOI were 85-94% of anatomic and physiological norm. The consolidation of humerus bone occurred in 50 patients with false joints with

Aim: to study the correlations of structural disorders of articular hyaline cartilage with changes in concentration of pro- and anti-inflammatory cytokines at the early stages of osteoarthritis. Material and Methods. Ultrasound and MRI investigations of knee joints (T2*-relaxometry) were performed to 67 females of main group aged 35-50 with initial manifestations of (0-1 stages) of primary osteoarthritis and 30 conventionally healthy individuals. The level of interleukin-1 (3 was determined in blood serum with multi-parameter system MAGPIX (Luminex Corporation), Urine CTX-II was identified in urine and YKL- 40, interleukin-4 — in blood serum of the subjects by ELISA. Results. The levels of Urine CTX-II: 32.5 (30.9; 35.1) ng/ml, interleukin-1 (3: 6.09 (4.81; 7.69) pg/ml and YKL-4064.1 (58.1; 77.0) ng/ml of main group patients were higherthan in the comparison group. The correlation force between Urine CTX-II and cartilage glycoprotein YKL-40 (R=0.7); interleukin-1 (3 and cartilage glycoprotein YKL-40 (R=0.3) was lower; and the correlation force between YKL-40 and CTX-II (R=0.4 (p<0.05)) the connection was higher. Conclusion. Early stages of primary osteoarthritis are accompanied by degenerative changes inhyaline cartilages that is verified by T2*-relaxometry results, and increased excretion of Urine CTX-II on  the background of pro-inflammatory mediators hyperproduction, more significant increase in the concentration of cartilage glycoprotein YKL-40 compared to interleukin-1 (3 which comes together with the alteration of the system of correlations between the levels of pro-inflammatory cytokines and the parameters of degenerative dystrophic changes in articular cartilage.

Aim: to reveal certain mechanisms of the pathogenesis of implant-associated inflammation by the level of resorption and bone tissue genesis markers in patients who underwent primary knee arthroplasty. Material and Methods. Main group consisted of 40 patients with implant-associated inflammation; first comparison group — of 20 patients with primary aseptic loosening of knee joint implant components; second comparison group — of 20 patients who underwent primary knee arthroplasty without complications in post-operative period; control group — of 20 conventionally healthy individuals. The levels of soluble receptor activator of nuclear factor kappa-B ligand and bone morphogenetic protein-2were defined in blood serum of all subjects by ELISA. Results. In patients of main group we observed more pronounced increase of soluble receptor activator of nuclear factor kappa-B ligand content and significant decrease of bone morphogenetic protein-2 content in blood serum; patients of first comparison group demonstrated activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased levels of bone morphogenetic protein-2 in blood serum; patients of second comparison group did not demonstrate any changes in the studied indexes. Conclusion. The activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased activity of bone morphogenetic protein-2 have leading role in the pathogenesis of implant-associated inflammation.

The Aim of the study was to estimate metabolic disorders in subjects with potential risk of primary knee osteoarthri-tis development. Material and Methods. The study included 27 patients: 10 men (37%), 17 women (63%) aged from 33 to 68 years, and 20 healthy people (8 men and 12 women). Traditional biochemical indexes characterizing certain metabolic aspects (total protein, urea, cholesterol, glucose, uric acid, amylase and bilirubin) were studied alongside with the assessment of articular cartilage state by the level of COMP (cartilage oligometric matrix protein), malondial-dehyde and ceruloplasmin. Results. In the course of our investigation we observed elevated COMP (Me=871,4 (792,2; 912,5)), malondialdehyde (Me=5,1 (4,7; 5,5)) and ceruloplasmin (Me=48,4 (41,2; 55,4)) levels. Conclusion. Negative metabolic shifts in the form of cartilage tissue metabolic disorders, activated lipid peroxidation and relative failure of body antioxidant system were observed in patients with potentially high risk of knee osteoarthritis without clinical manifestations of the disease.

 Aim: to analyze the method of choice of treatment for children aged 1-3 yrs. with hip joint dysplasia with respect to the complex of pathological changes by the elaboration of CAD programs. Material and Methods. We defined the grade of dysplastic changes in joint components of 82 children with hip joint dysplasia (113 joints) aged 1-3 yrs by CAD program. Results. The grade of dysplastic changes in hip joint (mild — I, moderate — II, severe — III) was identified with the elaborated program and the treatment was administered. We identified 28 children (33 joints) to have mild (I) dysplasia grade, moderate (II) 31 children (42 joints) and severe (III) 23 (38 joints). Mild dysplasia grade (I) corresponded to the score from 5 to 13, and to the option of conservative treatment with dynamic follow-up and coxarthritis prevention, moderate (II) — to the score from 14 to 26 and the option of intertrochanteric detorsion varus corrective osteotomy, severe (III) — to the score from 27 to 39 and the option of pelvis osteotomy and intertrochanteric detorsion varus corrective osteotomy. Conclusion. The treatment of patients with hip dysplasia depends on the grade of dysplastic changes. The elaborated program allows effectively define dysplasia grade and choose treatment method for the patients.

Aim: to study long-term results of posterior anchorage of subaxial vertebra in acute trauma. Material and Methods. We conducted an analysis of long-term results of posterior anchorage of subaxial vertebra in 17 patients with acute unstable trauma which had undergone complex clinical neurological and instrumental investigation, surgical treatment performed from dorsal approach, and the estimation of long-term results in preoperative period. Results. The obtained data indicate the method of transarticular anchorage to be effective and safe and not to have any negative effect on biomechanical properties of cervical spine in the long-term postoperative period. Conclusion. The use of posterior anchorage in acute unstable trauma is most reasonable in subaxial injuries accompagnied by the deformities of medial and posterior spinal columns.

We demonstrated a successful case of surgical treatment of the patient with metastatic lesion of upper cervical spine with respect to multidisciplinary approach. We performed simultaneous two-stage surgical intervention, the first stage being occipitospondylodesis by multi-segment construction; and second —tumor resection from expanded combined access. It has been stated that the proposed surgical tactics allows performing curative resection in one surgical session without neurological deficit buildup in the postoperative period.

Aim: to study the role of microbial associations in the etiology of implant-associated infection, the peculiarities of associates antibiotic resistance, to propose informative methods for the microbiological diagnostics of mixed infections. Material and Methods. The biological samples from 488 patients with infectious complications after total knee replacement were studied. Microorganisms were isolated and identified using a BD BBL™ Crystal™ AutoReader analyzer and Crystal™ Enteric/ Nonfermenter ID Kit, Crystal™Gram-Positive ID Kit panels. Results. Polyetiological infectious complications comprise up to 21.4-24.8% out of the total number of implant-associated infection cases; microbial associations have broad microbial spectrum and various component structure. Specific gravity of clinically significant microorganisms — methicillin-resistant Staphylococcus aureus, polyresistant enterobacteria and nonfermentative Gram- negative bacteria is statistically higher (p<0.05) among the associates (38.2, 25.2, 64.3 and 72.8% respectively) than in monocultures (18.2, 11.8, 47.5 and 58.3% respectively). Microbiological methods should be modified in order to verify polyetiological implant-associated infection. Conclusion. The organization of microbiological monitoring of polyetiologi-cal implant-associated infections with detailed study of microbial associations structure, the monitoring of associates antibiotic resistance is necessary to optimize the diagnostics and causal treatment of this pathology.

We presented surgical results of complicated aggressive hemangioma treatment in transitional sacrolumbar spine. It has been stated that individual peculiarities of decompressive stabilizing surgery depend on the volume of vertebral lesions and their results improve in the combination with presurgical X-ray therapy.

The article represents the history of the Hospital Therapy Department at the Saratov State Medical University served as a basis for new departments' organization. The stages of its development are highlighted.