№3, 2019, volume 15

The current review represents possibilities of magnetic-resonance imaging in bladder cancer diagnostics. The most important indicator that determines the bladder cancer prognosis and surgical treatment tactics is the muscle wall invasion. Dynamic-contrast-enhanced magnetic resonance imaging and diffusion-weighted magnetic resonance imaging can determine the depth of invasion, although although both are susceptible to over-staging. Magnetic resonance imaging and computed tomography have approximately the same accuracy in determining perivesical invasion as well as in relation to metastatic lymph nodes less than 8 mm in diameter. A promising new technique is the ultra-small paramagnetic iron oxide particles-enhanced magnetic resonance imaging.

The method of a long-term epidural anesthesia has been significantly improved and acquired the status of a well-developed and widely used clinical manipulation. Epidural anesthesia is a type of local anesthesia. Until now, there is no single definition of «epidural anesthesia» (or «epidural blockade»). The review is devoted to the history of the formation of epidural anesthesia and substantiation of the term «epidural anesthesia».

Objective: to demonstrate the potential of radiographic quadrant method for defining the correspondence of the administered femoral tunnel to the anatomical anterior cruciate ligament attachment. Material and Methods. We have surveyed 18 patients aged 23 to 36 yo. (mean age 26±2 yo.) who had underwent ACL arthroscopic transtibial plastic reconstruction in 2012-2014, and had post- surgical ACL graft rapture or knee joint instability. All patients had their knee joints X-raid in standard projections. Bernard and Hertel radiographic quadrant method was employed to take lateral view pictures for defining the accuracy of the administered femoral tunnel. Results. In all cases the sites of the administered femoral tunnels did not match ACL anatomic attachments, defined with Bernard and Hertel grid. Conclusion. Radiographic quadrant method of defining ACL anatomic attachments can be used for post-surgery complications analysis.

Objective: to perform comparative analysis of PRP-therapy efficiency in patients with various shoulder tendinopathies. Material and Methods. 122 patients with rotator cuff tendinopathies (66%), subacromial impingements and rotator cuff tendinopathies (16%), CLB tendon tendinopathies (18%) participated in the research. The diagnostic scales for estimation of pain syndrome and shoulder joint function, as well as ultrasound and MRT examinations were employed to assess the outcomes in 1 and 6 months after PRP-therapy. Results. Patients of all groups had significant improvements by scales compared to their condition at the beginning of PRP-therapy. The positive response obtained in one month after the treatment still subsisted in 6 months. The most impressive responses to treatment were observed in patients with rotator cuff and CLB tendinopathies (strong middle effect 0.8-0.88). The patients of these groups self-estimated their outcomes relatively high. The scores defining outcomes were somewhat lower in the group of patients with both rotator cuff tendinopathies and subacromial impingements. Both MRT and ultrasound examinations revealed improvements in shoulder joint structures: edema reduction and dissipation, hypoechoic signal areas. Conclusion. PRP-therapy at shoulder tendinopathies may be referred to safe effective biological methods of treatment.

Objective: to enhance the outcomes of the first ray surgical correction using osteotomy biomechanical modeling of the first metatarsal bone. It allows obtaining quantitative data for the «bone — fixator» system stability as additional criteria for selecting surgery methods and surgery therapeutic approaches. Material and Methods. 97 female patients underwent surgical corrections of static deformities in the anterior parts of the feet. Biomechanical modeling of osteotomies for the first metatarsal bone was used for the main group (50 patients) at the stage of pre-surgery planning. Results. Radiological results showed no significant differences between the groups of patients. The integrated ACFAS index in post- surgery period was statistically significant inpatients of the main group. The detection rate of the restriction of movements, pain syndrome and edema around the first metatarsal bone was higher in the control group. Conclusion. The identified differences in the dynamics of functional and restorative processes proved the efficiency of objective estimation and obtaining stability in «bone — fixator» system. Biomechanical modeling is an efficient tool of the decision making support system for surgical correction of the first ray deformities.

Objective: to perform comparative analysis of surgical outcomes in patients with types A2 and A3 ununited midshaft fractures of the femurs using Oswestry Disability Index (ODI), standardized assessment system for bone fracture outcomes and their consequences (SOI-1) and modified radiographic assessment of fracture healing (mRUS). Material and Methods. 40 patients with ununited midshaft fractures of the femurs including 22 patients with type A fractures (Group I) and 18 patients with type В fractures (Group II) were surveyed. The average follow-up period was 29.5±19.5 months. Results. In Group I the average ODI score made 47±0.9 and SOI-1 scores made 85±1.8% in 12 months. The mRUS fracture union score corresponded to 13.9±0.6. In Group II the average ODI score made 46.2±0.9 and SOI-181.8±1.7% in 12 months. The mRUS fracture union score corresponded to 13.7±0.6. Conclusion. The injured limbs functionality recovered sooner in patients of Group I (type A3 fractures) specifically in 6 months of a surgery proven by the absence of statistical differences in the results of estimation with ODI questionnaire and SOI-1 system observed in 12 months owing to the nature of fractures rather than the degree of their unions or the methods of surgical invasion applied.

Objective: based on retrospective outcome review of surgical rehabilitation perform assessment of possible usage for intramedullary locking rod structures meant to treat comminuted fractures of humeral shafts. Material and Methods. The intramedullary cross-locking rods were used to fix the fragments. The structures were inserted into humeral shafts by antegrade or retrograde techniques. In most cases surgical interventions were conducted as fracture closed reductions, at that the length and the axis of the limbs were restored without any additional fixation of separate fragments. Results. The review of outcomes for 33 patients with complicated traumatic destructions of humeral shafts showed high efficiency of intramedullary locking rod structures at managing patients with this type of injuries. Conclusion. Small surgical trauma and solid fixation provide for early functional rehabilitation of injured extremities as well as patients» quick return to everyday routine and activity before the fracture heals completely.

The case report for Hallux rigidus surgical management with endoprosthesis total replacement using zirconia ceramics has been presented.

The analysis of studies on pedicle screw fixation in the cervical spine has been carried out. Mathematical data on the accuracy of freehand placement of cervical pedicle screws, the frequency of screw malposition, the frequency of clinically significant complications are presented. The article describes the causes of perforation of pedicle of vertebra, the causes of complications of this technique, as well as recommendations to increase the accuracy of insertion the screws and reduce postoperative complications.

Ceramic cleavage on fixed orthopedic structures is a very common complication of occlusive trauma. Attempts intraoral repair of such defects have been undertaken since the 90s of the last century. The existing technique, including the treatment of the prosthesis with hydrofluoric acid and the subsequent application of silanes, quite successfully coped with the task at the boundary of the chip within the ceramics. When chipping to metal, this technique does not provide adhesion of the composite to the metal. The situation has changed dramatically with the appearance unsilane primers containing MDP monomer and providing reliable chemical adhesion of the metal to the composite. As follows from the presented clinical case, even after 1 year after the repair of the ceramic prosthesis, the anatomical, functional and aesthetic characteristics of the dentition are fully preserved.