Saratov JOURNAL of Medical and Scientific Research

Shchanitsyn I.N.

Saratov Scientific Research Institute of Traumatology and Orthopedics, Department of Cardiovascular Surgery and Vertebrology Candidate of Medical Sciences, cardiovascular and endovascular surgeon

Optimization of transpedicular spondylosynthesis application for type A3 lesions of the thoracolumbar transition: clinical experimental study

Year: 2019, volume 15 Issue: №2 Pages: 275-283
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shchanitsyn I.N., Shulga A.E., Zaretskov A.V., Ivanov D.V.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky
Summary:

Objective: the optimization of transpedicular systems application for type A3 lesions of the thoracolumbar transition using computer simulation based on the fnite elements method. Material and Methods. The examination data (post-traumatic kyphotic deformation, intensity of pain syndrome, length of operation and extent of blood loss) of 81 prospec-tively enrolled male patients who in 2017–2018 had been operated for Th11-L2 vertebrae simple fractures of А3N0M1 type (AOSpine classifcation). The patients were divided into 3 groups in accordance with the type of intervention performed on them: short-segment (n=42), 8-screws polysegment (n=25) and 6-screws polysegment (n=14). Biome-chanical simulation based on the computer tomography data was performed for each variant of the metal construction arrangement. Results. In the process of biomechanical simulation with all the variants of the instrumented spine 3D- models loading 8-screws construction proved to be the most consistent one, at that the stability of polysegmental constructions exceeds that of bisegmental one by an order. The results of surgical management were evaluated in terms of up to a year following the intervention. The loss was less and the correction worked better with polysegmental fxation despite more complicated initial conditions for the correction compared to those of group 1 Conclusion. Biomechanical simulation shows prerequisites for the development of bisegmental systems instability as the equivalent stresses and peak displacements are higher compared to those of polysegmental fxation. The efciency analysis of application of various transpedicular fxations for type A3 thoracolumbar transition lesions attests to the advantage of polysegmental arrangements of transpedicular systems, at that the implantation of the 6- screws polysegmental system should be considered the frst choice on the number of indices.

AttachmentSize
2019_02_275-283.pdf1.7 MB

Carotid arteries ultrasound screening in asymptomatic patients

Year: 2019, volume 15 Issue: №1 Pages: 190-199
Heading: Neurology Article type: Original article
Authors: Shchanitsyn I.N., Shvarts E.Yu., Ishmukhametova R.A., Vozdeeva A.S.
Organization: Saratov State Medical University
Summary:

Objective: to reveal the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Region with the help of multivariate analysis and to define an ideal patient for ultrasound screening. Material and Methods. In 2014-2018 off-site consultations and ultrasound screening were performed for asymptomatic patients with suspected carotid artery disease in outpatient clinics of Saratov and Saratov Region. Those patients were referred for screening by neurologists and general practitioners. The study used 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis (>50%). Results. The >30% carotid artery stenosis was detected in 24.5% (115/470) of participants, >50% stenosis — in 10.2% (48/470) of participants, >70% stenosis — in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding >50% stenosis in patients chosen by neurologists and general physicians for screening was significantly higher in the presence of following factors: age older then 72, male sex, acute cerebrovascular event more than 6 months ago, atherosclerosis in arteries of lower extremities, episodes of speech disorder. The point scale for risk assessment has been created. In the absence of prognostic factors the absolute risk of >50% stenosis was only 3%. In the presence of 1 point it was 16% and more than 50% in the presence of 4 points. Conclusion. The analysis we conducted allowed to specify major predictors of atherosclerosis in patients followed in outpatient clinics of Saratov and Saratov Region and to create the patient model which allows to optimize selection for ultrasound screening.

AttachmentSize
2019_01-1_190-199.pdf839.17 KB

Biomechanical aspects of circular spondylosynthesis of transitional thoracolumbar spine

Year: 2018, volume 14 Issue: №3 Pages: 560-566
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shul'ga A.E., Shchanitsyn I.N., Skripachenko K.K.
Organization:
Summary:

Aim: to present the potential of biomechanical modeling in individual choice of optimal surgical correction method for transitional thoracolumbar spine injury. Material and Methods. We built solid-base 3-dimensional model of the investigated spine segment in Mimics13 on the basis of CT data of injured thoracolumbar spine. Cage and anchorage models were created in CAE system SolidWorks. Numeric modeling was performed in ANSYS in Workbench medium. We analyzed full movement fields, their maximum values for each model as well as equivalent stress in vertebra and anchorage systems. Results. The analysis of equivalent stress and full movement fields emerging in the models under seven basic types of load revealed the most stable spondylosynthesis model which is circular spine

AttachmentSize
2018_3-1_560-566.doc77.62 KB

Personalized approach to diagnostics and treatment of patients with posttraumatic and degenerative diseases of cervical spine

Year: 2018, volume 14 Issue: №2 Pages: 244-250
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ostrovsky V.V., Shchanitsyn I.N.
Organization:
Summary:

Aim: to develop a personalized approach to diagnostics and treatment of patients outcomes with degenerative and post-injury deformities of cervical spine. Material and Methods. Between January 2009 and January 2016, 520 patients at the age of 15-80 years with degenerative (227) and traumatic (293) lesions of cervical spine were treated in neuro-surgical department. We conducted a comparative analysis of two groups of patients: treated in the period from 2009 to 2012 (group 1: 235 patients) and in the period from 2013 to 2016 (group 2: 285 patients). The developed diagnostic algorithm was used in patients of group 2 when the operation was planned. Results. The frequency of all complications was significantly lower in group 2. In the analysis of complications it was revealed that more often in group 1 there were: dysphagia, dysphonia, severe postoperative pain in the neck and upper limbs; breakdown or malposition of the screw, graft or plate. Conclusion. The comprehensive algorithms for diagnosis and treatment of patients with degenerative and post-injury deformities of cervical spine that take into account their individual morphometric and functional data allow to form an effective personalized program of surgical rehabilitation and reduce the number of perioperative complications from 35 to 9%.

AttachmentSize
2018_2_244-250.pdf2.34 MB

Public knowledge of risk factors, signs and treatment of stroke: Analysis of the survey results in 2014 and 2017

Year: 2018, volume 14 Issue: №1 Pages: 177-185
Heading: Neurology Article type: Original article
Authors: Shchanitsyn I.N., Razdorskaya V.V., Kolokolov O.V., Lukina E.V., Loi'ko V.S,
Organization: Center of Medical Inspection, Moscow, Saratov State Medical University
Summary:

Aim. This study was conducted to establish levels of knowledge in the general population, and also to determine the impact of educational sessions on stroke knowledge. Material and Methods. Two groups (2014 and 2017 years) completed a stroke knowledge questionnaire (435 respondents). Results. Overall, most of respondents could list 2 or more risk factors, but only 50% in 2014 could list 3 warning signs. More than 80% would call emergency number in response to stroke, but only 25% had heard of thrombolytic therapy. Overall stroke knowledge scores decreased in 2017 despite the public awareness in the media. Conclusion. Currently the knowledge of stroke risk factors, warning signs, and treatment is poor in Saratov. Our study demonstrates that more educational campaigns should be conducted for improve knowledge of stroke symptoms, and therapy.

AttachmentSize
2018_01-1_177-185.pdf1.17 MB

Transradial approach for carotid artery stenting

Year: 2016, volume 12 Issue: №2 Pages: 304-311
Heading: Neurology Article type: Review
Authors: Shchanitsyn I.N., Sharafutdinov M.R., Larin I.V.
Organization: Saratov State Medical University, State Autonomous Institution of Health of the Republic of Tatarstan "Emergency Hospital"
Summary:

Carotid artery stenting (CAS) has proved to be a valuable alternative to carotid endarterectomy in patients with carotid artery stenosis. Therefore, avoiding complications becomes crucial in CAS. The results are constantly improving because of the introduction of new embolic protection devices and small calibre stenting systems. For many years, transfemoral approach has been the most common access during CAS, mainly due to its short learning curve and possibility to accept large bore catheters. However, this approach is not always feasible because of vessel pathology or aberrant anatomy of the iliofemoral arteries and the aortic arch. Carotid artery stenting using transradial approach was safe and technically feasible, but limited data exist on radial access in carotid artery stenting. The rationale for the transradial approach was to attempt to reduce the incidence of bleeding complications at the vascular access site and to avoid the necessity for prolonged bed rest. Several pilot studies and one randomised prospective trial have confirmed the safety and efficacy of transradial approach for CAS. This article reports review of literature and our initial experience using the radial artery as access for carotid stenting.

AttachmentSize
2016_02-1_304-311.pdf819.03 KB