Saratov JOURNAL of Medical and Scientific Research

Shpinyak S.P.

Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky Department of Innovation Projects in Traumatology and Orthopedics, Junior Researcher, Candidate of Medical Scince

Thrombinogenesis in patients with aseptic instability of knee endoprosthesis and periprosthetic infection

Year: 2020, volume 16 Issue: №2 Pages: 478-484
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
Organization: Saratov State Medical University
Summary:

Objective: To evaluate thrombinogenesis in patients with periprosthetic infection and aseptic loosening of endoprosthesis after primary knee arthroplasty. Material and Methods: 28 of 52 examined patients who suffered from the loosening of knee endoprosthesis components and 24 from periprosthetic infection; 18 healthy individuals were also engaged into the study. Thrombinogenesis was analyzed with thrombin generation assay in an automated Ceveron alpha coagulometer (Technoclone, Austria) using RB and RC-low activators containing 2 and 5 pmol/ml of tissue factor respectively. Each of the main groups of patients was divided into two subgroups: in patients of the 1st subgroups RC-low activator aggravate thrombinogenesis while in the 2nd subgroups it inhibited the process as compared to the effects of RB activator. Results: In the 1st subgroup of patients with aseptic loosening RC-low activator caused chronometric hyperthrombinogenesis, and in the 2nd — both chronometric and structural ones. In patients with periprosthetic infection the effects of RB and RC-low activators were comparable. Conclusion: In patients with aseptic loosening of the implant and stopped periprosthetic infection that developed after primary knee replacement, the thrombin generation test reveals normal, paradoxical and inert types of thrombinogenesis.

AttachmentSize
2020_02_478-484.pdf358.6 KB

Clinical and laboratory indices of periprosthetic infection in patients with knee endoprosthesis instability

Year: 2019, volume 15 Issue: №2 Pages: 283-286
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shpinyak S.P., Galashina E.A., Babushkina I.V., Girkalo M.V., Kauts O.A., Grazhdanov K.A.
Organization:
Summary:

 Objective: to make assessment of clinical and laboratory indices in patients with deep periprosthetic infection and knee endoprosthesises aseptic instability. Material and Methods. 80 patients with septic and aseptic instability of knee endoprosthesises have been surveyed. All patients were subjected to comprehensive clinical and laboratory examination (intra-articular fuid cytology and microbiology testing, joint tissue histology testing, ELISA was employed for determining the levels of skeletal tissue remodeling markers). Results. The complete combination of several examination criteria specifc for knee periprosthetic infection was

AttachmentSize
2019_02_283-286.pdf291.67 KB

Hemostasis test parameters in patients requiring revision knee arthroplasty

Year: 2018, volume 14 Issue: №2 Pages: 266-271
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
Organization:
Summary:

Objective: comparative analysis of the blood coagulation system in patients requiring revision arthroplasty of the knee joint in connection with the developed infectious and aseptic complications after total arthroplasty. Material and Methods. 37 patients with complications of total knee replacement were examined. Patients were divided into 2 groups: 1st — with signs of suppuration (n=19); 2nd — withsigns of aseptic instability of the endoprosthesis components (n=18). The control group consisted of 22 conditionally healthy people. Studied screening coagulation: activated partial thromboplastin time, prothrombin time, fbrinogen concentration, thrombin time, antithrombin III, protein C, the content of soluble fbrin-monomer complexes and D-dimers. Results. There was an increase in activated partial thromboplastin time in patients of group 2, prothrombin time — in patients of groups 1 and 2 compared with the data obtained in the control group (p<0.001). An increase in the content of soluble fbrin- monomer complexes and D-dimers was recorded in the blood plasma of patients of the 1st and 2nd groups compared to their level in the control group (p<0.001). Conclusion. The data of local coagulogram tests in patients requiring revision arthroplasty of the knee joint refect the signs of maladaptation in the hemostatic system at the preoperative stage of examination. It is worth noting the lack of information content of the screening coagulogram, as its basic tests do not refect changes in the whole system of homeostasis, the search for new informative research methods remains relevant today.

Keywords: -
AttachmentSize
2019_02_266-271.pdf1.45 MB

Justification of intramedullary fixation devices modification and first clinical experience of application of the SarNIITO nails for femur shaft osteosynthesis

Year: 2019, volume 15 Issue: №1 Pages: 52-57
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Barabash А.Р., Norkin I.A., Barabash Yu.A., Ivanov D.V., Zuev P.P., Shpinyak S.P.
Organization:
Summary:

Objective: to estimate the changes of effective stresses (by Mises) at three types of loads (axial, lateral and twisting) for various types of intramedullary nails synthesizing modeled fractures of A1; A3; B2 types at the level of femur bone middle third. Material and Methods. To solve the preclinical tasks computer simulation of biomechanical systems bone-fixing pin and method of finite elements were employed. Results. The nails developed by SarNIITO excel ChM and Fixion rods in stress-deformed condition, fatigue strength and stability of fixation of the examined types of fractures parameters of 12- 23%. Conclusion. The mechanical characteristics of SarNIITO nails proved to be of clinical use and may be recommended for patients with femur bone diaphysis fractures.

AttachmentSize
2019_1_052-057_1.pdf1.55 MB

The methods of deep periprosthetic infection diagnostics in the area of knee joint

Year: 2018, volume 14 Issue: №3 Pages: 607-610
Heading: Traumatology and Orthopedics Article type: Review
Authors: Shpinyak S.P., Babushkina I.V., Maksyushina T.D., Galashina E.A., Chibrikova Yu.A., Bondarenko A.S., Norkin I.A.
Organization: Saratov State Medical University
Summary:

The data on the methods and promising areas of investigations potent to improve diagnostic tactics in patients with infectious complications after total knee replacement is presented.

AttachmentSize
2018_3-1_607-610.pdf254.24 KB

Comparative analysis of external osteosyn-thesis in the treatment of patients with extraarticular fractures of proximal femur

Year: 2018, volume 14 Issue: №3 Pages: 552-557
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Kauts О.А., Barabash Yu.A., Barabash А.Р., Grazhdanov К.А., Shpinyak S.P.
Organization:
Summary:

Aim: to perform comparative analysis of surgical outcomes of patients with extraarticular fractures of proximal femur with the use of various types of external osteosynthesis. Material and Methods. 169 patients with extaarticular fractures of proximal femur who underwent surgical interventions with various kinds of external osteosynthesis were the subject of the study. Results. Extra-cortical osteosynthesis with DHS-construction provided the restoration of anatomic and functional characteristics by 90.3±0.6% of normal values in the short-term and by 95.2±0.4% in the long-term postoperative period. The implantation of intramedullary constructs resulted in high percentage of positive short-term (92.1±0.6%) and long-term (96.7±0.75%) treatment outcomes. Conclusion. The use of intramedullary osteosynthesis

AttachmentSize
2018_3-1_552-557.pdf1.3 MB

The role of microbial associations in the development of implant-associated infection after primary total knee replacement

Year: 2018, volume 14 Issue: №3 Pages: 492-497
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Babushkina I.V., Bondarenko A.S., Mamonova I.A., Shpinyak S.P., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

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.

AttachmentSize
2018_3-1_492-497.pdf372.67 KB

The dynamics of patients' life quality indices under the conditions of two-stage knee joint replacement

Year: 2017, volume 13 Issue: №3 Pages: 768-772
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shpinyak S.P., Fedonnikov A.S., Barabash А.Р., Barabash Ju.A.
Organization:
Summary:

 The aim: to analyze the changes in the life quality indices of the patients with deep periprosthetic joint infection of the knee under the two-stage surgical treatment. Material and Methods. 57 patients who underwent two-stage revision-ary treatment in Research Institute of Traumatology, Orthopedics and Neurosurgery were interviewed with life quality questionnaire Short Form Medical Outcomes Study (SF 36 v.1). Interview results were compared with standardized population indices of SF-36 scales for males and females. Results. In all groups regardless of sex there was a general tendency for an increase in physical and psychological health component up to mean population values after the first stage of surgery and further growth after the second stage. Rehabilitation potential of psychomotor health was higher in women than in men. The ability to handle stress was lower in direct ratio with the patients' age. Conclusion. Two-stage reendoprosthetic treatment with articulating antimicrobial spacer implantation having high grade of fixation is an effective treatment method for deep periprosthetic infection which increases physical health and improves social functioning of patients.

AttachmentSize
2017_03-2_768-772.pdf1.16 MB

Using of computer simulation in surgical treatment of patients with fractures of proximal femur

Year: 2010, volume 6 Issue: №2 Pages: 419-421
Heading: Traumatology and Orthopedics Article type: Original article
Authors: I.A. Norkin, A.A. Svistunov, D.A. Markov, O.A. Kautz, S.P. Shpinyak A.G. Khachatryan, V.N. Belonogov
Organization: Saratov State Medical University, Saratov Scientific Research Institute of Traumatology and Orthopedics, First Moscow State Medical University n.a. I.M. Sechenov
Summary:

In this article questions of femur computer models base making for future it using in free patients medicine are discussed. Last allows possibility for educate doctors using computer models, increase their professional level and makes complications decrease. Comparing of fixation properties of DHS and PFN-A was performed

AttachmentSize
201002_419_421.pdf372.17 KB