Saratov JOURNAL of Medical and Scientific Research

Traumatology and Orthopedics

Complex diagnostics and treatment potential of deep implant- associated infection of knee joint

Summary:

The review of open access literature on the issues of complex diagnostics and treatment potential of implant-associated infection of the knee joint area was given in the article. We describe clinical signs, the potential of laboratory diagnostics of deep implant-associated infection from the point of view of sensitivity and specificity as well as main methods of surgical treatment of the pathology.

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Morphofunctional state of spleening under light desynchronosis in the experiment

Year: 2018, volume 14 Issue: №3 Pages: 533-536
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Zlobina O.V., Ivanov A.N., Karetnikova A.Yu., Terekhina E.S., Bugaeva I.O.
Organization: Saratov State Medical University
Summary:

 Aim: to study the effects of light desynchronosis on the morphofunctional state of the spleen of white male rats. Material and Methods. The study of light desynchronosis was carried out on 48 male rats using the Light Light model with an illumination power of 300 Ix in the daylight and 500 Ix in the dark. The laboratory animals in the experiment were divided into four groups: the control and three experimental ones, in which they were exposed to light for 1 day, 10 days, 21 days respectively. In the course of morphometry of histological sections of the spleen, the following parameters were assessed: the area of white pulp lymphoid follicles, B- and T-clependent zones of white pulp, the number of germinative centers and immunoblasts in B- and T-zones. Results. On day 1 of the experiment, an increase in the area of the lymphoid follicle, periarterial and B-dependent zones, an increase in the number of immunoblasts and reproduction centers was registered. By the 10th day there was a partial restoration of these indicators relative to the control values. On the 21st day of the experiment, a decrease in the growth dynamics of all the morphometric parameters of the spleen was observed. Conclusion. Light desynchronosis induces by the Light Light model leads to the development of the pathology of the immune system with an extensive shift of all measurable indicators. Key words: morphofunctional state of the spleen, morphometric criteria, light desynchronosis, immunity.

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The method of controlled growth for the correction of axial deformities of lower extremities in children

Year: 2018, volume 14 Issue: №3 Pages: 529-532
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Dokhov M.M., Mashukov T.S., Sertakova A.V., Rubashkin S.A., Timaev M.Kh., Kurkin S.A.
Organization:
Summary:

Aim: to estimate the outcomes of the method of controlled growth in the correction of axial deformities of lower extremities in children. Material and Methods. We fulfilled the analysis of surgical results of 37 children aged 3-13 yrs. with leg axial deformities, valgus (20) and varus (17) leg deformities at the level of knee joints. All patients were operated in the growth area with the method of controlled growth — temporary epiphysiodesis of external portions of distal growth areas in femoral bones. The assessment of controlled growth method was conducted at 3-14 months for valgus and 6-15 months for varus leg deformities. Results. The assessment of controlled growth method use indicated clinically and X-ray proved reduction in femoral-tibial angle before the elimination of metal construction in valgus deformity 4.1 times, in varus 3.8 times. Conclusion. The method of controlled growth is highly effective correction method for axial deformities of lower extremities in children, and is minimally traumatizing.

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Intramedullary osteosynthesis in the treatment of humerus fracture consequences

Year: 2018, volume 14 Issue: №3 Pages: 523-529
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Grazhdanov К.А., Barabash А.Р., Barabash Yu.A., Kauts О.А.
Organization:
Summary:

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

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The correlation between structural changes in articular hyaline cartilage and the parameters of systemic manifestations of inflammatory reaction in the pathogenesis of early stages of primary osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 518-523
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Gladkova Е.М., Ivanov A.N.
Organization:
Summary:

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.

 

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The role of skeletal tissue remodeling markers in the patho-genesis of implant-associated inflammation after primary knee arthroplasty

Year: 2018, volume 14 Issue: №3 Pages: 515-518
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Galashina Е.А., Bondarenko A.S., Ulyanov V.Yu., Klimov S.S.
Organization: Saratov State Medical University
Summary:

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.

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Metabolic shifts in subjects with potential risk of primary osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 511-514
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Belova S.V., Gladkova Е.М., Ulyanov V.Yu., Blinnikova V.V.
Organization:
Summary:

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.

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The assessment system of the grade of dysplastic changes in hip joint of children of early age

Year: 2018, volume 14 Issue: №3 Pages: 505-511
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Bakhteeva N.Kh., Anisimova Е.А., Zotkin V.V., Anisimov D.l.
Organization: Saratov State Medical University
Summary:

 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.

Long-term results of posterior anchorage of subaxial vertebra in acute unstable trauma

Year: 2018, volume 14 Issue: №3 Pages: 501-504
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Bazhanov S.P., Ulyanov V.Yu., Ostrovskiy V.V., Likhachev S.V.
Organization:
Summary:

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.

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The tactics of surgical treatment in metastatic lesions of upper cervical spine.

Year: 2018, volume 14 Issue: №3 Pages: 498-501
Heading: Traumatology and Orthopedics Article type: Case report
Authors: Bazhanov S.P., Gulyaev D.A., Ulyanov V.Yu., Ostrovskiy V.V., Tolkachev V.S.
Organization: The Almazov National Medical Research Centre, Head of Second Cerebral and Spinal Cord Tumors Department, Doctor of Medical Sciences
Summary:

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.

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