Saratov JOURNAL of Medical and Scientific Research

Traumatology and Orthopedics

Comparative analysis of clinical outcomes of various methods of anterior cruciate ligament arthroplasty in knee joint in complete rupture of the ligament.

Year: 2018, volume 14 Issue: №2 Pages: 251-259
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shormanov A.M., Norkin A.l., Klimov S.S., Chibrikova Ju.A., Ulyanov V.Yu., Bakhteeva N.Kh.
Organization: Saratov State Medical University
Summary:

The aim is to carry out the analysis of outcomes of anterior cruciate ligament arthroplasty undertaken by various methods in patients with complete ligament rupture. Material and Methods. 104 patients diagnosed with complete rupture of anterior cruciate ligament (ACL) in knee joint who underwent knee joint arthroplasty fulfilled by various methods were the object of the present study. Clinical outcomes of the treatment were estimated by clinical signs of ACL failure, the degree of functional impairment of knee joint (IKDC 2000) and motor pathology assessed instrumentally. Results. Significantly better function restoration in knee joint occurring as early as 3 months postoperatively has been stated in the group of patients with two-bundle ACL arthroplasty by synthetic implant "DONA-M" on the basis of IKDC subjective knee indices. Negative Lachman test and Pivot shift test were demonstrated as early as 3 months postoperatively by all patients after two-bundle ACL arthroplasty with synthetic implant "DONA-M", reduced support asymmetry 6 months postoperatively was stated in all patient groups as well as run path and surface area in patients with single-bundle ACL arthroplasty by synthetic implant "DONA-M". Conclusion. The use of single- and double-bundle ACL arthroplasty with synthetic implant and ACL arthroplasty with autograft of semitendinosus (ST) and gracilis allows providing equally full-fledge restoration of injured knee joint, without statistically significant differences between the groups, in great majority of patients up to 12 months of follow-up period which is proved by normalized knee joint function, the absence of ACL failure and motor pathology signs estimated instrumentally. Key words: knee joint, anterior cruciate ligament (ACL), co

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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%.

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Optimization of surgical treatment tactics at a customary shoulder dislocation

Year: 2018, volume 14 Issue: №2 Pages: 240-243
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Norkin A.l., Klimov S.S., Levchenko K.K., Shormanov A.M., Alieva A.M., Katerusha A.M., Amanova M.M., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

 Saratov Journal of Medical Scientific Research 2018; 14 (2): 240-243. The aim: the optimization of surgical treatment tactics at a customary shoulder dislocation, based on "on-track Hill-Sachs / off-track Hill-Sachs" concept. Material and Methods. The research group consists of 42 patients aged from 19 to 52 years with chronic recurrent anterior shoulder instability, who underwent a surgical treatment to restore previous shoulder anatomic and topographic correlations. Patients were divided into two subgroups according to diagnostic arthroscopy results. The first subgroup includes 14 patients with impaction visualized (off-track Hill-Sachs), the second one — 28 patients with head shoulder stability (on-track Hill-Sachs). Patients of the first subgroup underwent open surgical intervention according to Bristow — Latarjetand shoulder arthroscopic repair was carried out in the second group. Results. One month after the surgical treatment median total estimated figure exceeded by 1.8 times in patients of the first subgroup and by 1.2 times, by Rowe, in patients of the second subgroup and decreased by 2.1 times in patients of the first subgroup and by 1.7 times, by DASH, in the second subgroup in comparison with the indices before the operation, that was illustrative of a good treatment result. Six months after the operation median total estimated figure exceeded by 1.2 times, by Rowe, in patients both of the first subgroup and the second subgroup and decreased by 2 and 2.1 times, by DASH, in patients of the first and the second group, relatively in comparison with the indices found one month after the operation, that was illustrative of an excellent treatment result in the late postoperative period. Conclusion. Patients with anterior shoulder instability caused by a glenoid fossa deficiency less than 25% in combination with off-track Hill-Sachs lesion, the most convenient way is the replacement of the bone loss by coracoid process transposition. In patients with on-track Hill-Sachs lesion arthroscopic repair is preferable.

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The etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary total knee replacement

Year: 2018, volume 14 Issue: №1 Pages: 30-34
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Babushkina I.V., Bondarenko A.S., Ulyanov V.Yu., Chibrikova Yu.A., Adilov R.G., Kupina E.S.
Organization: Saratov State Medical University
Summary:

The aim: to study etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary knee joint replacement and antibiotic sensitivity of main agent groups. Material and Methods. The retrospective analysis of microbiological samples of 383 patients with implant-associated inflammation occurred after primary total knee replacement. Results. Gram-positive cocci (63.5%) are the leading agents of implant-associ- ated inflammation, and there is an increase in the etiological role of coagulase-positive Staphylococci. Main agents of Gram-negative group were Enterobacteraceae and non-enzyme bacteria. We revealed high resistance of Staphylo-coccus spp. to antibiotics of various groups. Oxazolidinones and glycylcyclines were the most active among all antibiotic groups. Gram-negative bacteria were highly resistant to cephalosporine and macrolides with carbapenems and fluoroquinolones being most active. Conclusion. Gram-negative Enterobacteraceae, non-enzyme bacteria and Gram-positive cocci are most significant etiological factors in the pathogenesis of implant-associated inflammation in patients after primary total knee replacement.

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Hirudotherapy as a method of hemoreological disorders correction efficiency on osteoarthrosis

Summary:

The aim: to study the hirudotherapy effectiveness in case of osteoarthrosis as a pathogenetic therapy in view of vascular disorders in the disease pathogenesis. Material and Methods. 81 patients with ostearthrosis, predominantly gonarthrosis, aged 36 to 76 years old with a disease duration from 1 to 15 years were under observation. There were clinical and laboratory studies (generally accepted in patients with osteoarthritis), special studies included bulbar conjunctiva biomicroscopy and lower limbs rheovasography. Results. Hirudotherapy is a clinically effective method for the articular syndrome treatment in various types of osteoarthrosis. It is advisable to use the method in patients with a disease duration up to 15 years, with severe pain syndrome, concomitant peripheral veins pathology, and hypertension. Conclusion. The influence of hirudotherapy on the state of microcirculation in patients with osteoarthritis with the evaluation of the clinical effect and the rheovasography and conjunctival biomicroscopy was first studied, confirmed by instrumental methods. The greatest clinical efficacy was achieved with a high degree of local inflammatory activity, what once again emphasizes the role of microchemocirculation disorders in the development of synovitis in osteoarthritis.

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Differentiated approach to surgical treatment of patients with rigid posttraumatic deformities of thoracic and lumbar spine

Year: 2017, volume 13 Issue: №3 Pages: 772-779
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shul'ga А.Е., Zaretskov V.V., Bogomolova N.V., Korshunova G.A., Smol'kin A.A.
Organization:
Summary:

The aim: to investigate the outcomes of surgical treatment of patients with rigid posttraumatic deformities in thoracic and lumbar spine on the basis of the comparative analysis of different approaches to the planning of operative intervention management. Material and Methods. A comparative analysis of the results of surgical treatment of 138 patients (main group) with old injuries of thoracic and lumbar spine was carried out with the help of the proposed surgery managing algorithm and 86 patients (comparison group) — without taking the given algorithm into account. The choice of surgery managing in the main group of patients was based on the study of the spinal deformity degree, pain syndrome intensity and life quality indices of patients before and after surgery. Results. In the main group in 122 (88,4%) patients after the surgery spinal deformity correction exceeding 80% was achieved, pain syndrome regressed in accordance with the visual analog scale up to 3 points and less, life quality indices improved up to the level of 0-25%. Conclusion. The application of the proposed algorithm approach enables surgeons to get persistent positive outcomes in the majority of cases.

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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.

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Computer modeling of biomechanical systems «femoral bone — endoprosthesis / transplant — tibia» in different methods of anterior cruciate ligament plastics in knee joint

Year: 2017, volume 13 Issue: №3 Pages: 764-768
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shormanov A.M., Ivanov D.V., Norkin A.l., Ulyanov V.Yu., Bakhteeva N.Kh., Klimov S.S., Chibrikova Yu.A.
Organization: Saratov State Medical University
Summary:

The aim: to specify the indices of dislocation (displacement) and effective stress in biomechanical systems «femoral bone — endoprosthesis / transplant — tibia» in different methods of anterior cruciate ligament by computer modeling of a knee joint geometrically, physically and mechanically similar to human. Material and Methods. Steady-state tasks of the stress given on a knee joint after anterior cruciate ligament plastics fulfilled by different methods were resolved numerically by the method of finite elements implemented in the system of finite element analysis. Results. Maximum dislocations comprised 3.45 mm. for the method of single-beam plastics of ACL, 0.35 mm. for two-beam plastics and 0.93 mm. for plastics with semi-tendinous and gracilis tendons. Maximum stress were 1190 MPa for single-beam plastics of ACL, 141 MPa for two-beam plastics and 150 MPa for plastics with semi-tendinous and gracilis tendons. Conclusion. Finite element modeling of different ways of ACL plastics indicates higher stability of synthetic endoprosthesis under rising stress in case of two-beam plastics and transplant of semi tendinous and gracilis tendons compared to the single-beam plastics.

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Medical and sociological issues of rehabilitation of patients after hip and knee joints replacement

Year: 2017, volume 13 Issue: №3 Pages: 761-764
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Fedonnikov A.S., Erugina M.V., Andriyanova E.A., Norkin I.A.
Organization: Saratov State Medical University
Summary:

The aim: research of medical and social issues of rehabilitation after hip and knee joints replacement. Material and Methods. Sociological study of 1175 patients who have undergone in 2015-2016 total hip and knee joints replacement was conducted. Results. Within the scope of medical surveillance after the surgery 69.8% of patients made regular visits to orthopedic specialists after joint replacement, but only 9.4% of surveyed patients confirm the practice of active monitoring of rehabilitation on the part of health services. There had been determined a high level of declared patients satisfaction (more than 80%) with weak health managers activities argue considerable informational gap between the key parties of rehabilitation. Conclusion. Provided study has designated problem areas of patient and health system communication in rehabilitation after hip and knee joints replacement.

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Role of humoral immunity markers and bone tissue metabolism in paraimplant inflammation pathogenesis after primary knee arthroplasty

Year: 2017, volume 13 Issue: №3 Pages: 756-761
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ulyanov V.Ju., Bondarenko A.S., Galashina E.A., Chibrikova Ju.A,. Avilov R.G., Kupina E.S.
Organization: Saratov State Medical University
Summary:

The aim: is to study the peculiarities of paraimplant inflammation pathogenesis after primary knee arthroplasty on the basis of dynamic changes of humoral immunity markers and bone tissue metabolism. Material and Methods. Research object includes 140 cases: 50 patients with paraimplant inflammation make up the main group; 30 patients with early aseptic instability make up the first experimental group; 30 patients undergoing primary arthroplasty make up the second experimental group; 30 conditionally healthy blood serum donors make up the control group. We determined the content of humoral immunity markers (circulating immune complexes binding C3d and containing IgG, triggering receptor expressed on myeloid cells) and bone tissue metabolism (tumor necrosis factor a, interleukin 1 (3, bone isoen-zyme of alkaline phosphatase) by the method of hardphase immune-enzyme analysis in all the groups. Results. We noticed elevated activity of circulating immune complexes binding C3d and containing IgG, triggering receptor expressed on myeloid cells, proinflammatory cytokines and alkaline phosphatase in blood serum of patients with paraimplant inflammation; proinflammatory cytokines and alkaline phosphatase — in patients with early aseptic instability; there were no changes in the studied indicators- in patients undergoing primary arthroplasty. Conclusion. Increased expression of triggering receptor expressed on myeloid cells causing release of proinflammatory cytokines and also elevated activity of circulating immune complexes binding C3d and containing IgG and bone isoenzyme of alkaline phosphatase play a significant role in paraimplant inflammation pathogenesis after primary knee arthroplasty.

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