Pub Date : 2023-12-12DOI: 10.29413/abs.2023-8.5.20
N. Sholokhova, D. K. Zharkov, D. A. Lezhnev, A. Vasilyev, V. Petrovskaya, E. Y. Lazarenko, N. N. Blinov, A. D. Sergeeva
The high incidence rate and wide range of musculoskeletal pathologies determine the improvement of the diagnostic process. Late diagnosis leads to complications, which in turn increase the percentage of disability. Therefore, the search for the most informative method with the least radiation load on the patient remains an urgent problem for radiologists. Cone beam computed tomography (CBCT) is a modern and promising technique that has already found wide application in dentistry and otorhinolaryngology. Among the advantages of CBCT are: three-dimensional image; high spatial resolution; low radiation dose. Thanks to technical improvements in equipment and the introduction of new image processing protocols, it has become possible to expand the indications for conducting the researches, including the researches based on imaging of the upper and lower extremities. Based on the results of a CBCT study, we can evaluate: the shape and contour of the bone; solution of continuity of the bone and malposition of bone fragments; the structure of bone tissue and the pathological processes occurring in it (destruction, osteoporosis, osteosclerosis); joint congruence and changes in articular surfaces surrounding soft tissues. Therefore, CBCT can be introduced into the diagnostic process of bones and joints diseases. The use of this technique will find wide application in traumatology and orthopedics (fractures, dislocations, post-traumatic deformities, aseptic necrosis, osteoarthritis), rheumatology (rheumatoid arthritis, polyarthropathy, juvenile arthritis, gout), surgery (osteomyelitis), oncology (benign and malignant bone tumors) both in the adult population and in pediatric practice. This paper presents a review of the literature, which examines the degree of development of the issue of using CBCT and describes study protocols and protocols for processing the obtained images in the diagnosis of musculoskeletal diseases.
{"title":"The current state of the issue of using cone beam computed tomography in the diagnosis of musculoskeletal diseases","authors":"N. Sholokhova, D. K. Zharkov, D. A. Lezhnev, A. Vasilyev, V. Petrovskaya, E. Y. Lazarenko, N. N. Blinov, A. D. Sergeeva","doi":"10.29413/abs.2023-8.5.20","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.20","url":null,"abstract":"The high incidence rate and wide range of musculoskeletal pathologies determine the improvement of the diagnostic process. Late diagnosis leads to complications, which in turn increase the percentage of disability. Therefore, the search for the most informative method with the least radiation load on the patient remains an urgent problem for radiologists. Cone beam computed tomography (CBCT) is a modern and promising technique that has already found wide application in dentistry and otorhinolaryngology. Among the advantages of CBCT are: three-dimensional image; high spatial resolution; low radiation dose. Thanks to technical improvements in equipment and the introduction of new image processing protocols, it has become possible to expand the indications for conducting the researches, including the researches based on imaging of the upper and lower extremities. Based on the results of a CBCT study, we can evaluate: the shape and contour of the bone; solution of continuity of the bone and malposition of bone fragments; the structure of bone tissue and the pathological processes occurring in it (destruction, osteoporosis, osteosclerosis); joint congruence and changes in articular surfaces surrounding soft tissues. Therefore, CBCT can be introduced into the diagnostic process of bones and joints diseases. The use of this technique will find wide application in traumatology and orthopedics (fractures, dislocations, post-traumatic deformities, aseptic necrosis, osteoarthritis), rheumatology (rheumatoid arthritis, polyarthropathy, juvenile arthritis, gout), surgery (osteomyelitis), oncology (benign and malignant bone tumors) both in the adult population and in pediatric practice. This paper presents a review of the literature, which examines the degree of development of the issue of using CBCT and describes study protocols and protocols for processing the obtained images in the diagnosis of musculoskeletal diseases.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"2 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.29413/abs.2023-8.5.22
D. V. Menshova
The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.
{"title":"Surgical treatment of massive rotator cuff tears (literature review)","authors":"D. V. Menshova","doi":"10.29413/abs.2023-8.5.22","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.22","url":null,"abstract":"The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"19 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.29413/abs.2023-8.5.25
E. Anastasieva, L. Cherdantseva, A. E. Medvedchikov, V. Lukinov, I. Kirilova
Over the past decade, in global practice, the frequency of using high-resolution multi-layer spiral computed tomography (MSCT) for assessing the state of cancellous and cortical bone tissue has significantly increased. Using high-resolution MSCT makes it possible to assess X-ray bone density at various times after replacement of cortical plate defects with osteoplastic materials. The aim of the research. To study the restoration of cortical bone density in the area of osteoplasty using tissue-engineered construct in the experiment. Materials and methods. In an in vivo experiment on New Zeland White (NZW) rabbits, perforation defects of cortical bone were formed in the femoral diaphysis. Three study groups were set up: group 1 – without bone defect replacement; group 2 – with bone defect replacement with deproteinized cancellous bone; group 3 – with bone defect replacement with tissue-engineered construct based on deproteinized cancellous bone with stromal vascular fraction of adipose tissue. Follow-up periods were 2, 4 and 6 weeks after the surgery. The X-ray density of cortical bone tissue was measured in Hounsfield units (HU). Fragments of deproteinized human cancellous bone were used alone and in combination with the stromal vascular fraction of NZW rabbit adipose tissue as a bone-replacing material for bone defect replacement. Results. Cortical plate density the in the area of the defect in the group 3 by the week 6 is on average 1.3 times lower than that of the intact cortical plate and corresponds to D1 according to Misch classification. Cortical plate density in the area of the defect on the side of medullary canal by the week 6 in the group 3 corresponds to D1 according to Misch classification and is equal to 1351.25 ± 221.18 HU (1052; 1805), which is 1.5 times higher than in group 2 (D2 according to Misch classification; p < 0.05). The obtained results indicate an earlier restoration of X-ray bone density when using a tissue-engineered construct (group 3) compared to the same indicators in groups 1 and 2.
{"title":"Restoration of X-ray bone density when replacing cortical plate defects with a tissue-engineered construct in the experiment","authors":"E. Anastasieva, L. Cherdantseva, A. E. Medvedchikov, V. Lukinov, I. Kirilova","doi":"10.29413/abs.2023-8.5.25","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.25","url":null,"abstract":"Over the past decade, in global practice, the frequency of using high-resolution multi-layer spiral computed tomography (MSCT) for assessing the state of cancellous and cortical bone tissue has significantly increased. Using high-resolution MSCT makes it possible to assess X-ray bone density at various times after replacement of cortical plate defects with osteoplastic materials. The aim of the research. To study the restoration of cortical bone density in the area of osteoplasty using tissue-engineered construct in the experiment. Materials and methods. In an in vivo experiment on New Zeland White (NZW) rabbits, perforation defects of cortical bone were formed in the femoral diaphysis. Three study groups were set up: group 1 – without bone defect replacement; group 2 – with bone defect replacement with deproteinized cancellous bone; group 3 – with bone defect replacement with tissue-engineered construct based on deproteinized cancellous bone with stromal vascular fraction of adipose tissue. Follow-up periods were 2, 4 and 6 weeks after the surgery. The X-ray density of cortical bone tissue was measured in Hounsfield units (HU). Fragments of deproteinized human cancellous bone were used alone and in combination with the stromal vascular fraction of NZW rabbit adipose tissue as a bone-replacing material for bone defect replacement. Results. Cortical plate density the in the area of the defect in the group 3 by the week 6 is on average 1.3 times lower than that of the intact cortical plate and corresponds to D1 according to Misch classification. Cortical plate density in the area of the defect on the side of medullary canal by the week 6 in the group 3 corresponds to D1 according to Misch classification and is equal to 1351.25 ± 221.18 HU (1052; 1805), which is 1.5 times higher than in group 2 (D2 according to Misch classification; p < 0.05). The obtained results indicate an earlier restoration of X-ray bone density when using a tissue-engineered construct (group 3) compared to the same indicators in groups 1 and 2.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"24 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.14
D. V. Menshova, N. Ponomarenko, I. Kuklin, N. Tishkov, M. Puseva
Rotator cuff tears are one of the most common musculoskeletal injuries and account for about 20 %. Massive rotator cuff tears account for up to 40 % of all tears. There is no single approach in the treatment of patients with massive rotator cuff tears. We have developed a new method of surgical treatment of these patients – arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. The aim of the study. To assess the effectiveness of surgical treatment of patients with massive rotator cuff tears who had arthroscopically assisted transposition of the latissimus dorsi tendon using an autograft of a 1/2 of the tendon of the long peroneal muscle. Materials and methods. The study included 15 patients with Patte stage III and Thomazeau grade 2–3 massive rotator cuff tears, who had arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. Results. The article presents the long-term results of surgical treatment of patients using the developed method. The following criteria were evaluated: average age; time since injury; duration of surgery. Functional outcome was assessed using the ASES (American Shoulder and Elbow Surgeons) scale. Taking into account the indicators on the ASES functional scale 1 year after surgical treatment, the following results were obtained: excellent – in 14 (93.3 %) patients, satisfactory – in 1 (6.7 %) patient. Conclusion. The developed method allows us to restore the function of the shoulder joint as early as it possible, to reduce the severity of the pain syndrome and to improve the quality of life of patients.
{"title":"Assessment of the effectiveness of surgical treatment of patients with massive tears of the rotator cuff tendons using arthroscopically assisted transposition of the latissimus dorsi tendon","authors":"D. V. Menshova, N. Ponomarenko, I. Kuklin, N. Tishkov, M. Puseva","doi":"10.29413/abs.2023-8.5.14","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.14","url":null,"abstract":"Rotator cuff tears are one of the most common musculoskeletal injuries and account for about 20 %. Massive rotator cuff tears account for up to 40 % of all tears. There is no single approach in the treatment of patients with massive rotator cuff tears. We have developed a new method of surgical treatment of these patients – arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. The aim of the study. To assess the effectiveness of surgical treatment of patients with massive rotator cuff tears who had arthroscopically assisted transposition of the latissimus dorsi tendon using an autograft of a 1/2 of the tendon of the long peroneal muscle. Materials and methods. The study included 15 patients with Patte stage III and Thomazeau grade 2–3 massive rotator cuff tears, who had arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. Results. The article presents the long-term results of surgical treatment of patients using the developed method. The following criteria were evaluated: average age; time since injury; duration of surgery. Functional outcome was assessed using the ASES (American Shoulder and Elbow Surgeons) scale. Taking into account the indicators on the ASES functional scale 1 year after surgical treatment, the following results were obtained: excellent – in 14 (93.3 %) patients, satisfactory – in 1 (6.7 %) patient. Conclusion. The developed method allows us to restore the function of the shoulder joint as early as it possible, to reduce the severity of the pain syndrome and to improve the quality of life of patients.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.17
V. Potapov, S. Larionov, A. Zhivotenko, A. V. Gorbunov, V. Sorokovikov
The aim. To study the frequency and treatment options for dysfunction of the dynamic stabilization system of the lumbar spine. Materials and methods. We carried out a retrospective analysis of the treatment of 58 patients with degenerative pathology of the lumbar spine and instability of the spinal motion segments, who were treated at the neurosurgical unit of the Irkutsk Scientific Centre of Surgery and Traumatology in 2011–2020. The stability of spinal motion segment was assessed using X-ray imaging, magnetic resonance imaging and multi-layer spiral computed tomography of the lumbar spine. Revision surgery was performed in 7 out of 58 previously operated patients using the dynamic fixation system of spinal motion segments “Coflex” (Paradigm Spine LLC, Germany). Results. Revision surgery was performed in 7 out of 58 patients with dynamic fixation of the spinal motion segments with an interosseous implant due to an increase in pain syndrome. In 1 patient, the reason for repeated surgery was primary instability of the hardware caused by a fracture of the spinous process. In the delayed period, 4 patients had an X-ray picture with heterotopic ossification of the implant and instability of PDS. In two observations, a recurrence of intervertebral hernia was diagnosed at the level of the operated spinal motion segment. During revision surgery, a facetectomy was performed with stabilization by a peek cage, followed by pain management and clinical manifestation regression. Conclusion. The conducted study shows that a number of patients after discectomy and dynamic stabilization of the spine using “Coflex” system have inconsistency and heterotypic ossification of the implant and neoarthrosis. Implantation of a lumbar peek cage while maintaining the “Coflex” device makes it possible to form a rigid interbody fusion, which means it is sufficient and justified surgical technology for treating the failure of the dynamic stabilization system.
{"title":"Revision surgery for failure of the dynamic stabilization system of the lumbar spine","authors":"V. Potapov, S. Larionov, A. Zhivotenko, A. V. Gorbunov, V. Sorokovikov","doi":"10.29413/abs.2023-8.5.17","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.17","url":null,"abstract":"The aim. To study the frequency and treatment options for dysfunction of the dynamic stabilization system of the lumbar spine. Materials and methods. We carried out a retrospective analysis of the treatment of 58 patients with degenerative pathology of the lumbar spine and instability of the spinal motion segments, who were treated at the neurosurgical unit of the Irkutsk Scientific Centre of Surgery and Traumatology in 2011–2020. The stability of spinal motion segment was assessed using X-ray imaging, magnetic resonance imaging and multi-layer spiral computed tomography of the lumbar spine. Revision surgery was performed in 7 out of 58 previously operated patients using the dynamic fixation system of spinal motion segments “Coflex” (Paradigm Spine LLC, Germany). Results. Revision surgery was performed in 7 out of 58 patients with dynamic fixation of the spinal motion segments with an interosseous implant due to an increase in pain syndrome. In 1 patient, the reason for repeated surgery was primary instability of the hardware caused by a fracture of the spinous process. In the delayed period, 4 patients had an X-ray picture with heterotopic ossification of the implant and instability of PDS. In two observations, a recurrence of intervertebral hernia was diagnosed at the level of the operated spinal motion segment. During revision surgery, a facetectomy was performed with stabilization by a peek cage, followed by pain management and clinical manifestation regression. Conclusion. The conducted study shows that a number of patients after discectomy and dynamic stabilization of the spine using “Coflex” system have inconsistency and heterotypic ossification of the implant and neoarthrosis. Implantation of a lumbar peek cage while maintaining the “Coflex” device makes it possible to form a rigid interbody fusion, which means it is sufficient and justified surgical technology for treating the failure of the dynamic stabilization system.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"30 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.19
I. Usoltsev, S. Leonova, M. Kosareva
Background. Brachymetatarsia is a rare disease characterized by abnormal shortening of one or more metatarsal bones. The clinical picture is most often dominated by complaints of aesthetic dissatisfaction, as well as pain in the forefoot caused by mechanical dysfunction. A radical way to solve the problem is surgical treatment. The aim. To demonstrate a rare clinical observation of a patient with bilateral brachymetatarsia of both feet. Materials and methods. The article presents a case of stepwise treatment of a patient with bilateral brachymetatarsia with shortening of the III and IV metatarsal bones in combination with hallux valgus. Results and discussion. According to the protocol, the patient underwent stepwise reconstruction of the forefoot of both feet with intervention on all five metatarsal bones. After all the rehabilitation measures, there was a complete restoration of all functions of both lower limbs after the surgery, and the patient was satisfied with the aesthetic result of the surgical treatment. Conclusions. The obtained result of treatment of a patient with bilateral brachymetatarsia allows us to conclude that the use of this group of techniques is acceptable with the obligatory preoperative calculation of the necessary shortening and lengthening of the metatarsal bones, focusing on the parameters of the metatarsal formula of the forefoot, even in combination with other deformities.
{"title":"Forefoot reconstruction in brachymetatarsia","authors":"I. Usoltsev, S. Leonova, M. Kosareva","doi":"10.29413/abs.2023-8.5.19","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.19","url":null,"abstract":"Background. Brachymetatarsia is a rare disease characterized by abnormal shortening of one or more metatarsal bones. The clinical picture is most often dominated by complaints of aesthetic dissatisfaction, as well as pain in the forefoot caused by mechanical dysfunction. A radical way to solve the problem is surgical treatment. The aim. To demonstrate a rare clinical observation of a patient with bilateral brachymetatarsia of both feet. Materials and methods. The article presents a case of stepwise treatment of a patient with bilateral brachymetatarsia with shortening of the III and IV metatarsal bones in combination with hallux valgus. Results and discussion. According to the protocol, the patient underwent stepwise reconstruction of the forefoot of both feet with intervention on all five metatarsal bones. After all the rehabilitation measures, there was a complete restoration of all functions of both lower limbs after the surgery, and the patient was satisfied with the aesthetic result of the surgical treatment. Conclusions. The obtained result of treatment of a patient with bilateral brachymetatarsia allows us to conclude that the use of this group of techniques is acceptable with the obligatory preoperative calculation of the necessary shortening and lengthening of the metatarsal bones, focusing on the parameters of the metatarsal formula of the forefoot, even in combination with other deformities.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.18
V. G. Fedorov, I. V. Kuzin
Background. Femoral diaphysis fractures are one of the most common and significant injuries to the bones of the limbs. Locked intramedullary osteosynthesis makes it possible to reduce the injury rate of the surgery and its length, as well as to carry out early rehabilitation of patients. The aim of the study. To conduct a continuous retrospective single-purpose comparative study of the results of treatment of patients with femoral diaphysis fractures treated with locked intramedullary osteosynthesis and extramedullary osteosynthesis for 10 years. This study did not include patients with double femoral fractures treated by osteosynthesis using a combination of two implants – locked intramedullary implant and extramedullary implant. Material and methods. We conducted a retrospective study of the results of treatment of patients from 2011 to 2020. During this period, we treated 794 patients aged from 16 to 77 years with femoral diaphysis fractures. The share of people of working age was 75 %. The patients were divided into two groups depending on the method of surgical treatment. Group 1 included 500 patients who had surgical treatment using locked intramedullary osteosynthesis. Group 2 included 294 patients who had surgical treatment using extramedullary osteosynthesis. Results. In patients of group 1 treated with locked intramedullary osteosynthesis, good anatomical and functional treatment results were achieved in 70 % of cases; satisfactory treatment results – in 25.2 % of cases, unsatisfactory results – in 4.8 %. In the group 2, good results were achieved in 61.9 % of cases, satisfactory – in 29.6 %, unsatisfactory – in 8.5 %. Conclusion. The obtained results of treatment of femoral diaphysis fractures show the undeniable advantage of using locked intramedullary osteosynthesis compared to extramedullary osteosynthesis.
{"title":"The results of treatment of femoral diaphysis fractures using locked intramedullary osteosynthesis and extramedullary osteosynthesis (results for 10 years)","authors":"V. G. Fedorov, I. V. Kuzin","doi":"10.29413/abs.2023-8.5.18","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.18","url":null,"abstract":"Background. Femoral diaphysis fractures are one of the most common and significant injuries to the bones of the limbs. Locked intramedullary osteosynthesis makes it possible to reduce the injury rate of the surgery and its length, as well as to carry out early rehabilitation of patients. The aim of the study. To conduct a continuous retrospective single-purpose comparative study of the results of treatment of patients with femoral diaphysis fractures treated with locked intramedullary osteosynthesis and extramedullary osteosynthesis for 10 years. This study did not include patients with double femoral fractures treated by osteosynthesis using a combination of two implants – locked intramedullary implant and extramedullary implant. Material and methods. We conducted a retrospective study of the results of treatment of patients from 2011 to 2020. During this period, we treated 794 patients aged from 16 to 77 years with femoral diaphysis fractures. The share of people of working age was 75 %. The patients were divided into two groups depending on the method of surgical treatment. Group 1 included 500 patients who had surgical treatment using locked intramedullary osteosynthesis. Group 2 included 294 patients who had surgical treatment using extramedullary osteosynthesis. Results. In patients of group 1 treated with locked intramedullary osteosynthesis, good anatomical and functional treatment results were achieved in 70 % of cases; satisfactory treatment results – in 25.2 % of cases, unsatisfactory results – in 4.8 %. In the group 2, good results were achieved in 61.9 % of cases, satisfactory – in 29.6 %, unsatisfactory – in 8.5 %. Conclusion. The obtained results of treatment of femoral diaphysis fractures show the undeniable advantage of using locked intramedullary osteosynthesis compared to extramedullary osteosynthesis.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.13
M. L. Lebed, M. G. Kirpichenko, E. V. Novikova, T. G. Lebed, A. Mankov
Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys. The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology. Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021. Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group. Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration. Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase. Conclusions. Acute kidney injury was detected in 7.3 % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in patients of the study group included relatively low initial and minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m2 allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement.
{"title":"Acute kidney injury after primary total hip replacement","authors":"M. L. Lebed, M. G. Kirpichenko, E. V. Novikova, T. G. Lebed, A. Mankov","doi":"10.29413/abs.2023-8.5.13","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.13","url":null,"abstract":"Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys. The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology. Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021. Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group. Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration. Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase. Conclusions. Acute kidney injury was detected in 7.3 % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in patients of the study group included relatively low initial and minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m2 allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"58 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.16
E. N. Slaykovskiy, N. Ponomarenko, I. Kuklin
Rotator cuff injury is a common pathology: up to 20 % of the population over 45 years of age has ruptures of varying severity, and up to 40 % of these ruptures are large and massive. The gradual development of tendon degeneration and fatty degeneration of muscle tissue and the asymptomatic course of the disease often lead to late medical attention when secondary arthropathy of the shoulder joint develops. With age, the probability of having a rupture increases, reaching 51 % in people over 80 years of age. The main diagnostic tools are radiography and magnetic resonance imaging of the shoulder joint combined with clinical examination. Conservative treatment for massive injuries is ineffective, and the risk of worsening rotator cuff tendinopathy to rupture reaches 54 %. There are three main directions in the surgery of rotator cuff injuries: tendon reconstruction or replacement of their defect with grafts; muscle transfer; shoulder arthroplasty. Subacromial balloon spacer and tenogenic patches are also used. Each of these methods has a number of disadvantages and limitations. The frequency of repeated ruptures of reconstructed tendons reaches 45 %. Muscle transfer is extremely demanding on the skill of the surgeon and is associated with high risks of neurological complications. Arthroplasty imposes a number of significant restrictions on the patient, reducing the quality of life, and prosthesis components wear increases the risk of complications, especially during revision interventions. The use of the subacromial spacer is limited by its high cost and lack of long-term follow-up of treatment outcomes. Tenogenic patches have not undergone clinical trials, being an experimental technique. There is no single approach to the treatment of massive rotator cuff ruptures. The results are contradictory, the advantages of each of the methods are balanced by their disadvantages, which provides a wide window of opportunity in the studying, optimizing classical and introducing new methods of treatment of this pathology
{"title":"Rotator cuff tendon ruptures (literature review)","authors":"E. N. Slaykovskiy, N. Ponomarenko, I. Kuklin","doi":"10.29413/abs.2023-8.5.16","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.16","url":null,"abstract":"Rotator cuff injury is a common pathology: up to 20 % of the population over 45 years of age has ruptures of varying severity, and up to 40 % of these ruptures are large and massive. The gradual development of tendon degeneration and fatty degeneration of muscle tissue and the asymptomatic course of the disease often lead to late medical attention when secondary arthropathy of the shoulder joint develops. With age, the probability of having a rupture increases, reaching 51 % in people over 80 years of age. The main diagnostic tools are radiography and magnetic resonance imaging of the shoulder joint combined with clinical examination. Conservative treatment for massive injuries is ineffective, and the risk of worsening rotator cuff tendinopathy to rupture reaches 54 %. There are three main directions in the surgery of rotator cuff injuries: tendon reconstruction or replacement of their defect with grafts; muscle transfer; shoulder arthroplasty. Subacromial balloon spacer and tenogenic patches are also used. Each of these methods has a number of disadvantages and limitations. The frequency of repeated ruptures of reconstructed tendons reaches 45 %. Muscle transfer is extremely demanding on the skill of the surgeon and is associated with high risks of neurological complications. Arthroplasty imposes a number of significant restrictions on the patient, reducing the quality of life, and prosthesis components wear increases the risk of complications, especially during revision interventions. The use of the subacromial spacer is limited by its high cost and lack of long-term follow-up of treatment outcomes. Tenogenic patches have not undergone clinical trials, being an experimental technique. There is no single approach to the treatment of massive rotator cuff ruptures. The results are contradictory, the advantages of each of the methods are balanced by their disadvantages, which provides a wide window of opportunity in the studying, optimizing classical and introducing new methods of treatment of this pathology","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.29413/abs.2023-8.5.15
A. I. Plakhov, L. Korytov, V. G. Vinogradov, M. Darenskaya, S. V. Makarov
Background. An in-depth analysis of the scientific works of scientists and medical practitioners allows us to conclude that locked nail intramedullary osteosynthesis is the optimal and the most effective method of treating closed diaphyseal fractures of the lower leg bones, which is caused by the high stability of osteosynthesis and minimal damage to soft tissues during surgery. The processes of microcirculation changes in the early postoperative period by various metal structures, including a locked intramedullary nail, still remain unexplored. In particular, there is insufficient data on the use of a locked intramedullary nail. The aim of the study. To identify the features of changes in microcirculation indices of injured lower leg bones during fixation of fragments with a locked intramedullary nail in the early postoperative period. Materials and methods. The microcirculation of the lower limb segment was studied in 25 patients using laser Doppler flowmetry. Data from 25 healthy volunteers were used as a comparison group. Results. It was found that in the early postoperative period, from day 1 to day 10, in patients with diaphyseal fractures of the lower leg bones operated with locked nail intramedullary osteosynthesis, there is a decrease in the cardiac range, an increase in the share of the shunt component of microcirculation compared to the nutritional share, as well as an increase in more than 1 ratio of the cardiac and respiratory range amplitude, which indicates an ischemia type of local circulatory disorder. Compensation of ischemia is done by anastomoses, since the bypass rate is increased. Conclusion. In case of surgical treatment with locked nail intramedullary osteosynthesis, in the early postoperative period, an ischemic type of compensated local circulatory disorder develops. The regeneration process takes place under conditions of reduced arterial microcirculation blood flow and stable venous outflow, as well as the inclusion of anastomoses to compensate for destroyed vessels, which is associated with nail damage to the internal blood flow of the bone endosteum and intraosseous nutrient artery during the surgery.
{"title":"Microcirculation parameters of the damaged segment of the lower extremity after treatment of diaphyseal fractures using a locked intramedullary nail","authors":"A. I. Plakhov, L. Korytov, V. G. Vinogradov, M. Darenskaya, S. V. Makarov","doi":"10.29413/abs.2023-8.5.15","DOIUrl":"https://doi.org/10.29413/abs.2023-8.5.15","url":null,"abstract":"Background. An in-depth analysis of the scientific works of scientists and medical practitioners allows us to conclude that locked nail intramedullary osteosynthesis is the optimal and the most effective method of treating closed diaphyseal fractures of the lower leg bones, which is caused by the high stability of osteosynthesis and minimal damage to soft tissues during surgery. The processes of microcirculation changes in the early postoperative period by various metal structures, including a locked intramedullary nail, still remain unexplored. In particular, there is insufficient data on the use of a locked intramedullary nail. The aim of the study. To identify the features of changes in microcirculation indices of injured lower leg bones during fixation of fragments with a locked intramedullary nail in the early postoperative period. Materials and methods. The microcirculation of the lower limb segment was studied in 25 patients using laser Doppler flowmetry. Data from 25 healthy volunteers were used as a comparison group. Results. It was found that in the early postoperative period, from day 1 to day 10, in patients with diaphyseal fractures of the lower leg bones operated with locked nail intramedullary osteosynthesis, there is a decrease in the cardiac range, an increase in the share of the shunt component of microcirculation compared to the nutritional share, as well as an increase in more than 1 ratio of the cardiac and respiratory range amplitude, which indicates an ischemia type of local circulatory disorder. Compensation of ischemia is done by anastomoses, since the bypass rate is increased. Conclusion. In case of surgical treatment with locked nail intramedullary osteosynthesis, in the early postoperative period, an ischemic type of compensated local circulatory disorder develops. The regeneration process takes place under conditions of reduced arterial microcirculation blood flow and stable venous outflow, as well as the inclusion of anastomoses to compensate for destroyed vessels, which is associated with nail damage to the internal blood flow of the bone endosteum and intraosseous nutrient artery during the surgery.","PeriodicalId":32463,"journal":{"name":"Acta Biomedica Scientifica","volume":"34 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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