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Lumbosacral transitional vertebrae in children and adolescents (literature review, illustrated with clinical observations) 儿童和青少年的腰骶部过渡椎体(文献综述,结合临床观察说明)
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-282-291
E. G. Skryabin, A. Y. Krivtsov, O. A. Kicherova, I. N. Klokov, P. B. Zotov, M. A. Akselrov
Introduction An analysis of the medical literature devoted to various aspects of transitional lumbosacral vertebrae shows that there are very few publications covering the course of this disease in  the  pediatric and adolescent population.Aim To study the issues of epidemiology, diagnosis, treatment and prevention of transitional lumbosacral vertebrae in paediatric and adolescent patients based on the analysis of current medical literature and illustrate the material with our own clinical observations.Material and methods To analyze the literature on the topic, 75 papers published between 1984 and 2023 were selected. Among them, there were 7 (9.3 %) domestic literary sources, 68 (90.7 %) were foreign. In the process of searching for scientific articles, the resources of the electronic databases of current medical information PubMed and CyberLeninka were used.Results and discussion The incidence of transitional vertebrae in children and adolescents is 16.8 % of clinical observations, as reported. In the structure of the transitional vertebrae in children, type II of  the  disease predominates according to the classification Castellvi et al (1984), 43.2 % of cases. The main clinical symptom of the pathology is pain of lumbosacral location, the intensity of which on the visual analog scale in children corresponds to an average of 3.0 points. In adult patients with similar pathology, the average pain intensity measured with the same scale is 7.5 points. The most informative method for  diagnosing the  disease is computed tomography, which allows obtaining both 3D images and sections at the level of pseudarthrosis between the enlarged transverse process (or processes) of the suprasacral vertebra and the wing of the sacrum. To  relieve pain in children with transitional vertebrae, both conservative and surgical methods are used. The most commonly used procedure is pseudarthrectomy. The study of  long-term results one year after the intervention allowed us to record the absence of pain in children who underwent surgery. Prevention measures for transitional lumbosacral vertebrae have not been developed.Conclusion The analysis of the published literature shows that transitional vertebrae are a frequently diagnosed pathology in children and adolescents. Current methods of imaging are able to accurately detect not only the  presence of the disease, but also to differentiate its type. The main clinical symptom of  transitional vertebrae is pain in the lumbosacral spine which is difficult to relieve with conservative therapy. Pseudarthrectomy is the most frequent surgical method of treatment in children and adolescents that provides stable relief of vertebrogenic pain syndrome. Measures for specific prevention of the disease have not been developed.
目的 在分析现有医学文献的基础上,研究儿童和青少年过渡性腰骶椎的流行病学、诊断、治疗和预防问题,并结合自己的临床观察进行说明。其中,国内文献资料 7 篇(9.3%),国外文献资料 68 篇(90.7%)。在搜索科学文章的过程中,使用了当前医学信息电子数据库PubMed和CyberLeninka的资源。结果与讨论 据报道,在临床观察中,儿童和青少年过渡椎的发病率为16.8%。根据 Castellvi 等人(1984 年)的分类,儿童过渡椎的结构以 II 型为主,占 43.2%。该病的主要临床症状是腰骶部疼痛,儿童患者的疼痛强度在视觉模拟量表上平均为 3.0 分。在患有类似病症的成年患者中,用相同量表测量的平均疼痛强度为 7.5 分。计算机断层扫描是诊断这种疾病最有用的方法,它可以获得三维图像和骶上椎体增大的横突(或多个突)与骶骨翼之间假关节水平的切面。为缓解患有过渡椎的儿童的疼痛,可采用保守和手术两种方法。最常用的方法是假关节切除术。通过对干预一年后的长期效果进行研究,我们可以记录下接受手术的儿童没有疼痛的情况。结论 对已发表文献的分析表明,过渡性腰椎是儿童和青少年中经常被诊断出的一种病理现象。目前的影像学方法不仅能准确检测出疾病的存在,还能区分其类型。过渡椎的主要临床症状是腰骶部疼痛,保守治疗难以缓解。假关节切除术是儿童和青少年最常用的手术治疗方法,可稳定缓解椎体源性疼痛综合征。具体的疾病预防措施尚未制定。
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引用次数: 0
Evolution of the first metatarsophalangeal joint replacement 第一跖趾关节置换术的演变
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-309-319
G. Kotelnikov, A. Nikolaenko, I. O. Grankin, V. V. Ivanov, P. Isaykin, S. O. Doroganov, D. Zgirsky
Introduction The diseases of the first metatarsophalangeal (1 MTP) joint that require surgical treatment include osteoarthritis (69 %), rheumatoid arthritis (26 %), tumors, tumor-like diseases and purulent arthritis (5 %). The treatment of arthritic 1 MTP is aimed at reducing pain and improving function. Joint replacement implants are meant to support body weight, maintain the length of the first metatarsal, provide metatarsal‑sesamoid joint functioning and restore joint motion. The purpose of the work was to analyze data from foreign and domestic literature on endoprosthetics of the 1 MTP, and briefly present analytical data on the results of using various implants.Material and methods The article presents the summary of the Russian and foreign publications on  1 MTP joint replacement. The original literature search was conducted on key resources including PubMed, eLIBRARY, MedLine, Scopus. The search strategy was comprised of keywords: “replacement of  the  first metatarsophalangeal joint”, “surgical treatment of hallux rigidus”, “osteoarthrosis of the first metatarsophalangeal joint”, “results of endoprosthetics of the 1st metatarsophalangeal joint”, "modernization of implants of the 1st metatarsophalangeal joint". Publications brought out between 1968 and 2022 inclusive were analyzed.Results and discussion The ideal implant should restore functional range of motion, improve function, maintain joint stability, distribute the stress across joint surfaces being wear-resistant. Over the years, various materials have been used to provide simple and reliable designs. Implants have been improved and divided into groups based on material and design, limited degrees of freedom, tribological pair composition, and the amount of articular surface replacement.Conclusion New generation implants have a more durable design, anatomical shape and improved osseointegration. The advances in joint replacement have resulted in greater patient satisfaction and increased service life. The complication rate for replacement of the 1 MTP joint remains high. This indicates the need for continued research and further work to improve implants to make them more effective and easier to use.
导言 需要手术治疗的第一跖趾关节(1 MTP)疾病包括骨关节炎(69%)、类风湿性关节炎(26%)、肿瘤、肿瘤样疾病和化脓性关节炎(5%)。治疗 1 MTP 关节炎的目的是减轻疼痛和改善功能。关节置换植入物旨在支撑体重、保持第一跖骨的长度、提供跖趾关节功能并恢复关节运动。这项工作的目的是分析国外和国内文献中有关第一跖骨内假体的数据,并简要介绍各种假体使用效果的分析数据。 材料和方法 文章总结了俄罗斯和国外有关第一跖骨关节置换的出版物。原始文献检索在PubMed、eLIBRARY、MedLine、Scopus等主要资源上进行。搜索策略包括以下关键词"第一跖趾关节置换术"、"僵直性拇指外翻的手术治疗"、"第一跖趾关节骨关节病"、"第一跖趾关节内固定术的结果"、"第一跖趾关节植入物的现代化"。结果与讨论 理想的假体应能恢复功能性活动范围、改善功能、保持关节稳定、分散关节表面的应力并具有耐磨性。多年来,各种材料被用于提供简单可靠的设计。根据材料和设计、有限的自由度、摩擦副成分和关节表面置换量等因素,植入体得到了改进和分组。关节置换术的进步提高了患者的满意度,延长了使用寿命。1 MTP 关节置换术的并发症发生率仍然很高。这表明有必要继续研究并进一步改进植入物,使其更有效、更易用。
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引用次数: 0
Evolution of tactical approaches to eliminating limb length discrepancy 消除肢长不一致战术方法的演变
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-301-308
K. I. Novikov, E. S. Komarova, S. V. Kolesnikov, O. V. Klimov, K. S. Sergeev
Introduction Limb length discrepancy (LLD) can be debilitating and may cause other medical and social problems. LLD is a serious physical condition and have a significant impact on the patient's quality of life changing the gait, forming pathological adaptive mechanisms and causing long-term musculoskeletal disturbances in children. The objective was to analyze the evolution of tactical approaches to the rehabilitation of patients with lower limb length inequality.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org). Literature searches included both Russian and English studies. The search strategy was comprised of keywords: lower limbs, limb length inequality, approaches and means of limb length correction, osteosynthesis. Clinical guidelines, clinical recommendations, systematic reviews, randomized controlled trials and multicenter cohort studies were selected for analysis.Results and discussion Normal individuals can often experience a difference in the length of the lower limbs from several mm to 1.5 cm and have no effect on the gait, condition of adjacent joints and joints of the opposite limb. Some authors report inequality of 5 mm leading to orthopaedic pathology. A variety of  conservative and  surgical treatments are offered for limb length equalization. Elimination of LLD is a  common and  unresolved medical problem. Conservative treatment of LLD can be considered as one of  the  stages of rehabilitation. Some patients can benefit from conservative treatments. Alternatively, surgical equalization is a treatment option for patients with LLD.Conclusion Surgical methods offered earlier to address LLD had disadvantages, which ultimately minimized their use, and orthopaedic surgeons abandoned some of them due to the high risk of severe complications. The device and the technique developed by Dr. Ilizarov in the 50s of the last century was an epoch-making event in the elimination of LLD and are constantly being improved.
导言 肢长不等(LLD)会使人衰弱,并可能引发其他医疗和社会问题。肢长不等是一种严重的身体状况,对患者的生活质量有重大影响,会改变步态,形成病态适应机制,并对儿童造成长期的肌肉骨骼障碍。研究目的是分析下肢长度不等患者康复战术方法的演变。材料和方法 在科学电子图书馆(www.elibrary.ru)和国家医学图书馆(www.pubmed.org)等重要资源上进行原始文献检索。文献检索包括俄文和英文研究。搜索策略包括关键词:下肢、肢体长度不等、肢体长度矫正的方法和手段、骨合成。结果与讨论 正常人的下肢长度通常相差几毫米到 1.5 厘米,但对步态、邻近关节和对侧肢体关节的状况没有影响。一些学者报告说,不等长达 5 毫米会导致骨科病变。有多种保守和手术治疗方法可用于肢体长度均衡。消除肢长不等是一个常见且尚未解决的医学问题。肢长不等的保守治疗可视为康复治疗的一个阶段。一些患者可以从保守治疗中获益。另外,手术均衡化也是 LLD 患者的一种治疗选择。结论 早先为解决 LLD 而提供的手术方法存在一些缺点,最终导致其使用率降至最低,骨科医生也因严重并发症的高风险而放弃了其中的一些方法。伊利扎罗夫医生在上世纪 50 年代开发的设备和技术在消除 LLD 方面具有划时代的意义,并在不断改进。
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引用次数: 0
Promising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defects 在骨不连和骨缺损患者的重建治疗中,前景看好的骨整形材料和手术技术
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-263-272
D. Borzunov, R. T. Gilmanov
Introduction Some progress has been made in the development of innovative implantation materials for  osteoplastic surgery. However, the problem of bone defect management still remains relevant due to the continued high prevalence of injuries resulting from road accidents, catatrauma, man-made disasters and military operations.The purpose of the work was to analyze the relevant literature and to identify options for solving the problems of  bone nonunion and defect management using materials developed on the principles of orthobiology and surgical technologies based on autologous repair.Materials and methods The search for sources was carried out with the ConnectedPapers analytical tool  and  the  capabilities of the eLibrary electronic library using keywords and without restrictions on publication date.Results and discussion Recent publications contain information about the effectiveness of the combination of  Masquelet technology and Ilizarov bone transport in patients with acquired and congenital defects, including in the conditions of active purulent infection. According to the literature, a promising autologous bone plastic material is the contents of the bone marrow cavity, containing osteogenic growth factors and bone morphogenetic proteins. Biomaterial is collected using the Reamer-Irrigator-Aspirator system (RIA) from the intramedullary canal of the femur or tibia. Currently, the effectiveness of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the restorative treatment of patients with bone defects and nonunion of various etiologies has actually been proven. The use of bone morphogenetic proteins has been introduced into foreign treatment protocols. Recent positive results of a combination of surgical technologies have proposed the  combined use of the Ilizarov and Masquelet technologies, supplemented by PRP therapy. The basis for  the  expected effect from the combination of surgical technologies and orthobiological materials are the results of preclinical studies of the osteogenic potential of PRP therapy.Conclusion There are grounds for studying the clinical effect of the combined use of surgical technologies based on autologous reparative processes and materials developed on the principles of orthobiology. It  is  necessary and advisable to clinically implement the use of bone morphogenetic proteins rhBMP-2 and  rhBMP-7 in the reconstructive treatment of patients with bone defects and nonunion of various etiologies. Multicenter clinical studies of a high level of evidence are needed to determine the effectiveness of PRP therapy in the reconstructive treatment of patients with bone nonunion and defects.
引言 在开发用于骨整形手术的创新植入材料方面已经取得了一些进展。然而,由于交通事故、创伤、人为灾害和军事行动造成的伤害持续高发,骨缺损管理问题仍然存在。这项工作的目的是分析相关文献,并确定使用基于骨生物学原理开发的材料和基于自体修复的外科技术解决骨不连接和缺损管理问题的方案。材料和方法 利用 ConnectedPapers 分析工具和 eLibrary 电子图书馆的功能,使用关键词搜索资料来源,不限制出版日期。根据文献,骨髓腔内容物是一种很有前景的自体骨整形材料,其中含有成骨生长因子和骨形态发生蛋白。生物材料是利用铰刀-灌注器-吸气器系统(RIA)从股骨或胫骨髓内管中收集的。目前,骨形态发生蛋白 rhBMP-2 和 rhBMP-7 在修复治疗各种病因引起的骨缺损和不愈合患者方面的有效性已得到证实。骨形态发生蛋白的使用已被引入国外的治疗方案中。最近,一种外科技术的组合取得了积极的成果,建议联合使用 Ilizarov 和 Masquelet 技术,并辅以 PRP 治疗。临床前对 PRP 治疗的成骨潜力进行的研究结果是外科技术与矫形生物学材料相结合产生预期效果的基础。在临床上使用骨形态发生蛋白 rhBMP-2 和 rhBMP-7 对各种病因引起的骨缺损和骨不连患者进行重建治疗是必要的,也是可取的。要确定 PRP 疗法在骨不连和骨缺损患者的重建治疗中的有效性,需要进行高水平的多中心临床研究。
{"title":"Promising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defects","authors":"D. Borzunov, R. T. Gilmanov","doi":"10.18019/1028-4427-2024-30-2-263-272","DOIUrl":"https://doi.org/10.18019/1028-4427-2024-30-2-263-272","url":null,"abstract":"Introduction Some progress has been made in the development of innovative implantation materials for  osteoplastic surgery. However, the problem of bone defect management still remains relevant due to the continued high prevalence of injuries resulting from road accidents, catatrauma, man-made disasters and military operations.The purpose of the work was to analyze the relevant literature and to identify options for solving the problems of  bone nonunion and defect management using materials developed on the principles of orthobiology and surgical technologies based on autologous repair.Materials and methods The search for sources was carried out with the ConnectedPapers analytical tool  and  the  capabilities of the eLibrary electronic library using keywords and without restrictions on publication date.Results and discussion Recent publications contain information about the effectiveness of the combination of  Masquelet technology and Ilizarov bone transport in patients with acquired and congenital defects, including in the conditions of active purulent infection. According to the literature, a promising autologous bone plastic material is the contents of the bone marrow cavity, containing osteogenic growth factors and bone morphogenetic proteins. Biomaterial is collected using the Reamer-Irrigator-Aspirator system (RIA) from the intramedullary canal of the femur or tibia. Currently, the effectiveness of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the restorative treatment of patients with bone defects and nonunion of various etiologies has actually been proven. The use of bone morphogenetic proteins has been introduced into foreign treatment protocols. Recent positive results of a combination of surgical technologies have proposed the  combined use of the Ilizarov and Masquelet technologies, supplemented by PRP therapy. The basis for  the  expected effect from the combination of surgical technologies and orthobiological materials are the results of preclinical studies of the osteogenic potential of PRP therapy.Conclusion There are grounds for studying the clinical effect of the combined use of surgical technologies based on autologous reparative processes and materials developed on the principles of orthobiology. It  is  necessary and advisable to clinically implement the use of bone morphogenetic proteins rhBMP-2 and  rhBMP-7 in the reconstructive treatment of patients with bone defects and nonunion of various etiologies. Multicenter clinical studies of a high level of evidence are needed to determine the effectiveness of PRP therapy in the reconstructive treatment of patients with bone nonunion and defects.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"64 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677587","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}
引用次数: 0
Orthopaedic complications of hemiparetic forms of cerebral palsy: problems of the lower extremities (literature review) 偏瘫型脑瘫的矫形并发症:下肢问题(文献综述)
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-292-300
U. F. Mamedov, A. V. Popkov, O. I. Gatamov, G. Chibirov, D. A. Popkov
Introduction Spastic hemiplegia (a unilateral neurological disorder) is encountered more often in full-term infants. In most cases, the cause of the condition is intrauterine or perinatal stroke. Children with hemiparetic forms maintain cognitive and functional capabilities in combination with the ability to move independently. Among other forms of cerebral palsy, hemiparetic spastic forms range from 10.4 to 15.3 %. Types with mild motor impairments predominate according to the Gross Motor Function Classification System: 87.8 % are level I GMFCS, 7.1 % are level II GMFCS.The purpose of the work was to summarize information on the use of orthopaedic interventions for  hemiparetic forms of cerebral palsy, both from the point of view of their planning and completeness of correction of anatomical disorders including lower limb length discrepancy, and assessment of functional results based on gait analysis.Materials and methods The search for publications was carried out in open electronic sources of  medical  literature PubMed, eLIBRARY, Scopus, Elsevier, Springer, Research Gate with a search depth of  20  years (2002–2022). The following inclusion criteria were used: systematic reviews of the literature, review articles, cohort studies on the topic of multilevel interventions for hemiparetic types of cerebral palsy.Results and discussion Lower limb length discrepancy of 1 cm or more affects the kinematics of the affected and  intact contralateral limb. The unaffected limb is characterized by a compensatory flexion in the hip and  knee joints and excessive dorsal flexion in the stance phase. On the affected side, the contribution of shortening to the development of pathological kinematics of the pelvis and spine is especially important. There is a high probability of equinus contracture after surgical correction due to unresolved discrepancy in  the  length of  the  lower extremities. Methods for correcting length discrepancy are conservative (compensation with  shoes), and surgical lengthening of the lower leg, epiphyseodesis of the contralateral limb, shortening of the contralateral limb. There is no opinion in the literature about the preference of this or that method, and on the necessary magnitude of limb length correction.Conclusion The assessment of limb length discrepancy and contribution of this orthopaedic component to systemic movement disorders in spastic hemiparesis is based on computed tomography or magnetic resonance imaging, as well as on computer gait analysis. In the literature, the issue of limb length correction is considered separately from the complex of other orthopaedic interventions, while the features of correction with regard to spontaneous growth potential or after growth completion have not been defined. The advantage of  equalizing the limb length in children with temporary epiphyseodesis over distraction osteogenesis is only supposed. There is not enough data on the effect of the limb length correction magnitude in pati
导言 痉挛性偏瘫(一种单侧神经系统疾病)多见于足月婴儿。大多数情况下,病因是宫内或围产期中风。患偏瘫的儿童在保持认知和功能能力的同时,还能保持独立活动的能力。在其他形式的脑瘫中,痉挛型偏瘫占 10.4%至 15.3%。根据粗大运动功能分级系统(GMFCS),轻度运动障碍类型占主导地位:87.8%为GMFCS I级,7.1%为GMFCS II级。这项工作的目的是总结有关对半身不遂型脑瘫进行矫形干预的信息,既包括对解剖结构紊乱(包括下肢长度不一致)的规划和完整矫正,也包括基于步态分析的功能结果评估。材料和方法 在公开的电子医学文献来源 PubMed、eLIBRARY、Scopus、Elsevier、Springer、Research Gate 中搜索出版物,搜索深度为 20 年(2002-2022 年)。纳入标准如下:系统性文献综述、评论性文章、针对偏瘫型脑瘫的多层次干预的队列研究。未受影响肢体的特点是髋关节和膝关节代偿性屈曲,以及在站立阶段过度背屈。在受影响的一侧,骨盆和脊柱的缩短对病理运动学的发展尤其重要。由于下肢长度差异未得到解决,手术矫正后很有可能出现马尾挛缩。纠正长度不一致的方法有保守治疗(穿鞋补偿)、手术延长小腿、对侧肢体外固定术、对侧肢体缩短术。文献中并没有关于这种或那种方法的偏好,以及肢体长度矫正的必要程度的观点。结论 对痉挛性偏瘫患者肢体长度不一致的评估,以及这种矫形因素对全身运动障碍的影响,是基于计算机断层扫描或磁共振成像,以及计算机步态分析。在文献中,肢体长度矫正问题与其他矫形干预综合问题分开考虑,而自发生长潜能或生长完成后的矫正特点尚未明确。与牵张成骨术相比,暂时性骺线切除术在均衡儿童肢体长度方面的优势只是一种假设。关于痉挛性偏瘫患者肢体长度矫正幅度对计算机步态分析参数的影响,目前还没有足够的数据。
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引用次数: 0
Current state of the treatment problem in the patients with elbow joint contractures due to ossification 骨化导致肘关节挛缩患者的治疗问题现状
Q3 Medicine Pub Date : 2024-04-22 DOI: 10.18019/1028-4427-2024-30-2-273-281
I. S. Petlenko, I. Shubnyakov, S. Fedyunina, A. G. Aliyev, S. S. Bilyk, M. V. Ryabinin
Introduction Surgical treatment of stiff elbow caused by ossification often result in poor outcomes due to anatomical and physiological characteristics, significant functional load and higher patient requirements for the elbow functionality.The purpose was to determine ways of improved surgical treatment for patients with elbow contractures caused by ossification, based on an analysis of literature reporting surgical strategy and outcomes.Material and methods An internet search of PubMed, Medline, Elibrary.ru, CyberLeninka, Google Scholar, International Clinical Trials Registry of the US National Institutes of Health, ISRCTN Registry of International Standard Randomized Clinical Trial Numbers, German Clinical Trials Registry DRKS, WHO Registry was performed. Search words and phrases included elbow contracture, ossification, surgical treatment, stiff, elbow, surgical treatment, ossification. The search depth was 10 years.Results and discussion Some important parameters (recurrence of stiffness, pain, decreased quality of life, etc.) are reported as “very unassertive” in patients with stiff elbow due to ossification at mid and long terms (12–24 months or greater). Poor outcomes are reported in approximately 50 % of the cases due to the range of  motion decreased to the preoperative level or less. Many patients (more than 90 % according to some authors) need a repeated surgery and are at risk for the stiff joint.Conclusion A critical analysis of the literature indicates lack of preoperative instrumentation examination of patients with use of new visualization methods (3D modeling). Preoperative examination and surgical planning based on additive technologies are essential for surgically treated patients with stiff elbow caused by ossification.
导言:由于骨化引起的肘关节僵硬的解剖和生理特点、巨大的功能负荷和患者对肘关节功能的更高要求,手术治疗往往效果不佳。目的是根据对报道手术策略和结果的文献的分析,确定改进骨化引起的肘关节挛缩患者手术治疗的方法。材料与方法 在互联网上搜索了PubMed、Medline、Elibrary.ru、CyberLeninka、Google Scholar、美国国立卫生研究院国际临床试验登记处、ISRCTN国际标准随机临床试验编号登记处、德国临床试验登记处DRKS、世界卫生组织登记处。搜索词和短语包括肘部挛缩、骨化、手术治疗、僵硬、肘部、手术治疗、骨化。搜索深度为 10 年。结果与讨论 据报告,在中长期(12-24 个月或更长时间)内,骨化导致的肘关节僵硬患者的一些重要参数(僵硬复发、疼痛、生活质量下降等)"非常不积极"。据报告,约有50%的病例因活动范围缩小至术前水平或更小而导致治疗效果不佳。结论 对文献的批判性分析表明,缺乏使用新的可视化方法(三维建模)对患者进行术前器械检查。对骨化引起的肘关节僵硬患者进行手术治疗时,基于添加剂技术的术前检查和手术规划至关重要。
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引用次数: 0
Validation and evaluation of the Russian version of the SEFAS questionnaire for assessing foot and ankle in surgically treated patients with forefoot disorders 验证和评估俄文版 SEFAS 问卷,用于评估接受手术治疗的前足疾病患者的足踝情况
Q3 Medicine Pub Date : 2024-04-21 DOI: 10.18019/1028-4427-2024-30-2-221-233
A. A. Akulaev, A. A. Ivanov, T. Ionova, T. P. Nikitina, K. A. Tishchenkov, A. A. Povaliy
Introduction The Self-reported Foot and Ankle Score (SEFAS) is one of the foot health assessment tools in Sweden. Validation procedures, reliability, validity, sensitivity, approval are essential for the Russian version of the questionnaire with a new language environment.The objective was to validate the Russian version of the SEFAS questionnaire and approve the tool in the Russian surgical patients with foot disorders.Material and methods The questionnaires the patients completed preoperatively included SEFAS, SF‑36, a general health survey questionnaire, and the Lower Extremity Functional Scale (LEFS). Patients were requested to  complete the SEFAS questionnaire at 2 months of surgery to assess the sensitivity of the instrument. Based on the case histories clinical researcher recorded general and physical parameters of the patients to include gender, age, socio-demographic data, nature of the foot disorder, a dorsiflexion angle of  the  first metatarsophalangeal joint. To  assess the reproducibility of  the  Russian version of the questionnaire, some patients were requested to complete the SEFAS questionnaire twice preoperatively with an interval of one day.Results The questionnaire was characterized by good internal consistency and reproducibility indicating acceptable reliability of the Russian version of SEFAS. Statistically significant correlations of varying strength were seen between the SF-36 scores and nearly all the selected questions of the SEFAS Russian version. Statistically significant correlations (moderate to weak) were observed between the LEFS total score and the selected SEFAS questions. Minimal clinically significant changes in MCID scored 3 in the assessment of clinical interpretability of the Russian version of SEFAS.Discussion The study demonstrated the reliability, validity and sensitivity of the Russian version of the SEFAS questionnaire. The questionnaire appeared to be an informative and clinically interpretable instrument for assessing foot in surgical adult patients with foot disorders.Conclusion The SEFAS questionnaire can be recommended for Russian trauma and orthopaedic practice to learn the patient's opinion of the condition.
引言 自我报告足踝评分(SEFAS)是瑞典的足部健康评估工具之一。材料和方法 患者术前填写的问卷包括 SEFAS、SF-36、一般健康调查问卷和下肢功能量表(LEFS)。为了评估该工具的灵敏度,要求患者在术后两个月时填写 SEFAS 问卷。临床研究人员根据病史记录了患者的一般和身体参数,包括性别、年龄、社会人口学数据、足部疾病的性质以及第一跖趾关节的外翻角度。为了评估俄文版问卷的可重复性,一些患者被要求在术前完成两次 SEFAS 问卷,每次间隔一天。结果 问卷具有良好的内部一致性和可重复性,表明俄文版 SEFAS 的可靠性可以接受。SF-36 评分与 SEFAS 俄语版几乎所有选定问题之间都存在不同程度的统计学意义上的相关性。LEFS 总分与 SEFAS 所选问题之间存在统计学意义上的相关性(中度至弱度)。在对俄文版 SEFAS 的临床可解释性进行评估时,MCID 得分为 3 的临床显著性变化极小。讨论 该研究证明了俄文版 SEFAS 问卷的可靠性、有效性和敏感性。结论 SEFAS 问卷可推荐用于俄罗斯创伤和骨科实践,以了解患者对病情的看法。
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引用次数: 0
Gait analysis characteristic features in children with spastic hemiplegia 痉挛性偏瘫儿童的步态分析特征
Q3 Medicine Pub Date : 2024-04-21 DOI: 10.18019/1028-4427-2024-30-2-234-244
U. F. Mamedov, T. Dolganova, O. I. Gatamov, D. A. Popkov
Introduction There are not enough published studies on the impact of early isolated triceps lengthening operations in hemiparesis on the state of motor characteristics and on the development of orthopedic complications in children with GMFCS II.Purpose Analyze motor locomotion in children with spastic hemiplegia who had not previously been operated on and those who had undergone isolated surgical lengthening of the triceps at an early age.Material and methods Four groups of children with spastic hemiplegia according to Rodda et Graham types: I) type 2a gait (4 children), II) type 3 (3 children), III) type 4 (7 children), IV) type 4 with previous triceps lengthening (9 children).Results The features revealed in gait types 2a, 3 and 4 in the sagittal plane correspond to the characteristic and  previously described features. In all groups, asymmetric rotational movements of the pelvis and tilt asymmetry in the frontal plane were observed. In the group of early isolated tricep lengthening, a decrease in  the  moment of  force by pushing with the foot at the end of the single-support phase was revealed, in combination with an increase in the moment of forces of knee joint extension in the single-support phase.Discussion Early isolated triceps lengthening that weakens its function leads to a compensatory increase in the work of the knee extensors which is similar to the mechanism to of iatrogenic crouch gait, but does not result in a complete loss of walking function in the conditions of a contralateral healthy limb.Conclusions Movement pathology is present in all three measurement planes in gait types 2a, 3, 4 according to the Rodda et Graham classification. The most pronounced deviations were found in gait type 3. The rotational turn of the pelvis is an initially compensatory mechanism due to intratorsion femur deformity. Isolated triceps lengthening surgeries performed at an early age lead to reduced plantar push strength, increased compensatory work of the knee extensors, and probably do not prevent the orthopedic pathology found in Rodda et Graham's gait type 4.
目的 分析既往未接受过手术的痉挛性偏瘫患儿和既往接受过肱骨三头肌单独延长手术的痉挛性偏瘫患儿的运动状态:结果 2a、3 和 4 型步态在矢状面显示的特征与之前描述的特征一致。在所有组别中,均观察到骨盆的不对称旋转运动和额面的不对称倾斜。在早期孤立肱三头肌拉长组中,发现在单支撑阶段结束时用脚用力的力矩减小,同时在单支撑阶段膝关节伸展的力矩增大。讨论 早期孤立的肱三头肌拉长削弱了其功能,导致膝关节伸肌的工作代偿性增加,这与先天性蹲踞步态的机制类似,但在对侧健康肢体的条件下不会导致行走功能的完全丧失。步态类型 3 的偏差最为明显。骨盆旋转是股骨内翻畸形导致的最初代偿机制。幼年时进行的肱三头肌单独拉长手术会导致跖推力量减弱,膝关节伸肌的代偿性工作增加,而且很可能无法防止在罗达和格雷厄姆的步态类型4中发现的矫形病变。
{"title":"Gait analysis characteristic features in children with spastic hemiplegia","authors":"U. F. Mamedov, T. Dolganova, O. I. Gatamov, D. A. Popkov","doi":"10.18019/1028-4427-2024-30-2-234-244","DOIUrl":"https://doi.org/10.18019/1028-4427-2024-30-2-234-244","url":null,"abstract":"Introduction There are not enough published studies on the impact of early isolated triceps lengthening operations in hemiparesis on the state of motor characteristics and on the development of orthopedic complications in children with GMFCS II.Purpose Analyze motor locomotion in children with spastic hemiplegia who had not previously been operated on and those who had undergone isolated surgical lengthening of the triceps at an early age.Material and methods Four groups of children with spastic hemiplegia according to Rodda et Graham types: I) type 2a gait (4 children), II) type 3 (3 children), III) type 4 (7 children), IV) type 4 with previous triceps lengthening (9 children).Results The features revealed in gait types 2a, 3 and 4 in the sagittal plane correspond to the characteristic and  previously described features. In all groups, asymmetric rotational movements of the pelvis and tilt asymmetry in the frontal plane were observed. In the group of early isolated tricep lengthening, a decrease in  the  moment of  force by pushing with the foot at the end of the single-support phase was revealed, in combination with an increase in the moment of forces of knee joint extension in the single-support phase.Discussion Early isolated triceps lengthening that weakens its function leads to a compensatory increase in the work of the knee extensors which is similar to the mechanism to of iatrogenic crouch gait, but does not result in a complete loss of walking function in the conditions of a contralateral healthy limb.Conclusions Movement pathology is present in all three measurement planes in gait types 2a, 3, 4 according to the Rodda et Graham classification. The most pronounced deviations were found in gait type 3. The rotational turn of the pelvis is an initially compensatory mechanism due to intratorsion femur deformity. Isolated triceps lengthening surgeries performed at an early age lead to reduced plantar push strength, increased compensatory work of the knee extensors, and probably do not prevent the orthopedic pathology found in Rodda et Graham's gait type 4.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"124 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140679336","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}
引用次数: 0
Soft-tissue origin joint contractures treated with the Ilizarov fixation method 用伊利扎罗夫固定法治疗软组织源性关节挛缩
Q3 Medicine Pub Date : 2024-04-21 DOI: 10.18019/1028-4427-2024-30-2-255-262
S. V. Yadkikar, R. Grover, P. Kaur, V. Yadkikar, A. Ojha
Introduction Soft-tissue origin joint contractures are a common orthopedic problem. It could be due to various etiologies. Treatment options are available from conservative to surgical methods. These joint contractures slowly become irreversible causing impairment in activities of daily routine. The Ilizarov method is a well established and time-tested method used for management of bone pathologies, but its use in the management of soft-tissue origin contractures is also possible. It has an established role in neoosteogenesis and histogenesis. Fixator assisted soft-tissue stretching done at sustained slow pace leads to histoneogenesis that avoids stretching of neurovascular structures and reduces the possibility of recurrence.Aims To determine usefulness of the Ilizarov method in management of joint contractures of soft tissue origin; to meet functional requirements of patients; to study complications of Ilizarov method in management joint contractures due to soft tissue origin.Material and methods A total of 6 cases of soft-tissue origin joint contractures due to tuberculosis, post‑traumatic stiffness, post-burn contracture, deformity due to a snake bite in the age group from 3 to 55 years were treated with gradual distraction of joint with the Ilizarov method from January 22 to October 23. Two cases were of triple knee deformity, two were post-traumatic elbow stiffness, one was post-burn great toe contracture and one was post snake bite valgus foot contracture. All cases were operated with transarticular Ilizarov frame application and gradual distraction of joints and soft tissue with the help of hinge- and rod distractor assembly done. All cases completed follow up of 1 year. Aggressive physiotherapy was given postoperatively.Results All cases obtained a reasonable functional outcome, with no recurrence of deformity. All patients walk independently.Conclusion The Ilizarov method can be used for treating joint contractures due to traumatic and non‑traumatic pathologies.
导言 软组织源性关节挛缩是一种常见的骨科问题。其病因多种多样。治疗方法有保守治疗和手术治疗。这些关节挛缩会慢慢变得不可逆转,导致日常活动能力受损。伊利扎洛夫法是一种行之有效的治疗骨病的方法,但也可用于治疗软组织源性挛缩。它在新骨生成和组织生成方面具有公认的作用。目的 确定 Ilizarov 法在治疗软组织源性关节挛缩中的作用;满足患者的功能要求;研究 Ilizarov 法在治疗软组织源性关节挛缩中的并发症。材料和方法 1月22日至10月23日,共对6例因结核、创伤后僵硬、烧伤后挛缩、蛇咬伤畸形引起的软组织源性关节挛缩进行了伊利扎洛夫法关节逐渐牵引治疗,患者年龄在3至55岁之间。其中两例为三膝关节畸形,两例为创伤后肘关节僵硬,一例为烧伤后大脚趾挛缩,一例为蛇咬伤后足部外翻挛缩。所有病例均采用经关节伊利扎罗夫架进行手术,并借助铰链和杆牵引器组件对关节和软组织进行逐步牵引。所有病例均完成了为期一年的随访。结果 所有病例都获得了合理的功能结果,畸形没有复发。结论 Ilizarov 方法可用于治疗创伤性和非创伤性病变引起的关节挛缩。
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引用次数: 0
Evaluation of the effectiveness of ankle arthrodesis options 评估踝关节固定方案的有效性
Q3 Medicine Pub Date : 2024-04-21 DOI: 10.18019/1028-4427-2024-30-2-210-220
R. Wang, I. F. Akhtiamov, J. Cai, B. Ziatdinov, E. S. Schigaev
Introduction Treatment methods for late stages of ankle osteoarthritis are varied, but the issue of assessing the long-term results of various fixation methods has not yet been studied, and this issue is of great importance in clinical practice.Purpose To compare the effectiveness of the fixation methods commonly used for ankle arthrodesis in patients with advanced ankle osteoarthritis.Materials and methods Eighty-two patients with advanced ankle osteoarthritis were treated with ankle fusion between 2019 and 2023 at three major medical institutions. All patients underwent 12-month follow-ups. The patients were divided into four groups depending on the method of surgical fixation of bone fragments.Results Most patients showed a significant improvement in the function and a decrease in pain intensity after the arthrodesis operation. The comparison of the effectiveness of various surgical fixation methods found that external apparatus screw fixation is characterized by lower blood loss and a relatively short duration of the operation. Plate and screw fixation resulted in higher AOFAS and VAS scores at 3 months postoperatively. However, by the 12th month after surgery, the differences in these two indicators were insignificant.Discussion Despite the various complications that occur in ankle arthrodesis, it remains effective for  most patients. Among them, the Ilizarov apparatus is more suitable for patients with compromised conditions in the surgical area. Each method of surgical fixation has its own advantages and shortcomings, but the difference in long-term effectiveness is small. Conclusion Ankle arthrodesis is an effective treatment for advanced ankle osteoarthritis. The choice of surgical method is still subject to the principle of individual approach.
引言 踝关节骨性关节炎晚期的治疗方法多种多样,但对各种固定方法的长期效果评估问题尚未进行研究,而这一问题在临床实践中具有重要意义。目的 比较晚期踝关节骨性关节炎患者踝关节融合术常用固定方法的有效性。所有患者均接受了 12 个月的随访。根据手术固定骨片的方法,患者被分为四组。结果 大多数患者在关节置换术后功能明显改善,疼痛强度降低。通过比较各种手术固定方法的效果发现,器械外螺钉固定的特点是失血量较少,手术时间相对较短。钢板和螺钉固定在术后 3 个月的 AOFAS 和 VAS 评分较高。讨论 尽管踝关节置换术会出现各种并发症,但它对大多数患者仍然有效。其中,Ilizarov器械更适合手术区域条件受损的患者。每种手术固定方法都有各自的优点和缺点,但在长期有效性方面差别不大。结论 踝关节置换术是治疗晚期踝关节骨关节炎的有效方法。手术方法的选择仍需遵循因人而异的原则。
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