Pub Date : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-35-42
V. D. Usikov, V. S. Kuftov
The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.
{"title":"Efficiency of transpedicular reduction of intracanal bone fragments in comminuted fractures of L1 vertebra","authors":"V. D. Usikov, V. S. Kuftov","doi":"10.18019/1028-4427-2023-29-1-35-42","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-35-42","url":null,"abstract":"The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84466653","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-7-11
R. H. Sagdiev, S. Dydykin, A. Shapkin, R. Sufianov, S. Lyulin, D. Borzunov, A. A. Sufianov
Introduction The method of endoscopic revision, neurolysis and decompression of the brachial plexus is a current minimally invasive method of treatment. It is able to completely preserve the anatomical structures (skin, fascia, muscles, clavicle, arteries, veins, nerves) and minimize damage to the structures of the brachial plexus, since neurolysis is carried out along the trunks and bundles of the plexus through a low-invasive transaxillary approach. However, the effectiveness of this type of operation has not been studied previously. The aim of the study To evaluate the effectiveness of brachial plexus neurolysis under video endoscopic assistance in the treatment of brachioplexopathies in adults Materials and methods The study involved patients hospitalized in the Tyumen Federal Center for the period from 2017 to 2022 with a diagnosis of brachial plexus palsy, who, for medical reasons, underwent neurolysis of the brachial plexus under video endoscopic assistance. The number of patients gave informed concent was 25 subjects. The results of treatment were assessed with score systems and questionnaires; neurological examination was performed and muscle strength was assessed according to the British scale (M5-M0), the type of sensory disorders and their degree on a scale from 0 to 10, where 10 is the complete preservation of sensitivity, and 0 is its complete absence and were confirmed by the data of functional diagnostics (stimulation ENMG) 3, 6 and 12 months after the operation. Statistical data processing was carried out using the Microsoft Excel (Microsoft Office 365) and Stattech 2.0 software package. For quantitative traits, the arithmetic mean (M) and standard error of the mean (SEM) were calculated. To assess the statistical significance of the results obtained, the parametric t-Student's test was used. Differences were considered significant at p < 0.05. Results The mean age of the patients was 48 ± 15 years, gender ratio (m/f) was 18/7, the affected side (right/left) ratio was 12/13. A positive result was achieved in 75 % of cases (n = 19), the absence of positive dynamics was noted in 25 % of cases (n = 6); there were no cases of poor results. When comparing the indicators in groups with a positive result and its absence, it was revealed that the degree of limb dysfunction and the degree of paresis affect the treatment outcome (p < 0.05). In all patients with a positive result, a positive trend was observed starting from 5.89 ± 0.93 (range 1-15) weeks after surgery. Conclusion The proposed method of neurolysis of the brachial plexus is an effective method for the treatment of patients with brachial plexus palsy of various etiologies. The main factor influencing the outcome of reatment is limb dysfunction, the severity of which is inversely proportional to the function recovery in the postoperative period. Based on the results obtained, neurolysis was not effective in paresis of the affected muscles scoring 0-1 points. If there is no posi
{"title":"The effectiveness of endoscopic brachial plexus neurolysis in the treatment of brachial plexus palsy in adults","authors":"R. H. Sagdiev, S. Dydykin, A. Shapkin, R. Sufianov, S. Lyulin, D. Borzunov, A. A. Sufianov","doi":"10.18019/1028-4427-2023-29-1-7-11","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-7-11","url":null,"abstract":"Introduction The method of endoscopic revision, neurolysis and decompression of the brachial plexus is a current minimally invasive method of treatment. It is able to completely preserve the anatomical structures (skin, fascia, muscles, clavicle, arteries, veins, nerves) and minimize damage to the structures of the brachial plexus, since neurolysis is carried out along the trunks and bundles of the plexus through a low-invasive transaxillary approach. However, the effectiveness of this type of operation has not been studied previously. The aim of the study To evaluate the effectiveness of brachial plexus neurolysis under video endoscopic assistance in the treatment of brachioplexopathies in adults Materials and methods The study involved patients hospitalized in the Tyumen Federal Center for the period from 2017 to 2022 with a diagnosis of brachial plexus palsy, who, for medical reasons, underwent neurolysis of the brachial plexus under video endoscopic assistance. The number of patients gave informed concent was 25 subjects. The results of treatment were assessed with score systems and questionnaires; neurological examination was performed and muscle strength was assessed according to the British scale (M5-M0), the type of sensory disorders and their degree on a scale from 0 to 10, where 10 is the complete preservation of sensitivity, and 0 is its complete absence and were confirmed by the data of functional diagnostics (stimulation ENMG) 3, 6 and 12 months after the operation. Statistical data processing was carried out using the Microsoft Excel (Microsoft Office 365) and Stattech 2.0 software package. For quantitative traits, the arithmetic mean (M) and standard error of the mean (SEM) were calculated. To assess the statistical significance of the results obtained, the parametric t-Student's test was used. Differences were considered significant at p < 0.05. Results The mean age of the patients was 48 ± 15 years, gender ratio (m/f) was 18/7, the affected side (right/left) ratio was 12/13. A positive result was achieved in 75 % of cases (n = 19), the absence of positive dynamics was noted in 25 % of cases (n = 6); there were no cases of poor results. When comparing the indicators in groups with a positive result and its absence, it was revealed that the degree of limb dysfunction and the degree of paresis affect the treatment outcome (p < 0.05). In all patients with a positive result, a positive trend was observed starting from 5.89 ± 0.93 (range 1-15) weeks after surgery. Conclusion The proposed method of neurolysis of the brachial plexus is an effective method for the treatment of patients with brachial plexus palsy of various etiologies. The main factor influencing the outcome of reatment is limb dysfunction, the severity of which is inversely proportional to the function recovery in the postoperative period. Based on the results obtained, neurolysis was not effective in paresis of the affected muscles scoring 0-1 points. If there is no posi","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83346697","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-92-98
A. L. Shastov, T. A. Stupina, N. S. Migalkin
of malignant transformation 34 years after the diagnosis of chronic osteomyelitis of the hip. Materials and methods The medical case history was studied and pathomorphological examination of the surgical material of patient D. with chronic osteomyelitis of the femur was conducted. Results Patient D., after a comminuted fracture of the left femur as a result of an accident, at the age of 25 years, developed chronic osteomyelitis, the surgical interventions did not lead to a long-term remission of the process. The course of the disease was complicated by malignancy and pathological fracture. The treatment ended with the amputation of the limb. The pathohistological examination revealed structural changes in bone tissue: necrosis, bone marrow fibrosis, bone microsequestration, inflammatory infiltrate with a high content of neutrophils that corresponded to the morphological signs of chronic osteomyelitis in the acute stage. Signs of pseudocarcinomatous hyperplasia, mass appearance of "horny pearls", invasion of the squamous epithelium of the bone tissue, squamous epithelial cells seemed to be highly differentiated. Discussion The pathomorphological picture of the surgical material was characterized as pseudocarcinomatous hyperplasia, the prolonged existence of which could cause the occurrence of squamous cell carcinoma of the femur. It is not clinically and histologically possible to establish when the reactive proliferation of the epidermis acquires fundamentally different biological properties of a malignant tumor. It is a serious problem in the timely diagnosis. Conclusion A thorough pathoanatomical assessment of the material from the affected areas (ulcers, fistulous tracts, bone marrow space) is necessary for the early detection of malignant neoplasms that may occur in osteomyelitis. The presence of long-term dynamics of pseudocarcinomatous hyperplasia requires vigilance in relation to the process of malignancy.
{"title":"Malignancy in chronic osteomyelitis of the femur: a case report","authors":"A. L. Shastov, T. A. Stupina, N. S. Migalkin","doi":"10.18019/1028-4427-2023-29-1-92-98","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-92-98","url":null,"abstract":"of malignant transformation 34 years after the diagnosis of chronic osteomyelitis of the hip. Materials and methods The medical case history was studied and pathomorphological examination of the surgical material of patient D. with chronic osteomyelitis of the femur was conducted. Results Patient D., after a comminuted fracture of the left femur as a result of an accident, at the age of 25 years, developed chronic osteomyelitis, the surgical interventions did not lead to a long-term remission of the process. The course of the disease was complicated by malignancy and pathological fracture. The treatment ended with the amputation of the limb. The pathohistological examination revealed structural changes in bone tissue: necrosis, bone marrow fibrosis, bone microsequestration, inflammatory infiltrate with a high content of neutrophils that corresponded to the morphological signs of chronic osteomyelitis in the acute stage. Signs of pseudocarcinomatous hyperplasia, mass appearance of \"horny pearls\", invasion of the squamous epithelium of the bone tissue, squamous epithelial cells seemed to be highly differentiated. Discussion The pathomorphological picture of the surgical material was characterized as pseudocarcinomatous hyperplasia, the prolonged existence of which could cause the occurrence of squamous cell carcinoma of the femur. It is not clinically and histologically possible to establish when the reactive proliferation of the epidermis acquires fundamentally different biological properties of a malignant tumor. It is a serious problem in the timely diagnosis. Conclusion A thorough pathoanatomical assessment of the material from the affected areas (ulcers, fistulous tracts, bone marrow space) is necessary for the early detection of malignant neoplasms that may occur in osteomyelitis. The presence of long-term dynamics of pseudocarcinomatous hyperplasia requires vigilance in relation to the process of malignancy.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85234159","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-57-63
E. E. Volkov, A. Goloshchapov, R. Mustafin, S. E. Nostaeva
Introduction Bone metabolic markers informatively reflect the complex balance of bone formation/resorption and are widely used in clinical practice. Genetic predisposition also plays a significant role in the etiopathogenesis of aseptic necrosis of the femoral head (ANFH). We aimed to establish probable associations between a number of biochemical parameters of bone tissue metabolism with clinical ones (sex, age, body mass index (BMI)), disease stage, T and Z criteria) with regard to the leading polymorphisms of the vitamin D3 receptor gene (VDR) in patients with ANFH. Materials and Methods Based on clinical and biochemical examination of 273 patients with ANFH, factor analysis was performed. Results Clinical parameters (age, BMI) correlated most with biochemical parameters. Age showed most association with β-CrossLaps, DPD, osteocalcin, and osteoprotegerin; BMI, in turn, was associated with 1.25(OH)2D, 25(OH)D, Ca, and DPID. Carriers of G/G genotype A-3731G were found to have more than a three-fold increased risk of ANFH compared to healthy controls; carriers of G allele had a 2.5‑fold increased risk. Carriage A/A genotype +283 A > G increases the risk of developing ANFH by 2.4 times. Carriage of the A allele of the same locus is associated with a 1.5-fold increased risk of ANFH. Discussion We determined a reliable association of age with β-CrossLaps, DPD, osteocalcin, osteoprotegerin, and BMI with 1.25(OH)2D, 25(OH)D, Ca, and DPD in patients with ANFH, suggesting significant prospects for using these biochemical parameters to monitor changes in bone tissue remodeling. An increased risk of ANFH was established in the presence of the G/G genotype and the G allele of the A-3731G (Cdx2) locus, the A/A genotype of the +283 A > G (BsmI) locus in the VDR gene. Conclusion Associations of BMI with 1.25(OH)2D, 25(OH)D, Ca, DPD characterize the relationship between resorption and osteogenesis processes and somatic parameters of the examined patients with ANFH. The genotypic variants G/G rs11568820 and A/A rs1544410 in the VDR gene are associated with an increased risk of AFHD.
骨代谢标志物信息反映骨形成/骨吸收的复杂平衡，广泛应用于临床实践。遗传易感性在股骨头无菌性坏死(ANFH)的发病机制中也起着重要作用。我们的目的是建立骨组织代谢的一些生化参数与临床参数(性别、年龄、体重指数(BMI)、疾病分期、T和Z标准)之间关于ANFH患者维生素D3受体基因(VDR)主要多态性的可能关联。材料与方法对273例ANFH患者进行临床及生化检查，进行因素分析。结果临床参数(年龄、BMI)与生化指标相关性最大。年龄与β-CrossLaps、DPD、骨钙素和骨保护素的相关性最大;BMI则与1.25(OH)2D、25(OH)D、Ca和DPID相关。G/G基因型a - 3731g的携带者患ANFH的风险是健康对照组的3倍以上;携带G等位基因的人患病风险增加2.5倍。携带A/A基因型+283 A > G使发生ANFH的风险增加2.4倍。携带同一基因座的A等位基因与ANFH风险增加1.5倍相关。我们确定了年龄与ANFH患者β-CrossLaps、DPD、骨钙素、骨保护素和BMI与1.25(OH)2D、25(OH)D、Ca和DPD之间的可靠关联，这表明使用这些生化参数监测骨组织重塑变化具有重要前景。存在G/G基因型和A- 3731g (Cdx2)位点的G等位基因，以及VDR基因中+283 A > G (BsmI)位点的A/A基因型，ANFH的风险增加。结论BMI与1.25(OH)2D、25(OH)D、Ca、DPD的相关性表征了ANFH患者骨吸收和成骨过程与躯体参数之间的关系。VDR基因中的基因型变异G/G rs11568820和A/A rs1544410与AFHD风险增加相关。
{"title":"Factor analysis of clinical and biochemical parameters of bone remodeling changes associated with leading VDR polymorphisms in patients with aseptic necrosis of the femoral head","authors":"E. E. Volkov, A. Goloshchapov, R. Mustafin, S. E. Nostaeva","doi":"10.18019/1028-4427-2023-29-1-57-63","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-57-63","url":null,"abstract":"Introduction Bone metabolic markers informatively reflect the complex balance of bone formation/resorption and are widely used in clinical practice. Genetic predisposition also plays a significant role in the etiopathogenesis of aseptic necrosis of the femoral head (ANFH). We aimed to establish probable associations between a number of biochemical parameters of bone tissue metabolism with clinical ones (sex, age, body mass index (BMI)), disease stage, T and Z criteria) with regard to the leading polymorphisms of the vitamin D3 receptor gene (VDR) in patients with ANFH. Materials and Methods Based on clinical and biochemical examination of 273 patients with ANFH, factor analysis was performed. Results Clinical parameters (age, BMI) correlated most with biochemical parameters. Age showed most association with β-CrossLaps, DPD, osteocalcin, and osteoprotegerin; BMI, in turn, was associated with 1.25(OH)2D, 25(OH)D, Ca, and DPID. Carriers of G/G genotype A-3731G were found to have more than a three-fold increased risk of ANFH compared to healthy controls; carriers of G allele had a 2.5‑fold increased risk. Carriage A/A genotype +283 A > G increases the risk of developing ANFH by 2.4 times. Carriage of the A allele of the same locus is associated with a 1.5-fold increased risk of ANFH. Discussion We determined a reliable association of age with β-CrossLaps, DPD, osteocalcin, osteoprotegerin, and BMI with 1.25(OH)2D, 25(OH)D, Ca, and DPD in patients with ANFH, suggesting significant prospects for using these biochemical parameters to monitor changes in bone tissue remodeling. An increased risk of ANFH was established in the presence of the G/G genotype and the G allele of the A-3731G (Cdx2) locus, the A/A genotype of the +283 A > G (BsmI) locus in the VDR gene. Conclusion Associations of BMI with 1.25(OH)2D, 25(OH)D, Ca, DPD characterize the relationship between resorption and osteogenesis processes and somatic parameters of the examined patients with ANFH. The genotypic variants G/G rs11568820 and A/A rs1544410 in the VDR gene are associated with an increased risk of AFHD.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75155193","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-110-116
A. V. Sertakova, V. Ulyanov, E. Magomedrasulova
The objective was to analyze experimental animal models of osteonecrosis (ON) using the femoral head, show advantages and disadvantages, capacity to translate the findings for adult and pediatric orthopaedics, potential model modifications for orthopaedic and rheumatology research. Material and methods The original literature search was conducted on key resources including PubMed, Web of Science, Cochrane Library, E-library, and the Springer databank. Literature searches included Russian, English, and Italian studies. The research covered studies of 1980 to 2021 and included important landmarks of laboratory experiments with animal models. Results and discussion Although there was no ON model with ideal conditions found for it, the choice of a model could be based on the researcher’s goal reproducing ON as a type of “osteochondropathy” to explore the results applicable to pediatric orthopaedics or classical ON in adults. Animals with long-term open growth plates, intensive blood circulation in the bone and rapid regeneration being characteristic of juvenile models of rats, rabbits and pigs could be appropriate for the experiment. Dogs, sheep, pigs and emus, in particular, were practical for reproducing ON in adults. Non-traumatic models of ON in adults were reversible and consistent with early stages of the condition. Conclusion The need for ON simulation increased due to progressing orthobiological techniques (PRP‑therapy, BMCs technologies, etc.) in the treatment of ON. Application of orthobiological treatment resulted in heterogeneous, scattered outcomes being statistically unreliable and necessitating the search for optimal animal models and assessment of treatment methods for ON in modern orthopaedics.
目的是分析使用股骨头的骨坏死(ON)实验动物模型，显示优点和缺点，将研究结果转化为成人和儿童骨科的能力，以及骨科和风湿病学研究的潜在模型修改。材料与方法在PubMed、Web of Science、Cochrane Library、E-library、Springer数据库等关键资源上进行原始文献检索。文献检索包括俄语、英语和意大利语研究。该研究涵盖了1980年至2021年的研究，包括动物模型实验室实验的重要里程碑。结果与讨论虽然没有找到理想条件的ON模型，但模型的选择可以基于研究者将ON作为一种“骨软骨病”再现的目标，探索适用于儿科骨科或成人经典ON的结果。大鼠、家兔和猪幼龄模型具有长期开放生长板、骨内血液循环强、再生快等特点的动物适合进行本实验。尤其是狗、羊、猪和鸸鹋，在成人体内繁殖ON是可行的。成人ON的非创伤性模型是可逆的，与病情的早期阶段一致。结论随着骨科技术(PRP疗法、BMCs技术等)在治疗ON方面的进步，对ON模拟的需求增加。骨科治疗的应用导致异质性、分散的结果在统计上不可靠，需要在现代骨科中寻找最佳的动物模型和评估治疗方法。
{"title":"Experimental animal models of osteonecrosis","authors":"A. V. Sertakova, V. Ulyanov, E. Magomedrasulova","doi":"10.18019/1028-4427-2023-29-1-110-116","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-110-116","url":null,"abstract":"The objective was to analyze experimental animal models of osteonecrosis (ON) using the femoral head, show advantages and disadvantages, capacity to translate the findings for adult and pediatric orthopaedics, potential model modifications for orthopaedic and rheumatology research. Material and methods The original literature search was conducted on key resources including PubMed, Web of Science, Cochrane Library, E-library, and the Springer databank. Literature searches included Russian, English, and Italian studies. The research covered studies of 1980 to 2021 and included important landmarks of laboratory experiments with animal models. Results and discussion Although there was no ON model with ideal conditions found for it, the choice of a model could be based on the researcher’s goal reproducing ON as a type of “osteochondropathy” to explore the results applicable to pediatric orthopaedics or classical ON in adults. Animals with long-term open growth plates, intensive blood circulation in the bone and rapid regeneration being characteristic of juvenile models of rats, rabbits and pigs could be appropriate for the experiment. Dogs, sheep, pigs and emus, in particular, were practical for reproducing ON in adults. Non-traumatic models of ON in adults were reversible and consistent with early stages of the condition. Conclusion The need for ON simulation increased due to progressing orthobiological techniques (PRP‑therapy, BMCs technologies, etc.) in the treatment of ON. Application of orthobiological treatment resulted in heterogeneous, scattered outcomes being statistically unreliable and necessitating the search for optimal animal models and assessment of treatment methods for ON in modern orthopaedics.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88863440","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-71-77
E. Ovchinnikov, T. A. Stupina, O. V. Dyuryagina, N. V. Kubrak, Yu.А. Stupina
Features of structural changes in the joint components (synovial membrane, articular cartilage, subchondral bone) under the conditions of adjacent limb segment osteomyelitis are poorly understood and require thorough histological studies. Purpose Сomparative assessment of the structural reorganization of the main components of the distal articular end of the femur in experimental modeling of osteomyelitis. Material and methods Objects: distal metaphyses of the femur of intact rats (n = 5) and experimental ones (n = 16) in the conditions of modeled osteomyelitis of the femur. The culture of S. aureus was injected into the medullary canal in the experimental animals (n = 8) while saline was injected in the control group (n = 8). The animals were taken out of the experiment on the 21st day. Methods: histological, morphometric, and statistical methods were used. Results In the control group, the articular cartilage, subchondral bone plate, and subchondral zone retained their normal structure. Synovitis was not revealed. The values of the morphometric parameters were comparable with the intact norm. In the experimental group, bone microsequesters, osteoclastic resorption of the subchondral bone plate, inflammatory infiltration with the content of plasma cells and neutrophils were detected in the subchondral zone. Histological changes in the articular cartilage according to the classification of the International Society OARSI (2006) corresponded to grades 1 to 3 and were accompanied by synovitis. There was a significant (р < 0.05) decrease in the thickness of non-calcified cartilage, a significant twofold decrease in the thickness of the subchondral bone plate, while the values of the thickness of the calcified cartilage exceeded those in the control group and the intact norm. Conclusion Under the conditions of an experimental model of chronic osteomyelitis of the femur, the revealed structural changes in the subchondral zone contribute to the progression of the destruction of the subchondral bone plate, articular cartilage and synovitis. This model of chronic osteomyelitis can be used to experimentally study various therapeutic strategies aimed at modifying subchondral bone remodeling and relieving synovitis.
{"title":"Structural changes in the distal articular end of the femur in experimental modeling of osteomyelitis","authors":"E. Ovchinnikov, T. A. Stupina, O. V. Dyuryagina, N. V. Kubrak, Yu.А. Stupina","doi":"10.18019/1028-4427-2023-29-1-71-77","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-71-77","url":null,"abstract":"Features of structural changes in the joint components (synovial membrane, articular cartilage, subchondral bone) under the conditions of adjacent limb segment osteomyelitis are poorly understood and require thorough histological studies. Purpose Сomparative assessment of the structural reorganization of the main components of the distal articular end of the femur in experimental modeling of osteomyelitis. Material and methods Objects: distal metaphyses of the femur of intact rats (n = 5) and experimental ones (n = 16) in the conditions of modeled osteomyelitis of the femur. The culture of S. aureus was injected into the medullary canal in the experimental animals (n = 8) while saline was injected in the control group (n = 8). The animals were taken out of the experiment on the 21st day. Methods: histological, morphometric, and statistical methods were used. Results In the control group, the articular cartilage, subchondral bone plate, and subchondral zone retained their normal structure. Synovitis was not revealed. The values of the morphometric parameters were comparable with the intact norm. In the experimental group, bone microsequesters, osteoclastic resorption of the subchondral bone plate, inflammatory infiltration with the content of plasma cells and neutrophils were detected in the subchondral zone. Histological changes in the articular cartilage according to the classification of the International Society OARSI (2006) corresponded to grades 1 to 3 and were accompanied by synovitis. There was a significant (р < 0.05) decrease in the thickness of non-calcified cartilage, a significant twofold decrease in the thickness of the subchondral bone plate, while the values of the thickness of the calcified cartilage exceeded those in the control group and the intact norm. Conclusion Under the conditions of an experimental model of chronic osteomyelitis of the femur, the revealed structural changes in the subchondral zone contribute to the progression of the destruction of the subchondral bone plate, articular cartilage and synovitis. This model of chronic osteomyelitis can be used to experimentally study various therapeutic strategies aimed at modifying subchondral bone remodeling and relieving synovitis.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"29 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78181092","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 : 2023-02-01DOI: 10.18019/1028-4427-2023-29-1-78-84
V. Petukhova, A. Mushkin, M. Kostik, T. Vinogradova, A. Kaftyrev, V. Evseev, A. Kulkov
Introduction The complex treatment of osteoarticular tuberculosis is based on combination of anti-tuberculosis therapy, complete (radical) removal of involved bone and restoration of the supporting and motor function of the affected musculoskeletal segment. Inhibited activity of osteoclasts involved in osteoresorption as one of the mechanisms of reparative osteoregeneration can be involved in regulation of bone formation after radical reconstructive surgery. The objective was to explore CT signs of osteoregeneration due to multimodal treatment of experimental tuberculous osteitis with use of bisphosphonates as targeted inhibitors of osteoclasts. Material and methods An experimental study was carried out on 21 mature male Chinchilla rabbits. The first stage included bone tuberculosis simulated in the medial condyle of the right femur using invasive local infection with M. tuberculosis strains H37Rv, a virulent reference laboratory strain. Pathological focus was resected and bone graft used at the second stage. Animals receiving antituberculosis therapy (ATT), ATT and bisphosphonates (BP) and BP only were divided into three groups at the third stage. Animals were sacrificed at 3 and 6 months of surgical treatment at the fourth stage. Autopsy implantation zone, bone of the contralateral condyle and intact femur were quantitatively and qualitatively assessed using micro-CT imaging. Results Positive dynamics in bone restoration was seen in the groups. ATT group showed complete lysis of the implant with bone cavities identified and no bone restoration in half of the cases seen at 6 months. Rabbits treated with BP demonstrated absence of complete lysis of the implant and CT signs of ingrowth of bone trabeculae. CT signs of maximum osteoregeneration were noted in the group of isolated BP therapy. Discussion The use of bisphosphonates can prevent lysis of grafts preserving the osteoconductive properties and facilitating formation of new bone. Conclusion Targeted osteoclast inhibitors can be safety and efficaciously used in the complex treatment of focal infectious skeletal lesions and be recommended as a potential component of pathogenetic therapy in the postoperative treatment of infectious (tuberculous) skeletal lesions.
{"title":"Use of bisphosphonates in experimental bone tuberculous osteitis: CT imaging","authors":"V. Petukhova, A. Mushkin, M. Kostik, T. Vinogradova, A. Kaftyrev, V. Evseev, A. Kulkov","doi":"10.18019/1028-4427-2023-29-1-78-84","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-78-84","url":null,"abstract":"Introduction The complex treatment of osteoarticular tuberculosis is based on combination of anti-tuberculosis therapy, complete (radical) removal of involved bone and restoration of the supporting and motor function of the affected musculoskeletal segment. Inhibited activity of osteoclasts involved in osteoresorption as one of the mechanisms of reparative osteoregeneration can be involved in regulation of bone formation after radical reconstructive surgery. The objective was to explore CT signs of osteoregeneration due to multimodal treatment of experimental tuberculous osteitis with use of bisphosphonates as targeted inhibitors of osteoclasts. Material and methods An experimental study was carried out on 21 mature male Chinchilla rabbits. The first stage included bone tuberculosis simulated in the medial condyle of the right femur using invasive local infection with M. tuberculosis strains H37Rv, a virulent reference laboratory strain. Pathological focus was resected and bone graft used at the second stage. Animals receiving antituberculosis therapy (ATT), ATT and bisphosphonates (BP) and BP only were divided into three groups at the third stage. Animals were sacrificed at 3 and 6 months of surgical treatment at the fourth stage. Autopsy implantation zone, bone of the contralateral condyle and intact femur were quantitatively and qualitatively assessed using micro-CT imaging. Results Positive dynamics in bone restoration was seen in the groups. ATT group showed complete lysis of the implant with bone cavities identified and no bone restoration in half of the cases seen at 6 months. Rabbits treated with BP demonstrated absence of complete lysis of the implant and CT signs of ingrowth of bone trabeculae. CT signs of maximum osteoregeneration were noted in the group of isolated BP therapy. Discussion The use of bisphosphonates can prevent lysis of grafts preserving the osteoconductive properties and facilitating formation of new bone. Conclusion Targeted osteoclast inhibitors can be safety and efficaciously used in the complex treatment of focal infectious skeletal lesions and be recommended as a potential component of pathogenetic therapy in the postoperative treatment of infectious (tuberculous) skeletal lesions.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90153981","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 : 2022-12-01DOI: 10.18019/1028-4427-2022-28-6-852-857
F. Lazko, D. A. Ananyin, A. Petrosyan, M. Awad, M. Panin, O. Al bawareed
Introduction Osgood-Schlatter disease is manifested by pain, swelling and the appearance of a painful "bump" in the area of the tibial tuberosity. For 90 % of patients, conservative treatment is effective. It relieves painful symptoms but if they persist after the closure of the growth plate, surgical treatment is recommended. The study of literature reviews on invasive methods of treatment of the Osgood-Schlatter disease revealed only a few works on various methods of treatment with a description of clinical cases. Purpose Review of current methods of invasive treatment of Osgood-Schlatter disease, comparison of their effectiveness from the point of current evidence-based requirements. Materials and methods The electronic databases eLibrary, PubMed and Scopus were used for literature search. Results This literature review presents a comparative analysis of the effectiveness of various surgical methods of treatment, namely, the use of surgical and puncture methods. The main advantages of the methods were discussed, as well as their disadvantages caused by postoperative complications or difficulties resulting from the techniques for their implementation. Conservative treatment, which is resorted to in the majority of cases, does not relieve pain in the knee joint, and discomfort at sport activities persists. Minimally invasive techniques, which were used by a number of authors whose works are described in this review, are at a low level in the hierarchy of evidence, because there no large comparative studies. Conclusions Due to the rarity of surgical treatment of this pathology, it makes sense to create a register of patients with Osgood-Schlatter disease for the purpose of a remote unified assessment of treatment results in order to identify the most appropriate method of surgical intervention.
{"title":"Invasive treatments for Osgood-Schlatter disease (systematic literature review)","authors":"F. Lazko, D. A. Ananyin, A. Petrosyan, M. Awad, M. Panin, O. Al bawareed","doi":"10.18019/1028-4427-2022-28-6-852-857","DOIUrl":"https://doi.org/10.18019/1028-4427-2022-28-6-852-857","url":null,"abstract":"Introduction Osgood-Schlatter disease is manifested by pain, swelling and the appearance of a painful \"bump\" in the area of the tibial tuberosity. For 90 % of patients, conservative treatment is effective. It relieves painful symptoms but if they persist after the closure of the growth plate, surgical treatment is recommended. The study of literature reviews on invasive methods of treatment of the Osgood-Schlatter disease revealed only a few works on various methods of treatment with a description of clinical cases. Purpose Review of current methods of invasive treatment of Osgood-Schlatter disease, comparison of their effectiveness from the point of current evidence-based requirements. Materials and methods The electronic databases eLibrary, PubMed and Scopus were used for literature search. Results This literature review presents a comparative analysis of the effectiveness of various surgical methods of treatment, namely, the use of surgical and puncture methods. The main advantages of the methods were discussed, as well as their disadvantages caused by postoperative complications or difficulties resulting from the techniques for their implementation. Conservative treatment, which is resorted to in the majority of cases, does not relieve pain in the knee joint, and discomfort at sport activities persists. Minimally invasive techniques, which were used by a number of authors whose works are described in this review, are at a low level in the hierarchy of evidence, because there no large comparative studies. Conclusions Due to the rarity of surgical treatment of this pathology, it makes sense to create a register of patients with Osgood-Schlatter disease for the purpose of a remote unified assessment of treatment results in order to identify the most appropriate method of surgical intervention.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73827693","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 : 2022-12-01DOI: 10.18019/1028-4427-2022-28-6-783-787
A. P. Antipov, E. M. Gordina, M. Markov, S. Bozhkova
Introduction Bone graft is the best option to repair postsurgical bone defects. The biomaterial is highly adaptive, structurally dynamic, metabolically active and characterized by high strength. Standard preparation of grafts for implantation includes cleaning followed by deep freezing and sterilization. However, methods used for processing bone material and reagents can change the biomechanical properties of the bone. The purpose was to explore the effect of chemical purification and subsequent lyophilization on the mechanical strength of bone grafts in comparison with native fresh frozen bone. Material and methods Metaepiphyseal sections of a single level of one tibia of a single cattle were used to rule out the influence of the variable density of native bone obtained from different donors. The bone was cut into blocks with a hand saw. Three groups of samples formed depending on the processing method included freshly frozen native bone, bone purified by combined chemical and physical methods and bone purified by the same technique followed by lyophilization. Mechanical properties were measured by axial compression mode using a 1958U-10-1 strength machine. Statistical data analysis was performed using the Kolmogorov-Smirnov (K-S) test and the Lilliefors correction with statistical significance of differences assessed with one-way analysis of variance (One-Way ANOVA). Results The cross-sectional area of hand-made blocks was comparable. No decrease in bone strength below the baseline was recorded regardless of the method of bone processing. Purified bone blocks demonstrated maximum strength characteristics prior to lyophilization. The sample strength decreased after lyophilization and was higher as compared to freshly frozen native bone. No statistically significant differences in the maximum force applied and the cross-sectional area were recorded between groups of samples. Modulus of elasticity and relative deformation had statistically significant differences in the groups (p < 0.05). Conclusion Modern methods of bone processing were shown to maintain biomechanical properties of the bone and can be used in the form of bone blocks or chips and as a structural graft.
{"title":"Influence of different methods of bone processing on bone mechanical properties","authors":"A. P. Antipov, E. M. Gordina, M. Markov, S. Bozhkova","doi":"10.18019/1028-4427-2022-28-6-783-787","DOIUrl":"https://doi.org/10.18019/1028-4427-2022-28-6-783-787","url":null,"abstract":"Introduction Bone graft is the best option to repair postsurgical bone defects. The biomaterial is highly adaptive, structurally dynamic, metabolically active and characterized by high strength. Standard preparation of grafts for implantation includes cleaning followed by deep freezing and sterilization. However, methods used for processing bone material and reagents can change the biomechanical properties of the bone. The purpose was to explore the effect of chemical purification and subsequent lyophilization on the mechanical strength of bone grafts in comparison with native fresh frozen bone. Material and methods Metaepiphyseal sections of a single level of one tibia of a single cattle were used to rule out the influence of the variable density of native bone obtained from different donors. The bone was cut into blocks with a hand saw. Three groups of samples formed depending on the processing method included freshly frozen native bone, bone purified by combined chemical and physical methods and bone purified by the same technique followed by lyophilization. Mechanical properties were measured by axial compression mode using a 1958U-10-1 strength machine. Statistical data analysis was performed using the Kolmogorov-Smirnov (K-S) test and the Lilliefors correction with statistical significance of differences assessed with one-way analysis of variance (One-Way ANOVA). Results The cross-sectional area of hand-made blocks was comparable. No decrease in bone strength below the baseline was recorded regardless of the method of bone processing. Purified bone blocks demonstrated maximum strength characteristics prior to lyophilization. The sample strength decreased after lyophilization and was higher as compared to freshly frozen native bone. No statistically significant differences in the maximum force applied and the cross-sectional area were recorded between groups of samples. Modulus of elasticity and relative deformation had statistically significant differences in the groups (p < 0.05). Conclusion Modern methods of bone processing were shown to maintain biomechanical properties of the bone and can be used in the form of bone blocks or chips and as a structural graft.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83262941","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 : 2022-12-01DOI: 10.18019/1028-4427-2022-28-6-760-767
A. Lazarev, E. Solod, Y. Gudushauri, E. Kalinin, V. Konovalov, I. N. Marychev
Introduction Stabilization of chronic injuries of the pelvic ring with standard methods may result in plate breach, destabilization of the implant and the need for repeated operations. Therefore, it has become necessary to use special tactical approaches in surgical treatment of chronic injuries for fixing traumatic foci and searching for adapted implant designs for such cases. Thus, an original plate has been developed. Purpose To study the features of fixation of chronic injuries of the pelvic ring using an original plate in comparison with the standard approach. Materials and methods We conducted a retrospective analysis of the surgical treatment performed using the developed plate (Group 2) and a group of patients who underwent fixation of the anterior pelvic ring with two reconstruction plates (Group 1). Results In group 1, four patients (16.7 %) had failed osteosynthesis within two weeks to two months after the operation. In group 2, thirty patients underwent surgical treatment using the developed design, and destabilization of the metal construct was detected only in 2 patients (6.6 %). In one case, migration of plate screws was detected after 3 years during routine X-ray study while the patient was not bothered by pain and did not feel any instability. Discussion Analyzing the positive and negative aspects of the methods used, we made a choice in favor of internal plating. Due to cases of destabilization of fixation using one or two plates, an original metal structure was developed and applied to strengthen fixation. Conclusion Changing the standard approaches to the treatment of chronic injuries (after 3 weeks since injury) of the anterior pelvic ring enables to create conditions for stable fixation, using the original monolithic plate, despite the rigidity of the pelvic ring in chronic injuries.
{"title":"Analysis of the use of original metal structures for anterior pelvic ring fixation","authors":"A. Lazarev, E. Solod, Y. Gudushauri, E. Kalinin, V. Konovalov, I. N. Marychev","doi":"10.18019/1028-4427-2022-28-6-760-767","DOIUrl":"https://doi.org/10.18019/1028-4427-2022-28-6-760-767","url":null,"abstract":"Introduction Stabilization of chronic injuries of the pelvic ring with standard methods may result in plate breach, destabilization of the implant and the need for repeated operations. Therefore, it has become necessary to use special tactical approaches in surgical treatment of chronic injuries for fixing traumatic foci and searching for adapted implant designs for such cases. Thus, an original plate has been developed. Purpose To study the features of fixation of chronic injuries of the pelvic ring using an original plate in comparison with the standard approach. Materials and methods We conducted a retrospective analysis of the surgical treatment performed using the developed plate (Group 2) and a group of patients who underwent fixation of the anterior pelvic ring with two reconstruction plates (Group 1). Results In group 1, four patients (16.7 %) had failed osteosynthesis within two weeks to two months after the operation. In group 2, thirty patients underwent surgical treatment using the developed design, and destabilization of the metal construct was detected only in 2 patients (6.6 %). In one case, migration of plate screws was detected after 3 years during routine X-ray study while the patient was not bothered by pain and did not feel any instability. Discussion Analyzing the positive and negative aspects of the methods used, we made a choice in favor of internal plating. Due to cases of destabilization of fixation using one or two plates, an original metal structure was developed and applied to strengthen fixation. Conclusion Changing the standard approaches to the treatment of chronic injuries (after 3 weeks since injury) of the anterior pelvic ring enables to create conditions for stable fixation, using the original monolithic plate, despite the rigidity of the pelvic ring in chronic injuries.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77027668","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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