Pub Date : 2023-04-01DOI: 10.18019/1028-4427-2023-29-2-167-172
V. Evreinov, A. V. Lukoyanova, D. Popkov, T. Zhirova
Surgical methods for treatment of spinal muscular atrophy (SMA) in children are aimed at improving their positioning and maintaining the ability of verticalization. Assessment of neurological, somatic and motor status of patients, individual selection of drugs for anesthesia and sedation at the stage of planning surgical interventions allow the anesthesiologist/resuscitator to avoid perioperative adverse events. Purpose To compare the course of the perioperative period in children with SMA who received pathogenetic therapy with nusinersen with the control group during orthopedic correction of acquired skeletal deformities. Materials and methods The retrospective analysis for the period from 2019 to 2021 included 23 children. Depending on the ongoing pathogenetic therapy, children with SMA were divided into 2 groups. The main group (SMA+N) included 9 children who received nusinersen; the control group (CG) included 14 children without antisense oligonucleotide therapy. Co-morbidities, hemodynamic parameters, blood loss, need for analgesics and complications were studied. Results Insignificant differences between the groups were recorded based on the Hammersmith Extended Scale (HFMSE). At the same time, similar comorbid pathology, the severity of respiratory failure, and the absence of differences in the frequency of the NIV application indicated that the groups were comparable. This is probably due to the late start of SMA treatment, degenerative changes in motor neurons, and fatty degeneration of muscle tissue. Conclusion Intake of nusinersen in patients with SMA type II-III and a long period of illness, severe neurological and respiratory disorders do not lead to a significant regression of symptoms in the perioperative period. The therapy with antisense oligonucleotides in severe muscle hypotonia does not exclude the risk of adverse events in the perioperative period in children with SMA type II-III during orthopedic correction of skeletal deformities.
{"title":"Assessment of the perioperative status in children with SMA receiving nusinersen and undergoing reconstructive orthopedic interventions","authors":"V. Evreinov, A. V. Lukoyanova, D. Popkov, T. Zhirova","doi":"10.18019/1028-4427-2023-29-2-167-172","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-2-167-172","url":null,"abstract":"Surgical methods for treatment of spinal muscular atrophy (SMA) in children are aimed at improving their positioning and maintaining the ability of verticalization. Assessment of neurological, somatic and motor status of patients, individual selection of drugs for anesthesia and sedation at the stage of planning surgical interventions allow the anesthesiologist/resuscitator to avoid perioperative adverse events. Purpose To compare the course of the perioperative period in children with SMA who received pathogenetic therapy with nusinersen with the control group during orthopedic correction of acquired skeletal deformities. Materials and methods The retrospective analysis for the period from 2019 to 2021 included 23 children. Depending on the ongoing pathogenetic therapy, children with SMA were divided into 2 groups. The main group (SMA+N) included 9 children who received nusinersen; the control group (CG) included 14 children without antisense oligonucleotide therapy. Co-morbidities, hemodynamic parameters, blood loss, need for analgesics and complications were studied. Results Insignificant differences between the groups were recorded based on the Hammersmith Extended Scale (HFMSE). At the same time, similar comorbid pathology, the severity of respiratory failure, and the absence of differences in the frequency of the NIV application indicated that the groups were comparable. This is probably due to the late start of SMA treatment, degenerative changes in motor neurons, and fatty degeneration of muscle tissue. Conclusion Intake of nusinersen in patients with SMA type II-III and a long period of illness, severe neurological and respiratory disorders do not lead to a significant regression of symptoms in the perioperative period. The therapy with antisense oligonucleotides in severe muscle hypotonia does not exclude the risk of adverse events in the perioperative period in children with SMA type II-III during orthopedic correction of skeletal deformities.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89096336","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 : 2023-04-01DOI: 10.18019/1028-4427-2023-29-2-127-136
E. Kolyado, V. A. Peleganchuk, A. N. Povalikhin, V. Lazareva
Introduction Scheduling and distribution of medical care capacities approved by a healthcare organization, management of the key processes of patient selection and hospitalization with the use of digital technology are the most important organizational tools for successful implementation of state assignments. Purpose To develop an organizational model of medical care capacities, management of the processes of patient selection and hospitalization at a specialized federal center with the use of digital technology. Materials and methods Analysis of the plans of rendering specialized medical care in 72,547 cases, including high-tech medical care, for 10-year period (years 2013-2022) in the fields of “traumatology and orthopedics” and “neurosurgery” by means of healthcare information system and digital patients’ registries was conducted by the continuous method. Results Rates and types of patients’ nonappearance for hospitalization were identified: the rate of informed nonappearance was 37.9 ± 0.4 (per 100 planned patients), the rate of uninformed nonappearance was 18.4 ± 0.4 (per 100 patients who referred to admission), the rate of repeated nonappearance was 1.6 ± 0.1, and the rate of patients’ unplanned referral (arrival) was 6.0 ± 0.1. The rate of hospitalization rejection for a 10-year period (2013-2022) was 6.4 ± 0.1 (per 100 patients who sought medical care). For a 3-year period (2020-2022), the rate of non-confirmed surgical indications was 6.9 ± 0.1 (per 100 patients). Comparative analysis of 5-year periods (2013-2017 and 2018-2022) identified a 1.4-fold increase in an average 5-year rate of hospitalization refusal (t = 13.6, P < 0.0001). For a 5-year period (2018-2022), the rate of hospitalization of patients aged 75 and older was 5.3 ± 0.1, of patients with co-morbidity (diabetes mellitus) 11.8 ± 0.2 per 100 treated patients. Multi-purpose calculation method for prediction of patients’ hospitalization was offered. Discussion Based on the specified rate of patients’ nonappearance for hospitalization it would be advisable to provide a number of patients that would be over the plan in order to achieve necessary hospitalization numbers. An operating reserve in the digital patients’ registry would solve an issue of hospitalization plan execution and to substitute the patients who were not able to appear. Conclusion Our study has identified regularities of implementation of planned hospitalization of patients to traumatology/orthopedics and neurosurgery units in the conditions of a federal center.
医疗保健组织批准的医疗保健能力的调度和分配、患者选择和住院的关键过程的管理以及使用数字技术是成功实施国家任务的最重要的组织工具。目的利用数字技术开发一个联邦专业中心的医疗保健能力、病人选择和住院过程管理的组织模型。材料与方法采用连续法对“创伤骨科”和“神经外科”领域10年(2013-2022年)72547例包括高科技医疗服务的专科医疗计划进行分析。结果确定了患者住院未见率和类型:知情未见率为37.9±0.4(每100例计划患者)，不知情未见率为18.4±0.4(每100例入院患者)，重复未见率为1.6±0.1，患者计划外转诊(到达)率为6.0±0.1。10年期间(2013-2022年)住院排斥率为6.4±0.1(每100名就诊患者)。在3年期间(2020-2022)，未确诊的手术指征率为6.9±0.1(每100名患者)。5年期间(2013-2017年和2018-2022年)的比较分析发现，平均5年住院拒绝率增加了1.4倍(t = 13.6, P < 0.0001)。2018-2022年5年期间，75岁及以上患者的住院率为5.3±0.1 / 100，合并糖尿病患者的住院率为11.8±0.2 / 100。提出了预测患者住院率的多用途计算方法。根据规定的病人不住院率，为达到必要的住院人数，建议提供超出计划的病人数目。在数字病人登记册中建立一个操作储备将解决住院计划执行的问题，并替代无法出现的病人。结论本研究确定了某联邦中心创伤/骨科和神经外科病人计划住院的实施规律。
{"title":"Management of medical care capacity and hospitalization process with the use of digital technology at a specialized federal center","authors":"E. Kolyado, V. A. Peleganchuk, A. N. Povalikhin, V. Lazareva","doi":"10.18019/1028-4427-2023-29-2-127-136","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-2-127-136","url":null,"abstract":"Introduction Scheduling and distribution of medical care capacities approved by a healthcare organization, management of the key processes of patient selection and hospitalization with the use of digital technology are the most important organizational tools for successful implementation of state assignments. Purpose To develop an organizational model of medical care capacities, management of the processes of patient selection and hospitalization at a specialized federal center with the use of digital technology. Materials and methods Analysis of the plans of rendering specialized medical care in 72,547 cases, including high-tech medical care, for 10-year period (years 2013-2022) in the fields of “traumatology and orthopedics” and “neurosurgery” by means of healthcare information system and digital patients’ registries was conducted by the continuous method. Results Rates and types of patients’ nonappearance for hospitalization were identified: the rate of informed nonappearance was 37.9 ± 0.4 (per 100 planned patients), the rate of uninformed nonappearance was 18.4 ± 0.4 (per 100 patients who referred to admission), the rate of repeated nonappearance was 1.6 ± 0.1, and the rate of patients’ unplanned referral (arrival) was 6.0 ± 0.1. The rate of hospitalization rejection for a 10-year period (2013-2022) was 6.4 ± 0.1 (per 100 patients who sought medical care). For a 3-year period (2020-2022), the rate of non-confirmed surgical indications was 6.9 ± 0.1 (per 100 patients). Comparative analysis of 5-year periods (2013-2017 and 2018-2022) identified a 1.4-fold increase in an average 5-year rate of hospitalization refusal (t = 13.6, P < 0.0001). For a 5-year period (2018-2022), the rate of hospitalization of patients aged 75 and older was 5.3 ± 0.1, of patients with co-morbidity (diabetes mellitus) 11.8 ± 0.2 per 100 treated patients. Multi-purpose calculation method for prediction of patients’ hospitalization was offered. Discussion Based on the specified rate of patients’ nonappearance for hospitalization it would be advisable to provide a number of patients that would be over the plan in order to achieve necessary hospitalization numbers. An operating reserve in the digital patients’ registry would solve an issue of hospitalization plan execution and to substitute the patients who were not able to appear. Conclusion Our study has identified regularities of implementation of planned hospitalization of patients to traumatology/orthopedics and neurosurgery units in the conditions of a federal center.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88024361","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: 10.18019/1028-4427-2023-29-1-12-19
I. Khodzhanov, D. Borzunov, G.Dz. Bayimbetov
Introduction Diagnosis and treatment of children with multiple injuries of the bones that form the elbow joint is a relevant problem in pediatric traumatology. Due to the high variability of the cases encountered, it is necessary to differentiate the volume, timing and sequence of surgical interventions, as well as the duration of fixation of the injured limb with immobilizing means. The aim of the work was to study the dependence of long-term anatomical and functional treatment results in children with multiple fractures around the elbow joint on the type of injury. Materials and methods The medical records of 82 pediatric patients with multiple injuries of the bones forming the elbow joint were studied. The patients involed in the study were divided into two groups. Group 1 were patients with multiple fractures of the bones that make up the elbow joint (35 children), and group 2 were patients with intra-articular fractures of the distal end of the humerus and fracture-dislocations of the forearm bones in the elbow joint (47 children). The results were evaluated using the DASH questionnaire and the Broberg-Morrey rating scale. Results In the first group of patients with multiple fractures of the bones that make up the elbow joint, the anatomical and functional results of treatment were significantly better, and the process of restoring the function of the elbow joint was shorter. The treatment results of patients in the second group largely depended on the severity of the injuries. The use of the Ilizarov method with rational arrangements of the apparatus enables to preserve the function of the elbow joint in the course of transosseous osteosynthesis. In hybrid fixation (the use of pins and apparatus or plaster immobilization and apparatus), patients frequently developed immobilization contracture of the elbow joint and the anatomical and functional results turned out to be worse, since the fixed elbow joint needed long-term rehabilitation. Discussion Multiple injuries of the bones of the elbow joint are highly variable. The treatment of patients with multiple injuries of the elbow joint remains a difficult clinical task, partly because there is no differentiated approach to rehabilitation measures depending on the nature of the injury, and, accordingly, a rational approach to the treatment of this group of patients has not been developed. Due to the fact that most dislocations are usually associated with fractures, accurate diagnosis of the severity of injuries and rational surgical intervention in terms of timing and volume are necessary to achieve good anatomical and functional results. Conclusion Accurate and timely diagnosis of skeletal injuries of the elbow joint and rational determination of treatment tactics are of great importance in pediatric emergency traumatology. They determine the anatomical and functional outcomes of rehabilitation.
{"title":"Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, Tashkent, Republic of Uzbekistan","authors":"I. Khodzhanov, D. Borzunov, G.Dz. Bayimbetov","doi":"10.18019/1028-4427-2023-29-1-12-19","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-12-19","url":null,"abstract":"Introduction Diagnosis and treatment of children with multiple injuries of the bones that form the elbow joint is a relevant problem in pediatric traumatology. Due to the high variability of the cases encountered, it is necessary to differentiate the volume, timing and sequence of surgical interventions, as well as the duration of fixation of the injured limb with immobilizing means. The aim of the work was to study the dependence of long-term anatomical and functional treatment results in children with multiple fractures around the elbow joint on the type of injury. Materials and methods The medical records of 82 pediatric patients with multiple injuries of the bones forming the elbow joint were studied. The patients involed in the study were divided into two groups. Group 1 were patients with multiple fractures of the bones that make up the elbow joint (35 children), and group 2 were patients with intra-articular fractures of the distal end of the humerus and fracture-dislocations of the forearm bones in the elbow joint (47 children). The results were evaluated using the DASH questionnaire and the Broberg-Morrey rating scale. Results In the first group of patients with multiple fractures of the bones that make up the elbow joint, the anatomical and functional results of treatment were significantly better, and the process of restoring the function of the elbow joint was shorter. The treatment results of patients in the second group largely depended on the severity of the injuries. The use of the Ilizarov method with rational arrangements of the apparatus enables to preserve the function of the elbow joint in the course of transosseous osteosynthesis. In hybrid fixation (the use of pins and apparatus or plaster immobilization and apparatus), patients frequently developed immobilization contracture of the elbow joint and the anatomical and functional results turned out to be worse, since the fixed elbow joint needed long-term rehabilitation. Discussion Multiple injuries of the bones of the elbow joint are highly variable. The treatment of patients with multiple injuries of the elbow joint remains a difficult clinical task, partly because there is no differentiated approach to rehabilitation measures depending on the nature of the injury, and, accordingly, a rational approach to the treatment of this group of patients has not been developed. Due to the fact that most dislocations are usually associated with fractures, accurate diagnosis of the severity of injuries and rational surgical intervention in terms of timing and volume are necessary to achieve good anatomical and functional results. Conclusion Accurate and timely diagnosis of skeletal injuries of the elbow joint and rational determination of treatment tactics are of great importance in pediatric emergency traumatology. They determine the anatomical and functional outcomes of rehabilitation.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90088432","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: 10.18019/1028-4427-2023-29-1-20-26
I.A. Solomiannik, S. Rodionova, A. Torgashin, P.S. Seropolov, S. Mironov, A. Gubin
Introduction The low detection rate of osteoporosis and the lack of treatment in the elderly can contribute to a higher rate of low-energy fractures, poor results of surgical treatment and mortality. The purpose of the work was to evaluate the frequency of detection and treatment of osteoporosis before the fracture and during specialized trauma and orthopaedic care provided for a low-energy fracture of the proximal femur in the elderly. Material and methods A retrospective analysis of 209 medical histories of individuals aged 60 years and older who received treatment for a low-energy fracture of the proximal femur in 2 randomly selected trauma departments and a telephone survey of the patients performed at 3-8 months were produced. Availability of the diagnosed osteoporosis and the treatment before and during fracture repair were identified. Results The diagnosed osteoporosis was established in 5.2 % prior to fracture occurrence and in 16.7 % after the fracture occurrence. In both cases, the condition was treated with colcalciferol, calcium and pathogenetic therapy used in some cases. Discussion Diagnosis and treatment of osteoporosis in the elderly remained low before a lowenergy fracture of the proximal femur and during trauma and orthopaedic treatment. Conclusion The initiation and treatment of osteoporosis during the trauma and orthopaedic management of a low-energy fracture should be considered as a component of the high-quality specialized care.
{"title":"Osteoporosis from the perspective of specialized trauma and orthopaedic treatment of low-energy fractures of the proximal femur","authors":"I.A. Solomiannik, S. Rodionova, A. Torgashin, P.S. Seropolov, S. Mironov, A. Gubin","doi":"10.18019/1028-4427-2023-29-1-20-26","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-20-26","url":null,"abstract":"Introduction The low detection rate of osteoporosis and the lack of treatment in the elderly can contribute to a higher rate of low-energy fractures, poor results of surgical treatment and mortality. The purpose of the work was to evaluate the frequency of detection and treatment of osteoporosis before the fracture and during specialized trauma and orthopaedic care provided for a low-energy fracture of the proximal femur in the elderly. Material and methods A retrospective analysis of 209 medical histories of individuals aged 60 years and older who received treatment for a low-energy fracture of the proximal femur in 2 randomly selected trauma departments and a telephone survey of the patients performed at 3-8 months were produced. Availability of the diagnosed osteoporosis and the treatment before and during fracture repair were identified. Results The diagnosed osteoporosis was established in 5.2 % prior to fracture occurrence and in 16.7 % after the fracture occurrence. In both cases, the condition was treated with colcalciferol, calcium and pathogenetic therapy used in some cases. Discussion Diagnosis and treatment of osteoporosis in the elderly remained low before a lowenergy fracture of the proximal femur and during trauma and orthopaedic treatment. Conclusion The initiation and treatment of osteoporosis during the trauma and orthopaedic management of a low-energy fracture should be considered as a component of the high-quality specialized care.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78188524","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: 10.18019/1028-4427-2023-29-1-43-48
E. Skryabin, A. Nazarova, P. B. Zotov, K.S. Denisov, M. A. Akselrov
There is a paucity of Russian medical literature reporting lumbosacral transitional vertebrae in children and adolescents. Many important aspects of the condition including two nosologies of sacralization of the L5 vertebrae and lumbalization of the S1 vertebrae have been under-explored. The objective was to establish overall frequency and frequency of certain types of lumbosacral transitional vertebrae in children and adolescents who sustained a lumbar injury and to investigate clinical manifestations of the pathology. Material and methods A comprehensive examination of 312children aged 7 to 18 years who suffered a lumbar injury was performed. Lumbosacral transitional vertebrae was radiologically diagnosed in 19 (6.09 %) subjects. Grading system of A.E. Castellvi et al. (1984) was used to classify the pathology. Results From 19 patients with lumbosacral transitional vertebrae, sacralization of the L5 vertebrae was detected in 16 (84.21 %) individuals. Lumbalization of the S1 vertebrae was diagnosed in 3 (15.79 %) children. Type II (n = 13) and subtype "b" (n = 10) were most common. No types III and IV of the disease were seen. No clinical symptoms indicating the likelihood of having lumbosacral transitional vertebrae were observed in the patients prior to the lumbar injury. Conclusion The frequency of occurrence of lumbosacral transitional vertebrae and its structure were reviewed in children and adolescents. The patients demonstrated no clinical manifestations of the condition before the children sustained lumbar injuries. Various aspects of transitional lumbar vertebrae in children and adolescents require further study.
俄罗斯医学文献中关于儿童和青少年腰骶过渡椎的报道很少。该疾病的许多重要方面，包括L5椎体骶骨化和S1椎体腰椎化的两种分类学尚未得到充分探讨。目的是建立总体频率和某些类型的腰骶移行椎体在儿童和青少年谁持续腰椎损伤的频率，并调查病理的临床表现。材料与方法对312例7 ~ 18岁腰椎损伤患儿进行了综合检查。19例(6.09%)患者被诊断为腰骶过渡椎。采用A.E. Castellvi et al.(1984)的分级系统对病理进行分类。结果19例腰骶骨移行椎体患者中，16例(84.21%)出现L5椎体骶骨化。3例(15.79%)患儿被诊断为S1椎体腰椎化。II型(n = 13)和b亚型(n = 10)最常见。未见III型和IV型病变。在腰椎损伤之前，没有观察到临床症状表明患者可能患有腰骶过渡椎体。结论回顾了儿童和青少年腰骶过渡椎的发生频率及其结构。在儿童持续腰椎损伤之前，患者没有表现出该病症的临床表现。儿童和青少年过渡性腰椎的各个方面需要进一步研究。
{"title":"Lumbosacral transitional vertebrae in children and adolescents with a lumbar injury: diagnosis frequency and clinical symptoms","authors":"E. Skryabin, A. Nazarova, P. B. Zotov, K.S. Denisov, M. A. Akselrov","doi":"10.18019/1028-4427-2023-29-1-43-48","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-43-48","url":null,"abstract":"There is a paucity of Russian medical literature reporting lumbosacral transitional vertebrae in children and adolescents. Many important aspects of the condition including two nosologies of sacralization of the L5 vertebrae and lumbalization of the S1 vertebrae have been under-explored. The objective was to establish overall frequency and frequency of certain types of lumbosacral transitional vertebrae in children and adolescents who sustained a lumbar injury and to investigate clinical manifestations of the pathology. Material and methods A comprehensive examination of 312children aged 7 to 18 years who suffered a lumbar injury was performed. Lumbosacral transitional vertebrae was radiologically diagnosed in 19 (6.09 %) subjects. Grading system of A.E. Castellvi et al. (1984) was used to classify the pathology. Results From 19 patients with lumbosacral transitional vertebrae, sacralization of the L5 vertebrae was detected in 16 (84.21 %) individuals. Lumbalization of the S1 vertebrae was diagnosed in 3 (15.79 %) children. Type II (n = 13) and subtype \"b\" (n = 10) were most common. No types III and IV of the disease were seen. No clinical symptoms indicating the likelihood of having lumbosacral transitional vertebrae were observed in the patients prior to the lumbar injury. Conclusion The frequency of occurrence of lumbosacral transitional vertebrae and its structure were reviewed in children and adolescents. The patients demonstrated no clinical manifestations of the condition before the children sustained lumbar injuries. Various aspects of transitional lumbar vertebrae in children and adolescents require further study.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84609206","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: 10.18019/1028-4427-2023-29-1-104-109
A. A. Karpushin, D. Naumov, A. Vishnevsky, A.A. Nakaev
Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p < 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.
{"title":"Thoracolumbar tuberculosis spondylitis: an analytical literature review of surgical reconstruction techniques","authors":"A. A. Karpushin, D. Naumov, A. Vishnevsky, A.A. Nakaev","doi":"10.18019/1028-4427-2023-29-1-104-109","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-104-109","url":null,"abstract":"Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p < 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89604034","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: 10.18019/1028-4427-2023-29-1-27-34
I. V. Sutyagin, A. Burtsev, L. Melnikova
Introduction The aim of the study was to analyze the functional results of surgical treatment in patients with unstable ankle fractures with the Ilizarov method (controlled retrospective cohort monocenter non-randomized study; Level of evidence II). Materials and methods Fifty-three patients, 15 males and 38 females, in the mean age of 48 years, with ankle fractures met the inclusion criteria. The patients were divided into three groups according to the principle of dominant lesion location and according to the number of damaged bone structures. The patients underwent surgical interventions comprising closed reduction and external fixation with the Ilizarov apparatus bridging the ankle and subtalar joints. The study period was 34.6 months after surgery. Functional outcomes were evaluated based on the data of the AOFAS questionnaire. Results The average AOFAS score for Weber type A fractures was 95.25 ± 6.84 (SD), 93.77 ± 6.85 (SD) for type B, and 93.57 ± 4.03 (SD) for type C. In the patients with isolated fractures of the lateral malleolus it was 93.44 ± 8.38 (SD), in bimalleolar fractures – 94.09 ± 6.41 (SD), and in trimalleolar fractures – 93.71 ± 6.39 (SD). There were no significant differences between the groups of patients with different (Weber) types of ankle fractures. There was tendency to worse outcomes in patients whose surgical treatment was carried out 7 days or more after the injury. Conclusion Ankle osteosynthesis with the Ilizarov apparatus in unstable ankle fractures demonstrates excellent mid-term (range, 2 to 4 years) functional outcomes. The number of damaged bone structures of the ankle joint and the location of the dominant injury are not predictors of an unfavorable outcome in unstable ankle fractures in case of definitive fixation with the Ilizarov apparatus. There is a tendency to worse functional outcomes in delayed surgical treatment if the time from injury to surgery is more than seven days.
{"title":"Mid-term outcomes of ankle fracture repair with the Ilizarov method","authors":"I. V. Sutyagin, A. Burtsev, L. Melnikova","doi":"10.18019/1028-4427-2023-29-1-27-34","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-27-34","url":null,"abstract":"Introduction The aim of the study was to analyze the functional results of surgical treatment in patients with unstable ankle fractures with the Ilizarov method (controlled retrospective cohort monocenter non-randomized study; Level of evidence II). Materials and methods Fifty-three patients, 15 males and 38 females, in the mean age of 48 years, with ankle fractures met the inclusion criteria. The patients were divided into three groups according to the principle of dominant lesion location and according to the number of damaged bone structures. The patients underwent surgical interventions comprising closed reduction and external fixation with the Ilizarov apparatus bridging the ankle and subtalar joints. The study period was 34.6 months after surgery. Functional outcomes were evaluated based on the data of the AOFAS questionnaire. Results The average AOFAS score for Weber type A fractures was 95.25 ± 6.84 (SD), 93.77 ± 6.85 (SD) for type B, and 93.57 ± 4.03 (SD) for type C. In the patients with isolated fractures of the lateral malleolus it was 93.44 ± 8.38 (SD), in bimalleolar fractures – 94.09 ± 6.41 (SD), and in trimalleolar fractures – 93.71 ± 6.39 (SD). There were no significant differences between the groups of patients with different (Weber) types of ankle fractures. There was tendency to worse outcomes in patients whose surgical treatment was carried out 7 days or more after the injury. Conclusion Ankle osteosynthesis with the Ilizarov apparatus in unstable ankle fractures demonstrates excellent mid-term (range, 2 to 4 years) functional outcomes. The number of damaged bone structures of the ankle joint and the location of the dominant injury are not predictors of an unfavorable outcome in unstable ankle fractures in case of definitive fixation with the Ilizarov apparatus. There is a tendency to worse functional outcomes in delayed surgical treatment if the time from injury to surgery is more than seven days.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84726767","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: 10.18019/1028-4427-2023-29-1-85-91
A. Shulga, V. Ostrovskii, V. Zaretskov, S. Bazhanov, S. V. Likhachev, A. Smolkin
Osteoporotic vertebral compression fractures (OVCF) are common fragility fractures of the spine that can lead to the functional failure and neurological deficit in 15-35 % of cases. There is no clear understanding of preferred surgical techniques to be used for treatment of patients with complicated thoracic and lumbar OVCF. The objective was to analyze reasons of failed ventral intervention in a patient with old Th12 injury affected by osteoporosis and demonstrate a short- and long-term outcome of repeated surgery. Material and methods A 63-year-old patient underwent stabilization of the thoracolumbar spine using a combined polysegmental (screws/hooks) dorsal system with screws augmented with bone cement. Results Physical examination and radiography at 12 months showed no loss of correction or signs of structural instability. Bone-metal fusion was observed at the level of the mesh endofixator (Th11-L1). VAS scored 0-1 (standing = lying), the Oswestry Disability Index was 12 %. Discussion The poor outcome of ventral intervention was caused by inadequate instrumentation of the transitional thoracolumbar spine in osteoporotic patient leading to L1 destruction and gradual kyphotization of the stabilized spine. The satisfactory short- and long-term outcomes of the revision dorsal intervention indicated the effective surgical strategy in the case. Conclusion With the results of the case reported, the reliability of anterior fixation is to be considered in osteoporotic patients to determine the feasibility of extended ventral systems in elderly patients. Dorsal stabilization and spinal fusion without preliminary abdominal revision are practical with unstable anterior fixation being not accompanied by significant secondary spinal deformity.
{"title":"Surgical treatment of a patient with failed ventral fixation of an old Th12 fracture affected by severe osteoporosis (case report)","authors":"A. Shulga, V. Ostrovskii, V. Zaretskov, S. Bazhanov, S. V. Likhachev, A. Smolkin","doi":"10.18019/1028-4427-2023-29-1-85-91","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-85-91","url":null,"abstract":"Osteoporotic vertebral compression fractures (OVCF) are common fragility fractures of the spine that can lead to the functional failure and neurological deficit in 15-35 % of cases. There is no clear understanding of preferred surgical techniques to be used for treatment of patients with complicated thoracic and lumbar OVCF. The objective was to analyze reasons of failed ventral intervention in a patient with old Th12 injury affected by osteoporosis and demonstrate a short- and long-term outcome of repeated surgery. Material and methods A 63-year-old patient underwent stabilization of the thoracolumbar spine using a combined polysegmental (screws/hooks) dorsal system with screws augmented with bone cement. Results Physical examination and radiography at 12 months showed no loss of correction or signs of structural instability. Bone-metal fusion was observed at the level of the mesh endofixator (Th11-L1). VAS scored 0-1 (standing = lying), the Oswestry Disability Index was 12 %. Discussion The poor outcome of ventral intervention was caused by inadequate instrumentation of the transitional thoracolumbar spine in osteoporotic patient leading to L1 destruction and gradual kyphotization of the stabilized spine. The satisfactory short- and long-term outcomes of the revision dorsal intervention indicated the effective surgical strategy in the case. Conclusion With the results of the case reported, the reliability of anterior fixation is to be considered in osteoporotic patients to determine the feasibility of extended ventral systems in elderly patients. Dorsal stabilization and spinal fusion without preliminary abdominal revision are practical with unstable anterior fixation being not accompanied by significant secondary spinal deformity.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73062143","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: 10.18019/1028-4427-2023-29-1-49-56
Y. Zeynalov, A. Burtsev, G. Diachkova, K. A. Diachkov
Introduction Multifactoriality in the etiology of idiopathic scoliosis (IS) requires an integrated approach to diagnosis, while the regular examination of patients is limited to radiography, computed tomography without a detailed analysis of the data obtained on the state of the musculoskeletal system. The problem of complex diagnosis of IS is practically not covered by the literature including the syndromic approach to the rationale for the method of treatment and rehabilitation. Purpose of the study To define the concept of "syndromocomplex" of idiopathic scoliosis based on the study of the state of the spine, muscles, proximal femur, bone mineral density (BMD), mineral metabolism and bone metabolism using current diagnostic methods. Materials and methods The state of the spine (300 patients), proximal femur (57 patients), paravertebral (40 patients) and gluteal muscles (60 patients of the main group and 40 of the control group) were studied using the method of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), densitometry – BMD (40 patients of the main and 40 of control one), mineral metabolism and bone metabolism were studied by biochemical methods in 55 patients with IS. Results and discussion The study of patients with idiopathic scoliosis at different ages and with different grades of deformities in various parts of the musculoskeletal system revealed pronounced disorders in the shape of the vertebrae, including an increase in the frontal diameter, wedge shape with a significant difference in density along the convex and concave sides, structural changes in the vertebrae, manifested in a decrease in density, the presence of rarefaction zones, areas of maximum density at the top of the deformity, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, a decrease in BMD, a decrease in the density of the femoral head, impaired mineral metabolism and bone metabolism. Conclusion Severe disorders in the shape, X-ray morphological changes in the vertebrae, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, concomitant changes in BMD, hip joint, mineral metabolism and bone metabolism, are included in the concept of "syndromocomplex” of idiopathic scoliosis, underlie the tactical concept for diagnosis, treatment and further rehabilitation measures for patients with severe forms of scoliosis.
{"title":"Idiopathic scoliosis \"syndromocomplex\"","authors":"Y. Zeynalov, A. Burtsev, G. Diachkova, K. A. Diachkov","doi":"10.18019/1028-4427-2023-29-1-49-56","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-49-56","url":null,"abstract":"Introduction Multifactoriality in the etiology of idiopathic scoliosis (IS) requires an integrated approach to diagnosis, while the regular examination of patients is limited to radiography, computed tomography without a detailed analysis of the data obtained on the state of the musculoskeletal system. The problem of complex diagnosis of IS is practically not covered by the literature including the syndromic approach to the rationale for the method of treatment and rehabilitation. Purpose of the study To define the concept of \"syndromocomplex\" of idiopathic scoliosis based on the study of the state of the spine, muscles, proximal femur, bone mineral density (BMD), mineral metabolism and bone metabolism using current diagnostic methods. Materials and methods The state of the spine (300 patients), proximal femur (57 patients), paravertebral (40 patients) and gluteal muscles (60 patients of the main group and 40 of the control group) were studied using the method of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), densitometry – BMD (40 patients of the main and 40 of control one), mineral metabolism and bone metabolism were studied by biochemical methods in 55 patients with IS. Results and discussion The study of patients with idiopathic scoliosis at different ages and with different grades of deformities in various parts of the musculoskeletal system revealed pronounced disorders in the shape of the vertebrae, including an increase in the frontal diameter, wedge shape with a significant difference in density along the convex and concave sides, structural changes in the vertebrae, manifested in a decrease in density, the presence of rarefaction zones, areas of maximum density at the top of the deformity, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, a decrease in BMD, a decrease in the density of the femoral head, impaired mineral metabolism and bone metabolism. Conclusion Severe disorders in the shape, X-ray morphological changes in the vertebrae, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, concomitant changes in BMD, hip joint, mineral metabolism and bone metabolism, are included in the concept of \"syndromocomplex” of idiopathic scoliosis, underlie the tactical concept for diagnosis, treatment and further rehabilitation measures for patients with severe forms of scoliosis.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80330429","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: 10.18019/1028-4427-2023-29-1-64-70
R. E. Melikova, A. Tsiskarashvili, A. Artyukhov, N. V. Sokorova
The objective was to explore the dynamics and duration of antibiotic elution in samples based on polymer hydrogel and PMMA. Material and methods The samples impregnated with vancomycin, rifampicin and cefazolin at various concentrations were placed in phosphate-buffered saline and incubated at 37 °C. The medium was completely replaced at 1, 3, 7, 14, 21 and 28 days. Spectrophotometry was used to measure concentration of drugs in solution and the release profiles. The median and 95 % CI were employed to statistically describe data obtained from 5 parallel studies. Results Concentrations of the antibiotics eluted from the polymer hydrogel were 7 times greater than those released from PMMA on day 1; 15 times greater on days 2 and 3; 6.6 times greater on day 7 and 3 times or more in the following days of observation. The rate of antibiotic release from hydrogel volumes also differed markedly. Discussion The drug release was more than 70% of the total amount for all hydrogel samples in contrast to PMMA with elution not exceeding 10 %. Despite the fact that a burst release was observed with 80 % of the antibiotic released in the first 5 days as seen in the case of bone cement, the concentration of the drug eluted from hydrogels was several times higher and exceeded the MIC throughout the observation period. The release of the antimicrobial agent from hydrogels was caused by diffusion of the particles from the entire volume of the matrix demonstrating an important advantage over PMMA with the potential being limited by surface depletion. Conclusion At this point, we have shown the possibility of creating potential depot systems based on unsaturated PVA derivatives with controlled release of antibiotics and characteristics being superior to PMMA.
{"title":"In vitro study of the dynamics in elution of antibacterial drugs impregnated into matrices based on polymer hydrogel","authors":"R. E. Melikova, A. Tsiskarashvili, A. Artyukhov, N. V. Sokorova","doi":"10.18019/1028-4427-2023-29-1-64-70","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-1-64-70","url":null,"abstract":"The objective was to explore the dynamics and duration of antibiotic elution in samples based on polymer hydrogel and PMMA. Material and methods The samples impregnated with vancomycin, rifampicin and cefazolin at various concentrations were placed in phosphate-buffered saline and incubated at 37 °C. The medium was completely replaced at 1, 3, 7, 14, 21 and 28 days. Spectrophotometry was used to measure concentration of drugs in solution and the release profiles. The median and 95 % CI were employed to statistically describe data obtained from 5 parallel studies. Results Concentrations of the antibiotics eluted from the polymer hydrogel were 7 times greater than those released from PMMA on day 1; 15 times greater on days 2 and 3; 6.6 times greater on day 7 and 3 times or more in the following days of observation. The rate of antibiotic release from hydrogel volumes also differed markedly. Discussion The drug release was more than 70% of the total amount for all hydrogel samples in contrast to PMMA with elution not exceeding 10 %. Despite the fact that a burst release was observed with 80 % of the antibiotic released in the first 5 days as seen in the case of bone cement, the concentration of the drug eluted from hydrogels was several times higher and exceeded the MIC throughout the observation period. The release of the antimicrobial agent from hydrogels was caused by diffusion of the particles from the entire volume of the matrix demonstrating an important advantage over PMMA with the potential being limited by surface depletion. Conclusion At this point, we have shown the possibility of creating potential depot systems based on unsaturated PVA derivatives with controlled release of antibiotics and characteristics being superior to PMMA.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"47 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83184522","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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