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Treatment of Patients with Ankle Fractures (Literature Review) 踝关节骨折的治疗(文献回顾)
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.12
N. I. Cherevatiy, L. Solomin
The consequences of ankle fractures are a leading cause of disability among injuries of the musculoskeletal system. The problems of treating patients with this pathology have been of interest to researchers throughout the entire period of development of ankle joint surgery. However, numerous attempts to define terminology and classify chronic ankle joint injuries were unsuccessful. It can be argued that the consequences of ankle fractures are a symptom complex that includes traumatic deformity and pseudoarthrosis of the ankles, subluxation of the foot, contracture and arthrosis of the ankle joint. Today, for the surgical treatment of chronic injuries of the ankle joint, a number of surgical techniques are used, the indications and contraindications for each of them are not completely determined. In addition, long- term results are also the subject of a debate. There is a need to develop an improved approach to the treatment of the pathology under consideration, to create a decision-making algorithm in each specific clinical case. There is no doubt that preference should be given to organ-preserving operations. Based on a review of world literature, data were obtained on the epidemiology, medical and social significance of the effects of ankle fractures, and the evolution of researchers’ views on the treatment of patients with this pathology and their development prospects were examined.
在肌肉骨骼系统损伤中,踝关节骨折的后果是导致残疾的主要原因。在踝关节外科发展的整个时期,治疗这种病理患者的问题一直是研究人员感兴趣的。然而,许多尝试定义术语和分类慢性踝关节损伤是不成功的。可以认为,踝关节骨折的后果是一个复杂的症状,包括创伤性畸形和踝关节假性关节、足部半脱位、踝关节挛缩和关节。目前,对于踝关节慢性损伤的手术治疗,使用了许多手术技术,每种手术技术的适应症和禁忌症尚未完全确定。此外,长期结果也是争论的主题。有必要开发一种改进的方法来治疗所考虑的病理,在每个具体的临床病例中创建一个决策算法。毫无疑问,应该优先考虑器官保存手术。本文在查阅国内外文献的基础上,对踝关节骨折的流行病学、医学和社会意义进行了综述,并探讨了研究人员对踝关节骨折患者治疗的看法演变及其发展前景。
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引用次数: 1
Functional State of the Bioelectrical Activity of the Brain in Cervical Osteochondrosis 颈椎病患者脑生物电活动的功能状态
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.1
I. N. Kinash, T. K. Verkhozina, E. G. Ippolitova, O. Sklyarenko, Z. Koshkareva
Spinal osteochondrosis takes one of the first places among all chronic diseases, and every second osteochondrosis patient has dystrophic and degenerative changes in the spine in the cervical region. Manifestations of osteochondrosis of the cervical spine are diverse, which often interferes with the diagnosis and subsequent treatment. In osteochondrosis of the cervical spine, clinical symptoms may occur associated with insufficient blood supply to areas of the brain and that would require diagnostic methods that are not included in the standards for diagnosing the disease. In order to study the bioelectrical activity of the brain in 25 patients of the Department of Neurosurgery of Irkutsk Scientific Centre of ACTA BIOMEDICA SCIENTIFICA, 2019, Vol. 4, N 6 8 Морфология, физиология и патофизиология Surgery and Traumatology with osteochondrosis of the cervical spine with cerebrovascular syndrome; a comparison was made of EEG indicators with a group of healthy volunteers that is representative by sex and age. Encephalogram indices were recorded using an EEG-21/26 Encephalan-131-03 encephalograph (Taganrog) with a standard installation of scalp EEG electrodes using the “10-20” system. An analysis of the rhythms of the bioelectrical activity of the brain in the clinical comparison group revealed a normal zonal distribution with an alpha rhythm dominating the EEG, which generally reflects a high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the main group, EEG indicators significantly differed from the values of the norm and indicators of the control group. Analysis of the bioelectrical activity of the brain of patients with osteochondrosis of the cervical spine was characterized by disorganization of cortical rhythmics with a combination of moderate and diffuse disorders of varying severity. There was a shift in the frequency of bioelectric activity towards slow waves, which is a characteristic of dyscirculatory encephalopathy. Thus, the study of brain biopotentials (EEG) in patients with osteochondrosis of the cervical spine has diagnostic and prognostic significance, as well as a measure of the current clinical condition of the patient.
脊柱骨软病在所有慢性疾病中居首位,每2个骨软病患者中就有1个在颈椎区发生脊柱营养不良和退行性改变。颈椎骨软骨病的表现多种多样,常常影响诊断和后续治疗。在颈椎骨软骨病中,临床症状可能与大脑区域血液供应不足有关,这将需要诊断方法,而诊断标准并未包括这种疾病。为了研究伊尔库茨克生物医学学报科学中心神经外科25例患者的脑生物电活动,2019,Vol. 4, N 6 8 Морфология, физиология, патофизиология颈椎骨性软骨病伴脑血管综合征的外科与创伤学;将脑电图指标与一组按性别和年龄具有代表性的健康志愿者进行比较。使用EEG-21/26 Encephalan-131-03脑电图仪(Taganrog)和标准安装的头皮EEG电极,使用“10-20”系统记录脑电图指数。对临床对照组脑生物电活动节律的分析显示,脑电图呈正常的区向分布,以α节律为主,这通常反映了神经活动的高度组织化,表明大脑稳态的稳定性。同时,主组脑电图指标与对照组的常模和指标值存在显著差异。分析颈椎骨软骨病患者的脑生物电活动,其特征是皮质节律紊乱,伴有不同程度的中度和弥漫性疾病。生物电活动的频率向慢波转移,这是循环障碍脑病的一个特征。因此,研究颈椎骨软骨病患者的脑生物电位(EEG)具有诊断和预后意义,也是衡量患者当前临床状况的一种手段。
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引用次数: 1
Multispiral Computed Tomography in the Diagnosis of Adrenal Incidentalomas 多螺旋ct在肾上腺偶发瘤诊断中的应用
Pub Date : 2019-12-17 DOI: 10.29413/ABS.2019-4.6.21
Мультиспиральная компьютерная, томография в диагностике, инциденталом надпочечников
Many years of experience in identifying patients with various pathologies of the adrenal glands using multispiral computed tomography are presented. Multispiral CT is a highly informative method of choice in the diagnosis of adrenal tumors. Multispiral CT in the perfusion version of the tumor of the adrenal gland increases the accuracy of diagnosis, which optimizes the tactics of treatment. Improving the algorithm for assessing perfusion indices of the adrenal gland incidentalomas using multispiral CT will allow to evaluate the histological nature of the pathological process. It is justified to conduct perfusion MSCT studies in patients with volumetric adrenal masses with the purpose of differential diagnosis of hyperplastic and tumor processes in them. An attempt was made to develop an algorithm for MSCT diagnostics of the adrenal glands and determine its effectiveness. The radiological characteristic of the adrenal glands incidentalomas is a reflection of their morphological structure. There are statistically significant differences in aldosterone-producing and cortisol-producing adenomas in size and CT density. Morphological signs of adrenal tumor degeneration correlate with functional activity. Surgical treatment is absolutely indicated for patients with incidentalomas corresponding to the radiological phenotype of malignant tumors, as well as for patients who have revealed hormonal activity during a comprehensive examination. Dynamic observation is indicatedfor patients with hormonal-inactive incidental small-sized (< 4 cm) in the absence ofradiological signs of malignancy. In patients with an extremely high risk of surgical treatment, endovascular interventions aimed at suppressing adrenal hyperfunction are advisable. The main prognostic factors for adrenal glands incidentalomas are: radiological phenotype, hormonal activity, duration of the disease, the choice of adequate treatment tactics. In surgical treatment, the prognosis depends on the morphological characteristics of adrenal gland incidentalomas.
多年的经验,在识别患者的各种病理肾上腺使用多螺旋计算机断层扫描提出。多层螺旋CT在肾上腺肿瘤的诊断中是一种非常有用的方法。肾上腺肿瘤灌注型多螺旋CT提高了诊断的准确性,优化了治疗策略。改进多螺旋CT评估肾上腺偶发瘤灌注指标的算法,将有助于评估病理过程的组织学性质。在肾上腺体积肿物患者中进行灌注MSCT研究以鉴别其增生和肿瘤过程是合理的。试图开发一种算法的MSCT诊断的肾上腺,并确定其有效性。肾上腺偶发瘤的放射学特征是其形态结构的反映。醛固酮分泌腺瘤和皮质醇分泌腺瘤在大小和CT密度上有统计学差异。肾上腺肿瘤退行性变的形态学特征与功能活动相关。对于与恶性肿瘤放射学表型相对应的偶发瘤患者,以及在综合检查中发现激素活性的患者,绝对需要手术治疗。在没有恶性肿瘤影像学征象的情况下,对伴有激素失活的偶发小肿块(< 4cm)的患者进行动态观察。对于手术治疗风险极高的患者,血管内干预旨在抑制肾上腺功能亢进是可取的。肾上腺偶发瘤的主要预后因素有:放射学表型、激素活性、病程、适当治疗策略的选择。在手术治疗中,预后取决于肾上腺偶发瘤的形态学特征。
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引用次数: 0
Changes in Bone Density in Patients with Osteochondrosis of the Cervical Spine 颈椎软骨病患者骨密度的变化
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.4
T. K. Verkhozina, E. G. Ippolitova, E. Tsyslyak, O. Sklyarenko, Z. Koshkareva
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引用次数: 0
Outcomes of Revision Arthroplasty of Large Joints with Periprosthetic Infection 假体周围感染大关节翻修置换术的疗效
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.16
S. Leonova, A. Kameka, A. N. Grishchuk
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引用次数: 1
Comparative Determination of the Mechanical Strength of a Transplant from a Tendon of a Semitendinosus Muscle for Plastic Surgery of the Anterior Cruciate Ligament Prepared in Various Ways (Experimental Study) 半腱肌肌腱移植用于不同制备方法前交叉韧带整形手术机械强度的比较测定(实验研究)
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.23
D. B. Balzhinimaev, I. Mikhaylov, N. Tishkov
According to modern literature, a sufficient number of studies have been carried out to determine the mechanical strength of transplants from the tendon of the semitendinous and gracilis muscles, the autologous ligament of the patella, the broad fascia, peroneus longus tendon, each of which has unique characteristics, but at present, transplants prepared by original (new) methods are understudied. In the period from November 5 to December 17,2018 we conducted an experimental study to determine the mechanical strength of a transplant from a tendon of a semitendinosus muscle taken from cadaveric material. The transplants were prepared by original and well-known (Graft-Link technique) methods. The experimental study was approved by the Ethics committee of Irkutsk Scientific Center of Surgery and Traumatology. The material for the study was prepared on the basis of the Irkutsk Regional Bureau of Forensic Medical Examination. After sampling the cadaveric material being studied, the main stages of the experimental study were carried out at the materials resistance department of the Irkutsk State Technical University. Studies of the mechanical properties of the transplant were carried out on a Shimadzu testing machine registered in the State Register of Measuring Instruments and approved for use in the Russian Federation. As a result of the study, we obtained the following data. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in an original way is on average 607.8 ± 101.2 N/mm. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in a traditional manner (Graft-Link technique) is on average 351.8 ± 133.0 N/ mm.
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引用次数: 0
Treatment of Dupuytren's Contracture at the Present Stage (Literature Review) Dupuytren挛缩的现阶段治疗(文献回顾)
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.11
Ch. Z. Butaev, I. Kuklin
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引用次数: 1
Surgical Treatment of Severe Deformities of the Toes in Rheumatoid Arthritis 类风湿关节炎严重脚趾畸形的外科治疗
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.19
I. Usoltsev, S. Leonova
The article presents the case of successful surgical treatment of a female patient with severe deformities of the toes arising from rheumatoid arthritis. After clinical and radiological examination the patient was diagnosed with a hallux valgus deviation of the first toe, with 64 degrees of valgus deviation angle, and a valgus-hammered deformity of the II, III, IV toes with a dislocation of the III and IV toes. There was a violation of the stato-dynamic function of the foot, severe pain. Two techniques of joint-preserving surgical treatment were selected. Correction of deformation of the first toe was carried out according to the author’s technology, to correct the deformation of other toes, the Helal technique was used in the author’s modification. The result of the treatment was the achievement of correction of the deformation of the first toe and the elimination of the deformation of the second, third, and fourth toes. The patient is satisfied with the outcome, the appearance of the left foot, its function, the ability to walk without pain and wear ordinary shoes. This clinical case of surgical treatment of severe deformities of the toes with rheumatoid arthritis shows the possibility and importance of joint-saving operations to obtain a good cosmetic and functional result. Performing osteotomy of the metatarsal bones in the proposed modifications allows to correct the hallux valgus deviation of the first toe and deformation of the other toes. As a result of using these technologies, it is possible to maintain metatarsophalangeal joints, eliminate dislocations and subluxations, restore joint function, form an arch of the transverse arch of the foot, relieve pain, thereby improving the anatomical and functional state of the entire foot.
文章提出的情况下,成功的手术治疗的女性患者严重畸形的脚趾引起的风湿性关节炎。经临床及影像学检查,诊断为第一趾外翻偏曲,外翻偏角64度,II、III、IV趾外翻锤击畸形,III、IV趾脱位。脚部的静态-动态功能受到了破坏,剧烈疼痛。选择两种保留关节的手术治疗方法。根据作者的技术对第一趾进行变形矫正,对其他趾进行变形矫正,采用Helal技术进行矫正。治疗的结果是矫正了第一脚趾的变形,消除了第二、第三和第四脚趾的变形。病人对治疗结果、左脚的外观、功能、无痛行走和穿普通鞋的能力都很满意。本临床病例的手术治疗严重畸形的脚趾类风湿性关节炎显示的可能性和重要性的关节保存手术,以获得良好的美容和功能效果。在建议的修改中进行跖骨截骨可以纠正第一个脚趾的拇外翻偏差和其他脚趾的变形。使用这些技术,可以维持跖趾关节,消除脱位和半脱位,恢复关节功能,形成足横弓的弓,减轻疼痛,从而改善整个足的解剖和功能状态。
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引用次数: 0
New Method of Surgical Treatment of Patients with a Fracture of the Proximal Humerus on the Background of Critical Osteoporosis 严重骨质疏松背景下肱骨近端骨折手术治疗的新方法
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.13
V. Monastyrev, N. Ponomarenko, M. Puseva, A. E. Evsukova
Fractures associated with osteoporosis, due to the high prevalence and high percentage of related complications, are a serious problem for modern traumatology and orthopedics. Among all injuries of the upper extremities, fractures in the proximal humerus occur in 32-65 % of cases. Fractures of the proximal humerus account for 4-5 % of all fractures and 50 % of fractures of the humerus. The aim of the research was to develop a new method for the surgical treatment of fractures of the proximal humerus against the background of osteoporosis and to evaluate the clinical effectiveness of the new method. A pilot study was conducted to evaluate the clinical efficacy and safety of surgical treatment of patients with a fracture of the proximal humerus. The results showed that the new "Method for the surgical treatment of patients with a fracture of the proximal humerus" is clinically effective and safe. Additional intramedullary bone stabilization of the proximal humerus with a fibular autograft allows for more rigid and stable fixation of fragments, especially in the presence of critical osteoporosis. The early restoration of passive and active movements in the shoulder joint made it possible to fully restore the function of the limb in a severe fracture of the proximal section.
骨折伴骨质疏松症,由于其高发病率和高比例的相关并发症,是现代创伤学和骨科的一个严重问题。在所有上肢损伤中,32- 65%的病例发生肱骨近端骨折。肱骨近端骨折占所有骨折的4- 5%,占肱骨骨折的50%。本研究的目的是为骨质疏松症背景下肱骨近端骨折的外科治疗提供一种新的方法,并评价新方法的临床效果。进行了一项初步研究,以评估手术治疗肱骨近端骨折患者的临床疗效和安全性。结果表明,新的“肱骨近端骨折手术治疗方法”在临床上是有效和安全的。自体腓骨移植物对肱骨近端髓内骨进行额外的稳定,使得碎片的固定更加刚性和稳定,特别是在严重骨质疏松症的情况下。肩关节被动和主动活动的早期恢复使近端严重骨折的肢体功能完全恢复成为可能。
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引用次数: 1
Modeling of Degenerative-Dystrophic Changes in the Lumbar Spine Intervertebral Disc in Experiment 腰椎椎间盘退行性营养不良变化的实验模拟
Pub Date : 2019-12-17 DOI: 10.29413/abs.2019-4.6.22
O. A. Goldberg, A. P. Zhivotenko, V. Sorokovikov, Z. Koshkareva
The paper presents an experimental model of the development of degenerative-dystrophic processes in the intervertebral disc at LVI - St level, worked out by specialists of Irkutsk Scientific Centre of Surgery and Traumatology. For the purposes of the research we used the techniques of laminectomy and LVI facetectomy. Materials and methods . The experiment was conducted on ten Wistar male rats using microsurgical instruments and binocular optics with a 6-fold magnification. The reliability and effectiveness of the obtained model were evaluated by X-ray and histological research methods. Spondylograms assessed the level, volume of surgical intervention and the likelihood of LVI spondylolisthesis occurrence relative to St against the background of impaired spinal support function created surgically on the day 15 of the experiment. The histological picture of degenerative changes in the intervertebral disc was assessed on the week 16 and 24 after the animals were sacrificed. Results. An X-ray examination on the day 15 revealed LVI spondylolisthesis relative to SI in 4 out of 10 experimental animals. To assess the nature of degenerative-dystrophic changes in the intervertebral disc, five rats were sacrificed at the 16th week and five - at the 24th week. When analyzing the obtained histological data, we noted the progression of degenerative-dystrophic changes in the intervertebral disc occurring by the 24th week. Conclusion. The designed model for the development of degenerative-dystrophic changes in the intervertebral disc is in direct correlation with the violation of the integrity of the posterior supporting complex with the subsequent formation of spondylolisthesis and instability in this segment. Histological studies in the intervertebral disc reliably confirmed the formation and progression of degenerative-dystrophic changes in the intervertebral disc at the LVI-SI level from the 16th to the 24th week of the experiment. The obtained experimental model of the formation of degenerative-dystrophic changes without mechanical damage to the intervertebral disc will allow clinicians to obtain information about the primary changes in the intervertebral disc, to study the mechanisms of development and the course of degenerative changes in the intervertebral disc on the model of disturbance of the back supporting complex with pathological changes in the biomechanics of the spine after laminectomy and facetectomy. Understanding and knowledge of the pathogenesis of degenerative-dystrophic disease of the spine will allow specialists to exercise an etiopathogenically reasonably approach to the issues of prevention and treatment.
本文介绍了由伊尔库茨克外科和创伤学科学中心的专家制定的LVI - St水平椎间盘退行性营养不良过程发展的实验模型。为了研究的目的,我们使用了椎板切除术和LVI面切除术技术。材料和方法。实验以10只Wistar雄性大鼠为实验对象,使用显微外科器械和6倍放大的双眼光学系统。通过x线和组织学研究方法评价模型的可靠性和有效性。在实验第15天手术造成的脊柱支持功能受损的背景下,腰椎图评估手术干预的水平、体积以及相对于St发生LVI椎体滑脱的可能性。在动物被处死后的第16周和第24周评估椎间盘退行性改变的组织学图像。结果。第15天的x线检查显示10只实验动物中有4只相对于SI的LVI脊柱滑脱。为了评估椎间盘退行性营养不良改变的性质,在第16周和第24周分别处死5只大鼠。在分析获得的组织学数据时,我们注意到椎间盘退行性营养不良变化的进展发生在第24周。结论。所设计的椎间盘退行性营养不良变化发展模型与后部支撑复合体完整性的破坏以及随后该节段椎体滑脱和不稳定的形成直接相关。从实验第16周到第24周,椎间盘组织学研究可靠地证实了LVI-SI水平椎间盘退行性营养不良改变的形成和进展。所获得的无椎间盘力学损伤的退行性营养不良变化形成的实验模型,将使临床医生能够获得椎间盘原发变化的信息,并在椎板切除术和面切除术后背部支撑复合物紊乱伴脊柱生物力学病理改变的模型上,研究椎间盘退行性变化的发生机制和过程。理解和了解脊柱退行性营养不良疾病的发病机制将使专家能够运用病因学上合理的方法来预防和治疗问题。
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引用次数: 0
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Acta Biomedica Scientifica (East Siberian Biomedical Journal)
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