In severe forms, funnel-shaped chest deformity (FSCD) requires surgical correction. The method of choice is the Nuss operation and its modifications. Objective. To study the changes that occur in the stressed-deformed state of the chest model and the fixator under different methods of its implementation during the minimally invasive correction of FSCD according to Nuss. Material and methods. 4 schemes of FSCD correction were modeled: 1 — alignment with one retrosternal plate with transverse stabilizers, the point of entry and exit of the fixator is located parasternal at the level of the bone-cartilage transition, the fixator on the sides of the chest ends at the level of the front axillary line; 2 — sternal plate with transverse stabilizers, the point of entry and exit is located at the level of the front armpit line, the fixator ends at the level of the middle armpit line; 3 — the use of a double plate with transverse bars that connect the plates with the help of screws with medial conduction; 4 — a double plate with transverse slats, which connect the plates with the help of screws with lateral guidance. The models were loaded with a distributed force of 100 N applied to the sternum. The results. When using FSCD correction schemes, the maximum level of stress occurs in the metal plates, because they bear the main loads from the sternum, which tries to return to its original position after correction. The same reason causes the highest level of stress among the elements of the skeleton in the sternum. Conclusions. Under the conditions of using any FSCD correction scheme, the maximum stress level occurs in the metal plates, sternum, fifth and sixth ribs, which are in direct contact with the plates. The use of long plates with lateral points leads to a slight decrease in stress values in all elements of the model. The «Bridge» fastener allows you to significantly reduce the level of stress, both in the plates themselves and in the elements of the skeleton due to an increase in their contact area.
{"title":"STUDY OF THE DISTRIBUTION OF STRESSES IN THE ELEMENTS OF THE STERNO-COSTAL COMPLEX AND METAL PLATES IN THE CASE OF MINIMALLY INVASIVE CORRECTION OF THE FUNNEL-SHAPED DEFORMATION OF THE CHEST ACCORDING TO NUSS","authors":"Vlasii Pylypko, Anatolii Levytskyi, Mykhailo Karpinsky, Olena Karpinska, Olexander Yaresko","doi":"10.15674/0030-59872023328-35","DOIUrl":"https://doi.org/10.15674/0030-59872023328-35","url":null,"abstract":"In severe forms, funnel-shaped chest deformity (FSCD) requires surgical correction. The method of choice is the Nuss operation and its modifications. Objective. To study the changes that occur in the stressed-deformed state of the chest model and the fixator under different methods of its implementation during the minimally invasive correction of FSCD according to Nuss. Material and methods. 4 schemes of FSCD correction were modeled: 1 — alignment with one retrosternal plate with transverse stabilizers, the point of entry and exit of the fixator is located parasternal at the level of the bone-cartilage transition, the fixator on the sides of the chest ends at the level of the front axillary line; 2 — sternal plate with transverse stabilizers, the point of entry and exit is located at the level of the front armpit line, the fixator ends at the level of the middle armpit line; 3 — the use of a double plate with transverse bars that connect the plates with the help of screws with medial conduction; 4 — a double plate with transverse slats, which connect the plates with the help of screws with lateral guidance. The models were loaded with a distributed force of 100 N applied to the sternum. The results. When using FSCD correction schemes, the maximum level of stress occurs in the metal plates, because they bear the main loads from the sternum, which tries to return to its original position after correction. The same reason causes the highest level of stress among the elements of the skeleton in the sternum. Conclusions. Under the conditions of using any FSCD correction scheme, the maximum stress level occurs in the metal plates, sternum, fifth and sixth ribs, which are in direct contact with the plates. The use of long plates with lateral points leads to a slight decrease in stress values in all elements of the model. The «Bridge» fastener allows you to significantly reduce the level of stress, both in the plates themselves and in the elements of the skeleton due to an increase in their contact area.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":"238 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135943053","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 : 2023-10-18DOI: 10.15674/0030-59872023343-50
Nataliya Ashukina, Nazar Gontar, Zinaida Danуshchuk, Olga Nikolchenko, Yaryna Kaliyuzhna
Polylactide (PLA) frameworks printed on a 3D printer are used for filling the bone defects. The osteotropic properties of 3D-PLA can be improved by combining with tricalcium phosphate (TCP) and mesenchymal stromal cells (MSCs). Objective. Study the reconstruction in the rat femurs after implanting 3D-printed implants based on PLA and TCP (3D-I) in combination with cultured allogeneic MSCs into defects in the distal metaphysis. Methods. 48 white laboratory rats (age 5–6 months) were used, which were randomly divided into groups: Control — 3D-I; Experiment-I — 3D-I, saturated MSCs; Experiment II — 3D-I, with injection of 0.1‒0.2 ml of medium with MSCs into the area of surgical intervention 7 days after implantation. 15, 30 and 90 days after the operation, histological (with histomorphometry) studies were conducted. Results. The area of 3D-I decreased with time in all groups and connective and bone tissues formed in different ratios. 15 days after the surgery, in the Experiment-I group, the area of the connective tissue was 1.9 and 1.6 times greater (p<0.001) in comparison to the Control and Experiment II; 30 days it was greater 1.6 times (p < 0.001) and 1.4 times (p=0.001), respectively. 30 days after the surgery, the area of newly formed bone in the Experiment-I group was 2.2 times (p < 0.001) less than in the Control. On the contrary, in the Experiment-II, the area of newly formed bone was 1.5 and 3.3 times greater (p < 0.001) compared to Experiment-I and Control, respectively. Conclusions. The studied 3D-I with time after their implantation into the metaphyseal defects of the rats’ femurs are replaced by connective and bone tissues. The use of 3D-I, saturated MSCs, 15 and 30 days after the surgery, caused excessive formation of connective tissue and slower bone formation. Local injection of MSCs 7 days after the implantation of 3D-I caused to the formation of a larger area of newly bone 30th day after surgery compared to 3D-I alone and 3D-I with MSCs.
{"title":"HISTOLOGICAL STRUCTURE OF THE RAT FEMURS AFTER FILLING OF DEFECTS IN THE DISTAL METAPHYSIS WITH 3D-PRINTED IMPLANTS BASED ON POLYLACTIDE AND TRICALCIUM PHOSPHATE IN COMBINATION WITH MESENCHYMAL STROMAL CELLS","authors":"Nataliya Ashukina, Nazar Gontar, Zinaida Danуshchuk, Olga Nikolchenko, Yaryna Kaliyuzhna","doi":"10.15674/0030-59872023343-50","DOIUrl":"https://doi.org/10.15674/0030-59872023343-50","url":null,"abstract":"Polylactide (PLA) frameworks printed on a 3D printer are used for filling the bone defects. The osteotropic properties of 3D-PLA can be improved by combining with tricalcium phosphate (TCP) and mesenchymal stromal cells (MSCs). Objective. Study the reconstruction in the rat femurs after implanting 3D-printed implants based on PLA and TCP (3D-I) in combination with cultured allogeneic MSCs into defects in the distal metaphysis. Methods. 48 white laboratory rats (age 5–6 months) were used, which were randomly divided into groups: Control — 3D-I; Experiment-I — 3D-I, saturated MSCs; Experiment II — 3D-I, with injection of 0.1‒0.2 ml of medium with MSCs into the area of surgical intervention 7 days after implantation. 15, 30 and 90 days after the operation, histological (with histomorphometry) studies were conducted. Results. The area of 3D-I decreased with time in all groups and connective and bone tissues formed in different ratios. 15 days after the surgery, in the Experiment-I group, the area of the connective tissue was 1.9 and 1.6 times greater (p<0.001) in comparison to the Control and Experiment II; 30 days it was greater 1.6 times (p < 0.001) and 1.4 times (p=0.001), respectively. 30 days after the surgery, the area of newly formed bone in the Experiment-I group was 2.2 times (p < 0.001) less than in the Control. On the contrary, in the Experiment-II, the area of newly formed bone was 1.5 and 3.3 times greater (p < 0.001) compared to Experiment-I and Control, respectively. Conclusions. The studied 3D-I with time after their implantation into the metaphyseal defects of the rats’ femurs are replaced by connective and bone tissues. The use of 3D-I, saturated MSCs, 15 and 30 days after the surgery, caused excessive formation of connective tissue and slower bone formation. Local injection of MSCs 7 days after the implantation of 3D-I caused to the formation of a larger area of newly bone 30th day after surgery compared to 3D-I alone and 3D-I with MSCs.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":"876 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135943490","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 : 2023-09-11DOI: 10.15674/0030-59872020464-71.
Nataliya Prytula, Inga Fedotova, Iryna Korzh
Comorbidity is one of the leading problems in clinical practice. Interaction of diseases, involutive processes of natural aging and pathomorphosis of drugs significantly change clinical picture and course of the disease, the nature and severity of complications, limit or complicate the treatment and diagnostic process. Objective. To analyze current information on available recommendations for the treatment of comorbid diseases in patients with orthopedic pathology. Materials. An overview of the recommendations of the European Society of Cardiology, European Society of Hypertension, European Society for Vascular Surgery, Ukrainian Gastroenterological Association and American Diabetes Association for the period 2017–2019 is presented. Results. The first stage in the treatment of arterial hypertension is the lifestyle optimization, and the initial therapy of most patients with hypertension should be a combination of two drugs. Management of patients with lower extremity artery disease is associated with an increased risk of any cardiovascular events. Therefore, preventive measures are of particular importance. Gastropathies induced by non-steroidal anti-inflammatory drugs are widespread in orthopedic practice. In the prevention of their occurrence, a well-chosen gastroprotective therapy is important. Once the diagnosis of diabetes is made, lifestyle modification should be started immediately along with the start of pharmacotherapy. Metformin remains the first-line drug for treatment, drugs of other groups can be prescribed when there are contraindications to metformin. In the treatment of neuropathic pain in diabetes or pre-diabetes, only pharmacological treatment strategies are effective. Conclusions. In most cases, a number of comorbidities with timely diagnosis and compliance with the algorithms of medical care can be corrected and treated. Properly selected conservative therapy can reduce the risk of peri- and postoperative complications.
{"title":"Principles of pharmacological therapy of comorbid diseases in patients with orthopedic pathology","authors":"Nataliya Prytula, Inga Fedotova, Iryna Korzh","doi":"10.15674/0030-59872020464-71.","DOIUrl":"https://doi.org/10.15674/0030-59872020464-71.","url":null,"abstract":"Comorbidity is one of the leading problems in clinical practice. Interaction of diseases, involutive processes of natural aging and pathomorphosis of drugs significantly change clinical picture and course of the disease, the nature and severity of complications, limit or complicate the treatment and diagnostic process. Objective. To analyze current information on available recommendations for the treatment of comorbid diseases in patients with orthopedic pathology. Materials. An overview of the recommendations of the European Society of Cardiology, European Society of Hypertension, European Society for Vascular Surgery, Ukrainian Gastroenterological Association and American Diabetes Association for the period 2017–2019 is presented. Results. The first stage in the treatment of arterial hypertension is the lifestyle optimization, and the initial therapy of most patients with hypertension should be a combination of two drugs. Management of patients with lower extremity artery disease is associated with an increased risk of any cardiovascular events. Therefore, preventive measures are of particular importance. Gastropathies induced by non-steroidal anti-inflammatory drugs are widespread in orthopedic practice. In the prevention of their occurrence, a well-chosen gastroprotective therapy is important. Once the diagnosis of diabetes is made, lifestyle modification should be started immediately along with the start of pharmacotherapy. Metformin remains the first-line drug for treatment, drugs of other groups can be prescribed when there are contraindications to metformin. In the treatment of neuropathic pain in diabetes or pre-diabetes, only pharmacological treatment strategies are effective. Conclusions. In most cases, a number of comorbidities with timely diagnosis and compliance with the algorithms of medical care can be corrected and treated. Properly selected conservative therapy can reduce the risk of peri- and postoperative complications.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136027507","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 : 2023-06-27DOI: 10.15674/0030-598720232101-109
O. Baburkina, Oleg Ovchynnikov, Maryna Bludova
Ultrasound examination (ultrasound) of the knee joint left is one of the main methods of diagnosing its diseases and injuries, which are constantly improved thanks to the use of more accurate diagnostic equipment. Objection. Analyze modern scientific and practical information regarding the possibilities of ultrasound examination of the knee joint and determine pathological changes in its tissues, for the diagnosis of which this technique can be used. Methods. Selected and analyzed scientific articles for the last 6 years, in which the use of knee joint ultrasound is given from the Google search engine, scientific metrics databases PubMed, Medline and other relevant sources scientific and medical information. Results. Analyzed modern literature on the use of knee joint ultrasound in medical practice. Defined orthopedic pathological diseases and areas of the knee joint which investigated by ultrasound. This technique is used for diagnosis of gonarthrosis, synovitis, assessment blood circulation and fluid in the knee joint, Backer's cyst, neoplasms, pathology of menisci, injuries and inflammations ligaments, tendons and muscles. Most doctors and patients prefer the ultrasound technique due to its mobility, without heartburn, almost complete absence of contraindications to carrying out. Today, this research is necessary and an effective method of diagnosing orthopedic pathology traumatic diseases, including knee joint, both individually and in combination with other methods (radiography, computer tomography, magnetic resonance tomography, etc.). It should be noted that the method ultrasound becomes indispensable in case of contraindications to the procedure magnetic resonance imaging. Conclusions. Ultrasound of the patient of diseases and injuries of the knee joint is modern and effective by the method of express diagnostics and can be used both independently and in combination with other methods of diagnostics of pathological changes in the tissues of this localization.
{"title":"DIAGNOSTIC CAPABILITIES OF ULTRASOUND EXAMINATION OF THE KNEE JOINT AT THE CURRENT STAGE (LITERATURE REVIEW)","authors":"O. Baburkina, Oleg Ovchynnikov, Maryna Bludova","doi":"10.15674/0030-598720232101-109","DOIUrl":"https://doi.org/10.15674/0030-598720232101-109","url":null,"abstract":"Ultrasound examination (ultrasound) of the knee joint left is one of the main methods of diagnosing its diseases and injuries, which are constantly improved thanks to the use of more accurate diagnostic equipment. Objection. Analyze modern scientific and practical information regarding the possibilities of ultrasound examination of the knee joint and determine pathological changes in its tissues, for the diagnosis of which this technique can be used. Methods. Selected and analyzed scientific articles for the last 6 years, in which the use of knee joint ultrasound is given from the Google search engine, scientific metrics databases PubMed, Medline and other relevant sources scientific and medical information. Results. Analyzed modern literature on the use of knee joint ultrasound in medical practice. Defined orthopedic pathological diseases and areas of the knee joint which investigated by ultrasound. This technique is used for diagnosis of gonarthrosis, synovitis, assessment blood circulation and fluid in the knee joint, Backer's cyst, neoplasms, pathology of menisci, injuries and inflammations ligaments, tendons and muscles. Most doctors and patients prefer the ultrasound technique due to its mobility, without heartburn, almost complete absence of contraindications to carrying out. Today, this research is necessary and an effective method of diagnosing orthopedic pathology traumatic diseases, including knee joint, both individually and in combination with other methods (radiography, computer tomography, magnetic resonance tomography, etc.). It should be noted that the method ultrasound becomes indispensable in case of contraindications to the procedure magnetic resonance imaging. Conclusions. Ultrasound of the patient of diseases and injuries of the knee joint is modern and effective by the method of express diagnostics and can be used both independently and in combination with other methods of diagnostics of pathological changes in the tissues of this localization.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45163955","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 : 2023-06-27DOI: 10.15674/0030-59872023277-83
O. Sitenko
The war and Russian aggression against Ukraine require government and society long-term extraordinary efforts. It’s not only in the field of the destroyed economy. The primary necessity is to restore a dignified life to every person affected by the war, military or civilian. The fate of each of us, our society, and our country in general will depend on efforts effectiveness in this direction. Objective. To develop and substantiate proposals for a systematic approach to the provision of medical rehabilitation assistance in the country. Results. The principles on which it is expedient to create a system of rehabilitation assistance in Ukraine have been formulated and substantiated. They are the principles of statehood, modernity, science, continuity, phasing and unified tactics, regionalism, specializations, self-rehabilitation. Each principle is briefly described, the experience of the world's leading countries is given. The stateand society role in the rehabilitation process is noted. Proposals. Develop a strategy, concept and government program for creating a rehabilitation assistance system in Ukraine. Provide a construction and equipment of regional rehabilitation centers (RC) within the post-war country renovation program. It has to be used worldwide principles of new hospital’s design and construction regarding the 200 inpatient beds in the unit. To locate RC outside of bigcities, usually. Training of rehabilitation specialists should be provided in various levels medical educational institutions. Modified vehicles to manual control for disable people and training in its use. To prevent the liquidation of Ukrainian Research Prosthetics Institution. To transfer this institution functions and the property complex to Sytenko Institute of Spine and Joint Pathology National Ukrainian Academy of Medical Sciences. To transfer research medical rehabilitation organizer and executor functions to the National Ukrainian Academy of Medical Sciences, in generally.
{"title":"DEVELOPMENT OF THE REHABILITATION SYSTEM IN UKRAINE. ORGANIZATIONAL ASPECTS","authors":"O. Sitenko","doi":"10.15674/0030-59872023277-83","DOIUrl":"https://doi.org/10.15674/0030-59872023277-83","url":null,"abstract":"The war and Russian aggression against Ukraine require government and society long-term extraordinary efforts. It’s not only in the field of the destroyed economy. The primary necessity is to restore a dignified life to every person affected by the war, military or civilian. The fate of each of us, our society, and our country in general will depend on efforts effectiveness in this direction. Objective. To develop and substantiate proposals for a systematic approach to the provision of medical rehabilitation assistance in the country. Results. The principles on which it is expedient to create a system of rehabilitation assistance in Ukraine have been formulated and substantiated. They are the principles of statehood, modernity, science, continuity, phasing and unified tactics, regionalism, specializations, self-rehabilitation. Each principle is briefly described, the experience of the world's leading countries is given. The stateand society role in the rehabilitation process is noted. Proposals. Develop a strategy, concept and government program for creating a rehabilitation assistance system in Ukraine. Provide a construction and equipment of regional rehabilitation centers (RC) within the post-war country renovation program. It has to be used worldwide principles of new hospital’s design and construction regarding the 200 inpatient beds in the unit. To locate RC outside of bigcities, usually. Training of rehabilitation specialists should be provided in various levels medical educational institutions. Modified vehicles to manual control for disable people and training in its use. To prevent the liquidation of Ukrainian Research Prosthetics Institution. To transfer this institution functions and the property complex to Sytenko Institute of Spine and Joint Pathology National Ukrainian Academy of Medical Sciences. To transfer research medical rehabilitation organizer and executor functions to the National Ukrainian Academy of Medical Sciences, in generally.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45521243","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 : 2023-06-27DOI: 10.15674/0030-59872023291-95
D. Prozorovskiy, V. Staude, R. Buznytskiy
Postoperative rehabilitation of patients with hallux valgus is just as important, if not more so, than a technically flawless surgical intervention. Carrying out rehabilitation measures is an integral part of the postoperative period, which must be individual for each patient and depend on the volume and type of surgical intervention, the patient's age, and accompanying pathology. Objective. To improvethe results of the recovery of patients after orthopedic surgical interventions on the front part of the foot due to the developed complex system of postoperative rehabilitation. Methods. The articleprovides an analysis of the results of treatment of 70 patients with transversely spread deformation of the forefoot and hallux valgus 1–2 degrees using different approaches to rehabilitation measuresin the postoperative period. The patients were divided into 2 homogeneous groups by age, gender and degree of hallux valgus. Unlike the control group, manual therapy and myofascial massagetechniques were additionally used in the main group. The results. The results of the treatment were evaluated according to the AOFAS scoring scale for the forefoot, which is generally accepted inthe world. In the preoperative period, the average AOFAS score in the main and control groups was 65.4 and 64.7 points, respectively. 45 days after surgery, the average scores were 74.7 and 74.4 points,respectively. After 60 days, the average score in the main group was 92.1 points, and 82.6 in the control group. 3 months (90 days) after the surgical interventions, the average scores practically coincided in both groups and amounted to 93.7 points in the control group and 95.0 in the main group. The patients of the main group resumed their usual activities after 2 months. after the operation onthe front part of the foot, and the control after 3 months. Conclusions. The use of myofascial massage, manual therapy for mobilizing the metatarsophalangeal and interphalangeal joints of the toes with gymnastics to strengthen not only the stabilizers of the foot, but also to restore the bearing capacity of the girdle of the lower extremities and the stereotype of walking, made it possible to obtainnot only a positive functional result, but also to speed up the recovery compared to the control group per month.
{"title":"REHABILITATION OF PATIENTS AFTER SURGICAL TREATMENT OF STATIC DEFORMITIES OF THE FOREFOOT","authors":"D. Prozorovskiy, V. Staude, R. Buznytskiy","doi":"10.15674/0030-59872023291-95","DOIUrl":"https://doi.org/10.15674/0030-59872023291-95","url":null,"abstract":"Postoperative rehabilitation of patients with hallux valgus is just as important, if not more so, than a technically flawless surgical intervention. Carrying out rehabilitation measures is an integral part of the postoperative period, which must be individual for each patient and depend on the volume and type of surgical intervention, the patient's age, and accompanying pathology. Objective. To improvethe results of the recovery of patients after orthopedic surgical interventions on the front part of the foot due to the developed complex system of postoperative rehabilitation. Methods. The articleprovides an analysis of the results of treatment of 70 patients with transversely spread deformation of the forefoot and hallux valgus 1–2 degrees using different approaches to rehabilitation measuresin the postoperative period. The patients were divided into 2 homogeneous groups by age, gender and degree of hallux valgus. Unlike the control group, manual therapy and myofascial massagetechniques were additionally used in the main group. The results. The results of the treatment were evaluated according to the AOFAS scoring scale for the forefoot, which is generally accepted inthe world. In the preoperative period, the average AOFAS score in the main and control groups was 65.4 and 64.7 points, respectively. 45 days after surgery, the average scores were 74.7 and 74.4 points,respectively. After 60 days, the average score in the main group was 92.1 points, and 82.6 in the control group. 3 months (90 days) after the surgical interventions, the average scores practically coincided in both groups and amounted to 93.7 points in the control group and 95.0 in the main group. The patients of the main group resumed their usual activities after 2 months. after the operation onthe front part of the foot, and the control after 3 months. Conclusions. The use of myofascial massage, manual therapy for mobilizing the metatarsophalangeal and interphalangeal joints of the toes with gymnastics to strengthen not only the stabilizers of the foot, but also to restore the bearing capacity of the girdle of the lower extremities and the stereotype of walking, made it possible to obtainnot only a positive functional result, but also to speed up the recovery compared to the control group per month.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44880363","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 : 2023-06-27DOI: 10.15674/0030-59872023256-75
O. Vyrva
Chondrosarcoma (CHS) is a rare oncopathology, is the third most common primary bone tumor after multiple myeloma and osteosarcoma. It accounts for about 25 % of the total number of bone sarcomas. CHS mainly affects adults and occurs more often in people older than 40 years, in children and adolescents it is less than 5 % of all cases of primary CHS. The most common CHS sites can be any bone containing cartilage, but most often this tumor is found in pelvis, femur and shoulder bones, and ribs. CHS are divided: by origin (primary and secondary), anatomical site (central — inside the bone marrow canal, peripheral — inside the existing osteochondroma, periosteal — on the bone surface), histological degrees GI-GII-GIII. The WHO classification (2020) includes central normal, secondary peripheral, periosteal, dedifferentiated, mesenchymal and clear-cell CHS. More than 90 % of conventional CHS are tumors of low and medium malignancy degree, with a low potential for metastasis. CHS is caused by mutations in genes that control bone growth and development. The main risk factors are the patientʼs age, previous radiation, genetic factors and predisposition to oncological diseases. Diagnosis of CHS is based on a complex algorithm, which involves collecting the patient's complaints, anamnesis, clarifying clinical symptoms, imaging (X-ray, CT, MRI), histopathological picture. The biopsy conclusion is the most important in establishing the final diagnosis. However, there are several tumors whose histological picture is similar to CHS: enchondroma, chondroblastoma, osteosarcoma, giant cell tumor of bone, dedifferentiated liposarcoma, synovial sarcoma. The CHS treatment protocol is determined based on the results of anamnestic data, imaging, histopathological results, CHS classification, and its final tumor subtype. The «gold standard» remains surgical removal of the tumor. Radiation and chemotherapy don’t play a significant role in the treatment of CHS, but require further study. Targeted and immunotherapy have a certain potential, even with a high degree of CHS resistance to traditional chemotherapy.
{"title":"CHONDROSARCOMA IN THE XXI CENTURY","authors":"O. Vyrva","doi":"10.15674/0030-59872023256-75","DOIUrl":"https://doi.org/10.15674/0030-59872023256-75","url":null,"abstract":"Chondrosarcoma (CHS) is a rare oncopathology, is the third most common primary bone tumor after multiple myeloma and osteosarcoma. It accounts for about 25 % of the total number of bone sarcomas. CHS mainly affects adults and occurs more often in people older than 40 years, in children and adolescents it is less than 5 % of all cases of primary CHS. The most common CHS sites can be any bone containing cartilage, but most often this tumor is found in pelvis, femur and shoulder bones, and ribs. CHS are divided: by origin (primary and secondary), anatomical site (central — inside the bone marrow canal, peripheral — inside the existing osteochondroma, periosteal — on the bone surface), histological degrees GI-GII-GIII. The WHO classification (2020) includes central normal, secondary peripheral, periosteal, dedifferentiated, mesenchymal and clear-cell CHS. More than 90 % of conventional CHS are tumors of low and medium malignancy degree, with a low potential for metastasis. CHS is caused by mutations in genes that control bone growth and development. The main risk factors are the patientʼs age, previous radiation, genetic factors and predisposition to oncological diseases. Diagnosis of CHS is based on a complex algorithm, which involves collecting the patient's complaints, anamnesis, clarifying clinical symptoms, imaging (X-ray, CT, MRI), histopathological picture. The biopsy conclusion is the most important in establishing the final diagnosis. However, there are several tumors whose histological picture is similar to CHS: enchondroma, chondroblastoma, osteosarcoma, giant cell tumor of bone, dedifferentiated liposarcoma, synovial sarcoma. The CHS treatment protocol is determined based on the results of anamnestic data, imaging, histopathological results, CHS classification, and its final tumor subtype. The «gold standard» remains surgical removal of the tumor. Radiation and chemotherapy don’t play a significant role in the treatment of CHS, but require further study. Targeted and immunotherapy have a certain potential, even with a high degree of CHS resistance to traditional chemotherapy.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45656989","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 : 2023-06-27DOI: 10.15674/0030-59872023225-32
P. Vorontsov, N. Ashukina, Valentyna Maltseva, Zinaida Danуshchuk, O. Nikolchenko, Kateryna Samoylova
The increase in injuries and gunshot wounds because of the war in Ukraine makes it imperative to find methods for optimizing bone regeneration and filling large-size bone defects. Aim. Study morphological features of reparative osteogenesis when critical size femoral bone defects in rats in the early reproductive and mature stages are filled with allografts saturated with blood plasma growth factors (GF). Methods. Defects (3 × 3 mm) were created in the distal femoral metaphysis of 60 white laboratory rats, 3-months-old (n = 30) and 12-months-old (n = 30). The defects were filled with bone allografts saturated with GF in the two experimental groups (AlloG+GF), and unsaturated bone allografts in the two control groups (AlloG). All groups contained 15 rats of each age. At 14, 28 and 90 days after the surgery, 5 rats from each group were sacrificed, and histological analyses were performed. Results. In the AlloGgroups, excessive formation of connective tissue was observed 14 and 28 days after the surgery, most evident in the 3-monthold rats. In the AlloG+GF groups, bone formation was delayed at 14 days independent of age, while at 28 and 90 days, the area of bone trabeculae did not differ from the values in the AlloG groups. Throughout the experiment, decreases in allograft area (almost all of it was replaced by bone after 90 days) and connective tissue (completely absent in 3-month-old rats after 90 days) were observed in both AlloG+GF groups. The area of bone trabeculae increased in the period from 14 to 28 days. Conclusion. Saturating allografts with blood plasma growth factors facilitates an increase in the rate at which allografts are replaced by bone tissue, independent of the recipient’s age. However, excessive formation of connective tissues in the defect 14 and 28 days after the surgery, especiallyin 3-month-old rats, may negatively affect the mechanical properties of the bone, which should be considered in clinical practice.
{"title":"HISTOLOGICAL EVALUATION OF REPARATIVE OSTEOGENESIS IN CRITICAL SIZE FEMORAL BONE DEFECTS IN RATS OF DIFFERENT AGES AFTER INTRODUCTION OF ALLOGRAFTS SATURATED WITH BLOOD PLASMA GROWTH FACTORS","authors":"P. Vorontsov, N. Ashukina, Valentyna Maltseva, Zinaida Danуshchuk, O. Nikolchenko, Kateryna Samoylova","doi":"10.15674/0030-59872023225-32","DOIUrl":"https://doi.org/10.15674/0030-59872023225-32","url":null,"abstract":"The increase in injuries and gunshot wounds because of the war in Ukraine makes it imperative to find methods for optimizing bone regeneration and filling large-size bone defects. Aim. Study morphological features of reparative osteogenesis when critical size femoral bone defects in rats in the early reproductive and mature stages are filled with allografts saturated with blood plasma growth factors (GF). Methods. Defects (3 × 3 mm) were created in the distal femoral metaphysis of 60 white laboratory rats, 3-months-old (n = 30) and 12-months-old (n = 30). The defects were filled with bone allografts saturated with GF in the two experimental groups (AlloG+GF), and unsaturated bone allografts in the two control groups (AlloG). All groups contained 15 rats of each age. At 14, 28 and 90 days after the surgery, 5 rats from each group were sacrificed, and histological analyses were performed. Results. In the AlloGgroups, excessive formation of connective tissue was observed 14 and 28 days after the surgery, most evident in the 3-monthold rats. In the AlloG+GF groups, bone formation was delayed at 14 days independent of age, while at 28 and 90 days, the area of bone trabeculae did not differ from the values in the AlloG groups. Throughout the experiment, decreases in allograft area (almost all of it was replaced by bone after 90 days) and connective tissue (completely absent in 3-month-old rats after 90 days) were observed in both AlloG+GF groups. The area of bone trabeculae increased in the period from 14 to 28 days. Conclusion. Saturating allografts with blood plasma growth factors facilitates an increase in the rate at which allografts are replaced by bone tissue, independent of the recipient’s age. However, excessive formation of connective tissues in the defect 14 and 28 days after the surgery, especiallyin 3-month-old rats, may negatively affect the mechanical properties of the bone, which should be considered in clinical practice.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41719563","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 : 2023-06-27DOI: 10.15674/0030-59872023296-100
Olexandr Chernyshov, Maksym Golbaum
Spondylolisthesis is a pathology of the musculoskeletal system that causes a vertebra to move forward, sideways or backward. Most often, it is treated surgically using transpedicular structures. Objective. To present a clinical case of re-treatment for degenerative lumbar spondylolysis of the LV vertebral body using transpedicular and posterior autografting techniques. Methods. The clinical case of lumbar spine osteochondrosis, spondyloarthritis,posterior transpedicular fusion LV–SI, fracture of the screw in the body of the SI vertebra on the right, and spinal canal stenosis at the level of LV–SI is described. Lower paraparesis. Results. The patient underwent metal removal, decompression of the spinal canal at the level of LV–SI, open reduction of the LV vertebral body, posterior transpedicular fusion of LIV–SI and posterior autografting fusion. The surgical intervention was successful, despite the technical difficulties associated with removing the threaded part of the broken screw. According to the visual analogue scale, the patient had 8 points beforethe operation, which indicates acute pain syndrome, and after that the pain intensity decreased to 4 points. Muscle strength of the right and left lower extremities before surgery was 2 and 2.5 points, respectively, 5 days after surgery, improvement was recorded — 3 points for each limb. From the second day after repeated surgical treatment, the patient showed a significant improvement in muscle sensitivity and strength in both lower extremities.Conclusions. The clinical example of repeated surgery due to the failure of the metal structure and the deterioration of the patient's neurological status highlights the need for postoperative follow-up. Taking into account the percentage of complications after transpedicular spondylodesis, it is necessary tocontinue scientific research to improve the results of surgical treatment of patients with degenerative diseases of the spine.
{"title":"MISTAKES AND COMPLICATIONS AFTER SURGICAL TREATMENT OF LUMBAR SPONDYLOLISTHESIS. CLINICAL CASE","authors":"Olexandr Chernyshov, Maksym Golbaum","doi":"10.15674/0030-59872023296-100","DOIUrl":"https://doi.org/10.15674/0030-59872023296-100","url":null,"abstract":"Spondylolisthesis is a pathology of the musculoskeletal system that causes a vertebra to move forward, sideways or backward. Most often, it is treated surgically using transpedicular structures. Objective. To present a clinical case of re-treatment for degenerative lumbar spondylolysis of the LV vertebral body using transpedicular and posterior autografting techniques. Methods. The clinical case of lumbar spine osteochondrosis, spondyloarthritis,posterior transpedicular fusion LV–SI, fracture of the screw in the body of the SI vertebra on the right, and spinal canal stenosis at the level of LV–SI is described. Lower paraparesis. Results. The patient underwent metal removal, decompression of the spinal canal at the level of LV–SI, open reduction of the LV vertebral body, posterior transpedicular fusion of LIV–SI and posterior autografting fusion. The surgical intervention was successful, despite the technical difficulties associated with removing the threaded part of the broken screw. According to the visual analogue scale, the patient had 8 points beforethe operation, which indicates acute pain syndrome, and after that the pain intensity decreased to 4 points. Muscle strength of the right and left lower extremities before surgery was 2 and 2.5 points, respectively, 5 days after surgery, improvement was recorded — 3 points for each limb. From the second day after repeated surgical treatment, the patient showed a significant improvement in muscle sensitivity and strength in both lower extremities.Conclusions. The clinical example of repeated surgery due to the failure of the metal structure and the deterioration of the patient's neurological status highlights the need for postoperative follow-up. Taking into account the percentage of complications after transpedicular spondylodesis, it is necessary tocontinue scientific research to improve the results of surgical treatment of patients with degenerative diseases of the spine.","PeriodicalId":76291,"journal":{"name":"Ortopediia travmatologiia i protezirovanie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48058812","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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