Ortopediia travmatologiia i protezirovanie最新文献

In the article are analysed the results of limb segment lengthening after Ilizarov with 101 patient (49 thighs, 29 cruses, 13 feet, 9 arms, 4 forearms) at the age of 2-50 years. The average lengthening values are: crus--3.8 cm., thigh--3.4 cm., foot--2.5 cm., arm--4.7 cm., forearm--2.0 cm. For complete regenerate ossification, in terms of I cm. lengthening, the stable fixation by means of an apparatus is necessary during: crus--29.4 day, thigh--15.5, foot--33.2, arm--17.4, forearm--28.1. Good results have been obtained in 99 cases (95.3%), satisfactory--4 (3.8%), unsatisfactory--1 (0.9%).

A rare variant of knee joint developmental anomaly in the form of faulty fixation of knee transversal ligament to the menisci and absence of its connection to tibia is described. Defect of knee transversal ligament fixation is combined with discoid menisci and anomalous variants of menisci fixation. There have been operated 21 child aged 8-14 years. Knee transversal ligament has been fixed to the tibia epiphysis and in case of meniscus formation distortions they were paracapsularly resected. The results of treatment have been followed during 3 years, the stability of a knee joint has been restored.

5 patients have been implanted the endoprostheses of Sivash K. M. to restore functions of the upper limb after the gunshot injury in the area of elbow joint with the clinico-roentgenologic bone defect detection. Coarse cicatricial changes in the area of an articulation with presence of foreign bodies are characteristic for those patients. There have been achieved significant improvement of restoration of active movement of elbow joint and upper limb in whole with 4 of them in spite of high danger of possible post-operative inflammation. In one case due to hard physical labour there have been noted break of an endoprosthesis with the subsequent inflammation. The endoprosthesis has been removed. The most stable positive outcomes proved by physiological tests of the neuromuscular system of upper limbs are observed at endoprosthetics of elbow joint with replacement of the soft tissue defect with completely vascularized musculocutaneous autotransplant.

The experience of surgical treatment of children with the most grave hand injuries is presented. The authors consider that the restorative treatment is to begin from the moment of initial surgical processing of the explosive hand injuries. Three periods of treatment have been singled out. Each of them has its own objects and tasks. Logical combination of surgical treatment stages allows for maximum restoration of form and function of an injured hand during the shortest possible time and with the minimum losses for a patient.

Experiments, carried out by the author, have shown that the pathogenesis of congenital talipes is based on congenital muscular disbalance between flexors-supinators and extensors-pronators at the expense of strengthening of the former and insufficiency of the latter. An object of treatment of the considered developmental defect is restoration of myogenic balance. The existing methods of conservative treatment result in preservation of insufficiency of the anterolateral group of the crus muscles. Only the method of Vilensky V. Ya. allows to completely solve the posed problem. Operations on the posteromedial section of foot result in reduction of the myogenic disbalance as there is preserved insufficiency of extensors-pronators. Only operations, accompanied by shortening of anterolateral groups of the crus muscles allow to restore the myogenic balance straight on the operating table. The cause of recurrencies in case of congenital talipes is preservation of myogenic disbalance between flexors-spinators and their antagonist more frequent at the expense of insufficiency of the latter.

Apparatus correction of deformations of proximal segment of femur becomes one of the most effective method of treatment of hip joint diseases in children. The authors propose new arrangements of Ilizarov's apparatus to treat the most common diseases of locomotor apparatus: thigh subluxation, aseptic necrosis of the head of femur and coxa vara. The tactics of Ilizarov's apparatus application, its arrangements and indications for its utilization are based on the results of treatment of 40 patients with the above-mentioned diseases. There are presented the apparatus application outlines and clinical examples of the treatment methods realization.