bluuebunny/crossref_metadata_2025 huggingface dataset:
Levels of perfluorinated compounds (PFCs) in groundwater around improper municipal and industrial waste disposal sites in Thailand and health risk assessment
Authors: Hongkachok Chanidaporn , Boontanon Suwanna Kitpati , Boontanon Narin , Fujii Shigeo , Tanaka Shuhei , Suzuki Yuji
Published: April 2018

The aims of this study were to examine the levels of perfluorinated compounds (PFCs) in groundwater around improperly developed municipal and industrial waste disposal sites, including estimating non-cancer risk and cancer risk from ingestion of the groundwater. A total of 27 groundwater samples were collected from two cities in Thailand, Ayutthaya and Chonburi. Seven target compounds were extracted by solid phase extraction (SPE) and analyzed by high-performance liquid chromatography–tandem mass spectrometer (HPLC–MS/MS). The results showed that the total PFCs in groundwater around municipal waste disposal sites (MWDSs) varied from 1.68 to 7.75 ng/L. In groundwater around the industrial waste disposal site (IWDS), total PFCs varied from 2.64 to 42.01 ng/L, which were significantly different from those found in groundwater around the MWDSs at p < 0.01. PFOS and PFOA were ubiquitous in both areas, while perfluorohexane sulfonate (PFHxS) was frequently found in the samples around IWDS. The findings possibly suggest that PFHxS has been introduced for use as an alternative substance for most current C8 and higher due to it having shorter chain length and shorter half-lives. The results for both non-cancer risk and cancer risk in all samples were acceptable.
Probiotics and Prebiotics as Functional Foods: State of the Art
Authors: Khaneghah Amin Mousavi , Fakhri Yadolah
Published: April 2018

Foods, besides their nutritional value, are used to be as a tool in maintaining of physical
and mental well-being and prevent disease. Based on the definition of Functional foods as foods,
which may offer health benefits beyond basic nutrition, functional foods, are categorized as foods,
not medicine. Among the last decades, the growing market for functional foods, representing both
opportunities and challenges to food producers as well academic sections to cover such demand and
furthermore conquer the acceptance of consumer. In this article, an overview regarding the probiotics
as well as prebiotics as outstanding components of functional foods, compatibility and their use in
food products have been reviewed.
Predicting Truck At-Fault Crashes Using Crash and Traffic Offence Data
Authors: Rezapour Mahdi , Wulff Shaun S. , Ksaibati Khaled
Published: April 2018

Introduction:

The number of truck-related injuries and deaths can be reduced by understanding the factors that contribute to the higher risk of truck-related crashes and violations. Truck drivers are at fault of more than 80% of all the truck crashes on Wyoming interstates, and the literature review indicated that in order to identify appropriate countermeasure to crashes, each crash type should be analyzed individually. The literature review also revealed that relationships exist between driving records and driver culpability in crashes.

Method:

This study employed two approaches to identify contributory factors to truck-at-fault fatal and injury crashes, and truck-related violations. Interstate 80, a Wyoming corridor in a mountainous area with one of the highest truck crash rates in the US, was selected as a case study. Only truck-at-fault crashes and specific types of truck-related violations were considered in this study. The analyses include two approaches. First, the logistic regression model was employed to explore vehicle, driver, crash, and environmental characteristics that contribute to truck-at-fault fatal and injury crashes. Second, truck violations were used as a proxy for truck crashes to examine the tendency to violate truck-related traffic laws in relation to driver and temporal characteristics. Based on the literature, only violations associated with higher risk of severe crashes were included in the analyses. The included violations accounted for more than 70% of all the violations.

Result:

This study considered more than 30 variables and found that only 10 variables impact truck-at-fault crashes. These factors included: gender, history of past violation, crashes involving multiple vehicles, exceeding the speed limit, occupant distraction, driver ejection, fatigued driving, non-seat belt usage, overturn, and head-on collision. Results of the second analysis indicated that both residency and time of crash are factors that impact truck-related violations. Results of the analysis also indicated that both residency and time of the crash are factors that impact truck-related violations.
CRITICAL ANALYSIS OF THE MECHANOSTAT THEORY PART I. REORGANIZATION MECHANISMS OF SKELETAL ARCHITECTURE
Authors: Avrunin A. S. , Tikhilov R. M. , Shubnyakov I. I. , Parshin L. K. , Melnikov B. E.
Published: April 2018

The paper contains a critical analysis of the mechanostat theory. It is shown that for continuous modeling and osteoklastic-and-osteoblastic remodeling is not providing the necessary safety margin of skeletal structures and reduce risk of fractures. It is established that at each level of the hierarchical organization of a skeleton there are also other mechanisms of its reorganization. The functioning of this system is controlled by mechanisms of osteocytes and purposefully provides two effects: the first -preservation of bone structures deformability according to demanded productivity of convective fluid movement mechanism of a lacunary-tubular system, second - the optimization of the cross-section of the cavities of a lacunary-tubular system, respectively, the required level of throughput for the flow of fluid. As a result, the parameters of mechanical-metabolic environment surrounding the osteocytes are stored in the homeostatic limits, which increases cell viability, and hence bone and skeleton as a whole. However, this is often at the expense of the strength properties of bone structures.
FEATURES OF SURGICAL TREATMENT OF THE SACRUM FRACTURES
Authors: Samokhvalov I. M. , Kazhanov I. V. , Tyurin M. V. , Ganin V. N. , Denisov A. V.
Published: April 2018

The analysis of the frequency, structure and circumstances of the sacrum fractures in 148 patients, as well as evaluated the results of treatment 65 patients using conventional techniques and 83 with multiphase surgical tactic. The use during the first stage of external fixation devices, Ganz pelvic frame and active surgical treatment due to a quick stop the intrapelvic bleeding led to a decrease of the frequency of mortality by 2.6 times. The use of highly informative diagnostic methods and multi-stage surgical treatment in patients with concomitant pelvic injuries have reduced mortality by 1.4 times, the number of physical complications - by 1.6 times, local complications - by 2.4 times, the length of hospital stay - by 1.6 times, the frequency of permanent disablement - up to 28.9%, to restore the ability to work with 76.7% of patients within the first year.
USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF THE SHOULDER JOINT
Authors: Kutyanov D. I. , Rodomanova L. A.
Published: April 2018

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.
HEMATOLOGICAL PARAMETERS OF ENDOGENOUS INTOXICATION FOR ASSESSING THE SEVERITY OF COURSE AND EARLY DIAGNOSTICS OF PYO-INFLAMMATORY COMPLICATIONS IN PATIENTS WITH LONG BONE FRACTURES
Authors: Pisarev V. V. , L’Vov S. E.
Published: April 2018

314 patients were examined. The dynamics of changes in hematological parameters for assessing the severity of endogenous intoxication and prediction of postoperative pyo-inflammatory complications in surgical treatment of fractures of long bones has been studied. It is established that syndrome of endogenous intoxication by patients with fractures of long bones develops in the first 2 days from the time of injury There is risk of developing infectious complications of postoperative wound by patients whose hematologic indices are not reduced to 3 days before the normal range. The value of the index-day operations above the normal values increases the risk of infectious complications in the wound during subsequent treatment. Infectious inflammation in postoperative wound is characterized by normal LII values and GPI. To assess the risk of complications it is necessary to carry out the KLA at 3nd and 12th days of the postoperative period concerning LII (leukocyte index of intoxication), GPI (hematologic toxicity index), PTI (indicator of the severity of intoxication). Since the various indices of intoxication have predictive value in a certain period of time of injury
EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT
Authors: Mashkov V. M. , Sabodashevskiy O. V. , Netylko G. I. , Zayceva M. Y. , Nakonechniy D. G.
Published: April 2018

Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group), one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group). During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.
PECULIAR IMMUNOLOGICAL PROPERTIES OF CHRONIC POSTTRAUMATIC OSTEOMYELITIS
Authors: Chepeleva M. V. , Klyushin N. M.
Published: April 2018

A comparative study of cellular immunity parameters was performed in patients with long bone chronic posttraumatic osteomyelitis in regard to osteomyelitis stages. Thirty patients with the fistulous form of long bone chronic posttraumatic osteomyelitis and 13 patients with long bone chronic posttraumatic osteomyelitis in the remission stage were examined using laser flow citometry. It was revealed that a moderate leukocytosis, increased monocyte and neutrophile absolute number as well as increased CD25 and HLA-DR-positive T-lymphocyte number are typical for chronic osteomyelitis regardless of the pathological process stages. The remission stage in patients with chronic posttraumatic osteomyelitis is accompanied by moderate activation of humoral immunity (increased B-lymphocyte (CD19+) number and increased production of IgG). The decrease in the peripheral blood lymphocyte number and well as reduction of HLA-DR expression on monocytes creates prerequisites for the development of fistulous osteomyelitis form and can be an indication for administering the preparations of immunomodulating action.
SURGICAL APPROACH IN TREATMENT CHILDREN WITH TRANSCONDYLAR FRACTURES OF THE HUMERUS
Authors: Proshchenko Y. N.
Published: April 2018

The author presents the results of surgical treatment of 58 patients with transcondylar fractures in age from 3 to 18 years who were divided into two groups depending on the type of surgical approach. In the control group (26 patients) traditional posterior approach with dissection or intersection of the triceps was used, but in the main group (32 patients) - a modified low-traumatic posterior approach. The follow-up period was 3,4 ± 0,5 years. The results showed that the use of a modified posterior approach promotes to achieve a good functional result: range of motion in the joint - 140 °, while in the control group using the traditional posterior approach - only 120 °. A modified posterior approach is indicated for the treatment of children with extension transcondylar fractures, not accompanied by injury of blood vessels of the neurovascular bundle after a single unsuccessful reduction.
POSSIBILITIES AND PROSPECTS OF DOUBLE EFFECT DRUGS APPLICATION FOR SYSTEMIC OSTEOPOROSIS PHARMACOTHERAPY OF PATIENTS WITH BONE FRACTURES
Authors: Kochish A. Y. , Ivanov S. N. , Stafeev D. V. , Minasov T. B.
Published: April 2018

Scientific literature analysis shows that osteoporotic bone fractures appear to be actual and socially significant problem of modern medicine. Patients’ treatment with this pathology should be complex and include osteoporosis pharmacotherapy. The perspective drug for this case is strontium ranelate. Experimental and clinic researches show its positive influence on osteoporotic fractures healing, possibility to increase implants stability by osteosynthesis, moreover it can improve microarchitectonics of bone tissue and functional results of treatment of patients with such a pathology. However, strontium ranelate application efficiency with osteoporotic bone fractures patients requires further investigations.
LEADING ROLE OF KINEZOTHERAPY IN REHABILITATION OF PATIENTS AFTER OSTEOSYNTHESIS WITH APPLICATION OF MODERN CONSTRUCTIONS
Authors: Shimbaretskiy A. N.
Published: April 2018

Reliable fixation of bone splinters with the latest constructions increases the role of kinezotherapy in rehabilitation of the patients with fractures at all stages of treatment. The 50-years’ experience of surgical work in the Department of Traumatology and also regular examinations of patients at the out-patient department of the Institute persuade the author that knowing the basis of kinezotherapy is necessary for operating traumatologists who are the first to give recommendations for the patients marking the main stages and methods of functional therapy. The essential particularities and details of kinezotherapy after application of modern implants are revealed in the article. It is necessary to underline that exercises being maximally easy are very important and necessity of calculation of gravitational loading for the patients with the fractures of proximal parts of extremity is essential.
DISTRIBUTION OF MISBELIEFS ABOUT BACK PAIN AMONG MEDICAL STAFF
Authors: Cherepanov E. A. , Gladkov A. V.
Published: April 2018

The aim of this survey is the analysis of typical misbeliefs distribution about back pain among medical staff. Study design: cross-sectional discreptive study 110 medical professionals took part in this study. 48 of them were medical students (4th and 5th year of education), 62 were licensed medical doctors with ten years of experience in average. All participants were interviewed with special questionnarie containing 36 false statements about the spine and back pain. Every subject was asked to indicate whether he agrees or disagrees with each statement. The rate of incorrectly given answers was 63% in average for physicians (from 22% to 94%) and 60% in average for students (from 36% to 83%). In a small subgroup of neurosurgeons the rate of mistakes was 32% (varied from 11% to 47%). This study gives evidence of the high total level of misbeliefs about back pain among both licensed physicians and medical students. It is likely that majority of physicians do not use modern biopsychosocial model of back pain. Moreover they often act as carriers of irrational beliefs which could have negative influence on long therm effects of back pain.
ANESTHESIA IN SURGERIES ON THE FOOT AND ANKLE (REVIEW)
Authors: Koryshkov N. A. , Larionov S. V. , Murashova N. A. , Sobolev K. A.
Published: April 2018

Among the various anesthetic options the combination of spinal anesthesia with the implementation of regional nerve blocks of the lower extremity and local anaesthesia of area of the wound with long-acting local anesthetics is more interesting. However the recommendations for the choice of postoperative analgesia of the foot do not exist, inspite of the pain syndrome. The prospects for wider use of regional blocks include the use of electrical stimulator in conjunction with ultrasound identification of the nerve trunks, the use of infusion pumps and catheter techniques blockades.
MORPHOLOGICAL EVALUATION OF CONSEQUENCES OF LONG BONE OSTEOMYELITIS IN CHILDREN
Authors: Garkavenko Y. E. , Krasnogorskiy I. N.
Published: April 2018

The authors studied morphological changes in bone, cartilage and soft tissue from the zone of old inflammation and far from it in 36 children with pathological hip dislocation, in 23 - with limb shortening, in 13 - with pseudoarthrosis and long bone defects after osteomyelitis. Morphological assessment of proximal femur tissue in children, who had hematogenous osteomyelitis in early childhood, identified severe changes in cartilage and bone tissue which accompanied by muscle pathology. The state of the femoral head articular cartilage and acetabulum in patients with pathological hip dislocation is characterized by degenerative changes of varying severity (up to the formation of necrobiosis and necrosis focus), by the replacement of hyaline cartilage by tissue, formed by the type of fibrous cartilage and fibrous (scar) tissue. This picture did not have significant differences depending on the osteomyelitis prescription. Directly in the area of the former inflammatory process, as well as in the ends of pseudoarthrosis bone fragments of long bone the degenerative changes of bone tissue with the signs of resorption and low-grade osteogenic activity are marked. The morphological texture of the femur diaphysis, located far from the old inflammation, did not differ from normal. It may indicate its potency for normal bone formation. Muscle tissue in the area of old inflammation keeps the signs of unevenly expressed degeneration and atrophy. Far from this zone muscle tissue doesn’t differ from its usual structure. The described morphological changes can serve as justification for the improvement of methods of surgical treatment in children with consequences of osteomyelitis.
ASSESSMENT OF THE FUNCTIONAL STATE OF THE EXTREMITY IN PATIENTS WITH CLOSED FRACTURES OF SHIN BONES DURING THE TREATMENT BY ILIZAROV’S METHOD
Authors: Shchurov V. A. , Matsukatov F. A.
Published: April 2018

Objective - an assessment of influence an oxygen mode in tissues and rigidity of bone fragment fixation on blood supply in bone regenerate during the treatment by ILizarov's method of patients of different age with closed fractures of shin bones. Blood flow velocity in a region of closed tibia fracture was investigated using high-frequency Doppler ultrasound in the treatment of patients by Ilizarov (193 cases). The rate of blood flow in the area of fracture was increased in first weeks after injury and normalized with the increase of bone regenerate stiffness. In patients aged over 40 years in the tissues of the damaged shin a greater decrease in oxygen tension and a relatively greater increase in blood flow velocity in the zone of bone regenerate were noted.
THE INFLUENCE OF VARIOUS FACTORS ON BLOOD LOSS IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT
Authors: Tikhilov R. M. , Serebryakov A. B. , Shubnyakov I. I. , Pliev D. G. , Shilnikov V. A. , Denisov A. O. , Myasoedov A. A. , Boyarov A. A.
Published: April 2018

Objective: to assess the influence of various factors on blood loss and blood parameters in the postoperative period in patients undergoing hip replacement surgery with and without tranexamic acid. Material and methods. The operations of primary and revision hip arthroplasty were performed in 646 patients with various pathology of the hip by two surgery teams. Patients were divided into two groups: with the use the tranexamic acid - 284 and without its application - 362. We determined the amount of intraoperative blood loss, blood parameters (hemoglobin, red blood cells, platelets) before surgery and in the first, third and sixth days after the operation. Also the analysis of drainage system influence is carried out. Results. The tranexamic acid application during total hip arthroplasty allows to reduce intraoperative blood loss, to optimize the process of normalization red blood in the postoperative period. The renunciation of wound drainage decreased the total amount of blood loss on average 2.2 times and respectively, the need for blood transfusions.
ACETABULAR DEVELOPMENT AFTER SUPRAACETABULAR TUNNELIZATION IN CHILDREN WITH HIP CONGENITAL DYSPLASIA
Authors: Teplenkiy M. P. , Makushin V. D. , Chirkova N. G.
Published: April 2018

Introduction. The technology of wire tunnelization of joint elements is used at RISC “RTO” for treatment of young children (10-30 months) with the hip dysplasia of various forms. Aim - to assess the effect of supraacetabular tunnelization on the formation of dysplastic acetabula. Material and methods. The results of treatment 18 children (21 joints) with the hip congenital dysplasia of II (14 joints) and III (7 joints) degree according to Tonnis have been analyzed. Gradual closed reduction of the dislocation has been performed in all the cases. Mean age at the time of reduction was 8,2±0.56 months (5-14 months). Supraacetabular tunnelization was made six months after dislocation reduction. Indications for intervention were considered in view of the x-ray parameters and signs of acetabulum showing its potential developmental delay. Results. The initial value of the acetabular index on the side of dislocation amounted to 43±0.8°. The impairment of the shape of acetabular vault and its upper-and-outer edge of moderate (9 joints) and severe (12 joints) degree has been observed in all the joints involved. The mean value of the acetabular index amounted to 22.1±0.947° (P
USE OF THE REFERENCE ANATOMICAL STRUCTURES OF THE FEMORAL INTERCONDYLAR SPACE IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Suchilin I. A. , Malanin D. A. , Krayushkin A. I.
Published: April 2018

Purpose: rationale for using bony landmarks of the femoral intercondylar space for an accurate determination of ACL attachment during arthroscopic reconstruction. Material and methods: anatomic research of 57 femur bones in which were studied anterior cruciate ligament femoral footprint, lateral intercondylar ridge and lateral bifurcate ridge. Results: research has shown, that lateral intercondylar ridge was present at 52 supervision (91 %), and its average length was 15.4 ± 0.46 mm; lateral bifurcate ridge was determined in 28 (49 %), which average length was 3.95 ± 0.26 mm. Conclusions: these bone formation can be considered as the reference structure for the identification of the anterior cruciate ligament femoral insertion.
TOPOGRAPHIC AND ANATOMICAL APPROACHES TO THE DEVELOPMENT OF THE PROTECTION SYSTEM OF THE POPLITEAL ARTERY DURING ARTHROSCOPIC POSTERIOR CRUCIATE LIGAMENT PLASTY
Authors: Kuznetsov I. A. , Fomin N. F. , Shulepov D. A.
Published: April 2018

The purpose of this study was to determine relationships between bone elements of the knee and popliteal artery. Type of study: anatomy and clinical. Materials and methods consist of 12 cadaveric knees, 14 MRI of the knee, 59 arteriograms of lower extremity 6 of cadaveric knees were x-rayed in the axial and sagittal planes at each of 3 flexion angles (180°, 130° and 90°) to determine the distance between posterior cruciate ligament and popliteal artery. During the study was also measured lengths of bone tunnels for arthroscopy posterior cruciate ligament reconstruction. Was fined, that in 100% of cases popliteal artery was in lateroposition (form 1 to 6 mm). The maximal distance between posterior cruciate ligament and popliteal artery were noted at flexion 90°. The length of the tibial tunnel was in a range from 63 to 78 cm, femoral - from 38 to 47 mm. Methods aimed at reducing risk of popliteal artery injury are offered.
SURGICAL TREATMENT OF METACARPAL SYNOSTOSIS IN CHILDREN
Authors: Zaletina A. V.
Published: April 2018

Objective: to develop the surgical treatment of patients with congenital metacarpal synostosis. Material and methods. 65 operations were performed in 58 children. with congenital metacarpal synostosis. Surgical intervention was determined by the localization of congenital metacarpal synostosis and the presence of concomitant deformities. Results. Excellent and good results were observed in 69,4% (33 hands) cases, satisfactory - in 30,6% (15 hands), unsatisfactory results were not obtained. At the same time excellent results were obtained in patients with less severe variants of metacarpal synostosis, good treatment results were observed in children with more severe associated abnormalities, as well as in cases where the correction is not performed metacarpal shortening. Overall, the results were significantly (p
MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY
Authors: Mukutsa I. G. , Tsarenko S. V. , Lyadov K. V. , Koneva E. S. , Voloshin A. G.
Published: April 2018

Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale), a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05). The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05) and the second verticalization (70%, 25% and 17%, p ≤ 0.05). Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.
TACTICS OF TREATMENT IN CHILDREN WITH INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS
Authors: Proshchenko Y. N. , Pozdeeva N. A.
Published: April 2018

Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients) the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition). Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90%) patients, satisfactory - in 6 (7,5%) and poor - in 2 (2,5%). In the control group a good anatomical results were obtained in 7 (17,5%) patients, satisfactory - in 14 (35%), poor -in 19 (47,5%). Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.
A PRIMARY TEST OF COMBINED THROMBOPROPHYLAXIS AT LOWER EXTREMITIES ARTHROPLASTY: ASPECTS AND VARIANTS OF USAGE
Authors: Akhtyamov I. P. , Kolesnikov M. A. , Shigaev E. S. , Ziatdinov B. G. , Gatina E. B. , Korotkova O. S.
Published: April 2018

Expansion of vein thrombosis and embolism remains a serious problem in traumatology and orthopedics up to the present day. Maintaining the balance between the efficiency of thromboprophylaxis and the danger of post operative hemorrhage can be achieved only when the prevention medication, its dose and the duration of use have been correctly chosen. An anticoagulant of the new generation (Pradaxa), per oral direct thrombin inhibitors dabigatran etexilate to the utmost complies with the above specified requirements that are why the authors decided in favor of its use in everyday clinical practice. A primary test for open use of dabigatran in 48 patients who underwent hip or knee arthroplasty has been carried out. Taking into account the highest risk of thromboembolic complications after large joints plasty, the method of mechanical prophylaxis DVT - electro neurostimulation of shin muscles has been introduced into clinical practice. According to the results of follow-up of the patients, who received different anticoagulants, the algorithm of an anticoagulant’s choice has been developed in various kinds of clinical situations with the possibility of changing injectable preparation to per oral forms. Convenience of per oral administration and predictability of dabigatran effect made it possible to provide consistency of hospital and out-patient stages of treatment, which also contributed to the reduction of thromboembolic complications, especially at an out-patient stage.
PRIMARY SYNOVIAL CHONDROMATOSIS OF THE SHOULDER (CASE REPORT)
Authors: Tikhilov R. M. , Dokolin S. Y. , Vorobjev S. L. , Dubovik V. V. , Bazarov I. S.
Published: April 2018

Primary synovial chondromatosis of a shoulder is quite rare in clinical practice. The diagnostics of this pathology has to include the histological examination of intraarticular material to detect the signs of tissue malignant transformation. Currently surgical intervention of this disease involves the removal of intra-articular cartilaginous bodies and local synovectomy of the affected joint by arthroscopic or open methods. The authors describe the clinical, histologic and arthroscopic features of primary synovial chondromatosis of the shoulder in order to assess the possibility of its minimally invasive correction. The clinical example of diagnostics and treatment of patient with this pathology was presented.
SURGICAL TREATMENT OF ADULT PATIENTS WITH CONGENITAL CLUBFOOT IN SEVERITY DEGREE
Authors: Mukhamadeev A. A. , Norkin I. A. , Koryshkov N. A. , Balayan V. D. , Kireev S. N. , Ediev M. S.
Published: April 2018

There were treated 48 patients (adolescents and adults) with severe congenital clubfoot in Saratov Research Institute of Traumatology and Orthopedics. 43 patients had the age ranged from 16 to 30, 5 patients had the age over 30. 19 patients had bilateral clubfoot, 29 patients had unilateral clubfoot including 19 on right side and 10 left side. To improve treatment results and to prevent deformity recurrence we developed two-staged surgery for congenital clubfoot treatment in adults. Cartilages of talo-navicular, talo-calcanean, cuneo-talar joints are deleted and deformity is corrected with external fixator on I stage. Surgeon performs external fixator resetting, autobone grafting of these joints with compressive arthrodesis on second stage. This method results in full foot reconstruction, good functional outcome, full weight-bearing and improves patient life’s quality.
EXPERIENCE WITH MODULAR BLOCKS FOR REPLACEMENT OF MEDIAL CONDYLE BONE DEFECTS OF THE TIBIA IN PRIMARY KNEE ARTHROPLASTY
Authors: Kazemirsky A. V. , Kazemirsky A. V. , Preobrazhensky P. M.
Published: April 2018

Experience of using modular metal blocks for knee replacement for the replacement of defects of the tibial condyles in the Russian NIITO named after R.R. Vreden is more than 9 years. Authors analyzed the results of the using of blocks that replace defect of the medial condyles tibia bone, from 2003 to 2009 years. There were three group of patients: two group - comparison group and one - control group (the first group consist of 100 patient without defect of the condyle tibia. This patients a standard knee replacement was performed; the second group consist of 28 patient with the defects of the medial condyles tibia bone. This patient was used knee replacement with the bone autoplasty defects of the medial condyles of tibia bone; the third group (control) consists of 56 patients with the defects of the medial condyles of tibia bone. This patients a knee replacement with the using of blocks that replace defect of the medial condyles tibia bone was performed. Periods of studies were from 2 years till 7 years. Scale KSS was applied for the evaluation of the results. Among the patients were women (114-66.3%), nearly one third (58-33.7%) - men, mean age - 68.4 years. Similar demographics were occurred in all groups, however, a comparative evaluation on the scale of the study and control groups in the preoperative period revealed significant differences. In the postoperative period results were similar in all groups. The applying of modular units for replacement of defects of the medial condyle of the tibia bone during knee replacement is a simple and effective method, shown with significant bone defects - more than V the area of the condyle, a depth of 10 mm, which is an alternative to bone grafting and allowing early activation of patients.
EFFICIENCY OF USING ULTRASONIC FOR REMOVING BONE CEMENT IN REVISION ARTHROPLASTY
Authors: Reznik L. B. , Dzuba G. G. , Novikov A. A.
Published: April 2018

In the experiment on 5 dogs weighing from 6 to 10 kg the results of applying ultrasonic technology of polymer removal and treatment of bone mantle in revision total hip and knee arthroplasty were examined. As a source of high-amplitude low-frequency ultrasound an ultrasonic surgical apparatus «Tier», operating at 42 kHz, and provides the intensity of exposure at the end of the waveguide to 1200 W / cm2 was applied. The physical parameters of the influence of ultrasound on the bone were studied. The analysis of the rate of removal of the old plastic mantle was performed. The results of experimental and clinical studies proved that the use of ultrasound frequency of 42.5 kHz facilitates the removal of old bone cement in revision arthroplasty of large joints, reduces the duration and severity of the operation.
THE USE OF PROLONGED BLOCK OF PLEXUS AXILLARIS IN CHILDREN WITH EXTENSION CONTRACTURES OF THE ELBOWS DUE TO ARTHROGRYPOSIS
Authors: Zabolotskiy D. V. , Baindurashvili A. G. , Agranovich O. E. , Savenkov A. N. , Trofimova S. I.
Published: April 2018

Elbow deformities is one of the most widespread pathologies in patients with arthrogryposis. In the majority of the cases children have extension contractures. Most of the children have limitation of active and passive movements in elbow. The aim of this research was to establish the efficiency of prolonged block of plexus axillaris in children with extension contractures of the elbows due to arthrogryposis. From 2010 to 2011 we performed prolonged block of plexus axillaris in 23 children with arthrogryposis after mobilization of elbow. During catheterization of perineural space we use ultrasound navigation and neurostimulation. We carry out elbow capsulotomy and V-Y triceps lengthening with (or without) transposition muscles. Prolonged block of plexus axillaris after these operation helps to improve passive movements in the elbow (the average passive flexion was 80-50°, passive extension was 170-160°). The mean time of rehabilitation was 3 weeks. Combination of this method with physiotherapy helps to restore range of motion in elbow in patients with arthrogryposis.
SYMPTOM COMPLEX OF CHRONICAL ATLANTOAXIAL SUBLUXATION IN PAEDIATRIC PATIENTS
Authors: Baindurashvili A. G. , Ivanova N. E. , Kobyzev A. E. , Kononova E. L.
Published: April 2018

The objective of this study is to determine the complex of symptoms, including both orthopedic and neurological changes that occur against the backdrop of long-existing disturbances of the atlanto-axial joint. The authors conducted in-depth analysis of the orthopedic and neurological examination of 58 children aged between 10 and 17 years with first diagnosed disturbances of relationship between C1 and C2 vertebrae. Complexes of symptoms are identified from the combination of clinical data obtained with in-depth orthopedic and neurological examinations that are pathognomonic for lateral and posterior atlanto-axial chronic subluxation. Rotational subluxation of C1-C2 vertebral-motor segment was associated with concomitant neurological disorders and additionally with the no gross structural deformity of the spine and the disturbed foot support function in all cases. Using of the study findings will allow to make an adequate diagnosis and to determine the correct choice of additional diagnostic and therapeutic methods for this category of patients on the stage of conventional examination of the patient in clinical practice.
COMPARATIVE ANALYSIS OF BIOCHEMICAL PARAMETERS OF MUSCLE TISSUE ALTERATION DEPENDING ON APPROACHES FOR TOTAL HIP ARTHROPLASTY
Authors: Tikhilov R. M. , Andreev D. V. , Goncharov M. Y. , Shneyder O. V.
Published: April 2018

The results of the comparative analysis of biochemical alterations of muscle tissue in the blood serum of patients who underwent primary total hip replacement. In this study, we consider the data of 75 patients who underwent total hip arthroplasty (75 operations) from November 2010 to April 2012 to analyze the data was divided into 3 groups of patients: the first - using a minimally invasive technique MIS AL (22 operations), the second - with the use of the modified approach Muller (pending on the invention) - (29 operations), and the third - with approach by Hardinge (26 operations). The levels of glutamic oxaloacetic transaminase, creatinine phosphokinase, lactate dehydrogenase, myoglobin, creatinine, and C-reactive proteine in serum were determined preoperatively and at 3, 5, 7, 9 days after surgery. CRP included in the study as an indicator of non-specific inflammation of the tissues. When comparing the biochemical indicators in three types of approaches to the hip joint, the highest increase in GOAT, LDH, CPK, CRP, and myoglobin was detected at surgery approach by Hardinge. The results of this study may indicate a decrease in the degree of tissue trauma during surgery using a minimally-invasive approaches, which is characterized by the retention of attachment to the middle gluteal muscle of the femur.
FUNCTIONAL RESULTS OF SURGICAL TREATMENT FOR ISTHMIC SPONDYLOLISTHESIS USING ANTERIOR AND POSTERIOR EXPOSURES
Authors: Rudenko V. V. , Gulyaev D. A. , Godanyuk D. S. , Tatarintsev A. P.
Published: April 2018

Objective - to compare results of spondylolisthesis treatment using different surgical technologies. Material and methods: 84 patients (aged from 19 till 67) with spondylolisthesis of 1-3 degree (H.W Meyerding) were operated. Two methods of surgical exposures were used for decompression and stabilization. Anterior decompression and stabilization exposures from retroperitoneal access were used for the first group of patients. The second group was operated using posteriolateral interbody fusion with transpedicular screw fixation. The following results were estimated after operation: the level of patients’ postoperative adaptation period and the rate of neurological and orthopedic rehabilitation during the postoperative period. Conclusions. The obtained functional results show no difference for both groups where posterior and anterior exposures were used for spondylolisthesis surgical treatment of 1-3 degree.
HISTOMORPHOMETRIC ANALYSIS OF THE KNEE ARTICULAR CARTILAGE AND SYNOVIUM FOR METADIAPHYSEAL LEG LENGTHENING (EXPERIMENTAL-AND-MORPHOLOGICAL STUDY)
Authors: Stupina T. A. , Schoudlo N. A. , Petrovskaya N. V. , Stepanov M. A.
Published: April 2018

The knee articular cartilage and synovial membrane have been studied for metadiaphyseal leg lengthening using the methods of light miscroscopy, computer morpho- and stereometry. The manner of bone integrity breaking, the rate and rhythm of distraction conformed to the lengthening technique most often used in the clinic. The results of the histomorphometric analysis have demonstrated that when osteotomy at the level of metadiaphysis and manual distraction by 1 mm a day for 4 times is performed, synovitis of mild and moderate degree develops through subsynovial layer hypervascularization, as well as reactive-destructive changes in nerve fibers with the tendency to regeneration. The structural-functional changes of reactive and/or destructive-reparative character have been revealed in the articular cartilage, and the manifestation degree of these changes correlates with synovial membrane changes. The intensity of the destructive-reparative processes in the articular cartilage and synovial membrane depends on fixation stability.
FEATURES OF PATHOGENESIS, CLINICS AND DIAGNOSTICS OF EQUINOPLANOVALGUS IN PATIENTS WITH CEREBRAL PALSY
Authors: Umnov V. V. , Umnov D. V.
Published: April 2018

By data of the literature and own supervision, authors describe features pathogenesis of equinoplanovalgus foot deformations (EPVFD) in cerebral palsy patients and also the clinical displays of disease revealed by them at inspection of 52 patients (79 foot). In article you can find the earlier not described clinical supervision - presence by a considerable part of patients of the expressed feeling of tiredness feet at walking. This complaint was at 87,0 % patients. Main principles and methods of diagnostics of disease are described, and also a new way is computed tomography scan, allowing to visualize all characteristic for deformation of infringement of anatomy of joints and bones of foot in the conditions of influence modeling on it orthostatic load. Authors come to the conclusion that EPVFD by cerebral palsy children’s possesses a number of prominent features which probably to reveal special receptions and diagnostics methods, and also it is necessary to consider for increase of efficiency of the complex surgical approach to treatment EPVFD at patients with cerebral palsy.
Knee degenerative osteoarthritis secondary to ochronosis (case report)
Authors: Bliznyukov V. V. , Kovalenko A. N. , Rumakin V. P.
Published: April 2018

Alkaptonuria is rare disease with deficiency of homogentisate-1,2-dioxygenase enzyme, resulting in excess deposition of homogentisic acid in connective tissue. This deposition leads to ochronosis - brownish-black pigmentation of connective tissue. The result of pigmentation is weakness of connective tissue and, finally, chronic inflammation and osteoarthtritis. Currently specific treatment is absent, only sympothomatic. But total knee arthroplasty has good outcomes in patients of severe ochronotic arthritis similar to osteoarthritic patients without ochronosis. We present a case report of a patient with knee ochronotic arthritis treated with total knee arthroplasty.
Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures
Authors: Barabash A. P. , Shpinyak S. P. , Barabash J. A.
Published: April 2018

The comparative analysis of the results of the surgical treatment of 130 patients with closed comminuted unilateral diaphyseal femoral fractures, including assessment of anatomic functional outcomes of treatment according to the technique of the standardized investigations in traumatology and orthopedy and determination of quality of life according to SF-36 method is carried out. Osteosynthesis with the help of external fixation devices was performed in 36 patients, intramedullary interlocking osteosynthesis - in 57 patients, compression plating - in 37 patients. Level of anatomic functional rehabilitation of the patients in the early postoperative period made up 69-79 %, 6 months later increased up to 74-92%, and after the expiration of 12 months the level of rehabilitation reached 85-99%. During the treatment quality of life concerning physical component was within the limits from 36,8 up to 55,5 %, and concerning mental component - 54,3-60,8 %. After the expiration of a year increase in the parameters of physical and mental components up to 55,7 - 59,8 % and 57,2-65,8 % is detected respectively. In the group where the transosseous osteosynthesis technique was applied we got 93,7-95 % of positive outcomes, with the average disability period of 212,3±18,1 days. In 47,2 % of cases the following complications are observed: knee contracture - 7; inflammation of the soft tissues located near the transosseous fixators - 5 (13,9%); shortening of the limb less than 5% of its length - 3; false joint formation - 1; fracture union with formation of varus deformity in the femoral bone - 1. When using intramedullary interlocking osteosynthesis we had positive results in 96,5 % of cases, with the average period of disability 176±17,8 days. In 10,5 % cases the following complications are observed: suture sinus - 1(1,75 %); femoral osteomyelitis - 1; break of the design - 1; false joint formation - 1; knee contracture - 1; shortening of the limb less than 5% of its length - 1. The best outcomes of the surgical treatment (up to 100 %) were observed in cases when compression plating with LCP with fixation of no less than 57 % of the length of each fragment was performed. Complications in the form of a knee joint contracture were observed in 13,5% of patients.