bluuebunny/crossref_metadata_2025_split huggingface dataset:
STAGED SURGICAL RECONSTRUCTION OF MASSIVE PELVIC DEFECT
Authors: Pavlov V. V. , Pronskikh A. A. , Mamyladze T. Z. , Bazlov V. A. , Efimenko M. V. , Zhilenko V. Yu. , Tsegelnikov M. M. 
Published: October 2018

Purpose of the study — to illustrate on a particular clinical case an option of treatment for patients with severe pelvic defects by a staged surgery: vascularized bone grafting and revision arthroplasty using custom made implant produced by laser sintering based on layered 3D-visualisation. Material and Methods. Female, 61 years old, was admitted to clinic in 2016 with aseptic loosening of acetabular component and polyethylene insert wear following arthroplasty with total cementless prosthesis. Revision arthroplasty was made with hemispherical augment and anti-protrusion ring. On day 7th after the surgery a dislocation of prosthesis head, pubic bone fracture, migration of acetabular component and bone defect with pelvic discontinuity occurred due to trauma. To restore continuity of the pelvic ring and supportability of the lower limb the authors performed a staged multisession procedure: removal of prosthesis, free vascularized bone grafting by costal vascular pedicle graft and plating fixation of the pelvis. 6 months after the first stage a custom made prosthesis was implanted. Such prosthesis was produced based on a 3D pelvis reconstruction model by layered visualization and with evaluation of bone density on the Hounsfield scale and was printed on 3D-printer by laser sintering from LPW-TI64-GD23-TYPE5 titanium. Results. The authors did not observe any septic complications, dislocations and components migration in the early postoperative period. Function was assessed by Harris Hip Score. Scores prior to arthroplasty by a custom made implant was 12 points, one month postoperatively — 30 points, three months postoperatively — 51 points, six months postoperatively — 74 points. Life quality scores by SF-36 were reported as follows: prior to surgery РН — 21.32; МН — 40.92; one month postoperatively РН — 40.66; МН — 55.80; three months postoperatively РН — 52.14; МН — 57.81; six months postoperatively РН — 62.46; МН — 72.08. Conclusion. Vascularized bone autoplasty allows to restore pelvic continuity, and the use of custom made implants — to restore supportability of the lower limb and hip function in case of an extensive pelvic defect.
PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)
Authors: Petrushin A. L. , Pryaluchina A. V. 
Published: October 2018

Purpose of the study — to generalize and arrange the data published in scientific literature and to present current views on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.
CONSTRAINED LINERS AND DUAL MOBILITY SYSTEMS FOR PREVENTION OF INSTABILITY IN REVISION HIP ARTHROPLASTY
Authors: Efimov N. N. , Stafeev D. V. , Lasunskii S. A. , Mashkov V. M. , Parfeev D. G. , Shubnyakov I. I. , Tikhilov R. M. 
Published: October 2018

Purpose. Instability is a challenging complication of revision hip arthroplasty and a frequent cause of repeat revisions. Constrained liners and dual mobility systems have gained major attention among the options of dislocation prophylaxis. The aim of this study is to compare the outcomes of revision hip arthroplasy with use of constrained liners and dual mobility systems. Materials and Methods. We used DePuy Duraloc (inner diameter 28 mm) and Zimmer Trilogy (inner diameter 32 mm) systems in the constrained liners group (N 78, mean follow-up — 66.2 month, 54-82), Serf Novae and Biomet Avantage systems in the dual mobility group (N 58, mean follow-up — 17.8 month, 10-41). The two groups were comparable in age, sex and different potential dislocation risk factors, however, dual mobility cups were used more frequently in revisions due to unreduced and recurrent dislocations and in patients with the history of instability following total hip arthroplasty. There were also differences in the structure of primary diagnosis. Results. We observed 14 (17.9%) dislocations, 10 (12.8%) of which occurred within 2 years after surgery, and also 3 (3.8%) cases of aseptic loosening of the acetabular component, 4 (5.1%) cases of locking mechanism damage without dislocation and 8 (10.3%) cases of deep infection in the constrained liners group. In the dual mobility group we observed 3 (5.17%) large articulation dislocations, 1 (1.7%) case of aseptic loosening of the acetabular component and 4 (6.9%) cases of deep infection. The difference in dislocation rates in two groups was significant (p0.05). The analysis of the constrained liners group revealed an increased risk of dislocation in cases when a constrained system was implanted into a retained acetabular component compared to cases with acetabular shell revision (p0.01; RR = 7.2, 95% CI: 2.05-25.26), as well as a trend for increased risk of dislocation in cases when DePuy Duraloc liners (inner diameter 28 mm) were used compared to Zimmer Trilogy (inner diameter 32 mm) (p = 0.07; RR = 4.97, 95% CI: 1.03-24.04). Conclusion. Dual mobility systems proved to be more effective than constrained liners in revision hip arthroplasty although being used more frequently as a treatment rather than prophylaxis of instability. Constrained liners bear a higher risk of dislocations when implanted into retained acetabular components and when used with heads of lesser diameter.
OUTCOME OF PERIPROSTHETIC FEMORAL FRACTURES IN HIP ARTHROPLASTY
Authors: Korytkin A. A. , El Moudni Y. M. , Kovaldov K. A. , Novikova Y. S. , Belousov B. Yu. 
Published: October 2018

Periprosthetic fractures are one of the main reasons for revision surgery according to the data of large joint replacement registers. Treatment of patients with periprosthetic fractures is associated with a big number of complications and still keeps its relevance. Purpose of the study is to evaluate treatment outcome of patients with periprosthetic femoral fractures in hip replacement. Material and Methods. The authors performed a retrospective analysis of medical histories of 76 patients who underwent treatment of periprosthetic femoral fractures. The patients were divided into groups by the Unified Classification System (UCS). Follow up period was from 6 to 124 months (mean of 34.90±28.81). Results. 3 cases (3.9%) of periprosthetic femoral fractures were the complications after primary hip arthroplasty and occurred intraoperatively, 75 cases (96.1%) were complications after revision surgery; 56 cases (71.8%) were reported with uncemented and 22 cases (28.2%) with cemented femoral components. In 30 cases (38.5%) fractures had a iatrogenic nature and occurred intraoperatively, in 48 cases (61.5%) — occurred due to high- and low energy trauma. Type B fractures were observed most often — in 53 cases (68%). Conservative treatment, fixation by cerclage or by plate and screws has proven to be the least effective operative options. In the group of patients with extended osteotomy of the greater trochanter the healing was achieved in 90.5% of cases, while in the group without osteotomy — in 75% of cases. Low healing rate of periprosthetic fractures was observed for A and B1 type fractures (65% and 66.7% respectively). Follow up of patients with B2, B3 and C type fractures demonstrated consolidation in more than 80% of cases. Various complications were reported in 17 cases (21.8%). Conclusion. Effective treatment of patients with periprosthetic femoral fractures was associated with extended osteotomy of the greater trochanter (γ = 0.51; p = 0.032), absence of complications in postoperative period (R = 0.55; p = 0.00001), B2, B3 and C fracture types (γ = 0.40; p = 0.02) and use of revision uncemented femoral components with distal fixation (γ = 0.35; p = 0.018). In the authors opinion use of sutures or cerclage wires are not effective in cases of trochanteric fractures and stable femoral components; it would be preferable to perform internal fixation by a plate with hooks such as Dall-Miles. In case of doubts in regard of stem stability the revision should rather stipulate use of uncemented femoral components, in particular long stems with distal fixation.
PATIENT SATISFACTION FOLLOWING TOTAL HIP REPLACEMENT: PREDICTORS OF SUCCESS
Authors: Cherkasov M. A. , Tikhilov R. M. , Shubnyakov I. I. , Kovalenko A. N. , Mugutdinov Z. A. 
Published: October 2018

Background. Total hip arthroplasty (THA) is reliable and successful intervention in terms of relieving pain and improving joint function. Between 7% and 16% of patients are dissatisfied after THA. To assess predictors and postoperative determinants of satisfaction 3 and 12 months after THA. Material and Methods. During our research from 2015 to 2017 prospectively 1015 patients were interviewed using patient related outcome measures (a questionnaire of functional outcome (Oxford Hip Score, Harris Hip Score), health-related quality of life (EQ-5D)) preoperatively, 3 and 12 months postoperatively. Satisfaction was assessed using Visual Analogue Scale (VAS). Also Univariate and multivariate analyses were performed. Results. A female gender, absence of interventions on the operated joint in history were preoperative predictors of satisfaction. The main postoperative determinant of satisfaction was the fulfillment of patient’s expectations, improve physical function, quality of life, relief of pain. Conclusion. To improve patient satisfaction after THA, patients’ expectations and their fulfillment need to be carefully addressed. Patients with a history of interventions on the operated joint with low physical function or quality of life, high level of pain should be identified and specifically informed on expected surgical outcome
SACROILIAC JOINT PATHOLOGY IN ELDERLY PATIENTS WITH LOW BACK PAIN (OBSERVATION PROGRAM “IOLANTA”)
Authors: Kotelnikov G. P. , Zolotovskaia I. A. , Davydkin I. L. , Poverennova I. E. , Dolgushkin D. A. 
Published: October 2018

Pain in the lower back is one of the frequent reasons for seeking medical help among people over 60 years of age. The study of this problem is of interest to specialists of various profiles, including neurologists, rheumatologists, orthopedic surgeons and therapists. Purpose — to determine prevalence rate of sacroiliac joint pathology in elderly patients with low back pain (LBP) in conjunction with evaluation of clinical significance of bone resorption and cytokines markers. Materials and Methods.The study was conducted with consecutive inclusion of patients (n = 259) with mean age of 65.5 year old [62.5; 69.5] who addressed the hospital for the first time in calendar year with complaints for low back pain. The authors performed MRI examination of lumbar-sacral spine and sacroiliac joint, assessed transforming growth factor β1 (TGF β1), interleukin (IL) 1β and IL-6, Beta-Crosslaps (β-CrossLaps) criteria, P1NP (N-terminal propeptide of procollagen type I) concentration and deoxypyridinoline (DPD) level. Results. 39.4% of patients older 60 years with low back pain on MRI demonstrated changes in sacroiliac joints with statistically significant higher (p = 0.037) pain level as compared to patients without pathology of sacroiliac joint, as well as higher values of TGF-β1 (p = 0.033), IL-1β (p = 0.028), IL-6 (p = 0.041), β-CrossLaps (p = 0.028), P1NP (p = 0.037) and DPD (p = 0.002). Conclusion. Reported alterations in sacroiliac joint conditioned by degenerative and dystrophic processes are associated with distinctive signs of osteoarthrosis and confirm non-specific inflammation active with bone resorption in patients with low back pain.
ЕFFECTIVENESS OF FOUR-ROD FIXATION FOR PEDICLE SUBTRACTION SPINAL OSTEOTOMY
Authors: Panteleyev A. A. , Mironov S. P. , Buhtin K. M. , Sazhnev M. L. , Kazmin A. I. , Pereverzev V. S. , Kolesov S. V. 
Published: October 2018

Introduction. Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittal balance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common. The purpose of this study — to assess the effectiveness of four-rod fixation compared to literature data on standard two-rod fixation in patients undergoing PSO. Materials and Methods. The study is a retrospective analysis of 47 consecutive patients with rigid spinal deformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation. Results. In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length of fixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients. Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequent complication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure.
THORACIC AND LUMBAR HEMIVERTEBRA EXCISION IN PEDIATRIC PATIENTS: HOW DOES THE OPERATION TECHNIQUE INFLUENCE ON OUTCOMES? (СOHORT ANALYSIS AND LITERATURE REVIEW)
Authors: Mushkin A. Yu. , Naumov D. G. , Umenushkina E. Yu. 
Published: October 2018

Purpose of the study — to study impact of hemi-vertebrae extirpation technique in mono-segmental reconstruction on the surgical trauma.Material and Methods. 34 patients underwent 36 mono-segmental extirpations of hemi-vertebrae followed by a posterior fixation during a single center four years cohort study. Mean age of children at the moment of procedure was 4 years and 3 months (min — 1 year, max — 14 years). The authors studied impact of pathology level, surgical approach, type of bony structures removal technique and age of the patients on the time of procedure and volume of blood loss. Results. Extirpation of thoracic hemi-vertebrae was characterized by a lengthier procedure and greater blood loss in contrast to lumbar hemi-vertebrae. Patients were divided into three groups depending on extirpation technique: 1) extirpation from two approaches using a high-speed burr; 2) from a single dorsal approach using the same extirpation technique; 3) from dorsal approach using ultrasonic bone scalpel. Surgery time was 208±72 min in the first group, 187±54 min in the second group, and 170±30 min in the third group; blood loss volume was 181±39, 181±53, 132±73 ml respectively in the groups, or 11.5±4.3%, 9.4±2.8% and 9.6±5.2% of total blood volume, respectively.Conclusion. Surgical approach and hemi-vertebrae extirpation technique in children have a varying impact on surgery time and intraoperative blood loss, and the least values were reported for posterior approach using ultrasonic bone scalpel.
TRANSPATELLAR RECONSTRUCTION OF MEDIAL PATELLOFEMORAL LIGAMENT BY SEMITENDINOUS TENDON AUTOGRAFT
Authors: Korolev A. V. , Magnitskaya N. E. , Ryazantsev M. S. , Sinitskiy M. A. , Kadantsev P. M. , Afanas’yev A. P. , Il’in D. O. 
Published: October 2018

Purpose of the study — to evaluate surgical treatment outcomes of the patients with chronical patella instability who underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft. Material and methods. 26 patients with minimal 12 months follow up were included into the study. In all cases semitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery. Results. Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reported that the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity. Conclusion. Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficient treatment method of chronical patella instability.
Harland Bartholomew e o zoneamento racialmente informado: o caso de St. Louis | Harland Bartholomew and racially informed zoning: the case of St. Louis
Authors: Barone Ana Cláudia Castilho 
Published: October 2018

Este artigo busca recuperar os fundamentos raciais que contribuíram para configurar as propostas de zoneamento compreensivo desenvolvidas por Harland Bartholomew para a cidade de St. Louis, Missouri, entre 1916 e 1947. Além de ter sido um dos urbanistas que mais produziu planos e propostas de zoneamento dos EUA, Bartholomew também tornou-se referência fundamental para o urbanismo em São Paulo. O caso de St. Louis é emblemático por ter se implantado em um contexto de grande disputa racial no território, em que parte da elite branca que dava sustentação política aos seus planos urbanísticos defendia a adoção de normas legais de regulação da segregação residencial na cidade. Assim, analisamos os planos feitos por Bartholomew para St. Louis entre 1918 e 1946, cotejando as decisões estabelecidas nesses processos com os embates raciais presentes em cada momento. Com este trabalho, buscamos trazer novos elementos para o debate público acerca da pertinência do zoneamento como instrumento de regulação de uso e ocupação do solo urbano.
SELECTING THE MANAGEMENT OF PATIENTS WITH CHRONIC HEPATITIS B AFTER THE COMPLETION OF THE LONG-TERM ANTIVIRAL THERAPY
Authors: Esaulenko E. V. , Zakharov K. A. , Alikian I. S. , Sukhoruk A. A. , Stasishkis T. A. , Kovelenov A. U. 
Published: October 2018

Study aims: The study purpose was to analyze the results of the clinical and laboratory monitoring of HBeAg-negative chronic hepatitis B patients after discontinuation of longterm nucleosides analogues antiviral therapy in order to determine further management.Materials and methods: A retrospective-prospective investigation was performed in 106 patients with diagnosis of HBeAg-negative chronic hepatitis B during the course of antiviral therapy using nucleosides analogues. Average treatment duration was 190,1±77,7 weeks. The therapy was discontinued for 29 patients in the period of time from two to five years of the treatment, they were followed up from 6 months to 6 years. The activity of aminotransferases, the levels of HBV DNA were evaluated, the liver elastometry was performed during the patients monitoring. The relapse of disease after the treatment discontinuation was considered when the viral load exceeded 2.0x103 IU / ml and/or alanine aminotransferase levels were above the reference values.Results:The viral load varied from 4,0х102 IU/ml to 2,87 х 107 IU/ml at 86,2% cases after the 6 months of discontinuation of the treatment. However median levels of viral load were not higher than 2,5 х 103 IU/ml at different timepoints of observation. The VL was higher than 2,0 х 103 IU/ml in 62,1% patients and it matched to relapse criterion. Clinical relapse was not revealed in 13,8% cases at observational period from 6 months to 2 years. The second course of antiviral therapy was not required for 37,9% patients, at the same time it was necessary to consider it for the rest ones.Conclusion: Regular medical checkups with periodical clinical, laboratory and instrumental examinations after antiviral treatment discontinuation are required for timely detection of relapse and decision regarding the next course of antiviral therapy.