scholarly journals The influence of triple pelvic osteotomy on the spine-pelvis ratios in children with dysplastic subluxation of the hip

2019 ◽  
Vol 7 (2) ◽  
pp. 5-16
Author(s):  
Pavel I. Bortulev ◽  
Sergei V. Vissarionov ◽  
Vladimir E. Baskov ◽  
Dmitriy B. Barsukov ◽  
Ivan Y. Pozdnikin ◽  
...  

Introduction. Triple pelvic osteotomy is an effective surgical treatment for dysplastic subluxation of the hip in children aged above 12 years. However, modern studies did not assess the indicators of spine-pelvis ratios, sagittal profile of the spine in children with dysplastic subluxation of the hip following surgical treatment, and possibility of change on these values during the operation. Aim. This study aimed to evaluate the effectiveness of the improved technique of performing triple pelvic osteotomy on children with dysplastic subluxation of the hip. Materials and methods. We analyzed the x-ray images and surgical treatment of 35 female patients (44 hip joints) aged 13 to 18 years with dysplastic subluxation of the hip between 2016 and 2018. The patients were divided into two groups: the main group consisted of 20 patients (25 hip joints) who underwent surgical treatment that had taken into account the state of sagittal spine-pelvis ratios according to the improved method using personalized navigation templates, and the control group consisted of 15 patients (19 hip joints) who received surgical treatment according to the generally accepted method. Results. In addition to the typical clinical and radiological abnormalities of the dysplastic subluxation of the hip in 90% of patients in both groups, there were changes in the sagittal balance in the form of excessive pelvic anteversion and lumbar hyperlordosis. One year postoperatively, patients in the main group showed significant changes (p < 0.05) in the state of sagittal spine-pelvis ratios in the form of a decrease in the pelvic base angle, which led to the achievement of the average values of the angle of inclination of the sacral slope (SS) and the value of global lumbar lordosis. On the other hand, these radiological parameters in patients in the control group remained within the preoperative values. Conclusion. The improved technique of triple pelvic osteotomy provides conditions for the reduction of pelvic anteversion and restoration of the sagittal profile of the spine (p < 0.05). The use of personalized navigation templates allows for the most accurate multiplane correction of the acetabulum. It is necessary to include a specialized x-ray examination in the preoperative planning to assess the state of sagittal spine-pelvis ratios.

2019 ◽  
Vol 25 (3) ◽  
pp. 47-56
Author(s):  
P. I. Bortulev ◽  
S. V. Vissarionov ◽  
V. E. Baskov ◽  
D. B. Barsukov ◽  
I. Yu. Pozdnikin ◽  
...  

Purpose of the study — to evaluate the degree of correction of acetabular spatial position after triple pelvic osteotomy using patient-specific templates in children with dysplastic hip subluxation. Materials and methods. Study included 30 patients (30 hips) with dysplastic hip subluxation aging from 14 to 18 years (mean age of 16.3±1.4). All children were divided into two groups — main group consisted of 15 children (15 hips) who underwent triple pelvic osteotomy using patient-specific templates produced by 3D modeling and prototyping technology; control group consisted of 15 children (15 hips) who underwent triple pelvic osteotomy based on standard preoperative planning. X-ray and CT of hip joints was made in all patients. Results. Parameters of acetabular spatial position as well as integral parameters which define the ratio between acetabulum and femoral components and hip stability were in the range of normal variation in patients of the main group. Similar average parameters in patients of control group were below the lower margin of the physiological norm (p<0.05). Besides, the values of standard deviation of abovementioned X-ray parameters in some patients of control group demonstrated pronounced variability characterized by hyper- and hypo-correction values of spatial position of acetabular fragment. Conclusion. In contrast to standard preoperative planning the use of patient-specific templates during re-orienting triple pelvic osteotomy in children with dysplastic hip subluxation allows to level out possible errors in three-dimensional acetabulum positioning towards hyper- and hypo-correction (p<0.05) of pelvic component. This creates conditions to ensure adequate hip stability which is confirmed by key x-ray indices with values within normal reference range.


2018 ◽  
Vol 15 (2S) ◽  
pp. 98-105
Author(s):  
V. N. Kurochkin ◽  
T. V. Terekhova ◽  
Y. D. Glumskova ◽  
Y. I. Triludina ◽  
O. A. Shelikhova

Purpose: To analyze the effectiveness of Fresnel prism in the complex treatment of friendly strabismus.Patients and methods. The main group consisted of 428 patients with strabismus, who were assigned Fresnel prisms in combination with pleoptoorthoptic and surgical treatment. Indication for the appointment of Fresnel prism with a friendly strabismus was: angle of strabismus to 25 degrees, postoperative residual angles. The age of the patients ranged from 4 to 60 years. We evaluated the visual acuity without correction and with correction, refraction, character of vision, ability to bifoveal fusion evaluated with synoptophore. The results were compared with a control group treated without Fresnel prisms.Results. During initial selection of Fresnel prisms, doubling was revealed in 73% cases. With the constant wearing of glasses with Fresnel prisms, in which the state of orthotropy is achieved, in most patients doubling was cupped in the period from 2 weeks to 3 months. During the first month, doubling stopped in 72% of patients, and the minimum periods for arresting double vision were noted in preschool children. The absence of doubling served was an indication for surgical correction of strabismus. After the surgery, a good cosmetic effect was achieved in 392 persons (97%), and the state of orthotropy was in 330 of people (81.7%). Doubling after the operation was not observed, there was no relapse of strabismus. Comparative analysis of the main and control groups showed that in the main group of patients the use of prisms combined with pleoptoorthoptic and surgical treatment made it possible to restore binocular vision in 32.9% of cases.Conclusion. The use of Fresnel prism in the complex treatment of friendly strabismus in children allows to obtain not only a good cosmetic effect, but also to develop binocular vision in 32.9% of cases. The use of Fresnel prisms in the preoperative period in adults allows avoiding postoperative double vision, thereby reducing the risk of recurrence of strabismus because of the development of mechanisms for the formation of a single binocular image. 


Author(s):  
T. V. Zvyagintseva ◽  
S. I. Myronchenko ◽  
N. I. Kytsyuk ◽  
O. V. Naumova

Considering the particular danger of remote skin reactions to ultraviolet irradiation (UVI), it is advisable to use ointments with antioxidant activity to reduce its negative effect on the skin. The rationale for the choice of ointments with antioxidant activity was the fact that they reduce the damaging effect of ultraviolet radiation in the erythemal and early post-erythemal period. The presence of a regular connection between the development of the early and late periods has given reason to assume the protective effect of ointments on the remote skin reactions. Objective: to study the effect of thiotriazoline ointment and thiotriazoline ointment with silver nanoparticles on the state of the morphological structures of the skin of guinea pigs after local UVI. Material and methods of research. The study involved 132 albino guinea pigs weighing 400-500 g, divided into 4 groups: 1 - intact, 2 - control (guinea pigs subjected to local UVI), 3 and 4 main ones. The third main group included guinea pigs that after UVI were administered thiotriazoline ointment in the treatment and prophylactic regime, the fourth main group included guinea pigs that after UVI were administered thiotriazoline ointment with silver nanoparticles in the same mode as Group 3. Ointments were applied 1 hour before irradiation and daily until erythema disappeared. Ultraviolet erythema was caused by irradiation in 1 minimum erythemal dose. After 2, 4 hours, on the 3rd, 8th, 15th, 21st, 28th day, the fragments of irradiated skin were investigated using histochemical and morphometric methods (fibroblast density and epidermis thickness). Results. Morphological changes in the skin after applying ointments with antioxidant activity were unidirectional. It was revealed that in the early periods after irradiation, thiotrazoline ointment and thiotrazoline ointment with silver nanoparticles do not affect changes in the thickness of the epidermis, but statistically significantly reduce the density of fibroblasts in the dermis on the 3rd day of the experiment compared to the control group. In the later periods, under the influence of thiotriazoline ointment, a gradual decrease in the thickness of the epidermis, which reached the norm by the end of the experiment, was observed. On the 8th day, the maximum density of fibroblasts was recorded, in the subsequent periods of the experiment, the index gradually decreased, which was accompanied by collagenization of the papillary layer in the loci of damage to collagen and elastic fibers detected in 50% of cases. In later times, under the influence of thiotriazoline ointment with silver nanoparticles, the processes of restoring the morphological structures of the skin occurred faster. In parallel with the decrease in the density of fibroblasts in the loci of the previous damage to the collagen and elastic fibers of the papillary layer, thickening of collagen fibers was observed, replacing them with segments of destruction of elastic fibers. In this group, at the end of the experiment, the collagenization locus was small, single, occurring in 16.7% of cases. Conclusions Ointments with antioxidant activity exert a positive effect on the state of morphological structures of the skin, damaged as a result of local UVI, in erythemal and post-erythemic periods. In the early periods after the local UVI, there was a general tendency for the effect of both ointments, as they reduced the density of fibroblasts on the 3rd day, but did not result in complete normalization. In the late period after local UVI , under the influence of thiotriazoline ointment and thiotriazoline ointment with silver nanoparticles, thickness of the epidermis (by 21st and 15th day, respectively) and density of fibroblasts (by the 28th day) decreased to normal while without treatment both indicators exceeded the norm by several times for 28 days of the experiment.


2005 ◽  
Vol 12 (1) ◽  
pp. 11
Author(s):  
A. G Guseinov

In treatment of 87 patients (main group) with diaphysial shin fractures new techniques and devices for optimization of transosseous extrafocal osteosynthesis by Ilizarov were applied. All techniques and devices, i.e. devices for the perfection of Ilizarov apparatus stability, for bone fragment reposition, console compression arrangement for extrafocal osteosynthesis in commi­nuted fractures, devices for damper compression of bone fragments, for prevention of lower extremity edema at extrafocal osteosynthesis, for provision of early axial loading in Ilizarov apparatus, for activization of osteogenesis using asymmetrical dynamic compression were elabo­rated by the author. Control group (108 patients) was treated by traditional Ilizarov technique. Treatment results were assessed at terms from 4 months to 2 years. Data of clinical, X-ray and functional examinations as well as terms of fracture healing, duration of hospitalization and terms of working ability restoration were better in the main group as compared to the control one. In the main group good results were achieved in 47.1%c, satisfactory — in 49.4%, poor — in 3.5% of cases, in control group — 30.6%, 63.0%, 6.4%, respectively. Author believes that further perfection of Ilizarov technique is reasonable.


2011 ◽  
Vol 18 (4) ◽  
pp. 3-10
Author(s):  
A V Krut'ko ◽  
Shamil' Al'firovich Akhmet'yanov ◽  
D M Kozlov ◽  
A V Peleganchuk ◽  
A V Bulatov ◽  
...  

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.


2019 ◽  
Vol 6 (3) ◽  
pp. 108-114 ◽  
Author(s):  
A. D. Sergienko ◽  
V. E. Khoronenko ◽  
E. V. Gameeva ◽  
A. B. Ryabov ◽  
V. M. Khomyakov

Purpose of the study. To determine the effect of nutritional deficiency and nutritional therapy on the quality of life of patients with gastric cancer at the stage of surgical treatment. Patients and methods. In Thoracoabdominal Department of P. Herzen Moscow Oncology Research Institute within 2017– 2019 the quality of life at the stage of surgical treatment of gastric malignant neoplasms was evaluated in 62 patients (36 men and 26 women) aged 34 to 79 years (mean age 61.9 ± 9.55). At the outpatient stage, patients were divided into 2 groups: in the 1st (main) group, patients received nutritive support with specialized mixtures for 10 days before hospitalization, in the 2nd (control) group, patients were asked to follow a high-protein diet without adding specialized mixtures. The quality of life assessment was carried out on the basis of the EORTC-QLQ-C30 Questionnaire, which patients received on the day of hospitalization. Patients repeatedly filled in EORTC-QLQ-C30 Questionnaire before discharge from the hospital, which allowed to assess the dynamics of the quality of life indicators of the studied patients. The study groups were comparable in social and medical indicators. Results. The analysis of the survey results showed that the “general state of health” in the studied groups at the stage of hospitalization is estimated �bove average. Also, in both groups there is a positive dynamics in the values of the above indicator before discharge. Patients of the 1st group who received specialized nutritional mixtures, developed the statistical significance of the differences in the assessment of the quality of life upon admission and before discharge. Thus, it can be argued that nutritional therapy had a significant positive impact on the quality of life in terms of “general health”, in contrast to the control group of patients who did not receive specialized nutritional therapy. There was a general tendency toward an increase in the quality of life indicators at admission and before discharge on all scores of the questionnaire in groups. Thisis a positive assessment by patients of their condition after providing them with medical services. In this case, the discomfort from the symptoms accompanying the disease is reduced, which is confirmed by the scoring results. Statistically significant differences in the assessment of symptoms occur in the study group. Patients having received nutritional therapy noted a decrease in pain, an improvement in the processes of assimilation of food, as well as an improvement in well-being, physical condition, an increase in general tone and energy, a surge of strength and a sense of vitality. In “decreased appetite”score the indices of patients in the main group decreased by more than 3 times, i. e. their appetite improved significantly under treatment. Improving appetite in patients of the main group led to an improvement in the functioning of the gastrointestinal tract as a whole. Patients in this group noted an improvement in digestion and bowel movements. Conclusion The study showed that the quality of life of patients with gastric cancer largely depends on their nutritional deficiency, and nutritional therapy at the stages of surgical treatment, in turn, can significantly improve its results, including in the aspect of their perception by patients. Using the general EORTC QLQ-C30 questionnaire is one of the available methods for assessing the quality of life in patients with gastric cancer.


Author(s):  
Z. A. Azizzoda ◽  
K. M. Kurbonov ◽  
K. R. Ruziboyzoda ◽  
S. G. Ali-Zade

Aim. Improving outcomes of diagnosis and treatment of patients with liver echinococcosis and its complications. Materials and methods. A comparative analysis of the results of surgical treatment of liver echinococcosis and its complications with traditional laparotomy access surgery (control group) and minimally invasive interventions (main group) was performed.Results. The study included 300 patients (170 in the control and 130 in the main group). In the main group, 37 (28.4%) cases performed open echinococcectomy from various mini-accesses, and 27 (20.7%) performed twostage operations using minimally invasive technology. Laparoscopic echinococcectomy was performed in 23 (17.7%) patients, laparoscopic pericystectomy 12 (9.2%) and laparoscopic liver resection in 10 (7.7%) patients. The frequency of postoperative complications in the main group was 17.7%, in the control 51.8%, postoperative mortality decreased from 2.3% to 0.8%.Conclusion. Minimally invasive technologies in the surgical treatment of liver echinococcosis show the better immediate results compared to traditional open surgical methods.


Author(s):  
Omarov N.B., Aimagambetov M. Zh. ◽  
◽  
◽  

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).


Medicina ◽  
2020 ◽  
pp. 1-10
Author(s):  
M. V. Stogov ◽  
◽  
Y. P. Soldatov ◽  
G. M. Chibirov ◽  
E. A. Kireeva ◽  
...  

Heterotopic ossification (HO) is a common complication after injuries and orthopedic interventions. The aim of the study is to assess the feasibility of using laboratory tests to predict and determine the degree of risk of developing heterotopic ossification in patients after surgical treatment of bone fractures. Materials and methods. The results of surgical treatment of the effects of a humeral fracture in 25 patients were analyzed. In retrospect, all patients were divided into two groups: the main group included patients (n=9), who after surgery of the elbow fractures developed complications in the form of HO elbow para-articular tissues. The control group (n=16) consisted of patients who in the year after elbow fractures surgery developed no complications in the form of HO. Blood tests were performed in all patients prior to treatment, 7 days after surgery and at discharge from the hospital. The two groups of comparison (main and control) were comparable in age, time elapsed from the injury, the type of surgery performed, and length of hospital stay. Results. As a result of the study three potential predictors of HO were distinguished by laboratory tests in patients of the main group at the time of discharge: 1) high values of lactate (cut point with 100% sensitivity of the test – 2.32 mmol/l); 2) high values of hemoglobin (cut point with 100% sensitivity of the test – 130 g/l); 3) decreased activity of bone isoenzyme of acid phosphatase (cut point with 100% sensitivity of the test – 4.4 U/l). The odds ratio for a positive result of all three tests for predicting heterotopic ossification is 15.0. Conclusion. The identified laboratory tests allow to predict and determine the degree of risk of heterotopic ossification in patients after treatment of the effects of bone fractures.


TRAUMA ◽  
2021 ◽  
Vol 22 (4) ◽  
pp. 46-51
Author(s):  
I.I. Trufanov

Background. Acetabular fractures are severe intra-articular injuries that require anatomical reposition and early function, but they are often complicated by degenerative changes in both the acetabulum and the femoral head, leading to the development of post-traumatic coxarthrosis. The purpose was to study the clinical effectiveness of surgical treatment and postoperative management of patients using autologous platelet-rich plasma in patients with fractures of the acetabulum. Materials and methods. Twenty-eight patients with acetabular fractures of various degrees were operated at the City Emergency Hospital of Zaporizhzhia and the Municipal Clinical Hospital No 9 from 2017 to 2019. Gender composition: 22 men (78.57 %), 6 women (21.43 %), average age 46.64 ± 2.21 years, with a 95% confidence interval 42.31–50.96. Nineteen victims (67.86 %) had road traffic injuries, 7 (25 %) domestic injuries, and 2 (7.14 %) had industrial injuries. Results. In the main group of patients treated with platelet-rich plasma, radiologically visible adhesion of the injured area after 8 weeks occurred in 10 people (83.4 %). In one person (8.3 %), the adhesion occurred after 12, and in another (8.3 %) — 16 weeks after surgery. In the control group, adhesions at 8th week were registered in 14 patients (60.87 %), in 8 (34.78 %) — at 16th week. Given the general recovery of the body in the main group, the activation and social adaptation of patients occurred 2–3 weeks earlier. The assessment was performed radiologically and by the criteria of functional recovery.


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