PROGRESSION OF INFLAMMATORY PROCESSES IN PATIENTS AFTER IM NAILING USING BIOINERT AND BIODEGRADABLE IMPLANTS BASED ON MC-10 MAGNESIUM ALLOY

Summary. Modern medicine widely uses artificial materials to replace damaged tissues and organs. Biodegradable implants should be gradually replaced with living tissue and stay functioning within a specified period, don’t have any negative impact on surrounding tissues and a human body in general. Clinical studies of biochemical values specifying the intensity of inflammatory response to IM nailing with biodegradable implants are of clinical and scientific interest. Task of the study: to substantiate of the use of implants made of biodegradable magnesium alloy MS-10 in the dynamic IM nailing for diaphyseal fractures of the tibia. Materials and methods. The study involved 34 patients with diaphyseal tibial fractures, which resembled surgical treatment (IM nailing). Cannulated intramedullary titanium nails served as a blocking pin. The treatment included closed reposition followed with IM nailing of a tibia. To lock the nail, a screw made of magnesium alloy MS-10 was inserted in a static (round) hole in 16 patients. In 18 patients, a screw made of titanium was inserted into a static hole. The both groups passed blood sampling for studies, before and after the surgery, 2 and 4 weeks, 2 and 4 months after surgery. Biochemical blood tests were to determine the concentration of fibrinogen-monomer complexes in the blood plasma (β-naphthol test). Results. The study of the activity of AST and ALT found it lower (19 and 29%) in patients with biodegradable screws, compared to the group of patients with IM nailing locked with bioinert screws. The situation was similar with ESR, fibrinogen B and total bilirubin in the blood of patients in both groups. Conclusions. The study convincingly proves the expediency of the use of biodegradable material (magnesium alloy MS-10) to produce implants for the IM nailing for the patients with long bones’ fractures.

HYALURONIC ACID PREPARATIONS IN BIG JOINT OSTEOARTHRITIS MANAGEMENT

The authors of the paper analyzed the experience of domestic and foreign experts on the effi-ciency of HA preparation in big joint osteoarthritis management. Task of the study is to analyze literature sources to identify the efficiency of HA preparations in big joints osteoarthritis management. Materials and methods: articles published by specialized scientific journals, paper collections, internet sources. Results: The analysis of literature sources determined the essential role of HA in joint cartilage nutrition and function. The researches tend to believe that an ideal HA preparation must be as close as possible to the physiological HA of joint’s synovial fluid. The HA preparation elaborated in our state, Artropatch meets these demands completely. Conclusions. Modern HA injectable preparations are expedient on the 1-3 stage of OA. Anti-inflammatory effect of HA preparations predetermines the possibility to decrease the intake dose and period of non-steroid anti-inflammatory drugs, consequently decreasing the risk of many unfavorable side effects of NSAIPs. The high safety level of HA preparations and no significant side effects after long-term treatment make them widely used in clinical practice of modern orthopedic surgeons.

TIBIAL BONE NONUNION PLASTIC WITH THE USE OF MONOLOCAL OSTEOSYNTHESIS BY RING FIXATORS

Actuality. Monolocal extrafocal osteosynthesis by ring fixators (RF) of tibial nonunion is not a generally accepted method, there are no systematic guidelines for its implementation. These issues need to be further studied. Task. Formulate situational predominant properties of RF; features of application in different condi-tions. To offer a method of nonunion plastics and features of monolocal osteosynthesis of RF and to study its efficiency. Materials and methods. The data of treatment of 16 patients with aseptic nonunion of tibia, who required complex comprehensive specialized medical care with a possible positive result (scores from 51 to 75 according to the evaluation system Non-Union Scoring System - NUSS). Implementation of monolocal extrafocal osteosynthesis of RF nonunion of shin bones after fractures was performed by us taking into account the features that distinguished it from that by fractures. The principal requirement of surgical intervention was the need to treat the center of nonunion, local stimulation of repara-tive processes. The technical features of all components of the intervention in the future were of great im-portance. The so-called blood-saving tactics were used, which were carried out using squeezing and hemostatic tourniquets, tranexamic acid. The results obtained. The results of treatment of victims with nonunion of the tibia with the use of RF in monolocal mode were as follows. Taking in consideration the severity of the lesion, we consider this result to be good. Given the insufficient number of observations, it is necessary to continue the use of the proposed method of treatment and to investigate its effectiveness. Conclusions. 1. The use of monolocal RF in patients with nonunion of tibia after fractures has the advantage of use in cases with episodes of septic inflammation in the past, extensive scarring of soft tissues, short distal fragment and osteoporosis. 2. The peculiarities of monolocal osteosynthesis of RF were the use of thick Ilizarov needles Ø 2.0 mm with their conduction at an angle of two planes. The obtained results of treatment of victims with nonunion of the tibia with the use of RF in the monolocal mode should be considered encouraging.

FEATURES OF FORMATION OF CONTRACTURES OF A HIP JOINT AT PATIENTS WITH A HIP-LUMBAR SYNDROME

Resume. With significant destructive changes in the hip joints, endoprosthesis is the main method of surgical treatment of coxarthrosis. However, according to the Swedish and Canadian registries, 17-20% of patients have pain after arthroplasty. The cause of residual pain may be a concomitant lesion of the spine, and the study of issues related to the clinical features of the hip-lumbar syndrome are relevant from a scientific and practical point of view. The purpose of the study: to analyze the clinical and radiological picture of patients with coxarthrosis with concomitant pathology of the spine, to investigate the dependence of the severity of flexion contracture of the hip, variable parameters (pelvic angle RT and lumbar lordosis GLL) from constant angle and angle; to study the features of the clinical course of hip-lumbar syndrome. Materials and methods. An analysis of the results of examination of 150 patients with stage III-IV idiopathic coxarthrosis who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults of the State Institution "ITO NAMS of Ukraine" was performed. Hip pain and functional impairment were assessed according Harris and Womac scales also before hip arthroplasty and 3 months after surgery. Results. Analysis of the obtained data shows that with an increase in the angle of inclination of the pelvis and flexion contracture, the values of the parameters of the angle of pelvic deviation increase, which causes a statistically significant increase in the angle of lumbar lordosis. The correlation coefficients between the parameters PI-PT and PI-GLL were 0.65±0.15 and 0.74±0.11, respectively. Conclusions. Pain in patients with small contracture of the hip joint is associated with neuro-dystrophic syndrome in osteochondrosis of the lumbar spine, in patients with larger contracture - with spondyloarthritis. In the vertical position of the sacrum - GLL - the smallest, least pro-nounced and flexion contracture of the hip joint. On the contrary, in the horizontal position of the sacrum in patients with hyperlordosis and significant, more than 10 ° contracture in the hip joints.

THE ROLE OF DISCOGENOUS RADICULOPATHIES AND SPONDYLOLYSTHESIS IN THE STRUCTURE OF PAIN SYNDROME AFTER TOTAL HIP ARTHROPLASTY

Resume. In the structure of complications, pain syndrome, which is not associated with instability of the components of the endoprosthesis or infection, remains a serious problem due to difficulties in diagnosis and treatment. The cause of residual pain may be the presence in the patient of discogenic radiculopathy or spon-dylolisthesis of the lumbar spine. The aim of the study. To determine the role of discogenic radiculopathies and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and methods. A sample and retrospective analysis of case histories of 138 patients with hip and lumbar syndrome, who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults SI "ITO NAMS of Ukraine". All patients were examined clinically and radiologically. Additionally, all patients were examined by a neurolo-gist to determine the neurological status of patients, diagnosis. Evaluation of the effectiveness of treatment of patients with residual effects of discogenic radiculopathy and spondylolisthesis after hip arthroplasty was performed on the functional scale of Oswestry. Results. The analysis of the patient database revealed a statisti-cally significant (p≤0.05) predominance of patients with the presence of disc herniation at the level of L3-L4 and hypolordosis. The survey revealed 9 cases of discogenic radiculopathy and 6 cases of spondylolisthesis in patients with PD, which amounted to 6.5% and 4.5% of the total number of examined patients. The high effi-ciency of the developed treatment-and-prophylactic measures in patients with discogenic radiculopathy or spondylolisthesis and lumbar-lumbar syndrome has been determined. Timely appointment of complex conserva-tive and operative methods allowed to achieve satisfactory results in 100% of cases. Conclusions. Studies to determine the role of discogenic radiculopathy and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of clinical, diagnostic and treatment algorithms for patients with hip and lumbar syndrome.

ADVANTAGES AND FEATURES OF ARTHROSCOPIC REINSERTION OF THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE JOINT WITH INTERNAL SPLINTING (internal brace technology)

Background. Despite the annual increase in the number of patients with knee injuries, there is no gen-erally accepted algorithm for treating patients with anterior cruciate ligament injury (ACL). Conservative treatment is ineffective, as in 75-87% gives chronic anterior medial instability, increases the risk of post-traumatic arthritis by 51,2%. There is a considerable interest in arthroscopic primary recovery of ACL. The aim of the study is to evaluate the results of treatment of patients with ACL rapture and to develop a differentiated approach in its treatment. Materials and methods. The results of treatment of patients with ACl rupture who underwent ligament reinsertion (n = 40) and ACL reconstruction (n = 50) were analyzed. The assessment was performed on the scale of VAS for 2 days, VAS and IKDC 2-6-12 weeks after surgery Results. On the second day after the ligament reinsertion, patients had less pain compared to their post-reconstruction sensations: VAS 4,1 versus 5,3. In the group of patients after reinsertion of ACL in the period of 2-6 weeks there were lower rates of pain, namely 2,25 compared with 3,4 in the group of ACL reconstruction. At 2 weeks after reinsertion, patients reported moderate pain and an activity level of 66,4 ± 3,5 compared with the 61,3 ± 2,6 ligament reconstruction group on the IKDC scale. At 6 weeks, the positive dynamics persists, 80,2 ± 2,8 and 76,9 ± 3,1 IKDC, respectively. In 12 weeks, patients in both groups recover almost completely and return to daily activity, 93,9 ± 3,6 and 91,7 ± 2,4 on the IKDC scale, respectively. Conclusions. Primary recovery for proximal ACL ruptures shows good results and may be an alternative to ACL reconstruction. Success is based on the location of the ligament rupture and the tissues quality. The possibility of the initial ACL recovery is solved during surgery. If there is any doubt about the suitability of tissues for recovery, it is recommended to perform a standard reconstruction of ACL.

REINSERTION OF THE DISTAL TENDON OF A BICEPS USING ENDOBUTTON FROM A SINGLE INCISION TECHNIQUE

Summary. Surgical treatment of biceps distal tendon ruptures shows better functional results, compared to a conservative treatment. Recently, the one-incision surgical technique is becoming more and more popular. Task of the study: representation of a technique to recover a distal biceps tendon with a single incision and fixation with an Endobutton. Materials and methods: the single-incision technique for a distal biceps tendon recovery comprises of several steps: an incision place and layer-wise access, preparation of the distal biceps tendon, preparation of the radial tuberosity, fixation of the tendon. Results. The knowledge of anatomy and the correct sequence of steps in the single-incision technique with the fixation of a tendon with Endobutton (by ChM) makes the recovery of distal biceps tendon efficient, reliable, and, what is more important, safe.

POLARIZATION TOMOGRAPHY METHODS TO DIFFERENTIATE ASEPTIC AND SEPTIC LOOSENING AFTER TOTAL HIP REPLACEMENT

This article contains: • Structural-logical scheme and analytical description of the differential diagnosis for aseptic and septic loosening after total hip replacement using the methods of differential Mueller-matrix mapping of circular birefringence (CB) distributions of polycrystalline synovial fluid (SF) films. • Statistical analysis of the distributions of CB in polycrystalline SF films obtained from patients in the control group and groups with different hip joint pathology. • Results of establishing the strength of the differential Mueller-matrix mapping method of the distributions of CB polycrystalline films of SF by means of information analysis based on sensitivity determination, specificity and accuracy of the polarization tomography technique. • Clinical example of using polarization tomography methods to differentiate aseptic and septic cup loosening after total hip replacement

ANALYSIS OF THE CAUSES OF MECHANICAL COMPLICATIONS AFTER OSTEOSYNTHESIS OF THE LIMBS

Summary. The complications, reported most frequently by physicians are: additions of an infection, impaired fracture union processes, the occurrence of persistent joint contractures, especially after intra-articular fractures. Mechanical-related complications associated with bone-fixing devices are of particular importance. The information mechanical complications in the literature is rather controversial. Particularly debatable is the identification of any specific backgrounds of these complications. Virtually no attention is paid to the behavioral or social aspects of the issue, and the quality of the rehabilitation regime. Objective. Analysis of the background of the complications after surgical treatment, associated with mechanical factors, and identification of the means able to prevent them. Material and methods. The results of treatment of 36 patients operated on for fractures of their extremities, who had complications related to the inadequate mechanical fixation of their broken bones. The onset of complications ranged from 5 days to 1 year from the date of surgery. All patients were divided into 2 groups: Group I (iatrogenic) - 10 patients with iatrogenic complications; Group II (patient-dependent) - 26 patients with clearly identified patient-dependent disorders. Results. There were 15 fractures of a retainer (or its elements) and 21 cases of migration or deformation of structures. The most problematic segment was the proximal thigh, which, in our opinion, has a clear age dependence. Analyzing the errors of surgical treatment (group I), we have assumed that they could be prevented by the timely correction of postoperative complications. The prescribed treatment regimen was violated in 72,2% of cases (group II). 13 patients (50%) reported a repeated trauma in the early post-operative period. Conclusions. Prevention of mechanically-induced complications should be based on the adherence to surgical protocols, dynamic observation of the patients in the post-operation period through tight relations with the outpatient unit, considering both somatic and psychological criteria, and timely correction of the treatment regimen.