Secondary care organization

features of arrangement of medical care for victims of road traffic accidents in regions of Russia with low population density

Baranov A.V., Kubasov R.V., Lukashov A.G.

Baranov A.V., Kubasov R.V., Lukashov A.G.

Northern State Medical University, Arkhangelsk, Russia

Cherepovets State University, Cherepovets, Russia

Objective − to review the data of Russian and foreign literature on the organization of providing medical care to victims in road traffic accidents in the regions of Russia with low population density in order to identify features and determine ways to improve it.

Materials and methods. The analysis of the results of Russian and foreign scientific studies and regulatory legal acts on the problems of providing first aid to victims of road traffic accidents was carried out. A literature search was conducted in the specialized scientific search systems eLibrary, PubMed, Scopus, by keywords: road traffic trauma, road traffic accident, regions with low population density, medical care, prehospital period, hospital period. For the analysis, scientific articles published between 1980 and 2020 were selected. Resources with outdated or inaccurate information were excluded, some scientific research works were found using links to articles. The state of the problem of providing first aid to victims with road traffic trauma is mainly reflected in scientific publications over the past ten years.

Results. The main climatic-geographical and medical-social characteristics of the studied regions and areas of Russia with the low population density were noted, which predetermined the occurrence of road traffic accidents with medical consequences and worsen the possibility for timely and qualified medical care to victims at all stages of medical evacuation.

Conclusion. The ways to improve the providing of medical care for injured patients in road traffic accidents in Russian regions with low population density were proposed. The need for sufficient transport pool in the region to carry out the sanitary evacuation of victims was indentified, especially its aeromedical component. The need for the adoption and implementation by the government of significant socio-economic measures to recruit and solidify medical personnel in these territories was revealed, as well as the implementation of systemic medical register of sanitary consequences of road traffic injuries into practice in these areas of the Russian Federation.

Key words: road traffic accidents; road traffic injuries; polytrauma; regions of Russia with low population density; the Arctic.

Information about authors:

Baranov A.V., candidate of medical science, traumatologist-orthopedist, researcher at Northern State Medical University, Arkhangelsk, Russia; senior researcher at Cherepovetsk State University, Cherepovets, Russia.

Kubasov R.B., candidate of biological science, docent at department of mobilization training and disaster medicine, Northern State Medical University, Arkhangelsk, Russia.

Lukashov A.G., candidate of sociologic science, docent at department of public health, healthcare and social work, Northern State Medical University, Arkhangelsk, Russia.

Address for correspondence:

Baranov A.V., Gogolya St., 38-63, Cherepovets, Russia, 163612

Tel:+7 (960) 000-52-27

E-mail: Baranov.av1985@mail.ru  

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Clinical aspects of surgery

STANDARDIZATION OF TREATMENT AND DIAGNOSTIC

APPROACH FOR COMBINED BLUNT BOWEL INJURY

Maskin S.S., Aleksandrov V.V., Matyukhin V.V., Derbentseva T.V.

Maskin S.S., Aleksandrov V.V., Matyukhin V.V., Derbentseva T.V.

Volgograd State Medical University, Volgograd, Russia

Objective − standardization of medical and diagnostic equipment approaches for combined blunt bowel injury to improve treatment results.

Materials and methods. The analysis of literary sources of Russian and foreign authors on this issue.

Results. A clear therapeutic and diagnostic algorithm was developed for combined blunt intestinal injury based on the severity of patient's condition, and a detailed description of damage control surgical treatment was given founded on the principles of evidence-based medicine.

Conclusion. Standardization of the treatment and diagnostic approach for a combined blunt intestinal injury can improve the results of diagnosis and treatment of patients.

Key words: blunt abdominal trauma; damage control; severe combined injury; small intestinal injury; colon injury; delayed anastomosis.

Information about authors:

Maskin S.S., MD, PhD, professor, head of the department of hospital surgery, Volgograd State Medical University, Volgograd, Russia.

Aleksandrov V.V., candidate of medical science, associate professor at the department of hospital surgery, Volgograd State Medical University, Volgograd, Russia.

Matykhin V.V., candidate of medical science, associate professor at the department of hospital surgery, Volgograd State Medical University, Volgograd, Russia.

Derbentseva T.V., candidate of medical science, associate professor at the department of hospital surgery, Volgograd State Medical University, Volgograd, Russia.

Address for correspondence:

Aleksandrov V.V., Pavshikh Bortsov Sq., 1, Volgograd, Russia, 400131

Tel: +7 (917) 830-49-89

E-mail: 79178304989@yandex.ru

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Clinical aspects of traumatology and orthopedics

CLINICAL APPLICATION OF A NOMOGRAM TO ASSESS THE RISK OF COMPLICATIONS IN PATIENTS WITH A PROXIMAL FEMORAL FRACTURE

Yakubdzhanov R.R., Karimov, M.Yu., Akhtyamov I.F., Madrakhimov S. B.

Yakubdzhanov R.R., Karimov, M.Yu., Akhtyamov I.F., Madrakhimov S. B.

Tashkent Medical Academy, Tashkent, Uzbekistan

Kazan State Medical University, Kazan, Russia

Objective − to evaluate the clinical results of using a nomogram to predict the risk of complications in patients with a proximal femoral fracture.

Material and methods. This study analyzed 65 cases of proximal femoral fractures in patients who underwent surgical treatment at the multidisciplinary clinic of the Tashkent Medical Academy from January 2017 to December 2019, which comprised the main group of patients. The control group included 102 patients with a proximal femoral fracture who were treated in our clinic from January 2014 to December 2016. Data were taken from the medical archive and analyzed retrospectively.

The distribution of patients into low-risk (< 10 %), medium-risk (10-30 %), and high-risk (> 30 %) groups was based on a nomogram for predicting the risk of complications. The Harris Hip score for was used to evaluate functional results. Statistical analysis was performed using Microsoft Excel 2013 (Redmond, WA, USA) and SPSS Statistics software (version 22, IBM, Armonk, NY, USA). Quantitative data are presented as arithmetic averages M and the average value ± SD over the amplitude of the variation series in the form of Me (LQ-UQ), where Me is the median, (LQ – UQ) − the interquartile range (LQ - 25%, UQ – 75% quartile). The Student's t-test was used to assess the confidence level of differences between groups. The significance of the difference in observation frequencies was estimated using χ2 (chi-square). The critical significance level (α) was assumed 0.05.

Results. According to the type of fractures in the main and control groups, intra-articular fractures prevailed: 70.7 % and 67.6 %, respectively. Extra-articular fractures in the main and control groups amounted to 29.2 % and 32.3 % respectively. While patients of the main group were admitted to the hospital, the risk groups were distributed as follows: the low-risk group (< 10 %) – 7 patients (10.82 %), the moderate-risk group (10-30 %) – 41 patients (63.07 %), the high-risk group (> 30 %) − 17 patients (26.1 %).

After optimizing the somatic status, when re-evaluating the risk of possible postoperative complications, the patients of the main group were distributed as follows: the low-risk group (< 10 %) – 10 patients (15.4 %), the moderate-risk group (10-30 %) − 44 patients (67.7 %), the high-risk group (> 30 %) − 11 patients (16.9 %).

In our study, the number of complications decreased by 1.91 times, and excellent and good functional results improved by 1.29 and 1.43 times, respectively. Also, the total length of hospital stay in the main group of patients increased by 1.17 times.

Conclusion. The results of our study suggest the effectiveness of using a nomogram for predictive assessment of the risk of possible complications in patients with fractures of the proximal femur.

Key words: hip fracture; nomogram; comorbidity; assessment of clinical and functional results, complications.

Information about authors:

Yakubdzhanov R.R., traumatologist-orthopedist, Tashkent Medical Academy, Tashkent, Uzbekistan.

Karimov M.Yu., MD, PhD, professor, head of traumatology, orthopedics and military field surgery department, Tashkent Medical Academy, Tashkent, Uzbekistan.

Akhtyamov I.F., MD, PhD, professor, head of traumatology, orthopedics and surgery of extreme conditions department, Kazan State Medical University, Kazan, Russia.

Madrakhimov S.B., assistant of traumatology, orthopedics and military field surgery department, Tashkent Medical Academy, Tashkent, Uzbekistan.

Address for correspondence:

Karimov M.Yu., Shaykhantakhur district, Gulabod, 15-24, Tashkent, Uzbekistan, 100020

Tel: + (998) 97 767 88 85

E-mail: m.karimov@mail.ru

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8.    Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. 2005; 20(3): 494–500.

9.    Masuda T, Miura N, Ishii S, Hibino Y, Beppu M. New preoperative evaluation system of the physical findings of aged patients with femoral neck fracture. J Orthop Sci. 2004; 9(5): 434–439.

10. Hirose J, Mizuta H, Ide J, Nakamura E, Takada K. E-PASS for predicting postoperative risk with hip fracture: A multicenter study. Clin Orthop Relat Res. 2008; 466(11): 2833–2841.

11. Doyle DJ, Goyal A, Bansal P, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). Stat Pearls Publishing. 2020.

12. Milyukov AYu, Ustyantsev DD, Gilev YaKh, Mazeev DV. Predictive significance of comorbid status in development of complications in surgical management of patients with injuries to proximal femoral bone. Polytrauma. 2017; 2: 17-26.   Russian

13. Agadzhanyan VV, Milyukov AYu, Ustyantsev DD, Gilev YaKh. A predictive model of potential risk of complications in patients with fractures of proximal femoral bone. Polytrauma. 2018; 3: 6-19.     Russian

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Long-term outcomes of surgical management of osteochondritis dissecans with mosaic autochondroplasty

Bogatov V.B., Sadykov R. Sh.

Bogatov V.B., Sadykov R. Sh.

Sechenov First Moscow State Medical University, Moscow, Russia,

V.I. Razumovsky Saratov State Medical University, Saratov, Russia

Osteochondritis dissecans is a rather rear knee joint disease. It generally requires for surgical management. To date, one of the most common methods for the disease treatment is mosaic autochondroplasty.

Objective – to study long-term outcomes of mosaic plasty for osteochondritis dissecans.

Material and methods. We examined a group of 17 patients aged 17 to 56 years suffering from osteochondritis dissecans of degree 3-4 who underwent autochondroplasty by means of arthrotomy. The follow-up time was 1 to 3.5 years.

Results. Only 50 per cent of the patients reported on good outcomes, the rest had to undergo reoperations (total knee replacements) within 5 years due to progressing osteochondritis dissecans.

Conclusion. The results suggest autogenous osteochondral mosaic plasty to be a morbid traumatic treatment method that may be used for adolescents.

Key words: knee joint; osteochondritis dissecans; autogenous osteochondral mosaic plasty.

Information about authors:

Bogatov V.B., MD, PhD, professor at department of traumatology, orthopedics and emergency surgery, Sechenov First Moscow State Medical University, Moscow, Russia.

Sadykov R.Sh., trauma orthopedist, diagnostic center of Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University, Saratov, Russia.

Address for correspondence:

Bogatov V.B., Mnevniki St., 23-8, Moscow, Russia, 123423

Tel: +7 (916) 445-90-50

E-mail: vicbogatov@rambler.ru

REFERENCES:

1.        Hunziker EB, Lippuner K, Keel MJ, Shintani N. An educational review of cartilage repair: precepts & practice-myths & misconceptions-progress & prospects. Osteoarthritis Cartilage. 2015; 23(3): 334-350. DOI: 10.1016/j.joca.2014.12.011

2.        Bogatov VB, Zeynalov PV, Lyubun GP, Kozadaev MN, Matveeva OV, Salkovskiy YuE, et al. Rebuilding of articular cartilage in replacement of its defect with biocomposite material. Morphology. 2015; 147(1): 63-69. Russian

3.        Hancock KJ, Westermann RR, Shamrock AG, Duchman KR, Wolf BR, Amendola A. Trends in Knee Articular Cartilage Treatments: An American Board of Orthopaedic Surgery Database Study. J Knee Surg. 2019; 32(1): 85-90. DOI: 10.1055/s-0038-1635110

4.        Gerasimov SA, Tenilin NA, Korytkin AA, Zykin AA. Surgical treatment of limited injuries to articular surface: modern condition of the problem. Polytrauma. 2016; 1: 57-69. Russian

5.        Ayrapetov GA, Vorotnikov AA, Konovalov EA. Methods of surgical treatment of local defects of hyaline cartilage of big joints (literature review). Genius of Orthopedics. 2017; 23(4): 485-491. Russian

6.        Montgomery SR, Foster BD, Ngo SS, Terrell RD, Wang JC, Petrigliano FA, et al. Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc. 2014; 22(9): 2070-2075. DOI: 10.1007/s00167-013-2614-9

7.        Gowd AK, Cvetanovich GL, Liu JN, Christian DR, Cabarcas BC, Redondo ML, et al. Management of Chondral Lesions of the Knee: Analysis of Trends and Short-Term Complications Using the National Surgical Quality Improvement Program Database. Arthroscopy. 2019; 35(1): 138-146. DOI: 10.1016/j.arthro.2018.07.049

8.        Hangody L, Kish G, Kárpáti Z, Szerb I, Udvarhelyi I. Arthroscopic autogenousosteochondralmosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc. 1997; 5(4): 262-7. DOI: 10.1007/s001670050061.

9.        McCormick F, Harris JD, Abrams GD, Frank R, Gupta A, Hussey K, et al. Trends in the surgical treatment of articular cartilage lesions in the United States: an analysis of a Large Private-Payer Database over a period of 8 years. Arthroscopy. 2014; 30(2): 222-226. DOI: 10.1016/j.arthro.2013.11.001

10.    Richter DL, Tanksley JA, Miller MD. Osteochondral autograft transplantation: a review of the surgical technique and outcomes. Sports Med Arthrosc Rev. 2016; 24(2): 74-8.  DOI: 10.1097/JSA.0000000000000099

11.    Richter DL, SchenckRCJr, Wascher DC, Treme G. Knee articular cartilage repair and restoration techniques: a review of the literature. Sports Health. 2016; 8(2): 153-60. DOI: 10.1177/1941738115611350

12.    Epstein DM, Choung E, Ashraf I, Greenspan D,  Klein D, McHugh M, et al. Comparison of mini-open versus arthroscopic harvesting of osteochondral autografts in the knee: a cadaveric study. Arthroscopy. 2012; 28(12): 1867-1872. DOI: 10.1016/j.arthro.2012.06.014

13.    Frank RM, McCormick F, Rosas S, Amoo-Achampong K, Erickson B, Bach BRJr, et al. Reoperation rates after cartilage restoration procedures in the knee: analysis of a large US Commercial Database. Am J Orthop. 2018; 47(6). DOI: 10.12788/ajo.2018.0040

14.    Farr J, Tabet S, Margerrison E, Cole BJ. Clinical, radiographic, and histological outcomes after cartilage repair with particulated juvenile articular cartilage: a 2-year prospective study. Am J Sports Med. 2014; 42(6): 1417-1425. DOI: 10.1177/0363546514528671

Clinical aspects of neuro-surgery

TREATMENT OF NEUROGENIC LOWER URINARY TRACT DYSFUNCTION IN REHABILITATION OF DISABLED PERSONS WITH TRAUMATIC SPINAL CORD INJURY

Palatkin P.P., Filatov E.V., Boshchenko V.S., Baranov A.I.

Palatkin P.P., Filatov E.V., Boshchenko V.S., Baranov A.I.

Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia

Siberian State Medical University, Tomsk, Russia

Novokuznetsk State Extension Course Institute for Medical Practitioners – Affiliated Branch of Russian Medical Academy of Continuing Vocational Education, Novokuznetsk, Russia

Pelvic organ dysfunction significantly reduces quality of life of patients with traumatic spinal cord injury and requires treatment.

Objective − to compare the results of different methods of treatment of neurogenic lower urinary tract dysfunction used in rehabilitation of the disabled persons in the late period of traumatic spinal cord injury.

Materials and methods. Retrospective analysis was performed for 201 case records of patients in the late period of traumatic spinal cord injury admitted to the department of neurosurgery at Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons. The vast majority of patients (92.1 %) had disability group I. The mean time after injury was 6.9 ± 0.5 years. Patients were divided into 4 groups based on the increasing severity of micturition disorder: group 1 – with normoactive detrusor (6.9 %), group 2 – with hypoactive detrusor (32.3 %), group 3 – with hyperactive detrusor (40.8 %), group 4 – with epicystostomy and indwelling urethral catheter (19.9 %). The effectiveness of treatment methods such as tibial stimulation, electrical stimulation of the bladder, endosacral blocks with proserin, pudendal blocks with local anesthetics, acupuncture, and alteration of bladder volume, that were used in the clinic of Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons to treat neurogenic lower urinary tract dysfunction was assessed.

Results. With an increasing severity of neurological disorders among patients with traumatic spinal cord injury, the risk of secondary urological complications increases as well. Positive results of the treatment of neurogenic lower urinary tract dysfunction were found in the cases of tibial stimulation, electrical stimulation of the bladder, and endosacral blocks.

Conclusions. The proper choice of treatment methods of neurogenic lower urinary tract dysfunction when carrying out the rehabilitation activities allows to improve quality of life in patients with traumatic spinal cord injury and to reduce the risk of urological complications.

The acute urological pathology and patient’s concern regarding the possible changes to their accustomed lifestyle limit the treatment.

Key words: traumatic spinal cord injury; neurogenic lower urinary tract dysfunction; treatment methods; rehabilitation.

Information about authors:

Palatkin P.P., urologist, neurosurgery unit, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Filatov E.V., candidate of medical science, neurosurgeon, neurosurgery unit, neurosurgery unit, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Boshchenko V.S., MD, PhD, professor at department of general and pediatric urology-andrology, Siberian State Medical University, Tomsk, Russia.

Baranov A.I., MD, PhD, professor, chief of department of surgery, urology and endoscopy, Novokuznetsk State Extension Course Institute for Medical Practitioners – Affiliated Branch of Russian Medical Academy of Continuing Vocational Education, Novokuznetsk, Russia.

Address for correspondence:

Palatkin P.P., Malaya St., 7, Novokuznetsk, Russia, 654055

Tel: +7 (3843) 37-58-20

E-mail: root@reabil-nk.ru

REFERENCES:

1. Morozov IN, Mlyavykh SG. Epidemiology of spine and spinal cord injuries (review). Medical Almanac. 2011; 4(17): 157-159. Russian

2. Andreeva TM, Ogryzko EV. Trauma rate, orthopedic morbidity and condition of traumatological and orthopedic care for Russian population in 2016. Edited by S.P. Mironov. Moscow: Teler, 2017. 131 p. Russian

3. Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ. Trends in fracture incidence: a population-based study over 20 years. JBoneMinerRes. 2014; 29 (3): 581-589.

4. Norkin IA, Baratov AV, Fedonnikov AS, Akimova TN, Semenova SV, Palanchuk BA, et al. Significance of analysis of medicosocial parameters of spine injuries in organization of specialized medical aid. Spine Surgery. 2014; 3: 95-100. Russian

5. Belova AN, Polyakova AG. Disorder of urinary bladder function in spine and spinal cord injury, and correction. Neurorehabilitation: manual for doctors. Edited by A.N. Belova. Moscow: Antidor, 2002; 387-392. Russian

6. Tishchenko GE, Borodulina IV, Salyukov RV, Rachin AP. Neurogenic disorders of urination in spine and spinal cord injury: an opinion by neurologist and urologist. Russian Medical Journal. 2017; 25(9): 653-656. Russian

7.Karantanis E, Fynes M, Moore KH, Stanton SL. Comparison of the iciq-sf and 24-hour pad test with other measures for evaluating the severity of urodynamic stress incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction. 2004; 15(2): 111-116.

8. Palatkin PP, Mkrtchyan DM, Filatov EV. Use of technical tools of rehabilitation in treatment of neurogenic dysfunction of urinary bladder // Actual issues of interdepartmental interaction in realization of individual program of rehabilitation and abilitation of a disabled person: materials of scientific and practical conference as a part of federal program "Available medium", Saint Petersburg, August, 27-28, 2015; 156-158. Russian

9. Schneider MP, Gross T, Bachmann LM, Blok BF, Castro-Diaz D, Popolo GD, et al. Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. EurUrol. 2015; 68(5): 859-867.

10. Yokoyama T, Kumon H, Nagai A. Correlation of urinary nerve growth factor level with pathogenesis of overactive bladder. Neurourol. Urodin. 2008; 27: 417-420.

11. Morozov IN, Polyakova AG, Kareva OV. Complex rehabilitation of patients with consequences of spine and spinal cord injury. Herald of Ivanovo Medical Academy. 2011; 16(3): 40-43. Russian

12. Rozhnevskaya EP, Rudakov BE, Shapovalenko TV, Lyadov KV. The use of electric stimulation in treatment of patients with neurogenic dysfunction of urinary bladder. Physiotherapy, Balneology and Rehabilitation. 2010; 4: 26-28. Russian

13. Allazova SA, Toshaeva KhS, Allazova KhS. Aspects of urological aid for patients with spine and spinal cord pathology. Herald of Urgent Medicine. 2017; 11(3): 47-50. Russian

14. Lutsik AA, Sadovoy MA, Potekhin LD, Kelmakov VP. Rehabilitation of spinal patients: manual. Novokuznetsk, 2009; 235 p. Russian

15. Konovalova NG, Filatov EV, Levius SA, Konovalova AV, Leontyev MA. Gender differences in "relation to the body" in patients in late period of traumatic disease of spinal cord. Herald of All-Russian Society of Specialists in Medicosocial Expertise, Rehabilitation and Rehabilitation Industry. 2010; 3: 45-49.   Russian

16. Frolenko SYu, Leontyev MA, Konovalova NG, Stepanova EV. Influence of anxiety-depressive disorders on rehabilitation process in patients with traumatic disease of spinal cord. Modern technologies of prevention, diagnosis and treatment of main human disease: materials of all-russian conference, Leninsk-Kuznetsky, September 10-11, 2009. Federal Scientific Clinical Center of Miners' Health Protection. Novosibirsk: Izdatel, 2009; 98-99. Russian

17. Palatkin PP, Filatov EV. Urologic pathology in patients with traumatic disease of spinal cord. Materials of 3rd scientific and practical conference of urologists of North-Western District of RF, Saint Petersburg, April 20-21, 2017. Urological News. 2017; Vol. 7; 84-85. Russian

MULTIPLE FRACTURES OF VERTEBRAL BODIES IN CHILDREN AND ADOLESCENTS

Skryabin E.G., Smirnykh A.G., Bukseev A.N., Akselrov M.A.,

Naumov S.V., Sidorenko A.V., Chuprov A.Yu.

Skryabin E.G., Smirnykh A.G., Bukseev A.N., Akselrov M.A.,

Naumov S.V., Sidorenko A.V., Chuprov A.Yu.

Tyumen State Medical University,

Regional Clinical Hospital No. 2,

Tyumen, Russia

Various aspects of vertebral fractures in children and adolescents remain relevant.

Objective − to study the prevalence, nature and type of multiple fractures of the vertebral bodies in children and adolescents for the choice of management strategy.

Material and methods. Of 1,000 children and adolescents, aged 1.5 to 17 years, who were diagnosed with vertebral fractures, the injuries were multiple in 744 (74.4 %) clinical cases. The average age of the children in the studied cohort was 9 years and 2 months. To make a clinical diagnosis, clinical and radiation research methods traditional for emergency traumatology were used.

Results. Multiple vertebral fractures were most often identified in children at the age of 5-9 years (40.32 % of cases). The main mechanism of injury was a fall from the height of their own growth − 36.96 % of cases. Most often, children received fractures of two vertebrae − 37.23 % of cases. In 41.71 % of cases, these vertebrae were adjacent. In total, more than 40 different combinations of the location of injured vertebrae throughout the spinal column were recorded. Fractures localized in the thoracic region prevailed in the studied cohort − 71.79 % of cases. A total of 744 children received 2,547 vertebral fractures. Most often, compression of the bodies of ThV, ThVI, ThIV vertebrae was recorded − 11.66 %, 10.6 % and 10.09 % of observations, respectively. The structure of the severity of injuries was dominated by fractures of the first degree of compression − 46.25 % of cases. In 0.56 % of the injured, the injuries were presented by polytrauma. Magnetic resonance imaging allowed not only to diagnose the compressed vertebrae, to establish their number and location, but also to conduct differential diagnostics with such a condition as vertebral contusion. In 97.98 % of the victims, conservative methods were used in the treatment. Treatment results classified as good were found in 89.24 % of cases, satisfactory − in 10.76 % of cases.

Conclusion. Among children and adolescents who received unaligned compression fractures of the vertebral bodies, the proportion of patients with multiple injuries accounted for 74.4 % of clinical observations. Most often, children get fractures of two (37.23 %) vertebrae, with adjacent vertebrae in 41.71 % of cases. In total, 45 different combinations of localization of injured vertebrae were found in the studied cohort of patients. The severity of fractures received by children corresponds to types A (99.52 % of victims) and B (0.48 % of patients) in accordance with the AO/ASIF classification. In accordance with the severity of the injuries received, the majority of patients (99.52 % of clinical observations) received conservative treatment. Surgical methods were used in 2.02 % of cases.

Key words: children and adolescents; multiple vertebral fractures; diagnosis; treatment.

Information about authors:

Skryabin E.G., MD, PhD, professor at department of traumatology and orthopedics, Tyumen State Medical University, Tyumen, Russia.

Smirnykh A.G., resident, traumatology and orthopedics unit, pediatric hospital, Regional Clinical Hospital No. 2, Tyumen, Russia.

Bukseev A.N., head of traumatology and orthopedics unit, pediatric hospital, Regional Clinical Hospital No. 2, Tyumen, Russia.

Akselrov M.A., MD, PhD, head of pediatric surgery department, Tyumen State Medical University, head of pediatric surgery unit No.1, Regional Clinical Hospital No. 2, Tyumen, Russia.

Naumov S.V., resident, traumatology and orthopedics unit, pediatric hospital, Regional Clinical Hospital No. 2, Tyumen, Russia.

Sidorenko A.V., resident, traumatology and orthopedics unit, pediatric hospital, Regional Clinical Hospital No. 2, Tyumen, Russia.

Сhuprov A.Yu., resident, traumatology and orthopedics unit, pediatric hospital, Regional Clinical Hospital No. 2, Tyumen, Russia.

Address for correspondence:

Skryabin E.G., Kharkovskaya St., 59, building 3, app. 52, Tyumen, Russia, 625048

Tel: +7 (919) 958-09-78

E-mail: skryabineg@mail.ru

REFERENCES:

1.        Golovkin SI, Utkin VA, Krasavin GN, Zhuravleva IA, Vashchenkova TA. About necessity for optimization of schemes and terms of treatment of uncomplicated vertebral fractures in children. Mother and Child in Kuzbass. 2014; 56(1): 46-51.   Russian

2.        Khusainov NO, Vissarionov SV. Compression fractures of the spine in children: is it time to change something? Spine Surgery. 2019; 16(4): 6-12. Russian

3.        Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994; 3(4): 184-201. doi: 10.1007/bf02221591.

4.        Andrushko NS, Raspopina AV. Compression fractures of vertebral bodies in children. Moscow: Medicine, 1977. 148 p. Russian

5.        Baker SP, O′Neill В, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. Trauma. 1974; 14(3): 187-196. doi: 10.1097/00005373-197403000-00001.

6.        Merkulov VN, Bychkova VS, Mininkov DS. The modern approach to diagnosis of compression fractures of vertebral bodies in children and adolescents. Pediatric Surgery. 2012; 4: 49-51. Russian

7.        Yokoyama K, Endo K, Takata Y, Tezuka F, Manabe H, Yamashita K, et al. Bone Bruise of the Thoracic Spine Caused by Mild Physical Activity in Children. Case Rep. Orthop. 2017; 8451797. doi: 10.1155/2017/8451797.

8.        Na D, Hong SJ, Yoon MA, Ahn KS, Kang CH, Kim BH, et al. Spinal Bone Bruise: Can Computed Tomography (CT) Enable Accurate Diagnosis? Acad Radiol. 2016; 23(11): 1376-1383. doi: 10.1016/j.acra.2016.06.006.

9.        Rush JK, Kelly DM, Astur N, Creek A, Dawkins R, Younas S, et al. Associated injuries in children and adolescents with spinal trauma. J Pediatr Orthop. 2013; 33(4): 393-397. doi: 10.1097/BPO.0b013e318279c7cb.

10.    Saul D, Dresing K. Epidemiology of vertebral fractures in pediatric and adolescent patient. Pediatr. Rep. 2018; 10(1): 7232. doi: 10.4081/pr.2018.7332.

11.    Kanna RM, Gaike CV, Mahesh A, Shetty AP, Rajasekaran S. Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI. Eur Spine J. 2016; 25(4): 1163-1169. doi: 10.1007/s00586-015-4209-2.

12.    Franklin DB, Hardway AT, Sheffer BW, Spence DD, Kelly DM, Muhlbauer MS, et al. The Role of Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Pediatric Thoracolumbar Compression Fractures. J Pediatr Orthop. 2019; 39(7): 520-523. doi: 10.1097/BPO.0000000000001316.

13.    Baindurashvili AG, Zaletina AV, Vissarionov SV, Solovyeva KS. Screening of children with compression vertebral fractures (by the example of Saint Petersburg). Genius of Orthopedics. 2019; 25(4): 535-540. Russian

14.    Belenkiy VE, Savelyev LA, Sanakoeva II. About mechanism of compression vertebral fracture after falling onto the back. Orthopedics, Traumatology and Prosthetics. 1984; 8: 29-31. Russian

15.    Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 2003; 34(6): 426-433. doi: 10.1016/s0020-1383(02)00368-6.

CLINICAL RESULTS OF RECONSTRUCTIVE NEUROSURGICAL INTERVENTIONS FOR THE SKULL USING COMPUTER MODELING AND THREE-DIMENSIONAL PRINTING

Koporushko N. A., Mishinov S.V., Stupak V.V.

Koporushko N. A., Mishinov S.V., Stupak V.V.

Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia

Traumatic brain injury is one of the leading problems of neurosurgery. Every year, patients with various pathologies of the central nervous system undergo surgical interventions for the skull with the formation of large and giant defects that need to be closed due to pronounced clinical syndromes that invalidate patients. The closure of defects leads, according to a few literature data, to an improvement in the condition of patients and a partial regression of the clinical picture of the disease. Our work is based on the study of the dynamics of clinical syndromes of the disease, brain tissue changes detected on MRI, CT images and postoperative complications of this group of patients, in accordance with the classification developed at Burdenko Neurosurgery Research Center.

Objective − to study the clinical results of reconstructive interventions in patients with skull bone defects using individual titanium implants made using three-dimensional printing and standard titanium plates.

Material and methods. Clinical material – 161 patients with bone defects of the skull, operated in Tsivyan Research Institute of Traumatology and Orthopedics in 2009-2019. The analysis was conducted on the average age, sex, time of observation, location and size of the bone defect, leading to clinical syndromes, tissue changes of intracranial structures. Reliability was determined by statistical methods (the Mann-Whitney test, the exact Fisher method). Statistical processing of the obtained material was carried out using Statistica V. 10.

Results. All patients were divided into two groups: the study group (80 people with individual titanium implants installed) and the comparison group (81 patients using standard titanium plates). Within 2 years from the date of the operation, it was found that the type of implant used did not significantly affect the reduction of the total number of leading clinical syndromes, but the best clinical results of reconstructive surgery on the skull in the form of a significant predominance of a smaller number of them in the picture of the disease were obtained using an individual implant. The larger the size of the bone defect in the skull, the higher the frequency of syndromes and the degree of tissue damage to the brain. In the postoperative period, 11.2 % of the operated patients had superficial soft tissue complications. Progression of local suppuration in patients with individual and standard implants led to their removal in 2.3 % and 3.5 % of cases, respectively. In 6.2 % of cases, cranioplasty of extensive skull defects with standard titanium plates had the same type of error, consisting in incomplete closure of the defect.

Conclusion. The best clinical results of reconstructive surgery of the skull with decreasing number of clinical syndromes in the disease picture in late postsurgical period were obtained with use of the individual implant.

The larger size of a cranial defect, the higher incidence of syndromes of the disease, with higher degree of tissue injuries to the brain identified during CT and MRI.

Key words: clinical results; skull bone defect; treatment result; cranioplasty; implant; three-dimensional printing.

Information about authors:

Koporushko N. A., postgraduate, neurosurgery unit, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Mishinov S.V., candidate of medical sciences, senior researcher,   neurosurgery unit, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Stupak V.V., MD, PhD, professor, chief of research department of neurosurgery, Tsivyan Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.

Address for correspondence:

Koporushko N. A., Frunze St., 17, Novosibirsk, Russian Federation, 630091

Tel: +7-913-765-99-21

E-mail: nickolai92@mail.ru

REFERENCES:

1. Kolias AG, Viaroli E, Rubiano AM, Adams H, Khan T, Gupta D, et al. The current status of decompressive craniectomy in traumatic brain injury. Current trauma reports. 2018; 4(4): 326-332. DOI: https://doi.org/10.1007/s40719-018-0147-x

2. Kelly ML, Shammassian B, Roach MJ, Thomas C, Wagner AK. Craniectomy and craniotomy in traumatic brain injury: a propensity-matched analysis of long-term functional and quality of life outcomes. World neurosurgery. 2018; 118: e974-e981. DOI: https://doi.org/10.1016/j.wneu.2018.07.124

3.Segal DH, Oppenheim JS, Murovic JA. Neurological recovery after cranioplasty. Neurosurgery. 1994; 34(4): 729–731. DOI: 10.1227/00006123-199404000-00024.

4.Honeybul S, Morrison DA, Ho KM, Lind CR, Geelhoed E. A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty. Journal of Neurosurgery. 2017; 126(1): 81–90. DOI: 10.3171/2015.12.jns152004.

5.Wiggins A, Austerberry R, Morrison D, Ho KM, Honeybul S. Cranioplasty with custom-made titanium plates - 14 years experience. Neurosurgery. 2013; 72(2): 248–256. DOI: https://doi.org/10.1227/NEU.0b013e31827b98f3.

6. Konovalov AN, Potapov AA, Likhterman LB, Kornienko VN, Kravchuk AD, Okhlopkov VA, et al. Reconstructive and minimally invasive surgery of consequences of traumatic brain injury. Moscow: Publishing office IP "T.A. Alekseeva". 2012; 320 p. Russian

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12. Moon JW, Hyun DK. Decompressive craniectomy in traumatic brain injury: a review article. Korean journal of neurotrauma. 2017; 13(1): 1-8.

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17.Quah BL, Low HL, Wilson MH, Bimpis A, Nga VD, Lwin S, et al. Is there an optimal time for performing cranioplasties? Results from a prospective multinational study. World Neurosurgery. 2016; 94: 13-17. DOI: https://doi.org/10.1016/j.wneu.2016.06.081

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19.Wolff A, Santiago GF, Belzberg M, Huggins C, Lim M, Weingart J, et al. Adult cranioplasty reconstruction with customized cranial implants: preferred technique, timing, and biomaterials. Journal of Craniofacial Surgery. 2018; 29(4): 887-894.

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21. Sinbukhova EV, Kravchuk AD, Lubnin AYu, Danilov GV, Okhlopkov VA, Stepnova LA. Time course of cognitive functions in patients with skull defects after reconstructive interventions. Archive of Internal Medicine. 2017; 7 2(34): 131-138. Russian

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Functional, instrumental and laboratory diagnostics

experience with use of thromboelastogram for patients with severe combined pelvic

Kazhanov I.V., Afonchikov V.S., Kolchanov E.A., Mikityuk S.I., Shalamov D.V., Zhirnova N.A., Samohvalov I.M.

Kazhanov I.V., Afonchikov V.S., Kolchanov E.A., Mikityuk S.I., Shalamov D.V., Zhirnova N.A., Samohvalov I.M.

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine,

Kirov Military Medical Academy,

Saint Petersburg, Russia

The frequency of pelvic fractures in severe combined injuries reaches 10–42 %. Mortality in such victims can reach 58 %. It’s important to monitor the hemostasis system to identify and correct coagulopathy during the treatment of patients with severe combined pelvic injury (CPI) and acute massive blood loss due to continued intracranial bleeding. Thromboelastography (TEG) allows you to obtain data on all phases of blood coagulation, to assess the quality of the clot and fibrinolysis.

Objective − a comprehensive assessment of the blood coagulation system in patients with severe CPI and pelvic hemorrhage for the correction of transfusion therapy.

Materials and methods. We analyzed the results of treatment of 21 victims with severe CTI and intrapelvic bleeding, delivered to the level 1 trauma center in 2017-2020. There were 18 men (85.7 %) and 3 women (14.3%). 11 people had vertically unstable (type C), 8 – rotationally unstable (type B) pelvic injuries, 2 had complex fracture of the acetabulum, according to the classification of M. Tile and M. E. Muller – AO/ASIF. The severity of the injury was assessed using ISS and VPKh-P (MT) scales. Additionally, we analyzed the pathophysiological signs of acute massive blood loss and coagulogram data (fibrinogen, APTT, INR). The probability of massive hemotransfusion was assessed on the TASH scale.

Results. In order to stop pelvic bleeding, pelvic fractures were fixed with external fixation in 13 observations (including simultaneous stabilizing with Ganz frame in 2 cases and ileosacral screws in 8 cases). In one case, extraperitoneal pelvic tamponade was performed, in two − diagnostic pelvic angiography with embolization. The victims also received emergency operations to eliminate the life-threatening effects of injuries.

The victims were divided into two groups according to the volume of acute blood loss: 20-30 % and more than 30% of the circulating blood volume (CBV). The rate of initiation and amplification phases (R value, minutes) increased from 11.7 ± 3.1 to 13.5 ± 4.7, kinetics of clot formation changed (K value, minutes, α-angle, degrees) from 5.3 ± 2.8 to 4.1 ± 1.0 and from 42.8 ± 8.8 to 43.2 ± 6.0, respectively. The maximal range of clot formation increased (MA value, mm) from 45.8 ± 19.7 to 60.9 ± 14.7. In patients with blood loss > 30 % of CBV , the rate of initiation of phases of initiation and amplification (R value, minutes) increased from 14.6 ± 9.2 to 18.1 ± 10.8. Kinetics of clot formation changed (K values, α-angle, degrees) from 9.1 ± 4.7 to 8.0 ± 7.2 and from 27.3 ± 12.6 to 34.1 ± 13.1, correspondingly. The maximal range of clot formation (MA value, mm) changed from 39.9 ± 10.3 to 55.8 ± 15.6. There were not any statistically significant differences in MA value in TEG platelet-poor plasma samples in patients with deficiency of CBV > 30 % at admission and after 24 hours.

The analysis of treatment results showed no lethal outcomes after life-threatening consequences of injuries in the studied groups in acute period of injury. In two patients, unfavorable course of traumatic disease cause lethal outcome from developed complications (pneumonia and sepsis) in long term period.

Conclusion. According to thromboelastography, patients with severe CPI showed increasing rate of initiation and amplification phases (R value), kinetics of fibrin clot formation (K value, α-angle), value of maximal range of MA, which characterizes mechanical properties of a clot (MA value). It allowed us to estimate the efficiency of replacement hemotransfusion therapy.   

TEG can be used as a method for assessing the adequacy of replacement blood transfusion therapy, which allows correction the qualitative and quantitative composition of blood components.

In patients with CBV deficiency of more than 30 %, blood transfusion replacement therapy should be based not only on whole citrate blood, but also on platelet poor plasma TEG.

Key words: tromboelastography; polytrauma; pelvic ring injury; hemostasis.

Information about authors:

Kazhanov I.V., candidate of medical science, leading researcher at concomitant injury unit, Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; senior resident at clinic of military field surgery, Kirov Military Medical Academy, Saint Petersburg, Russia.

Afonchikov V.S., candidate of medical science, docent, deputy chief physician of anesthesiology and critical care medicine, Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.

Kolchanov E.A., surgeon at surgery block No. 2 (anti-shock), Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.

Mikityuk S.I., candidate of medical science, senior lecturer at educational center, Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; chief of clinic of military field surgery, Kirov Military Medical Academy, Saint Petersburg, Russia.

Shalamov D.V., anesthesiologist-intensivist, anesthesiology and intensive care unit No. 4, Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.

Zhirnova N.A., candidate of biological science, senior researcher at research laboratory of research department (experimental medicine) of research center, Kirov Military Medical Academy, Saint Petersburg, Russia.

Samokhvalov I.M., MD, PhD, professor, leading researcher at concomitant injury unit, Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; chief of clinic of military field surgery, Kirov Military Medical Academy, Saint Petersburg, Russia.

Address for correspondence:

Kazhanov I.V., Budapeshtskaya St., 3, Saint Petersburg, Russia, 192242

Tel: +7 (911) 148-95-86

E-mail: carta400@rambler.ru

REFERENCES:

1.      Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano RD, Blackburn A, et al. Pelvic fracture pattern predicts the need for hemorrhage control intervention - results of an AAST multi-institutional study. J Trauma Acute Care Surg. 2017; 82(6): 1030‐1038. doi:10.1097/TA.0000000000001465

2.      Tesoriero RB, Bruns BR, Narayan M, Dubose J, Guliani SS, Brenner L, et al. Angiographic embolization for hemorrhage following pelvic fracture: is it "time" for a paradigm shift? J Trauma Acute Care Surg. 2017; 82(1): 18‐26. doi:10.1097/TA.0000000000001259

3.      Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM, et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg. 2017; 82(2): 233‐242. doi:10.1097/TA.0000000000001324

4.      Tang J, Shi Z, Hu J, Wu H, Yang C, Le G, et al. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: a network meta-analysis. Am J Emerg Med. 2019; 37(4): 571‐578. doi:10.1016/j.ajem.2018.06.027

5.      Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019; 23(1): 98. doi:10.1186/s13054-019-2347-3

6.      Martini WZ, Cortez DS, Dubick MA, Park MS, Holcomb JB. Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs. J Trauma. 2008; 65(3): 535‐543. doi:10.1097/TA.0b013e31818379a6

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8.      Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care. 2017; 23(6): 503-510. doi:10.1097/MCC.0000000000000466

1. Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006; 60(6): 1228‐1237. doi:10.1097/01.ta.0000220386.84012.bf
2. A way of treatment of metabolic acidosis in severe associated injury: the patent RF; No. 2538655S2. Afonchikov VS, Kyrnyshev AG, Shakh BN, Lapshin VN, Smirnov DB, Teplov V; application from 05.04.2013; published on 10.01.2015 Russian

11. da Luz LT, Nascimento B, Rizoli S. Thrombelastography (TEG®): practical considerations on its clinical use in trauma resuscitation. Scand J Trauma Resusc Emerg Med. 2013; 21: 29. doi:10.1186/1757-7241-21-29

12. Gando S, Hayakawa M. Pathophysiology of Trauma-Induced Coagulopathy and Management of Critical Bleeding Requiring Massive Transfusion. Semin Thromb Hemost. 2016; 42(2): 155‐165. doi:10.1055/s-0035-1564831

13. Jeger V, Zimmermann H, Exadaktylos AK. Can RapidTEG accelerate the search for coagulopathies in the patient with multiple injuries? J Trauma. 2009; 66(4): 1253‐1257. doi:10.1097/TA.0b013e31819d3caf

14. Hagemo JS, Næss PA, Johansson P, Windeløv NA, CohenMJ, Røislien J, et al. Evaluation of TEG(®) and RoTEM(®) inter-changeability in trauma patients. Injury. 2013; 44(5): 600‐605. doi:10.1016/j.injury.2012.11.016

15. Hunt H, Stanworth S, Curry N, Woolley T, Cooper C, Ukoumunne O, et al. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding. Cochrane Database Syst Rev. 2015; 16(2): CD010438. doi:10.1002/14651858.CD010438.pub2

Researches of young scientists

EFFECTIVENESS OF SIMPLE SOLUTIONS IN SURGICAL TREATMENT OF DISLOCATIONS OF ACROMIAL EXTREMITY OF CLAVICLE

Parshikov M.V., Yarygin N.V., Lysov V.G., Gnetetskiy S.F., Chemyanov I.G.,

Govorov M.V., Chemyanov G.I., Uzhakhov I.M.

Parshikov M.V., Lysov V.G., Yarygin N.V., Chemyanov G.I., Govorov M.V., Gnetetskiy S.F., Chemyanov I.G., Uzhakhov I.M.

Department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia,

Trubchevsk Central Regional Hospital, Trubchevsk, Russia

Acromioclavicular joint (ACJ) injuries, and, primarily, clavicle dislocations in it, exceed 10-12 % of various injuries in the shoulder joint area. Their social importance is due to the fact that the vast majority of patients are young, able-bodied people, including those professionally engaged in sports, between the ages of 25 and 45. The percentage of unsatisfactory outcomes of acromial extremity of clavicle dislocation (AEC) treatment ranges from 25 to 35 %. The technology of many interventions requires sophisticated equipment and implants difficult to access in the surgical department settings of central district hospitals.

Objective − to study and analyze the results of operations in patients with dislocations of acromial extremity of clavicle without use of expensive complex fixing devices in the Central Regional Hospital.

Materials and research methods. The study included 106 victims treated for dislocation of acromial extremity of clavicle in Trubchevsk Central Regional Hospital from 1990 to 2019. Their age ranged from 18 to 62 years. There were 104 men and 4 women. At the same time, the largest number of patients was at the most active age from 29 to 38 years. In surgical treatment of victims with dislocations of acromial extremity of clavicle of type II-III according to Tossy classification, improved classic Watkins-Kaplan technique was used. The choice of this surgical technology was related to the reasons important in the conditions of the rural hospital: the minimum volume of necessary material, availability of surgery equipment and low traumatic intervention. After the operation, external fixation of the upper limb was carried out with the use of post-orthosis (bandages with different degree of rigidity), ready for use without additional rework.

Results. The outcomes of surgical interventions in 88 patients were studied from 4 months to 23 years. A Constant Score analysis of treatment effectiveness assessed the results as good and excellent. Unsatisfactory outcomes were absent. There were no infectious complications. Despite the specifics of the working specialties of most of the operated, we would like to emphasize that everyone has returned to the previous labour regime in full.

Conclusion. The traditional Watkins-Kaplan technology, developed long enough, for the operative treatment of dislocations of acromial extremity of clavicle leads to excellent and good anatomical-functional outcomes in many cases, while using simple and not expensive designs for fixation.

Key words: acromial extremity of clavicle; operative treatment.

Information about authors:

Parshikov M.V., MD, PhD, professor at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Lysov V.G., chief of surgery unit, traumatologist-orthopedist of superior expert category, Trubchevsk Central Regional Hospital, Trubchevsk, Bryansk region, Russia.

Yarygin N.V., MD, PhD, professor, corresponding member of RAS, chief of department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Chemyanov G.I., candidate of medical science, assistant at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Govorov M.V., assistant at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Gnetetskiy S.F., MD, PhD, docent at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Chemyanov I.G., candidate of medical science, docent at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Uzhakhov I.M., postgraduate, department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Address for correspondence:

Parshikov M.V., Mikhalkovskaya St., 26, building 1, app. 72, Moscow, Russia, 125008   

Тел.: +7 (903) 207-30-95                                                                                                                                                                 Е-mail: parshikovmikhail@gmail.com        

REFERENCES:

1.   Batpenov ND, Nabiev EN. A way of treatment of patients with fracture-dislocations of acromial end of the clavicle. Scientific Review. Medical Sciences. 2018; 1: 5-9. Russian

2.   Dyachkov KA, Dyachkova GV, Mitina YuL, Larionova TA. MRI-semiotics of dislocation of acromial extremity of clavicle. Genius of Orthopedics. 2019; 25(1): 15-20. Russian

3.   Egiazaryan KA, Lazishvili GD, Ratyev AP, Shukur-Zade ER. Recovery of new injuries to acromial clavician junction with dynamic two-bundle reconstruction. Herald of RSMU. 2018; 1: 90-96.   Russian

4.   Chen CH, Dong QR, Zhou RK, Zhen HQ, Jiao YJ. Effect of hook plate on shoulder function after treatment of acromioclavicular joint dislocation // Int. J. Clin. Exp. Med. 2014; 7 (9): 2564-2570.

5.   Kharyutin AS. Treatment of injuries to acromial extremity of clavicle: abstracts of candidate of medical science. Spb, 2005; 185 p. Russian

6.   Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, et al. Current Concepts in the Treatment of Acromioclavicular Joint Dislocations. Arthroscopy: J. of Arthroscopic and Related Surgery. 2013; 29 (2): 387-397.

7.   Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzayan R, et al.

ISAKOS Upper extremity committee consensus statement on the need for diversification of Rockwood classification for acromioclavicular joint injuries. J. of Arthroscopic and Related Surgery. 2014; 30 (2): 271-278.

8.   Lapusto AA. Treatment of dislocations of acromial extremity of clavicle in dependence on injury severity. Medical News. 2004; 7: 92-93. Russian

9.   Golovakha ML, Shishka IV, Zabelin IN, Banit OV, Babich YuA, Tverdovskiy AO. A method of low-invasive surgical treatment of dislocations of acromial extremity of clavicle. Herald of Traumatology and Orthopedics. 2012; 1-2: 90-93.   Russian

10.    Kogan PG, Chugaev DV, Sudyakova MYu, Lasunskiy SA, Sorokin EP, Stafeev DV. Experience with low-invasive recovery of anatomical ratios in acromioclavicular joint from mini-approach. Kazan Medical Journal. 2017; 98(5): 851-857. Russian

11.    Pearsall IV AW, Hollis JM, Russell GV, Stokes DA. Biomechanical Comparison of Reconstruction Techniques for Disruption of the Acromioclavicular and Coracoclavicular Ligaments . J. South. Orthop. Assoc. 2007; 11 (1): 225-228.

12.    Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006; 34(2): 236-246.

13.    Zagorodniy NV, Volna AA, Panin MA. Removal of metal constructs in traumatology: the manual. Moscow, 2009. 22 p. Russian

14.    Chiang CL, Yang SW, Tsai MY, Chen CKH. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J. of Shoulder and Elbow Surgery. 2010; 19(4): 13-15.

15.    Varrall CR. Clinical Outcome Following Treatment with Clavicular Hook Plate. J. Trauma Treatment. 2012; 1(9): 3-6.

16.    Chaudhary D, Jain V, Joshi D, Jain JK, Goyal A, Mehta N. Arthroscopic fixation for acute acromioclavicular joint disruption using the TightRope device. J. Orthop. Surg. 2015; 23 (3): 309-314.

17.    Kilybaev AK, Makhanov SA, Zubi YuKh, Zhumagulov MO, Abdoliev BG. Comparative assessment of results of surgical treatment of fracture-dislocations and fractures of acromial extremity of clavicle. Herald of KazNMU. 2016; 3(1): 276-277.   Russian

18.    Zabelin IN. Clinical and experimental substantiation of recovery of coracoclavicular ligament: abstracts of candidate of medical science. Zaporozhe, 2015. 168 p.   Russian

19.    Ryazantsev MS, Ilyin DO, Rybin KE, Magnitskaya NE, Afanasyev AP, Loginov AN, et al. Stabilization of acromioclavicular joint with DogBone (Arthrex): literature review and long term results. Genius of Orthopedics. 2018; 24(4): 4-15.   Russian

20.    Mohamed HS. Midterm results on acromioclavicular and coracoclavicular reconstruction using nylon tape. Arthroscopy. 2012; 28(8): 1050-1057.

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23.    Chernysh VYu, Shpachenko NN, Prikolota VD, Chernetskiy VYu, Maksimov VE. Complex estimation of results of treatment of injuries to acromioclavicular joint. Trauma. 2010; 11(4): 404-411. Russian

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25.    Leidel BA, Braunstein V, Pilotto S, Mutschler W, Kirchhoff C. Mid-term outcome comparing temporary K-wire fixation versus PDS augmentation of Rockwood grade III acromioclavicular joint separations. BMC Research Notes. 2009; 2 (1): 1-8.

revision surgery for patients with pseudoarthrosis and adjacent segment disease in degenerative dystrophic diseases of lumbosacral spine

Abakirov M.Dzh., Nurmukhametov R.M., Mamyrbaev S.T., Al-Bavarid O.

Abakirov M.Dzh., Nurmukhametov R.M., Mamyrbaev S.T., Al-Bavarid O.

Peoples' Friendship University of Russia,

Central Clinical Hospital of the Russian Academy of Sciences,

City Clinical Hospital No. 17 of Moscow City Health Department, Moscow, Russia

Objective − to conduct a comparative analysis of results of revision surgery in pseudoarthrosis and adjacent segment disease after decompressive stabilizing interventions.

Materials and methods. There were 44 patients with pseudoarthrosis and adjacent segment disease who received revision surgery in 2017-2020. The patients were distributed into two groups depending on pathology. The group 1 included 20 patients with pseudoarthrosis at the age of 36-68 (M ± SD = 55.6 : 9.9). The group 2 included 24 patients at the age of 38-79 (M ± SD = 58.9 : 12.1), with adjacent segment disease.

Results. The mean VAS and ODI was 7.3 and 55.4 in the group 1 before and after revision surgery, correspondingly, and it improved to 1.4 and 11.8 at the moment of final follow-up (p = 0.001). The mean VAS and ODI was 6.7 and 48.4 in the group 2 before and after revision surgery, correspondingly, and it improved to 17.2 and 2.7 at the moment of final follow-up (p = 0.001). Therefore, the mean VAS and ODI improved in both groups. There were statistically significant differences in VAS between two groups (p < 0.001), but ODI points were much more worse in the group 2.

Conclusion. In our study, the patients with revision surgery for pseudoarthrosis showed better clinical and radiologic results than the patients with adjacent segment disease. The patients with excessive body mass and obesity, with presurgical disk degeneration in the adjacent segment, should be completely informed about the risk of adjacent segment disease. ALIF is the theoretically substantiated and acceptable variant in treatment of pseudoarthrosis and achievement of sagittal balance by means of preservation of lumbar lordosis, resulting in decrease in the risk of adjacent segment disease.

Key words: revision surgery; sagittal balance; pseudoarthrosis; adjacent segment disease; ALIF; TLIF.                                         

Information about authors:

Abakirov M.Dzh., MD, PhD, professor at traumatology and orthopedics department, Peoples' Friendship University of Russia, traumatologist-orthopedist, vertebrology department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia.

Nurmukhametov R.M., candidate of medical science, chief of vertebrology department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia.

Mamyrbaev S.T., postgraduate student, traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Al-Bavarid O., postgraduate student, traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Address for correspondence:

Mamyrbaev S.T., Miklukho-Maklaya St., 6, Moscow, Russia, 117198

Tel: +7 (910) 424-04-80

E-mail: mamyrbaev-samat@mail.ru

REFERENCES:

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5. Emami A, Faloon M, Sahai N, Dunn CJ, Issa K,Thibaudeau D, et al. Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion. Asian Spine J. 2018; 12(5): 830–838. doi: 10.31616/asj.2018.12.5.830.

6. Lee CH, Hyun SJ, Kim KJ, Jahng TA, Yoon SH, Kim HJ. The efficacy of lumbar hybrid stabilization using the DIAM to delay adjacent segment degeneration: an intervention comparison study with a minimum 2-year follow-up. Neurosurgery. 2013; 73(2 Suppl Operative): ons224-31, discussion ons231-2. doi: 10.1227/NEU.0b013e31828e8ddc.

7. Zhang C, Berven SH, Fortin M, Weber MH. Adjacent Segment Degeneration Versus Disease After Lumbar Spine Fusion for Degenerative Pathology: A Systematic Review With Meta-Analysis of the Literature. Clin Spine Surg. 2016; 29(1): 21-29. doi: 10.1097/BSD.0000000000000328.

8. Xia XP, Chen HL, Cheng HB. Prevalence of Adjacent Segment Degeneration After Spine Surgery: A Systematic Review and Meta-analysis. Spine. 2013; 38(7): 597-608. doi: 10.1097/BRS.0b013e318273a2ea.

9. Lee JC, Choi SW.Adjacent Segment Pathology after Lumbar Spinal Fusion. Asian Spine J. 2015; 9(5): 807–817. doi: 10.4184/asj.2015.9.5.807.

10. Lee JC, Kim Y, Soh J, Shin B. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion. Spine. 2014; 39(5): E339–45.

11. Scemama C, Magrino B, Gillet P, Guigui P, Less V. Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series. J Neurosurg Spine . 2016; 25: 46–51. https://doi.org/10.3171/2015.11.SPINE15700.

12. Park JS, Shim KD, Song YS, Park YS. Risk factor analysis of adjacent segment disease requiring surgery after short lumbar fusion: the influence of rheumatoid arthritis. Spine J. 2018; 18(9): 1578-1583. doi: 10.1016/j.spinee.2018.02.005. Epub 2018 Feb 13.

13. Lenke LG, Bridwell KH, Bullis D, Betz RR, Baldus C, Schoenecker PL. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord. 1992; 5(4): 433-442. DOI:10.1097/00002517-199212000-00008.

14. Choudhri TF, Mummaneni PV, Dhall SS, Eck JC, Groff MW, Ghogawala Z, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion status. J. Neurosurg. Spine. 2014; 21(1): 23-30. DOI:10.3171/2014.4.SPINE14267.

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16. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology.1988; 166(1.Pt 1): 193-199. DOI: 10.1148/radiology.166.1.3336678.

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19. Bartynski WS, Lin L. Lumbar root compression in the lateral recess: MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation. AJNR Am J Neuroradiol. 2003; 24(3): 348-360.

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Case history

INDIVIDUAL APPROACH TO TREATING A PATIENT
WITH A CLOSED INTRAARTICULAR FRACTURE
OF THE PROXIMAL TIBIA IN A COMBINATION WITH THE INJURY TO SOFT-TISSUE KNEE JOINT STRUCTURES

Mikhaylov I.N., Balzhinimaev D.B.

Mikhaylov I.N., Balzhinimaev D.B.

Irkutsk Scientific Centre of Surgery and Traumatology,

Irkutsk, Russia

A closed intraarticular fracture of the proximal tibia in combination with a rupture of the anterior cruciate ligament of the knee joint is a serious surgical pathology. Untimely diagnosis and improper treatment of these injuries often lead to further disability of patients.

Objective − to show the result of an individual approach to surgical treatment of a patient with a closed intraarticular fracture of the proximal tibial epimetadiaphysis with displacement of bone fragments in combination with complete rupture of the anterior cruciate ligament, flap rupture of the lateral and medial menisci of the right knee joint.

Materials and methods. At the initial stage, we simultaneously revealed both intraarticular fracture of the proximal tibia and an injury to anterior cruciate ligament of the knee joint. Further treatment tactics which consisted of a two stages was determined. We originally planned to use patient’s own tendon of the long peroneal muscle as a material for the restoration of the injured ligament, which is important in the further active rehabilitation of the patient after surgery, since the long peroneal muscle is anatomically located outside the projection region of the knee joint.

The first stage of treatment was external osteosynthesis of the proximal epimetadiaphysis of the right tibia with a locked plate. The second stage included arthroscopic autotendoplasty of the anterior cruciate ligament with an autograft from the half of tendon of the long peroneal muscle and modeling partial resection of both menisci of the right knee joint. The follow-up period was 2 years after the surgery.

Results. Restoring only the integrity of the bone structures as the first stage allowed us to eliminate possible undesirable outcomes: the formation of a false joint or bone defects in the proximal tibia and incorrect orientation of the planned transplant channels. Also it helps to restore the tibial plateau and the range of motion in the knee joint at the stage of rehabilitation. At the second stage, the reconstruction of the anterior cruciate ligament using chosen tactics allowed us to achieve stability of the knee joint and to restore the full function of the knee joint.

Conclusion. The chosen tactics of two-stage treatment in this patient allowed us to restore full function of the knee joint and to improve the quality of the patient’s life.

Key words: intraarticular fracture of the proximal tibial epimetadiaphysis; anterior cruciate ligament; knee joint; anterior cruciate ligament plasty.

Information about authors:

Mikhaylov I.N., candidate of medical science, senior researcher at scientific and clinical department of traumatology, physician at traumatology and orthopedics unit, Irkutsk Scientific Centre of Surgery and Traumatology, Irkutsk, Russia.

Balzhinimaev D.B., postgraduate, traumatology and orthopedics unit, Irkutsk Scientific Centre of Surgery and Traumatology, Irkutsk, Russia.

Address for correspondence:

Balzhinimaev D.B., Bortsov Revolyutsii St., 1, Irkutsk, Russia, 664003

Tel: +7 (999) 686-68-90

E-mail: dorji45@mail.ru

REFERENCES:

1.      Wang Y, Cao F, Liu M, Wang J, Jia S. Incidence of soft-tissue injuries in patients with posterolateral tibial plateau fractures: a retrospective review from 2009 to 2014. J Knee Surg. 2016; 29(6): 451-457.

2.      Porrino J, Richardson ML, Hovis K, Twaddle B, Gee A. Association of tibial plateau fracture morphology with ligament disruption in the context of multiligament knee injury. Curr Probl Diagn Radiol. 2018; 47(6): 410–416. https://doi.org/10.1067/j.cpradiol.2017.09.001.

3.      Aldebeyan W, Liddell A, Steffen T, Beckman L, Martineau PA. Proximal tibial fracture following anterior cruciate ligament reconstruction surgery: a biomechanical analysis of the tibial tunnel as a stress riser. Knee Surg, Sports Traumatol, Arthrosc. 2015; 25: 2397-2404. doi:10.1007/s00167-015-3826-y.

Rehabilitation

REHABILITATION POTENTIAL OF PERSONALITY AND FUNCTIONAL INDEPENDENCE OF PERSONS WITH TRAUMATIC SPINAL CORD INJURY

Khokhlova O.I.

Khokhlova O.I.

Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons,

Novokuznetsk, Russia

Achieving one of the main objectives of rehabilitation of persons with traumatic spinal cord injury, that is increasing the degree of functional independence from others in everyday life, is impossible without consideration of personal resources. However, there is a lack of actual data describing the relation between these aspects of rehabilitation.

Objective – investigate the interrelation of the degree of functional independence and the level of rehabilitation potential of personality among persons with traumatic spinal cord injury (TSCI).

Materials and methods. Overall, 32 patients with TSCI admitted to the clinical settings at Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons with time after injury not longer than 3 years were examined. The degree of functional independence was assessed using the scales SCIM-III (Spinal Cord Independence Measure, version III) and FIM (Functional Independence Measure). To assess the rehabilitation potential of personality the method by I.Y. Kulagina, L.V. Senkevich (2011) was used.

Results. Half of the patients with TSCI showed low scores of functional independence (SCIM-III – lower than 44 scores, FIM – 71), in 93.7 % of participants were medium or high scores of general level of rehabilitation potential of personality. The value of the latter was defined by high levels of communicative component, but did not correlate with them. In addition, direct correlation was found between the general level of rehabilitation potential of personality and the scores for motivational, self-evaluation, emotional components and internal picture of the disease, as well as scores of functional independence. Persons with paraplegia showed negative correlation between communicative component and total scores of FIM scale (Spearman's rank correlation coefficient ρ = -0,604, р = 0,017), showing the negative influence of the high communicative component on rehabilitation outcomes which is related to the overprotection leading to development of dependency in caregivers.

Conclusion. Efforts directed to increase the levels of components of general rehabilitation potential of personality (motivational, self-evaluation, emotional and internal picture of the disease) and to the rational usage of the communicative component may advance the effectiveness of rehabilitation and the degree of functional independence of persons with TSCI.

Key words: traumatic spinal cord injury; rehabilitation; functional independence; daily activity; rehabilitation potential of personality.

Information about author:

Khokhlova O.I., MD, PhD, leading researcher at the department of medical, social and vocational rehabilitation, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:

Khokhlova O.I., Malaya St., Novokuznetsk, Kemerovo region, Russia, 654055

Tel: +7 (3843) 36-91-26

E-mail: root@reabil-nk.ru; hohlovaoliv@rambler.ru

REFERENCES:

1. Bickenbach J, Officer A, Shakespeare T, von Groote P. International perspectives on spinal cord injury. World Health Organization. 2013 https://apps.who.int/iris/handle/10665/94190.

2. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5): 459-480. doi: 10.1016/S1474-4422(18)30499-X.

3. Spinal cord injury facts and figures at a glance. J Spinal Cord Med. 2013; 36(5): 568–569. doi: 10.1179/1079026813Z.000000000209.

4. AlHuthaifi F, Krzak J, Hanke T, Vogel LC. Predictors of functional outcomes in adults with traumatic spinal cord injury following inpatient rehabilitation: A systematic review. J Spinal Cord Med. 2017; 40(3): 282-294. doi: 10.1080/10790268.2016.1238184.

5. Kulagina IYu, Senkevich LV. Rehabilitation potential of person with various chronic diseases. Cultural and Historical Psychology. 2015; 11(1): 50-60. Russian

6. Gudilina ON. Specifics of personal rehabilitation potential of adolescents with disorders of statodynamic function in relation to time of appearance of a disorder and degree of its severity. Electronic Journal − Psychological Science and Education. 2012; 4(4): 1-19. www.psyedu.ru.    Russian

7. Psychosocial Guidelines in Spinal Cord Injury Rehabilitation / The Asian Spinal Cord Network. Jagadamba Press. 2015: 36

8. Vasilchenko EM, Zoloev GK, Kislova AS, Kostrov VV, Lyakhovetskaya VV, Karapetyan KK, et al. A measure of independence in spinal cord injury (SCIM-III). Preparation of Russian language version. Medicosocial Expertise and Rehabilitation. 2016; 2: 96-102.    Russian

9. Ozelie R, Gassaway J, Buchman E, Thimmaiah D, Heisler L,  Cantoni K, et al. Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project. J Spinal Cord Med. 2012; 35(6): 527–546. doi: 10.1179/2045772312Y.0000000062.

10. Nemykh LS, Smirnova NN, Shulga AS. Rehabilitation of patients in modern conditions. Central Scientific Herald. 2017; 2(2): 8-10. Russian

11. Mrčela NT, Borovac JA, Vlak T, Vrdoljak D, Vižintin MP. The importance of individual' mental status for the true value of functional self-reported questionnaires used in medical rehabilitation. Psychiatr Danub. 2017; 29(3): 245-249. doi: 10.24869/psyd.2017.245.

12. Moreno A, Zidarov D, Raju Ch, Boruff J, Ahmed S. Integrating the perspectives of individuals with spinal cord injuries, their family caregivers and healthcare professionals from the time of rehabilitation admission to community reintegration: protocol for a scoping study on SCI needs. BMJ Open. 2017; 7(8): e014331. doi: 10.1136/bmjopen-2016-014331.

13. Jeyathevan G, Craven BC, Cameron JI, Jaglal SB. Facilitators and barriers to supporting individuals with spinal cord injury in the community: experiences of family caregivers and care recipients. Disabil Rehabil. 2020; 42(13): 1844-1854. doi: 10.1080/09638288.2018.1541102.

14. Jeyathevan G, Cameron JI, Craven BC, Munce SEP, Jaglal SB. Re-building relationships after a spinal cord injury: experiences of family caregivers and care recipients. BMC Neurol. 2019; 19(1): 117. doi: 10.1186/s12883-019-1347-x.

15. Smith EM, Boucher N, Miller WC. Caregiving services in spinal cord injury: a systematic review of the literature. Spinal Cord. 2016; 54(8): 562-569. 10.1038/sc.2016.8.

Reviews

OPPORTUNITIES AND PROSPECTS FOR THE USE OF PLASMA ENRICHED IN PLATFOLES IN THE TREATMENT OF FRACTURES AND BONE DEFECTS

Burykin K.I., Parshikov M.V., Yarygin N.V., Svetlov D.V., Govorov M.V., Chemyanov I.G., Prosvirin A.A.

Burykin K.I., Parshikov M.V., Yarygin N.V., Svetlov D.V., Govorov M.V., Chemyanov I.G., Prosvirin A.A.

Department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University,

Moscow, Russia

Fractures and bone defects are difficult to treat and they don`t get to achieve a satisfaction of the function injury limb. To optimize bone regeneration and recovery, various conservative and operative techniques are being developed for bone integrity and treatment. One of the last perspective  directions is  using of platelet-rich plasma (PRP).

Objective − studying  the possible prospects for the use of enriched plasma platelets in the treatment of bone fractures and bone deficiency replacement tissue with use of available systems and implants for optimization of bone tissue recovery.

Materials and methods. Internet resources: PubMed, Abstract Book, Cyberleninka.

Results. A thorough analysis of domestic and international literature (2015-2020) on the use of various bone substitute, platelet-rich plasma, as well as modern technologies of using various systems and implants to optimize bone tissue regeneration.

Conclusion. After  analysis of national and international literature, we concluded that there is a lot of interesting, promising researches of different  authors from all over the world which support the using of growth factors for optimization of bone regeneration. However, the clinical effectiveness of platelet-rich plasma and blood-derived growth factors still have to be proved. To date, there is no any single protocol for PRP. This leads to a high heterogeneity of researches, distorts the concept of the true properties of platelets and limits the possibility of using enriched plasma platelets. The question of using PRP in the treatment of acute trauma as a method replacement of bone tissue deficit in the fracture zone, as an independent or auxiliary element for reorganizing a graft of various origins in the zone the defect remains open. It requires for systematization, common usage protocols, and further study.

Key words: platelet-rich plasma; growth factors; bone regeneration; bone substitute; PRP therapy.

Information about authors:

Burykin K.I., postgraduate at the department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Parshikov M.V., MD, PhD, professor at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Yarygin N.V., MD, PhD, corresponding member of RAS, professor, head of department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Svetlov D.V., traumatologist-orthopedist, head of department of traumatology and orthopedics of City Clinical Hospital named after V.P. Demikhov, Moscow, Russia.

Govorov M.V., assistant at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Chemyanov I.G., candidate of medical sciences, associate professor at department of traumatology of orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Prosvirin A.A., candidate of medical sciences, assistant at department of traumatology, orthopedics and disaster medicine, A.I. Yevdokimov Moscow State Medical and Dental University, Moscow, Russia.

Address for correspondence:

Burykin K.I., Miklukho-Maklaya St., 29, building 1, app. 306, Moscow, Russia, 117485

Tel: +7 (919) 775-42-55

E-mail: bi.kirik@mail.ru

REFERENCES:

1.       Akhtyamov IF, Shakirova FV, Klyushkina YuA, Baklanova DA, Gatina EB, Aliev EO. Analysis of regenerative process in the site of tibial bone fracture (experimental study). Traumatology and Orthopedics of Russia. 2016; 1: 100-107. Russian

2.       Tao W, Yuankun Z, Marc N, Xiaochuan Y, Yunpeng Y, Xinping Z. Layer-by-layer Nanofiber-Enabled Engineering of Biomimetic Periosteum for Bone Repair and Reconstruction. Biomaterials. 2018; (182): 279–288. DOI: 10.1016 / j.biomaterials.2018.08.028

3.       Sawada K, Nakahara K, Haga-Tsujimura M, Iizuka T, Fujioka-Kobayashi M, Igarashi K, et al. Comparison of three block bone substitutes for bone regeneration: long-term observation in the beagle dog. Odontology. 2018; 106(4): 398–407. doi.org/10.1007/s10266-018-0352-7 

4.       Tebyanian H, Norahan MH, Eyni H, Movahedin M,Mortazavi SJ, Karami A, et al. Effects of collagen/β-tricalcium phosphate bone graft to regenerate bone in critically sized rabbit calvarial defects. Journal of Applied Biomaterials & Functional Materials. 2019; 17(1):  doi.org/10.1177/2280800018820490

5.       Shitole AA, Raut PW, Sharma N, Giram P, Khandwekar AP, Garnaik B. Electrospunpolycaprolactone/hydroxyapatite/ZnOnanofibers as potential biomaterials for bone tissue regeneration. J Mater Sci Mater Med. 2019; 30(5): 51. doi.org/10.1007/s10856-019-6255-5

6.       Malygina MA, Borovkova NV, Sakharova OM, Ponomarev IN. The use of platelet-enriched plasma for diseases and injuries to locomotor system. Transplantology. 2017; 9(4): 325-334.   Russian (Малыгина М. А., Боровкова Н. В., Сахарова О. М., Пономарев И. Н. Применение богатой тромбоцитами плазмы при заболеваниях и повреждениях опорно-двигательного аппарата // Трансплантология. 2017. Т. 9, № 4. С. 325–334. DOI:10.23873/2074-0506-2017-9-4-325-334)

7.       Peng K, Hsieh M, Lin CT, Сhen C, Lee MS, Huang Y, et al. Treatment of critically sized femoral defects with recombinant BMP-2 delivered by a modified mPEG-PLGA biodegradable thermosensitive hydrogel. BMC Musculoskelet Disord. 2016; 17: 286. doi.org/10.1186/s12891-016-1131-7 

8.       Krishnan L, Priddy LB, Esancy C, Li MA, Stevens HY, Jiang X, et al.  Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared WithAutograft. Clinical Orthopaedics and Related Research. 2015; 473(9): 2885–2897. doi.org/10.1007/s11999-015-4312-z

9.       Zhiwei S, Shuo C, Zabkiewicz C, Chang L, Lin Y. Bone morphogenetic proteins mediate crosstalk between cancer cells and the tumour microenvironment at primary tumours and metastases (Review). International Journal of Oncology. 2020; 56(6): 1335-1351. DOI: 10,3892 / ijo.2020.5030

10. Dashnyam K, Buitrago J, Bold T, Mandakhbayar N, Perez RA, Knowles JC, et al. Angiogenesis-promoted bone repair with silicate-shelled hydrogel fiber scaffolds. Biomaterials Science. 2019; 7(12): 5221-5231. DOI: 10.1039 / C9BM01103J

11.    Srnec R, Divín R, Skoric M, Snasil R, Krbec M, Necas A. Use of the Peptigel with Nanofibres in the Bone Defects Healing. Journal of orthopedic surgery and traumatologiae Cechoslovaca . 2018; 85(5): 359-365. https://www.ncbi.nlm.nih.gov/pubmed/30383533

12.    Gentile P, De Angelis B, Agovino A, Orlandi F, Migner A, D Pasquali C, et al. Use of Platelet Rich Plasma and Hyaluronic Acid in the Treatment of Complications of Achilles Tendon Reconstruction. World J Plast Surg. 2016; 5(2): 124–132. Availableat: PMID:27579267

13.    Makarov MS, Ponomarev IN. The role of platelet-enriched plasma in reparation of bone tissue defects. Surgery. 2015; 10: 94-99. Russian

14.    Buryanov AA, Chorniy VS, Dedukh NV, Dubok VA, Protsenko VV, Omelchenko TN, et al. Features of regeneratory responses in replacement of bone tissue defects with bioglass in combination with platelet-enriched autological plasma. Trauma. 2019; 1: 56-61. Russian

15.    Vaza AY, Makarov MS, Slastinin VV, Borovkova NV, Klyukvin IY, Pokhitonov DY, et al. Effi ciency of allogenic platelet-rich plasmsa, combined with collagen, in rat's humerus injury healing. Transplantologiya. 2016; 2: 36-44. https://www.jtransplantologiya.ru/jour/article/view/121?locale=en_US

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