ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS最新文献

{"title":"PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES","authors":"M. Korzh, O. Popsuishapka, V. Lytvyshko, Igor Shevchenko, Y. Doluda, Stanislav Gubskyi, Anastasiia Hrytsenko, Dmytro Mikhanovskiy, Olexii Marushchak, Mykola Tokhtamyshev, Zorik Arutunan","doi":"10.15674/0030-598720234109-120","DOIUrl":"https://doi.org/10.15674/0030-598720234109-120","url":null,"abstract":"Due to the military conflict in Ukraine, the problem of treating gunshot fractures has become acute, which requires an urgent solution. Objective. On the basis of own experience, to determine the primary problems in the treatment of gunshot diaphyseal fractures of the long bones of the limbs and evaluate the preliminary results. Methods. The treatment process and its results were analyzed in 128 victims with gunshot fractures of long limb bones for the period 08.2022–08.2023. Classical methods of clinical, X-ray and laboratory investigations were used. The assessment was carried out according to the AO classification, that was supplemented with new options for tangent and perforated bone injuries, as well as the volume of destruction of adjacent soft tissues. Wounds of all the patinets were treated using vacuum aspiration, the fragments were fixed with external devices manufactured by Biomet, Stryker, ТОВ «Ейч Ві Орто», ОРТОПАК. Results. The analysis showed that 64 (50 %) of the wounded had a need to take additional measures to preserve or improve the position of the fragments: improvement of the geometry of the external apparatus, replacement of the apparatus with a more perfected one, with a plate or intramedular osteosynthesis; replacement of the apparatus with a plaster bandage or orthosis. Conclusions. Based on the study, it can be argued, that most gunshot diaphyseal fractures of long bones are multifragmental and accompanied with destruction of predominantly peripherally located soft tissues. At the same time, the periosteum with a layer of adjacent muscles for the most part retains integrity, viability and connection with the surface of the fragments. The basic and rational method of fixation of fragments for diaphysical gunshot fractures it is necessary to consider external osteosynthesis with schanz-screws devices. According to our preliminary data, the use of external fixator treatment led to fracture healing in 84% of patients with gunshot hip fracture, 56 % — tibia fracture, 59 % — humerus fracture, and 44 % — forearm fractures.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":"36 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139528439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A REVIEW OF 2021 AND 2022 AAOS GUIDELINES FOR MENISCAL ARTHROSCOPIC PROCEDURES IN OSTEOARTHRITIS","authors":"Olena Baburkina, Maryna Bludova, Oleg Ovchynnikov","doi":"10.15674/0030-59872023456-62","DOIUrl":"https://doi.org/10.15674/0030-59872023456-62","url":null,"abstract":"For many decades, arthroscopy was considered the least invasive of all existing surgical methods of treating patients with gonarthrosis, however, carried out at the beginning of the XXI century randomized clinical trials (RCTs) demonstrated the futility of isolated lavage and debridement for this category of patients. The purpose of this work is to show trends in the indications for debridement and partial meniscectomy in patients with osteoarthritis in the 2021–2022 AAOS guidelines. Methods. AAOS 2021, 2022 recommendations for the treatment of osteoarthritis (without arthroplasty). The strength of recommendations depends on the number and quality of studies that may or may not recommend surgery. The results. In 2021, the third edition of the AAOS clinical guidelines for the treatment of osteoarthritis was released, which was supported by four studies. They suggest that arthroscopic partial meniscectomy be used for the treatment of meniscal tears in patients with concomitant mild or moderate osteoarthritis in whom physical therapy or other nonsurgical treatments have been ineffective. The 2022 AAOS guidelines reviewed 216 osteoarthritis situations and indications for arthroscopic procedures. The developed criteria are aimed at covering the most common clinical scenarios faced by qualified specialists treating osteoarthritis of the knee joint. The final decision on any particular criterion must take into account all the circumstances presented by the patient, as well as the needs and resources specific to the area or institution. Conclusions. The 2021 AAOS guidelines do not recommend arthroscopy with lavage and/or debridement in patients with a primary diagnosisof knee osteoarthritis. According to AAOS 2022 recommendations, arthroscopic interventions are suitable for young people with arthrosis of the knee joint in one or 2–3 departments. Arthroscopy as a method of choice for the treatment of terminal gonarthrosis has exhausted itself: most studies prove the ineffectiveness of lavage, debridement, microfracturing of the subchondral bone, and partial meniscectory.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFECT OF CHANGES IN THE LENGTH OF THE COMPONENTS OF THE MUSCULOTENDINOUS ELEMENT OF THE ELBOW FLEXOR MUSCLES ON THE ISOMETRIC FORCE AND JOINT TORQUE","authors":"O. Tyazhelov, O.D. Karpinska, Mykola Rykun, Oleksandr Branitskyi","doi":"10.15674/0030-59872023448-55","DOIUrl":"https://doi.org/10.15674/0030-59872023448-55","url":null,"abstract":"Immobilization of the joint leads to the formation of immobilization contracture, which is accompanied by a decrease in the elasticity of tendons and muscles, i.e. loss of full contraction and stretching. The torque in human joints is one of the key indicators in assessing rehabilitation. Objective. To study the effect of changes in the strength, length of muscles and tendons of the elbow joint on the torque in flexion. Methods. The basic OpenSim model arm26 was used for modeling. To determine the change in the length of the components of the muscle-tendon element (MTE), their length was determined at a 90° angle of elbow flexion. The decrease in muscle strength was considered a loss per day for elbow flexors — 1.2 %, extensors — 1.1 %. The decrease in strength was calculated for a period of immobilization of 45 days. Three models were created: Normal — a model without changes in muscle parameters; Contracture — a change in the length of muscles and tendons; Contracture + muscle (CM) — an additional decrease in muscle strength. Results. The obtained data of torques when changing the length of the MTE components showed their increase in conditions of unchanged isometric muscle strength. But this option is not possible after immobilization of the limb. Therefore, it is closer to the real model of СM, in which the torque is significantly reduced by the amount of decrease in muscle strength. These models show a tendency that the change in the components of the MTE due to immobilization increases the joint torque and, when trying to apply excessive force during joint development, can lead to traumatic consequences. During immobilization, the flexor muscles shorten, which prevents the patient from fully extending the elbow joint. Conclusions. This work on predicting the elbow joint torque generated by the muscles can be useful in studying specific clinical situations with elbow joint contractures, but cannot be fully transferred to practice due to the significant conventionality of the model parameters. However, the modeling method can show trends in changes in muscle function parameters when their geometry changes.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BIOMECHANICAL ASPECTS OF TRANSPEDICULAR FIXATION IN THE THORACOLUMBAR JUNCTION AREA: THE INFLUENCE OF LATEROFLEXION","authors":"O. Nekhlopochyn, Vadym V. Verbov, I. Cheshuk, Mykhailo Karpinsky, O. Yaresko","doi":"10.15674/0030-59872023414-21","DOIUrl":"https://doi.org/10.15674/0030-59872023414-21","url":null,"abstract":"The paradigm shift in surgery of the injured spine during the last few decades is characterized by the active implementation of the principle of stabilization without fusion. This approach significantly expands the possibilities of surgical interventions in terms of the completeness of decompression and spinal axis restoration, but also it determines higher requirements for the reliability of the fixation systems and the uniformity of load distribution on both metal systems and bone structures. Objective. To determine the features of load distribution in the area of the thoracolumbar junction after resection of one vertebra, as well as the effect of the transpedicular screw length and cross-links of the stabilization system. Methods. Mathematical finite-element model of the thoracolumbar human spine was developed. The model simulated the state after surgical treatment of a traumatic injury to the thoracolumbar junction with significant damage to the body of the ThXII vertebra. We studied 4 variants of transpedicular fixation (using monocortical screws and long bicortical screws, as well as two cross-links and without them). Results. When analyzing the stress-stain state of the model, we found that the most loaded bone structures during lateroflexion are the vertebral bodies. For the LII vertebral body, the load values were 17.2, 16.2, 16.3, and 15.5 MPa, respectively, for models with monocortical screws without cross-links, bicortical screws without cross-links, monocortical screws and cross-links, and bicortical screws and cross-links. The peak loads on the transpedicular screws were recorded on those implanted in the body of the ThXI vertebra (24.8, 25.7, 22.8 and 24.3 MPa, respectively, for the considered models) and in the body of the LII vertebra (20.2, 24.6, 19, 7 and 23.7 MPa). Conclusions. The use of long transpedicular screws causes less stress on the bony elements than the short screws. At that time stresses on the screws themselves and the bone tissue around them increase. Сross-links help to reduce stress at all control points on models with both short and long transpedicular screws.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" November","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BIOCHEMICAL MARKERS OF BLOOD SERUM AND ARTICULAR CARTILAGE IN DIFFERENT FORMS OF IDIOPATHIC COXARTHROSIS PROGRESSION","authors":"Sadrudin Magomedov, Oleksiy Kalashnikov, Larisa Polishchuk, T. Kuzub, V. Zayets","doi":"10.15674/0030-59872023443-47","DOIUrl":"https://doi.org/10.15674/0030-59872023443-47","url":null,"abstract":"Deformation due to arthrosis of the hip joint affects 40 % of the total number of patients with osteoarthritis, which is from 7 to 25 % of the adult population. For the activity of the pathological process evaluation we studied biochemical changes in the metabolism of collagen, namely: glycosaminoglycans (GAG), hydroxyproline (HP) fractions, collagenase, hyaluronidase activity, etc. Objective. To determine the biochemical changes in blood serum and articular cartilage depending on the form of progression of idiopathic coxarthrosis. Methods. 23 patients were examined (8 (34.8 %) men, 15 (65.2 %) women, age 45‒75 years and more) with idiopathic arthrosis of the hip joint IV stage (Kellgren–Lawrence). Progression forms of idiopathic coxarthrosis were distinguished: group I — rapid (the period from the initial to the final stage of the disease was 5 years and less), II — moderate (5‒10 years), III — slow (over 10 years). Collagenase activity, HP fractions, total GAG content were determined in patients’ blood serum, and collagen content was determined in the cartilage tissue of the femoral head. Results. Compared with the age reference norm in the blood serum of patients of group I activity collagenase increased to 114 %, in II and III — 122 and 135 %, respectively; the content of the free fraction of GP — up to 111, 169, 128 %, respectively; GAG concentrations — up to 110, 122, and 135 %, respectively; protein-bound HP was reduced to 60% in group II, up to 84 % — in group III. In cartilage tissue, the GAG content decreased in group III to 63 %, II — 55 %, I — 47 %; collagen — 32, 25, 24 % in accordance. Conclusions. The course of idiopathic coxarthrosis is determined by metabolic changes in the components of the organic basis of connective and cartilaginous tissues in blood serum. The most profound changes were found in the synthetic phase of HP metabolism, especially in the group with a rapid course disease. A decrease in the content of organic components of connective tissue (GAG and collagen) was determined","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":"44 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USING 3D PRINTING FOR OPEN REDUCTION OF CHRONIC POSTERIOR SHOULDER DISLOCATION (CASE FROM PRACTICE)","authors":"M. Golovakha, Stanislav Bondarenko","doi":"10.15674/0030-59872023493-97","DOIUrl":"https://doi.org/10.15674/0030-59872023493-97","url":null,"abstract":"Objective. An example of the treatment of a patient with chronic posterior dislocation of the shoulder, previously operated on by the Latarge technique due to recurrence of anterior instability, is given. Methods. The patient presented with an old fixed posterior dislocation of the left shoulder joint, large bone defect of the front part of the head (reverse Hill-Sachs). The patient has already undergone 2 operations on the left shoulder due to chronic anterior dislocation of the humeral head: 2018 — arthroscopy and capsuloplasty according to Bankart; 2020 — arthrotomy with Latarje transposition (due to recurrence of anterior instability). The peculiarity of this case is a bone block with screws located on the front surface of the glenoid made a massive defect front part of the humeral head. Planning performed on the basis of a CT scan of the shoulder joint in the FreeformPlus program. Assessment of functioning performed on the QuickDASH and Constant scales. The results. To improve the performance of intraoperative osteoplasty of the defect, a plastic model of the humeral head was printed for simulating bone graft and osteosynthesis. According to the QuickDASH scale before the operation, the patient had 45 points, that is, a significant decrease in the function of the upper limb — constant discomfort, pain. After surgery for 2 days — 35 points, 6 weeks — 12, and 3 months. — 12 points, that is, the patientʼs quality of life has improved significantly. According to the Constant scale before the operation, there were 16 points, of which: pain — 6, household activity — 2, range of motion — 8. After surgery on the 2nd day, a total of 33 points: pain — 10, household activity — 7, range of motion (passive) — 16, after 6 weeks — 80 points, this result remained after 3 months. Conclusion. The use of three-dimensional planning and an individual tool greatly facilitated the main stages ofsurgical intervention in the case of chronic posterior dislocation of the humeral head and made it possible to quickly and conveniently prepare a bone graft and install it in the defect. The printed navigation made it possible to perform a stabilizing osteosynthesis, ensure high patient satisfaction and a good functional result.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DETERMINATION OF THE RISK OF OBTAINING UNSATISFACTORY RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH STATIC DEFORMITIES OF THE FOREFOOT WHEN USING VARIOUS SURGICAL APPROACHES","authors":"D. Prozorovskiy","doi":"10.15674/0030-59872023463-70","DOIUrl":"https://doi.org/10.15674/0030-59872023463-70","url":null,"abstract":"The main method of treatment of static deformations of the forefoot (SDPVS) is surgical. The most static deformities of the foot in its front part most often include valgus deformity of the first toe — Hallux valgus (HV), hammer-like deformities of 2–4 toes, and Taylor's deformity. Objective. To assess the effectiveness of surgical treatment of SDPVS and to determine the risk of obtaining an unsatisfactory result with different surgical approaches. Methods. The treatment of 565 patients (1009 feet) was analyzed, the main group — 729 feet, control 280 feet. The groups of patients differed in the methods of surgical treatment of deformities of the forefoot. The choice of surgical intervention in the main group was carried out according to the algorithmized system of surgical treatment of patients with SDPVS. Results. The results of treatment of patients with static deformities of the front part of the foot in the main group were significantly (p < 0.001) better than the results in the control group of patients. In the main group, good results accounted for 55.0 % of cases, satisfied — 39.2 %, unsatisfactory — 5.8 %, compared to the control group — 26.1 %, 43.2 and 30.7 %, respectively. The reduction of the relative risk of obtaining an unsatisfied result (RRR) in the main group when using the proposed algorithmized system of treatment of SDPVS is 68 %. In the treatment of combined VDPPS with deformities of 2–5 toes, the risk of an unsatisfactory result is higher compared to isolated VDPPS in both groups. The risk of an unsatisfactory treatment result in patients with combined HV deformity and deformities of 2–5 toes in the control group is 15.9 % higher (RR = 0.159 ± 0.174) than in the main group. The use of the proposed approach to the selection of surgical treatment tactics based on the developed algorithmized system of surgical treatment of SDPVS can reduce the relative risk of obtaining unsatisfactory treatment results by 84 % (RRR = 0.841).","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE HISTORY OF THE FORMATION AND ACTIVITY OF THE KHARKOV REGIONAL BRANCH OF THE ALL-UKRAINIAN PUBLIC ORGANIZATION «UKRAINIAN ASSOCIATION OF ORTHOPEDIC SURGEONS»","authors":"V. Filipenko, Svitlana Zolotarova, Olena Shevchenko","doi":"10.15674/0030-598720234133-137","DOIUrl":"https://doi.org/10.15674/0030-598720234133-137","url":null,"abstract":"The article is devoted to the Kharkiv regional branch of the All-Ukrainian public organization \"Ukrainian Association of Orthopedic Surgeons and Traumatologists\".","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139619007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological principles of diagnosis verification and treatment tactics determination in combat limb injuries with bone defects","authors":"O. Burianov, V. Kvasha, Y. Sobolevskiy, Yurii Yarmoliuk, Y. Klapchuk, D. Los, Valentyn Кuprii, Gennadii Kolov","doi":"10.15674/0030-5987202345-13","DOIUrl":"https://doi.org/10.15674/0030-5987202345-13","url":null,"abstract":"Objective. To develop a classification system for long bone defects resulting from combat limb injuries, establish criteria for predicting pathological fractures, and determine indicators for assessing the feasibility of converting the fixation method in combat-related injuries. Methods. The modern literature regarding the treatment of combat-related long bone defects resulting was analyzed in three databases: PubMed, Scopus, and Web of Science. The analysis was conducted using keywords such as combat injuries, bone defect, non-union, auto- and allograft transplantation, Ilizarov method — bone transport, Masquelet method — induced membrane, and fixation method replacement. The clinical material used for this study was derived from the evaluation and treatment of 457 patients with long bone defects at the III–IV medical intervention stage. Results. The determination of modern perspectives on the fundamental issues of combat injuries, combined with the analysis of treatment outcomes for such patients, enabled the development and validation of a classification of bone defects that incorporates the volume of bone tissue loss. Furthermore, a prognostic table for the risk of pathological fractures in cases of bone defects and a scoring scale for assessing the feasibility of fixation method conversion have been introduced and applied. Conclusions. The proposed classification allows the verification of all types of long bone defects. Its application in clinical practice offers the possibility of obtaining optimal and standardized treatment methods for different types of bone defects, thus improving outcomes by choice of appropriate technologies for their replacement. The objectification of fracture risk factors identification for bone defects enables the choice of the method and means of segment stabilization. The assessment of the feasibility of the fixation method change allows the evaluation of the patientʼs condition and the local status, facilitating the determination of the potential for method conversion — transition from external fixation devices to intramedullary osteosynthesis, significantly reducing complications during this stage.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TWO-STAGE SURGICAL TREATMENT OF LARGE AND RIGID SPINAL DEFORMITIES (ANTERIOR MOBILIZATION OF THE CURVATURE AND POSTERIOR INSTRUMENTATION OF THE SPINE)","authors":"O. Barkov, Volodymyr Radchenko, Y. Katsalap, I. Fedotova","doi":"10.15674/0030-59872023422-30","DOIUrl":"https://doi.org/10.15674/0030-59872023422-30","url":null,"abstract":"The choice of method of surgical treatment of large and rigid spinal deformities remains debatable. Objective. To evaluate the results of two-stage surgical treatment of large and rigid spinal deformities (anterior mobilization of the curvature and posterior instrumentation of the spine). Methods. Seventeen patients, the average age of which was 17.7 years (from 12 to 38 years), the average follow-up period was 36 months. Distribution of patients by etiology: 13 — idiopathic scoliosis, 2 — neurofibromatosis, and 2 — congenital kyphoscoliosis. All patients underwent two-stage surgical treatment (anterior mobilization of the curvature and posterior correction of the deformity), evaluation of the results of correction and complications was performed retrospectively. Results. The average deformation of the spine in the frontal plane before the operation was 103° ± 10° according to Kob (from 90° to 126°), after the anterior mobilization — 85° ± 8° (from 74° to 104°), which is (17.6 ± 3.3) % of correction (from 13.7 to 24.5 %), and at the time of completion of the posterior correction of the deformity — 40° ± 22° (from 2° to 78°), in percentage terms it amounted to (62.1 ± 20.61) % correction (from 19.6 to 97.8 %). Statistical significance according to the T- criterion had the following indicators: 63.4 ± 19.6 (M ± SD); t = 13.344; p = 0.001. Conclusions. Two-stage surgical treatment of large and rigid spinal deformities is a modern technique for achieving spinal deformity correction and obtaining the desired cosmetic result. Carefully performed anterior mobilization with the subsequent use of the system of stretching the patient in bed, allows to increase the mobility of the spine and gradually adapt the tissues and spinal cord to the next posterior correction of the spine, which significantly reduces the risks of neurological complications, as well as obtaining the most satisfactory correction results.","PeriodicalId":137495,"journal":{"name":"ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}