Хирургическое лечение молоткообразной деформации пальцев стоп (обзор литературы)

The high prevalence of hammertoe deformity in the population, the effect of this pathology on the ability and the quality of life allow us to consider this pathology as a important medical problem. The most common surgery is arthrodesis of the proximal interphalangeal joint with a Weil-osteotomy. Specific complication is a floating toe, which leads to overload of adjacent toes and metatarsal heads. For to correct the instability of the metatarsophalangeal joint, the flexor to extensor transfer Girdlestone-Taylor can be used. However, the use of this procedure had limitations associated with difficult surgery techniques and below the average cosmetic result of the procedure. In the study of the causes of hammertoe deformity, the conclusion of the importance of the plantar plate of the metatarsophalangeal joint was made. Plantar plate repair leads to the stabilization of the metatarsophalangeal joint, reduces the risk of developing a floating toe, leads to the restoration of the support function and normal biomechanics of movement and foot function. Simultaneously, the plantar plate repair technically complicates surgical treatment. An promising direction of treatment is minimally invasive technologies for correction of hammertoe deformity that can reduce the risk of infectious complications, improve the cosmetic result of the surgery and reduce the risk of postoperative contracture in the joint, the time of the operation and rehabilitation, postoperative pain, emotional stress for the patient. However, the technique this type of surgery is more difficult, it requires a long training of the surgeon. The potential risk of intraoperative damage to various anatomical structures increases, which requires use of special tools during surgery. The choice of the surgical procedures is based on the individual characteristics of the pathological changes in the patients foot, the equipment of the operating room and the experience of the surgeon. It is necessary to evaluate the elasticity of the deformity, the stability of the metatarsophalangeal joint, the presence and severity of concomitant overloading metatarsalgia, as well as to take into account the subjective personalized requirements and expectations of the patient.Широкая распространенность молоткообразной деформации пальцев стоп, влияние данной патологии на трудоспособность и качество жизни позволяют считать ее значимой медицинской проблемой. Наиболее распространенная операция в настоящее время ― артродез проксимального межфалангового сустава в сочетании с Weil-остеотомией. Специфическое осложнение ― флотирующий палец приводит к перегрузке смежных пальцев и головок плюсневых костей. Одной из причин данного осложнения является нестабильность плюснефалангового сустава, для коррекции которой используется операция по транспозиции сухожилия длинного сгибателя пальца на проксимальную фалангу. Использование данной методики имеет ограничения, связанные со сложной техникой операции и посредственным косметическим результатом. При изучении причин молоткообразной деформации пальцев был сделан вывод о важном значении подошвенной связки плюснефалангового сустава, восстановление которой приводит к стабилизации сустава, восстанавливает опорную функцию и нормальную биомеханику стопы. Перспективным направлением лечения молоткообразной деформации является использование малоинвазивных технологий, которые позволяют снизить риск инфекционных осложнений, послеоперационной контрактуры сустава, сократить время проведения операции, сроки реабилитации, уменьшить послеоперационный болевой синдром. Техника минимальной инвазивной операции сложнее, требует длительного обучения хирурга, продолжительного контроля за послеоперационным ведением пациента, имеет более высокий потенциальный риск интраоперационного повреждения анатомических структур. Выбор метода лечения основывается на индивидуальных особенностях патологических изменений стопы пациента, технических возможностях и опыте хирурга. При выборе тактики лечения необходимо оценивать эластичность деформации, степень стабильности плюснефалангового сустава, наличие и выраженность сопутствующей перегрузочной метатарзалгии; учитывать персонифицированные требования и ожидания конкретного пациента. Результаты хирургического лечения пациентов, по данным различных авторов, полученные с помощью опросника AOFAS для резекционной артропластики проксимального межфалангового сустава, улучшились в среднем в 2,4 раза (до операции 36,1 балла, на контрольном осмотре 87,3 балла). По визуальной аналоговой шкале (ВАШ) отмечалась положительная динамика в 4,8 раза (до операции 7,2, на контрольном осмотре 1,5). При восстановлении подошвенной связки среднее улучшение по опроснику AOFAS у различных авторов составило 1,8 раза (до операции 47,2, на контрольном осмотре 85,1). По шкале ВАШ результаты улучшились в 5,7 раза (до операции 6,8, на контрольном осмотре 1,2). При применении минимально инвазивных методик удовлетворенность пациентов составила 87,3%. При пересадке сухожилий послеоперационный балл по шкале AOFAS составил 83,4. Дополнительных данных о результатах не представлено, либо они представлены в недостаточном объеме

CONTINUOUS PALEOENVIRONMENTAL SEDIMENT RECORD FROM TWO LAKES ON VALDAY ICE MARGINAL ZONE STARTED SHORTLY AFTER THE ICE RETREAT

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Measurement of RudsR_{\text{uds}} and RR between 3.12 and 3.72 GeV at the KEDR detector

Using the KEDR detector at the VEPP-4M $e^+e^-$ collider, we have measured the values of $R_{\text{uds}}$ and $R$ at seven points of the center-of-mass energy between 3.12 and 3.72 GeV. The total achieved accuracy is about or better than $3.3\%$ at most of energy points with a systematic uncertainty of about $2.1\%$. At the moment it is the most accurate measurement of $R(s)$ in this energy range

New precise determination of the \tau lepton mass at KEDR detector

The status of the experiment on the precise $\tau$ lepton mass measurement running at the VEPP-4M collider with the KEDR detector is reported. The mass value is evaluated from the $\tau^+\tau^-$ cross section behaviour around the production threshold. The preliminary result based on 6.7 pb$^{-1}$ of data is $m_{\tau}=1776.80^{+0.25}_{-0.23} \pm 0.15$ MeV. Using 0.8 pb$^{-1}$ of data collected at the $\psi'$ peak the preliminary result is also obtained: $\Gamma_{ee}B_{\tau\tau}(\psi') = 7.2 \pm 2.1$ eV.Comment: 6 pages, 8 figures; The 9th International Workshop on Tau-Lepton Physics, Tau0

Measurement of \Gamma_{ee}(J/\psi)*Br(J/\psi->e^+e^-) and \Gamma_{ee}(J/\psi)*Br(J/\psi->\mu^+\mu^-)

The products of the electron width of the J/\psi meson and the branching fraction of its decays to the lepton pairs were measured using data from the KEDR experiment at the VEPP-4M electron-positron collider. The results are \Gamma_{ee}(J/\psi)*Br(J/\psi->e^+e^-)=(0.3323\pm0.0064\pm0.0048) keV, \Gamma_{ee}(J/\psi)*Br(J/\psi->\mu^+\mu^-)=(0.3318\pm0.0052\pm0.0063) keV. Their combinations \Gamma_{ee}\times(\Gamma_{ee}+\Gamma_{\mu\mu})/\Gamma=(0.6641\pm0.0082\pm0.0100) keV, \Gamma_{ee}/\Gamma_{\mu\mu}=1.002\pm0.021\pm0.013 can be used to improve theaccuracy of the leptonic and full widths and test leptonic universality. Assuming e\mu universality and using the world average value of the lepton branching fraction, we also determine the leptonic \Gamma_{ll}=5.59\pm0.12 keV and total \Gamma=94.1\pm2.7 keV widths of the J/\psi meson.Comment: 7 pages, 6 figure

Search for narrow resonances in e+ e- annihilation between 1.85 and 3.1 GeV with the KEDR Detector

We report results of a search for narrow resonances in e+ e- annihilation at center-of-mass energies between 1.85 and 3.1 GeV performed with the KEDR detector at the VEPP-4M e+ e- collider. The upper limit on the leptonic width of a narrow resonance Gamma(R -> ee) Br(R -> hadr) < 120 eV has been obtained (at 90 % C.L.)

Measurement of main parameters of the \psi(2S) resonance

A high-precision determination of the main parameters of the \psi(2S) resonance has been performed with the KEDR detector at the VEPP-4M e^{+}e^{-} collider in three scans of the \psi(2S) -- \psi(3770) energy range. Fitting the energy dependence of the multihadron cross section in the vicinity of the \psi(2S) we obtained the mass value M = 3686.114 +- 0.007 +- 0.011 ^{+0.002}_{-0.012} MeV and the product of the electron partial width by the branching fraction into hadrons \Gamma_{ee}*B_{h} = 2.233 +- 0.015 +- 0.037 +- 0.020 keV. The third error quoted is an estimate of the model dependence of the result due to assumptions on the interference effects in the cross section of the single-photon e^{+}e^{-} annihilation to hadrons explicitly considered in this work. Implicitly, the same assumptions were employed to obtain the charmonium leptonic width and the absolute branching fractions in many experiments. Using the result presented and the world average values of the electron and hadron branching fractions, one obtains the electron partial width and the total width of the \psi(2S): \Gamma_{ee} =2.282 +- 0.015 +- 0.038 +- 0.021 keV, \Gamma = 296 +- 2 +- 8 +- 3 keV. These results are consistent with and more than two times more precise than any of the previous experiments

Measurement of the Bs0→J/ψKS0B_s^0\to J/\psi K_S^0 branching fraction

The $B_s^0\to J/\psi K_S^0$ branching fraction is measured in a data sample corresponding to 0.41$fb^{-1}$ of integrated luminosity collected with the LHCb detector at the LHC. This channel is sensitive to the penguin contributions affecting the sin2$\beta$ measurement from $B^0\to J/\psi K_S^0$ The time-integrated branching fraction is measured to be $BF(B_s^0\to J/\psi K_S^0)=(1.83\pm0.28)\times10^{-5}$. This is the most precise measurement to date

Measurement of the CP-violating phase \phi s in Bs->J/\psi\pi+\pi- decays

Measurement of the mixing-induced CP-violating phase phi_s in Bs decays is of prime importance in probing new physics. Here 7421 +/- 105 signal events from the dominantly CP-odd final state J/\psi pi+ pi- are selected in 1/fb of pp collision data collected at sqrt{s} = 7 TeV with the LHCb detector. A time-dependent fit to the data yields a value of phi_s=-0.019^{+0.173+0.004}_{-0.174-0.003} rad, consistent with the Standard Model expectation. No evidence of direct CP violation is found.Comment: 15 pages, 10 figures; minor revisions on May 23, 201

Absolute luminosity measurements with the LHCb detector at the LHC

Absolute luminosity measurements are of general interest for colliding-beam experiments at storage rings. These measurements are necessary to determine the absolute cross-sections of reaction processes and are valuable to quantify the performance of the accelerator. Using data taken in 2010, LHCb has applied two methods to determine the absolute scale of its luminosity measurements for proton-proton collisions at the LHC with a centre-of-mass energy of 7 TeV. In addition to the classic "van der Meer scan" method a novel technique has been developed which makes use of direct imaging of the individual beams using beam-gas and beam-beam interactions. This beam imaging method is made possible by the high resolution of the LHCb vertex detector and the close proximity of the detector to the beams, and allows beam parameters such as positions, angles and widths to be determined. The results of the two methods have comparable precision and are in good agreement. Combining the two methods, an overall precision of 3.5% in the absolute luminosity determination is reached. The techniques used to transport the absolute luminosity calibration to the full 2010 data-taking period are presented.Comment: 48 pages, 19 figures. Results unchanged, improved clarity of Table 6, 9 and 10 and corresponding explanation in the tex