Analysis of temperaturepain sensitivity in patients with consequences of the cervical spinal cord injury

Background. The standard neurological assessment in patients with long-term consequences of spine-and-spinal cord injury and severe neurological deficit does not allow to accurately identify changes in sensitivity that determine the level, degree and nature of spinal cord injury, as well as to evaluate the minimal dynamics of these disorders with different treatment options. As a result, an objective instrumental assessment of the sensory sphere in the long-term period of spinal cord injury has not lost its relevance.The aim. To conduct an instrumental study of the temperature-pain sensitivity condition in patients with partial gross damage to the cervical spinal cord in the long-term period of the disease (type B on the ASIA scale).Methods. We examined 23 patients with consequences of vertebral fractures of the cervical spine in the late period of traumatic spinal cord disease, Grade B on the ASIA scale ASIA. The clinical analysis of sensitive disorders was performed according to ISNCSCI and ASIA scales. While studying the temperature-pain sensitivity the threshold of thermal sensitivity and the threshold of pain from hot were determined in СIV–SI dermatomes on the right and on the left using an electricesthesiometer.Results. The examined patients had hypesthesia of heat and pain sensitivity, hyperesthesia of pain sensitivity, thermoanesthesia and thermoanalgesia. The degree of changes in the temperature-pain sensitivity depended on the topographic localization of dermatomes. The more distally the study area was located from the level of damage, the more pronounced the disorders were. In 30.4 % of patients, the pain sensitivity from hot in the chain of dermatomes from CIV to SI was preserved on at least one side. The combination of thermoanesthesia with thermoanalgesia was observed in 69.6 % of cases in dermatomes with ThVII and distally.Conclusions. The instrumentally registered level of the temperature-pain sensitivity disorder did not correspond to clinically determined localization of sensory disorders. The range of discrepancy ranged from 2 to 12 dermatomes, with defining the sensitivity subclinical deficit over the area of clinical sensory disorders

History of biomechanical research at the Ilizarov Centre (to the 100th anniversary of Academician G.A. Ilizarov)

Background. Biomechanical studies of both the Ilizarov apparatus itself and the physiological system “apparatus – limb” occupy a significant place in the history of the formation and elaboration of the Ilizarov method, developed in the middle of the last century at the Kurgan Research Institute of Experimental Traumatology and Orthopaedics (nowadays – the world-famous Centre named after its creator). The analysis of the history of biomechanical research in the formation of Ilizarov method is not without interest.The aim. To analyze the history and stages of development of biomechanical research in order to substantiate the effectiveness of the Ilizarov method of transosseous osteosynthesis.Results. The national medical industry did not produce the appropriate equipment for biomechanical research in the early 1970s. That is why a group of engineers was included into the Laboratory of Clinical Physiology and Biomechanics (established in 1971) of the Ilizarov Centre, which created equipment for studying the processes in the tissues of the limbs and in the structure of the Ilizarov apparatus itself during its traction and compression impact on biological structures. The community of physicians, scientists and engineers made it possible to overcome a number of difficulties and problems. In their scientific publications and dissertations, the laboratory staff paid great attention to biomechanical research during transosseous osteosynthesis with the Ilizarov apparatus. At present, the staff of the Ilizarov Centre continues the traditions established by G.A. Ilizarov. For the first time in our country, a computer 3D video analysis of the kinematics and kinetics of orthopedic patients gait was introduced; it was supplemented with embedded software for the preparation of a clinical report of human gait biomechanics.Conclusions. The initial stage of the biomechanical research at the Ilizarov Centre included the creation of the research equipment. Subsequently, the biomechanical studies carried out by the staff of the Centre for almost half a century have shown an applied and functional result of the realization of general biological regularities of the Ilizarov’s discovery. At present, the biomechanical research continues at a higher level with the use of modern high-tech equipment

Analysis of the Degree of Involvement of the Lower Limb Muscles in the Pathological Process in Adolescents with Idiopathic Scoliosis

Background. The problem of the effect of adolescent idiopathic scoliosis on the functional condition of the lower limb muscles is still highlighted insufficiently.Aim. Analysis of the degree of involvement of the lower limb muscles in the pathological process in adolescents with idiopathic scoliosis.Methods. A comparative analysis has been made on the results of examination of 209 adolescents: 25 adolescents with idiopathic scoliosis; 170 normal adolescents; 14 adolescents with congenital scoliosis. The moments of force ofthe lower limb muscles were evaluated using dynamometric stands. Electrophysiological characteristics of the lower limb muscles were registered by the method of global and stimulation electroneuromyography.Results. The decrease in the amplitude of voluntary EMG of the femoral muscles in adolescents with idiopathic and congenital scoliosis is accompanied by dropping the moments of force relative to the values of the control group. The leg muscles are characterized by the preservation of the values of force at the level of normal test subjects under the conditions of the reduced voluntary EMG of high frequency. The amplitude of the M-responses of the indicator muscles and the values of the excitation propagation velocity along the motor fibers were also preserved. There are no statistically significant correlations between the amount of the spine deformity, on the one hand, and the values of asymmetry of the characteristics of the muscles in adolescents with idiopathic scoliosis.Conclusion. In adolescents with idiopathic scoliosis the function of femoral muscles is decreased, and there is no relationship between the amount of the spine deformity and the values of asymmetry of the characteristics of the lower limb muscles. The similar character of muscle function changes in adolescents with idiopathic and congenital scoliosis can testify that the cause of the observed changes is not the disease etiology, but the insufficient level of motor activity

Особенности состояния мягких тканей на вершине деформации у больных кифосколиозом на фоне нейрофиброматоза 1-го типа

Objective. Evaluation of skin sensitivity and analysis of morphological changes in paravertebral muscles and back skin in kyphoscoliotic deformity projection in patients with type 1 neurofibromatosis (NF-1).Materials and methods. Ten NF-1 patients who underwent surgery to treat kyphoscoliosis were examined. Using an electrical esthesiometer thermal pain sensitivity before the surgery was studied in dermatomes corresponding to the apex of the deformity. Skin and muscle biopsy samples were collected intraoperatively in the projection of the apex of the deformity curve and were subsequently analyzed by light and scanning electron microscopy.Results. Patients with kyphoscoliosis with underlying NF-1 were characterized by abnormal thermal pain sensitivity, pathological structural changes in skin and muscles accompanied by disrupted innervation and blood supply.Discussion. The observed changes may be responsible for lowered postoperative reparative potential of tissues and they must be considered in prevention and prognosis of treatment and rehabilitation efficacy.Цель работы. Оценка кожной чувствительности и анализ морфологических изменений паравертебральных мышц и кожи спины в проекции вершины кифосколиотической деформации у пациентов с нейрофиброматозом 1-го типа (НФ-1).Материалы и методы. Обследованы 10 больных НФ-1, которым проводилось хирургическое лечение по поводу кифосколиоза. Температурно-болевую чувствительность до операции исследовали с использованием электрического эстезиометра в дерматомах, соответствующих вершине деформации. Биоптаты кожи и мышцы забирали интраоперационно в проекции вершины дуги деформации позвоночника с последующим гистологическим анализом с помощью световой и сканирующей электронной микроскопии.Результаты. У больных кифосколиозом на фоне НФ-1 были выявлены нарушения температурно-болевой чувствительности, патологические структурные изменения кожи и мышц, нарушения их полноценной иннервации и кровоснабжения.Обсуждение. Обнаруженные изменения могут обусловливать снижение репаративного постоперационного потенциала тканей, что необходимо учитывать в профилактике и прогнозе эффективности лечения и реабилитации

Some Morphological and Functional Aspects of Chronic Osteomyelitis in Patients with Neurogenic Foot Deformities

Relevance. Neurological disorders are one the most frequent cause for developing of chronic foot inflammation. Analysis of pathological picture of chronic osteomyelitis in patients with neurogenic foot deformities, including cases of spina bifida, is not adequately addressed.Purpose of the study — to examine morpho-functional aspects of chronic osteomyelitis in patients with multicomponent foot deformities and with spina bifida.Materials and Methods. The present paper is based on the study of 30 patients with multicomponent neurological foot deformities complicated by chronic osteomyelitis who had medical history of spina bifida (myelomeningocele type). Histology was used to examine resected fragments of affected bone tissue, bone sequestration and skin adjacent to osteomyelitis area. Laser doppler flowmetry was used to study capillary cutaneous blood flow on plantar foot surface. Thermal and pain sensitivity was assessed by electric sensimeter in L4, L5, S1 dermatomas on the right and on the left sides.Results. Biopsy skin specimens harvested at osteomyelitis area demonstrated signs of parakeratosis, absence of stratum lucidum, epidermis acanthosis with 25% thickness increase (р = 0,04), 2,2 times increase of density for microvessels of the dermis (р = 0,73Е-4) and increased rate of capillary blood flow at 81,6±14,2% (р = 0,0004), fibrosis and dermis thinning at 19,1% (р = 0,03), 1,37 times increase in bulk density of perspiratory glands (р= 0,04), loss of adipose tissue and degeneration of nerve fibers in the majority of nerve stems of the dermis. Above factors were accompanied by disorders in thermal and pain sensitivity in 100% of cases and in 29% of those sensitivity was missing. Morphological picture of bone tissue in osteomyelitic area was manifested by multiple destruction cavities with pyogenic membrane, granular tissue of varying maturity, combined chronic and acute stages of the process, and by poor restorative bone formation.Conclusion. Disorders or lack of thermal and pain sensitivity in dermatomas L4, L5, S1, of safety sense and motion control, resulting chronic load on atypical foot segments, as well as patho-histological skin alterations contribute to ulcer formation and osteomyelitis in patients with spina bifida and multicomponent foot deformities. Morphological picture of foot bony tissue at osteomyelitic site indicates typical patho-morphological signs of chronic inflammation with poor restorative bone formation

THE STUDY OF BLOOD FLOW DYNAMICS IN TIBIAL SUBCHONDRAL EPIPHYSEAL ZONE OF PATIENTS WITH GONARTHROSIS AFTER TUNNELIZATION AND INFUSING AUTOLOGOUS BLOOD WITH BONE MARROW ELEMENTS

Introduction. The knee osteoarthrosis leads to a significant reduction of working ability. as well as to disability of working-age people. Arthroplasty is dominated the main method in treatment of such patients. However, many orthopedists are more and more inclined to the surgeries which allow to preserve the knee anatomic-and-functional integrity and to delay the surgery of the knee total replacement for later periods. Subchondral tunnelization with infusing autologous blood with bone marrow elements is one of such methods. of treatment for the patients of this category.Purpose to study the dynamics of the blood flow in the tibial epiphyseal subchondral zone after tunnelization and infusing autologous blood with bone marrow elements and its effect on the rehabilitation process of patients with gonarthrosis.Material and methods. The work was based on the results of studying 26 patients with Degree grade 2-3 gonarthrosis. Surgical treatment included performing tunnelization of femoral and tibial condyles with infusing autologous blood containing bone marrow elements. Circulation of tibial subchondral epiphyseal zone was studied in the operation room, before surgery, after tunnelization and after infusing autologous blood. Blood flow registered using high-frequency ultrasonic Dopplerography. The patient functional condition and the pathology severity analyzed using complex index score.Results. The significant (42-108%, р<0.05) increase in blood flow registered in tibial subchondral epiphyseal zone in patients with gonarthrosis after tunnelization of femoral and tibial condyles in 46.2% of cases, and the increased blood flow persisted after infusing autologous blood with bone marrow elements in 58% of the patients from this group. In patients with significant blood flow increase the index score rate of gait, muscle strength and mean rehabilitation criterion was reliably 23% (р<0.05), 21% (р<0.05) and 17.4% (р<0.05) more, respectively, comparing with the group of patients without the pronounced increase. The proportion of patients with the increase in the index score of gait, muscular strength, joint deformity, function, quality of life was also higher in the group of patients with blood flow rate increase.Conclusions. The significant increase in blood flow of tibial subchondral epiphyseal zone after tunnelization and infusing autologous blood with bone marrow elements contributed to the improvement of joint function and quality of life in patients with gonarthrosis

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

The aim of the study is to evaluate the efficiency of triple arthrodesis of foot and its effect on soft tissues blood supply at the surgical site during simultaneous correction of segment deformity in patients with cerebral palsy.Material and Methods. The present study reflects the authors’ experience of triple arthrodesis for correction and stabilization of foot multicomponent deformities of varying severity in 75 patients (136 feet) with cerebral palsy (IIIV level by Gross Motor Function Classification System (GMFCS)) treated in the Ilizarov center in the period from April 2012 to December 2016. The average age of the patients was 16.4±4.3 years (from 11 years 8 months to 43 years 3 months). All patients included into the study had severe arthrosis of hind and midfoot. The main option of foot fixation in this group of patients was internal fixation (elastic threaded wires, compression screws) together with plaster cast immobilization for 6–8 weeks. All patients underwent average of 4.59 surgical elements during a procedure as part of simultaneous multilevel interventions. The blood supply at the surgical site was evaluated by laser and high-frequency Doppler flowmetry before and after all stages of the surgery.Results. Long-term outcomes were evaluated at the average of 19 months after the surgery in 56 (74.7%) patients. 37 patients (66.1%) demonstrated good treatment outcomes and 19 patients (33.9%) — satisfactory outcomes. No unsatisfactory outcomes were observed. The clinical outcome of foot surgery was evaluated using the Angus-Cowell criteria. The obtained significant x-ray enhancement was maintained at the control stages of the follow up. Despite large simultaneous correction of foot deformity, there was no decrease in the parameters of microcirculatory blood supply of the skin, muscles and subcutaneous fat of the foot. The authors observed a stabilized or an increased perfusion of soft tissues.Conclusion. Triple arthrodesis for correction of foot deformities in patients with cerebral palsy and severe arthrosis in hind and midfoot is an efficient method which allows to correct and stabilize gained position of segments. The data of physiological research testify the sparing approach of such procedure and a possibility of an earlier weight-bearing on operated limb