An advanced method of bone tissue reconstruction in patients with osteoregeneration disorders (experience with clinical application of scaffold technologies) [ПЕРСПЕКТИВНЫЙ МЕТОД ВОССТАНОВЛЕНИЯ КОСТНОЙ ТКАНИ У ПОСТРАДАВШИХ С ТЯЖЕЛЫМИ НАРУШЕНИЯМИ ОСТЕОРЕГЕНЕРАЦИИ (ОПЫТ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ СКАФФОЛД-ТЕХНОЛОГИЙ)]

Nonunion and defects of bone tissue are the same complex of comparable pathological processes − impairment of reparative osteoregeneration of the diaphysis of the long bone. With objective of recovery of bone tissue and improvement in extremity function, the original technique for replacement of a bone defect in combination with internal fixation was offered. Materials and methods. We studied 119 patients with non-unions and 19 wounded persons with a bone defect in the diaphysis of the long bone. In the main group of patients, the bone defect was plastered with autobone and collagen hydrogel. Internal osteosynthesis was performed. In the control group, the bone tissue defect was restored by the method of G.A. Ilizarov. The result of treatment was assessed clinically, radiographically and by testing. Results. In the main group of patients with non-unions (61 people), the post-resection bone defect was restored in the mid-physiological terms of the segment bone fusion (mean time – 107.41 ± 41.29 days), which was 1.5 times better than the similar result of the control group (58 patients) – on average 170.45 ± 7.30 days. In the main group of wounded with post-traumatic bone defect (9 people), restoration of the integrity of the bone tissue was completed on average after 267.57 ± 32.61 days, which was 1.4 times faster than in the control group (10 people). According to the test results in the main group, a good effect of treatment was obtained by 8-24 % more, than in the control group. Conclusion. Collagen hydrogel is an effective matrix for the construction of a tissue-engineered structure when replacing a bone defect. The proposed algorithm for the treatment of patients with severe disorders of reparative osteoregeneration allows restoring the integrity of the bone and obtaining excellent and good treatment results. © 2021 The Charity Fund of Clinical Center of Miners' Health Protection. All rights reserved

Pathogenetic features of chronic osteomyelitis treatment

Over the past decades, there has been a steady increase in the incidence of osteomyelitis. It is associated with an increased use of implants in traumatology and orthopedics. The social aspects of osteomyelitis are, on the one hand, significant financial costs for the healthcare system, and on the other hand, high recurrence and re-infection in the treatment of joint pathology associated with long-term loss of work ability and a high risk of patient’s disability. Purpose To conduct a search and analysis of publications in Russian and English, devoted to the problem of osteomyelitis and periprosthetic infection, on the basis of which to summarize the main current notions about the etiology, pathogenesis, diagnosis and treatment of osteomyelitis. Materials and methods The search was carried out in the Pubmed and CyberLeninka databases of literature sources over the past 10 years. The data were analyzed and compared with the materials from earlier publications. Only publications from peer-reviewed journals were considered for analysis. Results and discussion Success in the treatment of peri-implant infection with prosthesis re-implantation and satisfactory joint function has been achieved in only just more than a half of patients. Recent studies have significantly changed the understanding of the etiology and pathogenesis of osteomyelitis. It has been proven that in osteomyelitis and implant-associated infection, four reservoirs of infection are formed in the patient's body: abscesses in soft tissues and bone marrow canal, biofilms on the surface of implants and necrotic tissues, intracellular colonization with bacteria of the macroorganism and lacunar-canalicular system. Understanding the mechanisms of osteomyelitis development and its course forces the specialists to take a fresh look at the causes of failures in the fight against such a severe pathology and change approaches to its prevention, diagnosis and treatment. © Rimashevskiy D.V., Akhtyamov I.F., Fedulichev P.N., Zaalan Wessam, Ustazov K.A., Basith Abdul, Moldakulov J.M., Zinoviev M.P., 202