The modern principles in treatment of Legg – Calve – Perthes syndrome in children

The aim: to improve the results of treatment of degenerative hip’s diseases in children by means of pathogenetic pattern. Methods and Materials. 56 children with Legg — Calve — Perthes syndrome aged from 4 to 12 years and 20 children of control group without hip’s diseases have been studied. Results. The modern principles of surgical treatment of Legg — Calve — Perthes syndrome in children have been identified. Conclusion. The results of surgical treatment of patients with a different degree of pathological process depending on a type of surgery (osteoplastic surgery, formation of vascularizing autotransplant, varus osteotomy, rotational intertrochanteric osteotomy) have been presented

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ИЗОЛИРОВАННОЙ АСЕПТИЧЕСКОЙ НЕСТАБИЛЬНОСТИ ВЕРТЛУЖНОГО КОМПОНЕНТА У ПАЦИЕНТОВ СО СТАБИЛЬНЫМ ФЕМОРАЛЬНЫМ КОМПОНЕНТОМ

Background: Aseptic acetabular loosening currently occupies the 1st place in the structure of delayed complications after total hip arthroplasty. The basis of treatment is the replacement of a loosening cup and a pair of friction. The tactics of surgical treatment of the stable correctly oriented femoral component have not been determined, thoroughly which confirms the relevance of the study.Aims: Compare the effectiveness of total hip revision and isolated acetabular revision in patients with aseptic acetabular loosening and stable correctly oriented femoral component.Materials and methods: The study presented the results of surgical treatment performed in 44 patients (45 revisions) with isolated aseptic acetabular loosening and stable correctly oriented femoral component were presented, Patients were divided into two groups depending on the severity of surgery. The first group included 16 patients with a total revision due to irregular cone of the stem. The second group included 28 patients (29 revisions) with an isolated replacement of the unstable cup and a pair of friction.Results: In the 1st group, revision surgery was performed to replace both cup with the friction pair and stable correctly oriented stem which finally results in lower postoperative red blood counts (erythrocytes, hemoglobin, hematocrit), as well as higher intraoperative blood loss volume and longer duration of surgical intervention if compare to the 2nd group where the stable correctly oriented femoral component was not changed. Postoperative results assessed using Harris scales and Oxford Hip Score in the comparison group were at a higher level during the whole period of follow-up. A moderate coorelation between the severity of the revision intervention and its results was detected.Conclusions: Preservation of a stable correctly oriented stem allows to reduce the severity of the revision intervention which improves the results and shortens the period of patient rehabilitation.Обоснование. Асептическая нестабильность вертлужного компонента в настоящее время занимает первое место в структуре отдаленных осложнений тотального эндопротезирования тазобедренного сустава. Основу лечения составляет замена расшатанной чашки эндопротеза и пары трения (головка-вкладыш). Тактика действий в отношении же стабильного правильно ориентированного феморального компонента до сих пор не определена, что и подтверждает актуальность исследования.Цель исследования ― сравнить эффективность тотальной замены компонентов эндопротеза и изолированной ревизии чашки эндопротеза у пациентов с асептической нестабильностью вертлужного компонента и стабильным правильно ориентированным феморальным компонентом.Методы. Представлены результаты проспективного контролируемого исследования 44 пациентов (45 ревизий) с изолированной асептической нестабильностью вертлужного компонента и стабильным правильно ориентированным феморальным компонентом, которые в зависимости от объема проведенного вмешательства были разделены на две группы. В 1-ю группу были включены 16 пациентов (16 ревизий) с тотальной ревизией компонентов эндопротеза по причине отсутствия головок под нестандартный конус ножки. Во 2-ю группу вошли 28 пациентов (29 ревизий) с изолированной заменой расшатанной чашки эндопротеза и пары трения.Результаты. В 1-й группе, где ревизионное вмешательство помимо замены нестабильной чашки эндопротеза и пары трения включало удаление и замену стабильной правильно ориентированной ножки эндопротеза, были получены более низкие послеоперационные показатели красной крови (эритроциты, гемоглобин, гематокрит), а также более высокие значения объема интраоперационной кровопотери и продолжительности оперативного вмешательства, чем во 2-й группе, где стабильный правильно ориентированный феморальный компонент сохранялся. Послеоперационные результаты, оцененные при помощи шкал Харриса и Oxford Hip Score, во 2-й группе на всех сроках наблюдения находились на более высоком уровне. Между тяжестью ревизионного вмешательства и его результатами была выявлена корреляционная связь средней силы.Заключение. Сохранение стабильного правильно ориентированного феморального компонента позволяет снизить тяжесть ревизионного вмешательства, что способствует улучшению его результатов и сокращению сроков реабилитации пациентов

The method of controlled growth for the correction of axial deformities of lower extremities in children

Aim: to estimate the outcomes of the method of controlled growth in the correction of axial deformities of lower extremities in children. Material and Methods. We fulfilled the analysis of surgical results of 37 children aged 3-13 yrs. with leg axial deformities, valgus (20) and varus (17) leg deformities at the level of knee joints. All patients were operated in the growth area with the method of controlled growth — temporary epiphysiodesis of external portions of distal growth areas in femoral bones. The assessment of controlled growth method was conducted at 3-14 months for valgus and 6-15 months for varus leg deformities. Results. The assessment of controlled growth method use indicated clinically and X-ray proved reduction in femoral-tibial angle before the elimination of metal construction in valgus deformity 4.1 times, in varus 3.8 times. Conclusion. The method of controlled growth is highly effective correction method for axial deformities of lower extremities in children, and is minimally traumatizing.</p

Comprehensive approach to the assessment of the functional status of patients with degenerative joint diseases of the lower extremities

Aim: development of an integrated biomechanical index that reflects the state of kinematic and static function in patients who need replacement of large joints as well as evaluation of the myoneural complex of lower extremities activity of category of patients. Material and Methods. 103 patients with osteoarthrosis of the hip and knee joints. A biomechanical survey included podography, stabilometry and dynamometry. An electrophysiological study of the peripheral nerves of the lower extremities with the determination of the amplitude of the muscle response and late neuronal responses was carried out. The level of activity of the gluteal muscles was determined. Results. The most sensitive indicators reflecting the state of biomechanical status were identified, specialized software for the integral biomechanical index calculation was developed. Conclusion. Methods of clinical biomechanics allow specialists to assess the state of kinematic and static function of the musculoskeletal system, matching of the integral biomechanical index with the data of neurophysiological monitoring makes possible to select individual tactics of treatment.</p

Talipes equinovarus in children

The research goal of the review is to present data on etiology, prevalence, classification of different types TEN/ in children. Mechanisms of pathological foot type, indications for conservative and surgical methods of treatment have been analyzed.</p

Coxar-throsis in infancy and adolescence: opportunities of preventive treatment

The review systematizes scientific data on the major groups of heterogeneous diseases which have infant and adolescence coxarthrosis as their outcome and contains materials on etiology, pathogenesis, diagnostic, treatment and precaution methods of complication (dystrophic changes in hip joints) for each disease.</p

Biomechanical criteria of orthopedic status of patients with dysplastic coxarthrosis (Crowe) IV before and after treatment

The aim: to analyze locomotor function of lower limbs in patients with dysplastic coxarthrosis Crowe IV type before and after single-step hip joint endoprosthesis and femoral bone osteotomy conducted by our own technology. Material and Methods. 42 patients with one-side dysplastic coxarthrosis Crowe IV type were examined and operated. The mean age at the time of admission in men was 47.3±1.2 years, women — 46.1 ±1.1 years. Static and kinematic function of lower limbs was evaluated with the help of stabilometrics and podometry before and one year after the operation. Results. Before treatment, the patients had deviations of static and dynamic function of locomotor system stabilometri-cally seen as instability in upright position and podographically as a compromised gait. One year postsurgically we indicated static balance between the limbs within the normal range, expanded motoring mode, which was supported by significant improvement in the biomechanical characteristics of locomotor function of the patients. Conclusion. Total hip replacement in combination with modifying osteotomy of the hip conducted by a unique technique restores static and kinematic function of lower limbs in patients with high congenital hip dislocation (dysplastic coxarthrosis Crowe type IV) which is proved by stabilographic and podographic indices one year after operation.</p