Experience of endoscopic transcapsular axillary nerve decompression: а series of clinical cases

Background: Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after a shoulder joint trauma. It can also appear as a complication after orthopedic surgeries, for example, after the Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: a large trauma of soft tissue, severe bleeding, a high rate of complications, and also a poor cosmetic effect. The endoscopic surgical technique of decompression is an effective and less traumatic alternative to open procedures. Clinical case description: We present the results of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of patients was 44.414.9. An original surgical technique of decompression was developed and applied to all the patients which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position. The statistical analysis was performed using the MannWhitney U test. According to the VAS-scale, the severity of pain syndrome before the surgery was 64.6 points, while 6 months after the surgery it decreased to 1.40.5 points (p 0.05). According to the DASH scale, the function of the shoulder joint before the surgery was 77.66.9 points, and 6 months after surgery it increased to 125.2 points (p 0.05). According to the BMRC scale (M0M5), the strength of the deltoid muscle before the surgery was 20.4 points, and after the surgery it increased to 4.40.5 points (p 0.05). The range of motion in the shoulder joint was as follows: before the surgery flexion 10745.6, extension 10249, external rotation 2213.6; 6 months after the surgery flexion 15425.6, extension 15622.4, external rotation 508 (p 0.05). The thickness of the middle portion of the deltoid muscle according to the US was 7.21.04 mm before the surgery, 11.81.44 mm after the surgery (p 0.05). All the patients (100%) at a long-term follow-up noticed complete relief of pain and regression of the neurological symptoms. Conclusion: The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique, providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients

Опыт эндоскопического транскапсулярного невролиза подмышечного нерва

INTRODUCTION Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after shoulder joint trauma. It can also occur as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: large trauma of soft tissue, severe bleeding, high rate of complications, poor cosmetic effect. Endoscopic surgical technique of decompression is an effective, less traumatic alternative to open procedures.AIM To improve the outcomes of treatment of patients with axillary nerve neuropathy.MATERIAL AND METHODS We present the outcomes of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of the patients was 44.4±14.9. An original surgical technique of decompression, which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position, was developed and applied to all the patients. Statistical analysis was performed using the MannWhitney U test.RESULTS According to VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, 6 months after surgery it decreased to 1.4±0.5 points (p<0.05). According to DASH scale, the function of the of shoulder joint before surgery was 77,6±6,9 points, 6 months after surgery it increased to 12±5,2 points (p<0.05). According to BMRC scale (M0–M5), strength of the deltoid muscle before surgery was 2±0,4 points, after surgery it increased to 4,4±0,5 points (p<0.05). Range of motion in the shoulder joint before surgery was as follows: flexion 107±45,6°, extension 102±49°, external rotation 22±13,6°; 6 months after surgery: flexion 154±25,6°, extension 156±22,4°, external rotation 50±8° (p<0,05). The thickness of the middle portion of the deltoid muscle according to ultrasound examination before the surgery was 7.2±1.04 mm, after surgery 11.8±1.44 mm (p<0.05). All the patients (100%) during long follow-up noticed complete relief of pain and regression of neurological symptoms.CONCLUSION The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.АКТУАЛЬНОСТЬ Посттравматическая нейропатия подмышечного нерва является достаточно распространенной патологией при травмах области плечевого сустава. Стандартным вмешательством в таких случаях является открытый невролиз подмышечного нерва, который в силу анатомического расположения нервного ствола травматичен, сопровождается относительно высокой частотой осложнений, обладает плохим косметическим эффектом. Малоинвазивной альтернативой открытому невролизу является эндоскопическая хирургическая техника.ЦЕЛЬ Улучшить результаты лечения пациентов с посттравматической нейропатией подмышечного нерва.МАТЕРИАЛ И МЕТОДЫ За период с 2018 по 2021 год нами были прооперированы 5 пациентов с клинической картиной посттравматической нейропатии подмышечного нерва. Всем больным была выполнена артроскопия плечевого сустава с диагностическим и лечебным компонентами, транскапсулярный эндоскопический невролиз подмышечного нерва по оригинальной методике. Статистическое сравнение параметров проводилось согласно критерию Манна–Уитни.РЕЗУЛЬТАТЫ Средний возраст пациентов составил 44,4±14,9 года. По шкале ВАШ интенсивность болевого синдрома до операции составила 7±1 балл, через 6 месяцев после операции боль уменьшилась и составила в среднем 1±0,4 балла (p<0,05). По шкале DASH функция плечевого сустава до операции была 77,6±6,9 балла, через 6 месяцев после операции составила 12±5,2 балла (p<0,05). По шкале BMRC (M0–M5) сила дельтовидной мышцы до операции составляла 2±0,4 балла, а после операции увеличилась до 4,6±0,5 балла (p<0,05). Амплитуда движений в плечевом суставе до операции: сгибание 107±45,6°, отведение 102±49°, наружная ротация 22±13,6°, через 6 месяцев после операции возросла до: сгибание 154±25,6°, отведение 156±22,4°, наружная ротация 50±8° (p<0,05). Толщина среднего пучка дельтовидной мышцы, по данным ультразвукового исследования, до операции составила в среднем 7±0,8 мм, через 6 месяцев после операции 10,6±1,1 мм (p<0,05).ЗАКЛЮЧЕНИЕ Полученные результаты позволяют охарактеризовать методику эндоскопического невролиза как воспроизводимую, малотравматичную и эффективную, которая позволяет уменьшить интенсивность болевого синдрома и способствует раннему восстановлению функции верхней конечности

Сравнение реологических и вязкоупругих свойств медицинских изделий гиалуроновой кислоты для внутрисуставного введения

Osteoarthritis (OA) is the most common joint disease that affects more than 80% of people over 55 years and in its final stages leads to disability. One of the safe non-surgical methods of OA treatment is intra-articular injections of hyaluronic acid (HA).Objective: to compare the viscoelastic rheological properties of HA medical products with different concentrations of sodium hyaluronate (SH) available in the Russian Federation.Material and methods. The study was carried out using a modular rheometer MCR 302 (Anton Paar, Austria). All measurements were carried out at a temperature of 25.0±0.1 °C using the measuring system "cone-plane" (angle – 2 ˚ , cone diameter – 40 mm, gap height – 0.169 mm). The determination of the elastic moduli (G’) and viscosity (G”) was carried out depending on the frequency in the linear region of the shear stress, and the dynamic viscosity was determined at a shear rate of 1 sec-1.Results. The evaluation of the rheological properties of the studied samples revealed a positive relationship with the concentration of SH and no relationship with the molecular weight of SH. The highest viscoelastic properties were possessed by medical products in the 1% SH group: Armaviscon and Ripart; in the group with SH concentration of 1.5–1.6%, all the studied samples, except for Hyalubrix, showed similar higher results compared to the previous group; in the group with SH concentration of 2–3%, Armaviscon Platinum had the highest results and Flexotron Ultra and Armaviscon Forte – somewhat lower results.Conclusion. The study of the rheological viscoelastic properties of HA medical products is the most accessible method, on the basis of which it is possible to predict the clinical effect.Остеоартрит (ОА) – наиболее распространенное заболевание суставов, которое поражает более 80% лиц старше 55 лет и на последних стадиях приводит к инвалидности. Одним из безопасных неоперативных методов лечения ОА является использование внутрисуставных инъекции медицинских изделий гиалуроновои кислоты (ГлК).Цель исследования – сравнение вязкоупругих реологических свойств медицинских изделий ГлК с различной концентрацией гиалуроната натрия (ГН), доступных для использования в Российской Федерации.Материал и методы. Исследование проводилось с помощью модульного реометра MCR 302 (Anton Paar, Австрия). Все измерения выполнялись при температуре 25,0±0,1 °С с использованием измерительной системы «конус-плоскость» (угол – 2°, диаметр конуса – 40 мм, высота зазора – 0,169 мм). Определение модулей упругости (G’) и вязкости (G”) осуществляли в зависимости от частоты в линейной области напряжения сдвига, а динамической вязкости – при скорости сдвига 1 с-1.Результаты и обсуждение. Оценка реологических свойств исследуемых образцов выявила положительную связь с концентрацией ГН и отсутствие связи с молекулярной массой ГН. Самыми высокими вязкоупругими свойствами обладали медицинские изделия в группе с концентрацией ГН 1%: Армавискон и Рипарт; в группе с концентрацией ГН 1,5–1,6% все исследуемые образцы, кроме Хиалубрикса, показали схожие, более высокие по сравнению с предыдущей группой, результаты; в группе с концентрацией ГН 2–3% наиболее высокие показатели имел Армавискон Платинум и несколько меньшие – Флексотрон Ультра и Армавискон Форте.Заключение. Изучение реологических вязкоупругих свойств медицинских изделий ГлК является наиболее доступным методом, на основании которого можно прогнозировать клинический эффект

Хирургическое лечение заднелатеральной ротационной нестабильности локтевого сустава: систематический обзор

Posterolateral rotational instability (PLRI) of the elbow joint can occur acutely as a result of dislocation of the bones of the forearm, and also be chronic, for example, after inadequate healing of a previous rupture of the lateral ligamentous complex, in particular the lateral ulnar collateral ligament (LUCL). It is necessary to take into account that, as a result of repeated microtraumas, persistent pain syndrome and recurrence of dislocation develop, which can lead to disability. We conducted a systematic review of the literature according to the protocol outlined in the PRISMA guidelines. From 1,903 publications, 11 studies were selected that met our criteria and assessed the results of treatment of 181 patients. The main reason for the development of PLRI was simple traumatic dislocation of the forearm bones (37.5%). Of the studies that assessed the elbow joint using the MEPS, 86.5% of patients had excellent or good results, with a mean MEBS score of 91 points. Before surgery, pain syndrome was present in 131 patients (87.3%) out of 150, and in the postoperative period it was observed in 55 (36.6%) out of 150 (p=0.01). The incidence of recurrent instability after surgery was observed in 6.6% of patients. A review of the literature on the problem of the elbow joint shows that this problem has not been fully studied, treatment strategies differ and should be performed based on the surgeon’s experience and available data, however, it has been proven that the key to the stability of the elbow joint is the LUCL, which requires its restoration through its refixation or plastic surgery.Заднелатеральная ротационная нестабильность (ЗЛРН) локтевого сустава может возникать остро в результате вывиха костей предплечья, а также быть хронической, например, после неадекватного заживления ранее произошедшего разрыва латерального связочного комплекса, в частности латеральной локтевой коллатеральной связки (ЛЛКС). Необходимо учитывать то, что вследствие повторяющихся микротравм развивается стойкий болевой синдром, рецидив вывиха, что может приводить к инвалидности. Нами был проведен систематический обзор литературы в соответствии с протоколом, изложенным в рекомендациях PRISMA. Из 1903 публикаций были отобраны 11 исследований, соответствующих нашим критериям и оценкой результатов лечения 181 пациента. Основной причиной развития ЗЛРН был простой травматический вывих костей предплечья (37,5%). Из исследований, в которых проводили оценку локтевого сустава по шкале MEPS, у 86,5% пациентов были отличные или хорошие результаты со средним значением MEBS=91 балл. До операции болевой синдром присутствовал у 131 пациента (87,3%) из 150, а в послеоперационном периоде у 55 (36,6%) из 150 (р=0,01). Частота рецидивирующей нестабильности после операции отмечалась у 6,6% пациентов. Анализ литературы по проблеме ЗЛРН локтевого сустава показывает, что данная проблема до конца не изучена, стратегии лечения различаются и должны выполняться на основе опыта хирурга и имеющихся данных, однако доказано, что ключом к стабильности локтевого сустава является ЛЛКС, которая требует своего восстановления путем ее рефиксации или пластики

Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites

[EN] Insights within thermal expansion, conductivity, and decomposition dependencies with temperature on symmetrical and unsymmetrical layered carbon (CF) or basalt (BF) fabrics in combination with flax fibers (FF) were approached. Driven by commercial application and environmental concerns, the paper draws attention on a modified formula of cyanate ester with a common epoxy resin under an optimized ratio of 70:30 (vol%) as well as on the hybrid reinforcements stacking sequences. Synergetic effects were debated in terms of the CF and BF stacking sequences and corresponding volume fraction followed by comparisons with values predicted by the deployment of hybrid mixtures rules (RoHM/iRoHM). CF hybrid architectures revealed enhanced effective thermophysical properties over their BF counterparts and both over the FF-reinforced polymer composite considered as a reference. Thermal conductivities spread between 0.116 and 0.299 W m-1 K-1 from room temperature up to 250 C on all hybrid specimens, giving rise to an insulator character. Concerning the coefficient of thermal expansion, CF hybrid architectures disclosed values of 1.236 10-6 K-1 and 3.102 10-6 K-1 compared with BF affine exhibiting 4.794 10-6 K-1 and 6.245 10-6 K-1, respectively, with an increase in their volume fraction.The corresponding author gratefully acknowledges the financial assistance of German Academic Exchange Service-DAAD that enabled and supported the internship with Fraunhofer Research Institution for Polymeric Materials and Composites-PYCO, Germany. Many thanks go to Dr. Christian Dreyer and Dr. Maciej Gwiazda for the resin formula and access to the composite manufacturing technology.Motoc, DL.; Ferrándiz Bou, S.; Balart, R. (2018). Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites. Journal of Thermal Analysis and Calorimetry. 133(1):509-518. https://doi.org/10.1007/s10973-018-7222-yS5095181331Assarar M, Zouari W, Sabhi H, Ayad R, Berthelot J-M. Evaluation of the damping of hybrid carbon–flax reinforced composites. Compos Struct. 2015;132:148–54.Duc F, Bourban PE, Plummer CJG, Månson JAE. Damping of thermoset and thermoplastic flax fibre composites. Compos A Appl Sci Manuf. 2014;64:115–23.Saba N, Jawaid M, Alothman OY, Paridah MT. A review on dynamic mechanical properties of natural fibre reinforced polymer composites. Constr Build Mater. 2016;106:149–59.Tian H, Zhang S, Ge X, Xiang A. Crystallization behaviors and mechanical properties of carbon fiber-reinforced polypropylene composites. J Therm Anal Calorim. 2017;128(3):1495–504.Alvarez V, Rodriguez E, Vázquez A. Thermaldegradation and decomposition of jute/vinylester composites. J Therm Anal Calorim. 2006;85(2):383–9.Manfredi LB, Rodríguez ES, Wladyka-Przybylak M, Vázquez A. Thermal degradation and fire resistance of unsaturated polyester, modified acrylic resins and their composites with natural fibres. Polym Degrad Stab. 2006;91(2):255–61.Lazko J, Landercy N, Laoutid F, Dangreau L, Huguet MH, Talon O. Flame retardant treatments of insulating agro-materials from flax short fibres. Polym Degrad Stab. 2013;98(5):1043–51.Bar M, Alagirusamy R, Das A. Flame retardant polymer composites. Fibers Polym. 2015;16(4):705–17.Kollia E, Loutas T, Fiamegkou E, Vavouliotis A, Kostopoulos V. Degradation behavior of glass fiber reinforced cyanate ester composites under hydrothermal ageing. Polym Degrad Stab. 2015;121:200–7.Jawaid M, Abdul Khalil HPS. Cellulosic/synthetic fibre reinforced polymer hybrid composites: a review. Carbohyd Polym. 2011;86(1):1–18.Azwa ZN, Yousif BF, Manalo AC, Karunasena W. A review on the degradability of polymeric composites based on natural fibres. Mater Des. 2013;47:424–42.H-y Cheung, M-p Ho, K-t Lau, Cardona F, Hui D. Natural fibre-reinforced composites for bioengineering and environmental engineering applications. Compos B Eng. 2009;40(7):655–63.Dittenber DB, GangaRao HVS. Critical review of recent publications on use of natural composites in infrastructure. Compos A Appl Sci Manuf. 2012;43(8):1419–29.Faruk O, Bledzki AK, Fink H-P, Sain M. Biocomposites reinforced with natural fibers: 2000–2010. Prog Polym Sci. 2012;37(11):1552–96.Praveen RS, Jacob S, Murthy CRL, Balachandran P, Rao YVKS. Hybridization of carbon–glass epoxy composites: an approach to achieve low coefficient of thermal expansion at cryogenic temperatures. Cryogenics. 2011;51(2):95–104.Jawaid M, Abdul Khalil HPS, Alattas OS. Woven hybrid biocomposites: dynamic mechanical and thermal properties. Compos A Appl Sci Manuf. 2012;43(2):288–93.Swolfs Y, Gorbatikh L, Verpoest I. Fibre hybridisation in polymer composites: a review. Compos A Appl Sci Manuf. 2014;67:181–200.Rojo E, Alonso MV, Oliet M, Del Saz-Orozco B, Rodriguez F. Effect of fiber loading on the properties of treated cellulose fiber-reinforced phenolic composites. Compos B Eng. 2015;68:185–92.LeGault M. Natural fiber composites: market share, one part at the time. Compos World. 2016;5(2):68–75.Joshi SV, Drzal LT, Mohanty AK, Arora S. Are natural fiber composites environmentally superior to glass fiber reinforced composites? Compos A Appl Sci Manuf. 2004;35(3):371–6.Wambua P, Ivens J, Verpoest I. Natural fibres: can they replace glass in fibre reinforced plastics? Compos Sci Technol. 2003;63(9):1259–64.Bertomeu D, García-Sanoguera D, Fenollar O, Boronat T, Balart R. Use of eco-friendly epoxy resins from renewable resources as potential substitutes of petrochemical epoxy resins for ambient cured composites with flax reinforcements. Polym Compos. 2012;33(5):683–92.Alam M, Akram D, Sharmin E, Zafar F, Ahmad S. Vegetable oil based eco-friendly coating materials: a review article. Arab J Chem. 2014;7(4):469–79.Bakare FO, Ramamoorthy SK, Åkesson D, Skrifvars M. Thermomechanical properties of bio-based composites made from a lactic acid thermoset resin and flax and flax/basalt fibre reinforcements. Compos A Appl Sci Manuf. 2016;83:176–84.Pardauil JJR, de Molfetta FA, Braga M, de Souza LKC, Filho GNR, Zamian JR, et al. Characterization, thermal properties and phase transitions of amazonian vegetable oils. J Therm Anal Calorim. 2017;127(2):1221–9.Głowińska E, Datta J, Parcheta P. Effect of sisal fiber filler on thermal properties of bio-based polyurethane composites. J Therm Anal Calorim. 2017;130(1):113–22.Mosiewicki MA, Aranguren MI. A short review on novel biocomposites based on plant oil precursors. Eur Polym J. 2013;49(6):1243–56.Lligadas G, Ronda JC, Galià M, Cádiz V. Renewable polymeric materials from vegetable oils: a perspective. Mater Today. 2013;16(9):337–43.Fombuena V, Sanchez-Nacher L, Samper MD, Juarez D, Balart R. Study of the properties of thermoset materials derived from epoxidized soybean oil and protein fillers. J Am Oil Chem Soc. 2013;90(3):449–57.Pil L, Bensadoun F, Pariset J, Verpoest I. Why are designers fascinated by flax and hemp fibre composites? Compos A Appl Sci Manuf. 2016;83:193–205.Wooster TJ, Abrol S, Hey JM, MacFarlane DR. Thermal, mechanical, and conductivity properties of cyanate ester composites. Compos A Appl Sci Manuf. 2004;35(1):75–82.Mallarino S, Chailan JF, Vernet JL. Glass fibre sizing effect on dynamic mechanical properties of cyanate ester composites I. Single frequency investigations. Eur Polym J. 2005;41(8):1804–11.Sothje D, Dreyer C, Bauer M, editors. Advanced possibilities in thermoset recycling. In: The 3rd international conference on thermosets. 2013; Berlin, Germany.Yuan L, Huang S, Gu A, Liang G, Chen F, Hu Y, et al. A cyanate ester/microcapsule system with low cure temperature and self-healing capacity. Compos Sci Technol. 2013;87:111–7.Czigány T. Special manufacturing and characteristics of basalt fiber reinforced hybrid polypropylene composites: mechanical properties and acoustic emission study. Compos Sci Technol. 2006;66(16):3210–20.Marom G, Fischer S, Tuler FR, Wagner HD. Hybrid effects in composites: conditions for positive or negative effects versus rule-of-mixtures behaviour. J Mater Sci. 1978;13(7):1419–26.Torquato S. Random heterogeneous materials: microstructure and macroscopic properties. New York: Springer; 2002.Cherki A-B, Remy B, Khabbazi A, Jannot Y, Baillis D. Experimental thermal properties characterization of insulating cork–gypsum composite. Constr Build Mater. 2014;54:202–9.Bismarck A, Aranberri-Askargorta I, Springer J, Lampke T, Wielage B, Stamboulis A, et al. Surface characterization of flax, hemp and cellulose fibers; Surface properties and the water uptake behavior. Polym Compos. 2002;23(5):872–94.Motoc Luca D, Ferrandiz Bou S, Balart Gimeno R. Effects of fibre orientation and content on the mechanical, dynamic mechanical and thermal expansion properties of multi-layered glass/carbon fibre-reinforced polymer composites. J Compos Mater. 2014;49(10):1211–1221.CES EduPack. Granta Design; 2013.Monteiro SN, Calado V, Rodriguez RJS, Margem FM. Thermogravimetric behavior of natural fibers reinforced polymer composites—An overview. Mater Sci Eng, A. 2012;557:17–28

A COMPARISON OF RESULTS BETWEEN HOOK PLATE AND TIGHTROPE FOR ACUTE ACROMIOCLAVICULAR JOINT DISLOCATION

Purpose the study - despite of this fact that there are different surgical techniques to treat acromioclavicular dislocation and also the surgery remains controversial, the purpose of our study is to compare the results of surgery treatment to acromioclavicular joint dislocation on the condition of surgical method: Hook Plate versus TightRope. Between 2015 and 2019, 30 patients were with acute Rockwood type III-VI acromioclavicular dislocation at the age of 23-54. Patients were divided into 2 groups according to the surgical methods (Hook plate: n=15; TightRope: n=15)to compare the functional outcome after using either Hook plate and TightRope stabilization. Patients were evaluated using Constant Score and radiography. Comparing the functional results, were observed some differences between the two groups. According to Constant Score the results were: Hook plate - 78.5, TightRope - 81.4. 14 patients in the hook plate group were reoperated to remove the device, except 1 patient who refused to be reoperated. There was insignificant difference between both groups regarding severity pain. The majority of tightrope group (70%) regained their normal functional activities, whereas only 40% of the hook plate patients did (р<0.001)/ About half (50%) of the tightrope group in comparison with 30% of hook plate group had active forward flexion more than 150° (р<0.01). Both groups showed no significant differences regarding degree of muscle strength, patients' satisfaction, and total outcome. Both operative methods are effective techniques and could be recommended to treat an acute acromioclavicular joint dislocation. Between the two groups are no significant differences. However, TightRope fixation provides a low rate of failure and complications and avoids the need for second surgery to remove the implant

Remedial sanation arthroscopy in gouty arthropathy of the knee joint

Tsel' issledovaniya. Izuchali effektivnost' artroskopicheskoy sanatsii u patsientov s podagricheskoy artropatiey kolennogo sustava. Material i metody. Lechebnuyu sanatsionnuyu artroskopiyu vypolnyali 36 bol'nym podagroy s mnogoletnim anamnezom zabolevaniya i porazheniem kolennogo sustava. Pokazaniem k artroskopii schitali khronicheskiy artrit, rezistentnyy k standartnomu lecheniyu, a takzhe nalichie vyrazhennoy funktsional'noy nedostatochnosti porazhennogo kolennogo sustava. Pri sanatsionnoy artroskopii naryadu s aktivnym promyvaniem sustava vypolnyali ochishchenie sustavnykh poverkhnostey ot obshirnykh skopleniy uratnykh depozitov s pomoshch'yu artroskopicheskoy sheyvernoy frezy. Rezul'taty issledovaniya. Otmecheny khoroshaya perenosimost' dannoy operatsii, a takzhe vyrazhennyy protivovospalitel'nyy effekt i znachitel'noe uluchshenie funktsii kolennogo sustava na protyazhenii 2 let posleoperatsionnogo nablyudeniya. Avtory polagayut, chto nakoplenie bol'shoy massy uratov v sustave yavlyaetsya vazhnym faktorom khronizatsii podagricheskogo artrita i opredelyayushchim faktorom formirovaniya biomekhanicheskikh narusheniy v kolennom sustave. Zaklyuchenie. Predlozhennaya avtorami metodika sanatsionnoy artroskopii znachitel'no rasshiryaet spektr lechebnykh vozmozhnostey i pozvolyaet optimizirovat' lechebnuyu taktiku pri khronicheskom podagricheskom artrite kolennogo sustava

EXPERIENCE OF USING INSPACE SUBACROMIAL BALLOON FOR TREATMENT OF PATIENTS WITH LARGE AND MASSIVE ROTATOR CUFF TEARS

The large and massive rotator cuff tears lead to a significant decrease in the shoulder joint (SJ) function and the development of severe pain syndrome in it. Frequently, such injuries are difficult to recover fully, and the number of relapses after their recovery is quite high. The combined method of rotator cuff repair single-row suture anchor technique with concomitant use of a subacromial balloon spacer, allows to achieve the best results in the treatment of this group of patients. Objective - improvement of the treatment results in patients with large and massive rotator cuff injuries. The results of treatment using a single-row suture anchor technique with concomitant use of a subacromial balloon spacer have been described in 25 patients (mean age 58±5 years) with large and massive rotator cuff injuries. In the study were involved the patients with 1-2 grade of fatty muscle atrophy according to the Goutallier classification, and retraction of the damaged tendons did not exceed 2 degrees. The mean UCLA activity scores prior to the surgery was 16±3 points (15-19), and in 12 months after the surgery 33±1 points (32-34), respectively. All the results obtained were regarded as: good and excellent. The obtained results evidence the advantage of the combined method of rotator cuff repair by insulated suture

CLINICAL CASE OF ENDOSCOPIC BRACHIAL PLEXUS DECOMPRESSION IN A PATIENT WITH ROTATOR CUFF RUPTURE AND POST TRAUMATIC PLEXOPATHY

Posttraumatic brachial plexopathy - is an actual problem, which is usually seen after shoulder area trauma and is often accompanied with intraarticular pathology. In case of failed conservative treatment, open brachial plexus decompression is an effective procedure, however, it is pretty traumatic and is accompanied by number of complications and recurrences, what explains the necessity of development of low-traumatic, miniinvasive alternative techniques. Purpose - develop a new mini-invasive endoscopic technique of brachial plexus decompression. The new technique of fully endoscopic brachial plexus decompression was developed and presented in a 60-years old male patient with posttraumatic plexopathy and rotator cuff tear. Short-term clinical results were followed-up. The patient had a severe neuropathic pain syndrome in shoulder area before the surgery, there were neurologic impairments in upper extremity. The aspects of surgical technique are represented step-by-step. According to VAS scale the severity of pain syndrome in the patient before the surgery was 9 points, 6 months after surgery decreased to 2 points. Patient underlines the regression of neurologic problems, increasing of strength in the hand. The preliminary results do let us characterize the developed technique of endoscopic brachial plexus decompression as a low-traumatic and effective alternative to open decompression, which eliminates pain syndrome and promotes early restoration of normal function of arm in patients with post-traumatic brachial plexus pathology, and which can be easily combined with intra-articular pathology treatment - rotator cuff rupture suturing