[Endoscopic total hip replacement in conditions of acetabulum bone structures deficiency].

76 patients with acetabulum defects of posttraumatic, oncologic, displastic or systemic character, as wall as due to complications after previous hip replacement, were operated on. The author's non-tensioned acetabular component installation technique worked out for the endoscopic total hip replacement was used. Long-term follow-up results were considered to be successful in 88.6% of cases. Maximal follow-up period is 10 years.

[Surgical treatment of chronic purulent diseases of extremities' bones and great joints].

Results of treatment of chronic purulent diseases of extremities' bones (n=414) and great joints (n=136) were analyzed. Combined treatment included surgical sanation of the inflammatory focus, autospongioplasty of residual cavities and defects after sequesterectomy (87 cases), extrafocal osteosynthesis, aspiration- flushing drainage. In 46 cases of severe suppuration in the zone of hip joint's endoprosthesis the resection arthroplasty was performed, in 43 cases of severe consequences of ankle-joint's fracture-dislocations -- compression talo-tibial and calcaneo-tibial arthrodesis. The follow-up was 15 years. Positive results were seen in 93.6% patients.

[Development and clinical use of autohemotransfusion during elective surgeries for severe locomotor system diseases].

Autohemotransfusion is applied widely in the Division of Orthopedic Surgery of Moscow Regional Research Clinical Institute during elective reconstructive surgeries on the locomotor system. The paper shows that the method allows 90% reduction in donor blood transfusion, and its application to orthopedic patients is effective, provided that indications for it are determined correctly.

[Endoprosthesis of great joints of extremities in difficult anatomic conditions]. / Endoprotezirovanie krupnykh sustavov konechnostei v slozhnykh anatomicheskikh usloviiakh.

Experience in endoprosthesis of great joints in 408 patients in difficult clinical cases associated with defects and deformations of bones of posttraumatic, oncological, dysplastic and systemic character, and also in the cases of complications after primary endoprosthesis is analyzed. Special constructions of implants, instruments, surgical technique were used depending on anatomic and functional changes. Results of endoprosthesis of great joints were accessed as successful in 95% patients in maximal period of follow-up during 13 years.

[Bioelectric myocardial activity in orthopedic surgery with autohemotransfusion]. / Bioélektricheskaia aktivnost' miokarda pri khirurgicheskikh vmeshatel'stvakh v ortopedii s primeneniem autogemotransfuzii.

20 patients who have undergone difficult operations on locomotor apparatus with autohemotransfusion were examined. Twenty-four-hour ECG-monitoring before and after operation was used for registration of bioelectric myocardial activity. Tachycardia, in night time chiefly, disorders of circadian cardiac rhythm, ischemic depression of ST-segment without clinical symptoms were revealed in all the patients in postoperative period. These disorders are maximal in older age group that must be taken into account during planning surgery and hemotransfusion.

[Use of autoblood and its components in orthopedics and traumatology]. / Primenenie autokrovi i ee komponentov v ortopedii i travmatologii.

The results of the autoblood donation in 304 patients with complex surgical operations in orthopedics and traumatology are analyzed. The method of the intraoperation blood loss compensation with own red cells is offered. It should be noted that the red cells must be prepared 2 days and less before the operation. The use of modern methods of autoblood donation allowed to reduce 3 times the requirement in homologous blood.

[Surgical treatment of chronic post-traumatic osteomyelitis of the femur in pseudarthrosis, ununited fractures and defects]. / Khirurgicheskoe lechenie khronicheskogo posttravmaticheskogo osteomielita bedrennoi kosti pri lozhnykh sustavakh, nesrosshikhsia perelomakh i defektakh.

The authors have analyzed the results of treatment for chronic posttraumatic osteomyelitis of the femoral bone in 69 cases of ununited fractures, false joints ad femoral bone defects. The treatment included surgical sanation of the osteomyelitic nidus together with aspiration lavage drainage and extranidal osteosynthesis by external fixation as well as local and general antibacterial therapy. In 13 cases free bone autoplasty of the osteomyelitic cavities or defects was used together with spongious structures of iliac bone (crest and wing), in 2 of these patients it was applied for replacement of the large defects of the diaphysis of the femoral bone (8 and 12 cm). In 57 patients surgical treatment was carried out in one stage, a major requisite for this was the opportunity for joining bone fragments inside the open wound after sequestrectomy as well as stable external fixation by the apparatus. This treatment gave successful results in 97% of patients.

Treatment of neglected complicated multiple musculoskeletal injuries.

Two hundred eighty-nine patients with multiple bone fractures who had combined impairment of bones and soft tissues were treated from 1960 to 1993 in the authors' institution. All patients were transferred from local hospitals of the Moscow district between several months and 3 years after trauma, and had neglected fractures complicated by dislocations, false joints, and imperfectly united bone fractures. The authors prefer an individual approach to patient treatment and used simultaneous surgical intervention on several bone segments using stable osteosynthesis with AO-POLDI plates and the Ilizarov apparatus. Two-stage operations were done in cases of > or = 3 injured segments. Positive results with restoration of the extremity and its supporting motor systems were obtained in 96% of patients.

[Osseous stable functional osteosynthesis in the sequelae of bone and joint diseases and injuries]. / Nakostnyi stabilno-funktsionalnyi osteosintez pri posledstviiakh zabolevanii i povrezhdenii kostei i sustavov.

The method of osteosynthesis association was applied in 1,000 patients with sequelae of diseases and injuries of large joints and bones of the limbs. The results show that stable-functional osteosynthesis with compression plates is a very effective modern method of surgical treatment of patients with serious sequelae of injuries and diseases of the epi-meta-diaphyseal parts of the bone and must be used more extensively in practice.

[Compression arthrodesis of the hip joint]. / Kompressionnyi artrodez tazobedrennogo sustava.

The results of surgical treatment of grave degenerative dystrophic, traumatic, and inflammatory coxarthroses are discussed. Employment of present-day compression arthrodesis with metal plates designed by the authors helped achieve the union of articulated bones in 97% of 170 patients. This method essentially improves the results of treatment, as against the traditional methods; due to solid fixation of compressed bones the terms of complete rehabilitation of patients are shortened, and no prolonged immobilization with a plaster bandage is necessary.

[Experience in the use of AO-Poldy implants for supraosseus osteosynthesis]. / Opyt ispol'zovaniia implantatov AO-Pol'di dlia nakostnogo osteosinteza.

Having used since 1968 in MONICI the massive metal plates of different configuration and size, developed by Swiss association of osteosynthesis AO and Czechoslovakian company Poldy, the authors summarize the experience of great clinical material. Altogether, there have been operated over 1000 patients with recent and inveterate fractures of tubular bones, pseudoarthroses, incorrectly consolidated fractured fragments, and 603 of them in MONICI. Some of the implants have been adapted by the authors. In doing so, AO principles and techniques were thoroughly observed. Positive results obtained at 96% of patients with grave bone pathology demonstrate expediency of more broad introduction of the mentioned implants for supraosseous osteosynthesis in our country.

[Several aspects of general biological concept of osteogenesis]. / Nekotorye aspekty obshchebiologicheskoi kontseptsii osteogeneza.

Basing on the literature data and their own findings, the authors present the general biological concept of osteogenesis. The significance of copper compounds (ceruloplasmin) in bone tissue synthesis was revealed; the role of bound iron (transferrin) in the development and maintenance of the inflammatory process induced by opportunistic bacteria and in bone regeneration was confirmed. Analysis of clinical and microbiological findings in the patients with chronic posttraumatic osteomyelitis, coral uroliths, gastrointestinal diseases complicated by cholelithiasis has lead the authors to a suggestion that fecal microcenosis may become one of the criteria for estimating mineral metabolism in the body; the markers of this metabolic disorders are shifted levels of full-value E. coli, Lactobacilli, and, to a lesser degree, of L. bifidum. The presence of E. coli hemolytic variant also essentially contributes to these disorders, when its level surpasses by 2-3 orders the level of this microorganism in normal subjects and in patients whose mineral metabolism is virtually unchanged. When planning multiple-modality treatment of patients with locomotor system defects and disordered salt metabolism, a physician should investigate intestinal biocenosis and prescribe agents to correct the detected disorders.

[Surgical correction of deformities of the knee joint]. / Operativnaia korrektsiia deformatsii v oblasti kolennogo sustava.

Fifty-nine knee joint deformities were corrected by supracondylar (24 surgeries) and subcondylar (35 cases) osteotomies. Stable fixation with massive submerged implants and Ilizarov's devices promoted a functional management during the postoperative period. Osteotomies are advisable before degenerative dystrophic changes develop in the joint. It should be borne in mind that arthrosis severity and advanced age of the patients are not contraindications against corrective osteotomies if the knee joint mobility is intact. The clinical result depends on the adequacy of the deformation hypercorrection. Despite the absence of an essential regression of degenerative changes in the joint, 35 of the 38 patients evidenced neither pain nor pain alleviation, and improvement of the motor activity in a year after surgery.