[Nonreconstructive revascularizing operations in limb ischaemia].

Presented herein are the findings of experimental studies substantiating interrelationship between osteogenesis and blood circulation, as well as effects of surgical interventions based on excitation of reparative regeneration of the bone and aimed at improvement of blood circulation in the extremities. Reflected also are the main indications for the use of each operative intervention concerned. Based on the clinical findings obtained by follow up of 1,477 patients operated on for limb ischaemia secondary to obliterating arterial lesions efficacy of the methods of treatment devised is demonstrated.

[Diagnostic significance of podography in patients with gonarthrosis].

Results of podography in 48 women aged 24-62 (46.6 +/- 2) years with bilateral gonarthrosis of metabolic/dystrophic etiology (grade I, II, III by N.S. Kosinskaya's osteoarthrosis classification) were analysed using a DIASLED-SCAN computed system (Sankt-Peterburg). Qualitative and quantitative changes detected by podography proved to be typical of different stages of female knee osteoarthrosis. A summary table illustrating dynamics of quantitative podogram characteristics as a function of severity of the disease is presented.

[Dynamics of acoustic properties of skin integument and hydroxyproline content during surgical treatment of congenital limb malformation].

The aim of the work was to examine mechanical and acoustic properties of the skin and collagen metabolism in patients with congenital and developmental malformation (CDM) of extremities. Acoustic tests were performed in 39 patients with forearm CDM and in 30 with leg CDM aged 4-18 years using an ASA-4 apparatus (Russia and Yugoslavia). Mean radial and ulnar lengthening was 6.4 +/- 1.0 (5.5-8) cm, tibial and fibular lengthening 5.0 +/- 1.2 (3-8) cm, and femoral lengthening 6-12 cm. Longitudinalvelocity of sound 1 and 2 months after distraction was 42.3% and 62.9% respectively higher than the preoperative value (p < 0.05). A similar increase (36.8 and 58.4% respectively) was recorded with the ASA-4 sensor in the transverse position. Acoustic inhomogeneity in the thigh skin also increased during distraction. Maximum free to protein-bound hydroxyproline ratio in blood was measured in the end of distraction (0.58 +/- 0.04) and in the beginning of fixation (0.6 +/- 0.01). Its subsequent decrease reflected structural and metabolic changes related to proliferative and biosynthetic processes in the skin, fibrillogenesis, and altered homogeneity patterns.

[The interrelationship between compact tissue defect and bone shaft cavity circulation].

The intraosseous pressure of tissue fluid, the electrical resistance between electrodes and the parameters of hemodynamics in tibial shaft cavity were measured experimentally. It was established that the occurrence and increase of compact defects led to the enhancement of fluid filtration from capillaries and tissue blood filling, whereas the reduction of compact defects led to hemodynamics parameter decrease. The shunting influence of newly formed regenerate bone capillaries cause an arterial wall elasticity increase and volumetric circulation rate limitation. The filtration-and-resorption balance of bone shaft cavity restored and circulation enhanced after compact defect healing.

Muscle spindles in elongation of the extremity: proprioceptive conflict or activity deficit?

Comparison of electrophysiological and morphological parameters of shin muscles of experimental animals during shin elongation by Ilizarov's method indicates involvement of muscle spindles into reconstruction of the skeletal muscular tissue in response to its dosed distraction, which results in temporary deficit of specific somatosensory afferentation.

[Peculiarities of sciatic nerve endoneurium cellular composition in hip distraction osteosynthesis in dogs].

Using light and electron microscopy, sciatic nerve endoneurium cellular content was studied in 14 adult mongrel dogs subjected to hip elongation for 28-35 days after osteotomy. For light microscopy, semithin sections were prepared. The application of an automated image analysis has demonstrated a moderate increase in macrophage, fibroblast and mast cell content, which remained undetected during visual examination. The morphofunctional state and the distribution of these cells is suggestive of their participation in the extracellular matrix synthesis and remodeling, angiogenesis control, blood flow and endoneurial fluid content regulation in the process of peripheral nerve structural adaptation to extremity elongation.

[Changes in hemodynamics of tibial diaphysis in case of blood flow disorder in superficial femoral artery].

Changes in tibial hemodynamics have been studied experimentally after applying a clamp (n=41) and resection of superficial femoral artery (n=22) in 63 adult dogs. It has been revealed with the help ofrheovasography that, in case of blood flow disorders in the superficial femoral artery, anastomoses with deep femoral artery branches contribute to maintenance of blood circulation in tibia, and in this connection the parameters of tibial blood flow may significantly differe from those of circulation in the leg soft tissues. Preservation of intraosseous pressure all along tibial diaphyseal cavity demonstrates a possibility of using its driving force to compensate for the circulatory insufficiency in the leg soft tissues and, moreover, in that part of the bone the environment of which in ischemia is involved.

[Functional state of lower extremities muscles at the patients with shin congenital defects before and after treatment with Ilizarov device].

Results of examination (dynamometry, electromyography, ultrasonography) of 34 patients aged 6 to 23 years before and after treatment with Ilizarov's method are analyzed. Decrease of dynamometry and electromyography parameters, ultrasonic data are evidence of hard structural and functional disorders of motor system of these patients. Decrease of force and activation characteristics of tested muscles of operated extremity after removal of external fixator relates to high level of central protective inhibition and prolonged afferentation dysbalance at somatosensory system. Degree of recovery is limited and depends on patient age: recovery resources are presented at children before 8 years, but at juveniles they are depleted during the growth.

[Description of rearrangement of distraction reclaim in the extension of the lower extremities and elimination of their deformity in patients with various etiology of shortening].

The data of X-ray and computed tomographic studies of a long tube distraction reclaim were analyzed in 80 patients who had limb shortening and deformity of varying etiology. The analysis has shown that during distraction there is a positive correlation between the increase in the connective-tissue interlayer area of a distraction reclaim and the overall increase in the area of the distraction reclaim (their ratio is not greater than 30% under the optimal elongation conditions). During fixation there is a decrease in the ratio of the area of a growth zone to the total area of a reclaim and in its total density with a parallel increase in the density of cortical laminae of a newly formed bone. Complete organotypic rearrangement comes to the end in the range of 1-3 years depending on the magnitude of pathomorphological and biomechanical changes and limb function.

[Ultrastructural characteristics of endotheliocytes of skeletal muscle hemomicrocirculatory bed during tibial lengthening using G. A. Ilizarov technique].

The method of transmission electron microscopy was used to study the ultrastructure of endotheliocytes in the hemomicrocirculatory bed of the anterior tibial muscle of adult dogs during tibial lengthening with Ilizarov method. The capacity of endotheliocytes to reduction and renewal was established. The tension stress induced in the biological tissues of the lengthened limb stimulates and supports high activity of endotheliocyte nuclear apparatus, which is characterized by the prevalence of euchromatin. Presence of capillaries with closed lumen at all time points studied is indicative of a prolonged angiogenesis process in the terminal parts of the hemomicrocirculatory bed, which is accompanied by regeneration and growth of the muscle fibers. After the cessation of distraction, while the muscle tissue continued to grow and differentiate, the endotheliocyte growth and the activation of their synthetic apparatus was noted.

[Use of hinge joints in devices for treatment of human locomotor system].

An analytical review of hinge joints used in external osteosynthesis apparatuses is presented. The goal of this review was to help to optimize the construction of new external osteosynthesis apparatuses based on hinge joints and to improve the procedure of their installation. Several variants of hinge joint construction are considered. The review points out the specific properties of these joints that have to be taken into account in development of medical equipment.

[Peculiarities of repair osteogenesis during the transverse traction of the longitudinal diaphysis fragment under the conditions of intraosseus vessel preservation].

The application of technique for obtaining the tibial fragment (split) with a preserved vascular network of the nutrient artery and its branches, that participate in the blood supply of this bone area, permits to detect significant osteogenetic potential of both endosteum and undifferentiated bone marrow cells. Under these conditions it was possible to increase the bone thickness 2 to 3 times in short time. The regeneration process in this case is characterized by a rapid course and formation of large massive of cancellous bone. The results of this study suggest that an adequate blood supply, stable fixation of bone using Ilizarov apparatus and the chosen rate of split displacement create the favorable conditions for the active osteogenesis.

[Primary hemodynamic changes at the tunneling of bone diaphysis].

This paper describes one of the mechanisms of the effect of bone tunneling on limb circulation. The study was carried out in 33 adult mongrel dogs with the leg length measuring 10 to 12 cm. The tunneling of tibial bone diaphysis was performed using 1.8-mm-diameter wire. Measurements were the made of the pressure in the bone diaphyseal cavity. Medullography was accomplished over time. It has been revealed that the growth in the size of the compact substance defect led to the lowering of the pressure in the bone diaphyseal cavity associated with its stabilization at a new level. After the healing of the bone defects the pressure was restored. Medullography performed over time has demonstrated that the substrate filling the compact substance defects prior to their healing is permeable for aqueous solutions. This allowed the conclusion that the cause of pressure lowering was translocation of the interstitial fluid from the diaphyseal cavity to the bone-surrounding tissue. To replenish the amount of the interstitial fluid, filtration from the vascular bed of the diaphyseal cavity was increased providing for pressure stabilization.

[Changes in hemodynamics of the long bone due to tunnelization under pulsing and non-pulsing pressure in a shaft cavity].

In 25 dogs, it was revealed that the pressure in a long bone shaft cavity (IBP) pulsed at relatively high values. According to rheovasography data, the pulse changes of the vascular blood filling of a shaft cavity caused the IBP. The blood filling changes at pulsing IBP produced pulse changes in interstitial fluid amount, at non-pulsing IBP they provided for fluid coming into the interstitial space of the shaft cavity without pulsations. Tunnelization led to appearance of compact substance defect, at the size of which, coming to 2.4% of shaft area, IBP always decreased, remained decreased during 2 months and restored during the third month. The IBP decrease changed the bone hemodynamics.

[Dynamics of the blood supply in the leg soft tissue in the course of experimental defect filling]. / Dinamika krovosnabzheniia miagkikh tkanei goleni pri zameshchenii kostnykh defektov v éksperimente.

Hemodynamics in the leg soft tissues during bone regeneration in the diaphyseal defects separated from surrounding paraosseous tissues, was studied experimentally using 10 adult mongrel dogs. It has been established, that circulation changes occur both in the operated limb and in the contralateral limb. They are most obvious in the operated leg and have a phase character corresponding to posttraumatic period. Restoration of blood flow parameters starts just from the 28th day of the experiment, the parameters become completely stabilized by the end of the experiment (90 days). Bone regeneration in tibial defects is accompanied by circulation increase in the respective limb segment.

[Elastic stable intramedullary nailing in Ilizarov bone lengthening]. / Embrochage centro-médullaire dans les allongements osseux selon Ilizarov.

PURPOSE OF THE STUDY: Bone lengthening with the Ilizarov technique gives good results but certain disadvantages are common: possible axial deviation during lengthening, long time to bone union, risk of fracture after removal of the external fixator. Associating the Ilizarov technique with elastic stable intramedullary nailing (ESIN) commonly used in traumatology has to be evaluated. We conducted an experimental study and report results of the first clinical application. MATERIAL AND METHODS: Eleven lengthenings of the tibia were conducted in dogs aged 1 to 4 years using an Ilizarov external fixator associated with ESIN. Lengthening started on day 1 and continued for 28 days. X-rays were obtained every week during lengthening, then at 15 and 30 days during the fixation period and 30 days after removal of the fixator. In two cases, arteriography was performed. In a pilot clinical trial, fourteen patients (8 males, 6 females) were treated with this method (1 humerus, 1 forearm, 7 femurs, 5 tibias). Mean patient age was 14 years. RESULTS: In the experimental study, the x-rays showed rapid ossification of the regenerate which led to increased tibia length in 7 cases from 1.25 to 2 mm/day. Total bone union was observed in four dogs during the lengthening period. At day 15 of the fixation period, all tibia had fused with a good quality cortical bone and healing of the growth part of the regenerate. In three dogs, the external fixator was removed at day 15 of fixation and weight-bearing was total with the ESIN in place. No axial deviation and no skin problems were observed. The medullary artery was seen on the two arteriograms. In the clinical trial, bone union of the regenerate appeared earlier than in the Ilizarov series. The regenerate always displayed good density on the x-rays, proving intense bone activity. In three patients, the lengthening rate was increased to avoid premature bone fusion. The endosteal bone regenerate was obvious. Mean healing index was 18.6 days/cm (SD=6.2). Weight-bearing was allowed at six weeks. The desired correction was achieved in all patients and no complications were related to ESIN. DISCUSSION: Bone lengthening may be obtained with an intramedullary locking nail which avoids the use of an external fixator but also destroys the endomedullary circulation. Our experimental and clinical study shows that use of an ESIN does not inhibit the endosteal regenerate and seems to improve new bone formation. In many patients, the lengthening rate had to be increased to avoid premature bone fusion. When used in optimal conditions, ESIN can stimulate new endosteal and periosteal bone formation. In addition, ESIN increases shaft stability avoiding the risk of axial deviation. ESIN plays an additional role of stabilization after early removal of the external fixation.

[Circulation changes depending on manifestations in soft tissue tensioning in the leg lengthening process]. / Izmeneniia krovoobrashcheniia v zavisimosti ot proiavlenii natiazheniia miagkikh tkanei pri udlinenii goleni.

Surgical intervention was found to intensify circulation in the limb and redistribute the blood flow. Leg lengthening led to arterial inflow limitation due to the magisterial artery strain. The changes were accompanied both by increase of functioning capillaries in number and increase of venous outflow dependence on blood inflow. The decreased after surgery oxygen tension in m. gastrocnemius did not change throughout distraction. The increase of functioning capillaries in number in resting contributed to maintenance of tissue oxygenation in the initial period of distraction, and in case of maximal tissue tensioning hydrostatic pressure increased in the capillaries due to arterial pressure rise. Restoration of the circulation parameters in the fixation period started with an increase of circulation volumetric rate in vessels with preservation of the rest mechanisms of the tissue oxygenation maintenance.

[The morbidity rate among machine operators in the Kurgan Region]. / Zabolevaemost' mekhanizatorov Kurganskoi oblasti.

The research results of complex medical examinations among machine-operators (age: 18-60, labor record: 1 to 20 years) are described in the paper for 12 district of the Kurgan Region.

[Structural fundamentals of biomechanical skin properties at dilation]. / Strukturnye osnovy biomekhanicheskikh svoistv kozhi pri rastiazhenii.

The article gives a systemic overview of data on biomechanical human skin status studied in vivo and in samples, on conformational reconstruction of collagen fascicles, and modification of the collagen ligature of derma at dilatation of induviate tissues, as well as results of own research of a limb derma dilatation function, the limb being under form and size modeling with the Ilizarov apparatus.

Radiosonographic substantiation of algorithms for examination of patients during operative lengthening of the tibia.

The muscles of 70 patients with lower limb shortening due to various etiologies were studied using three radiographic diagnostic methods: contrast radiography (CR), ultrasonography (US), and computed tomography (CT). The studies were performed before surgery, during lengthening using the Ilizarov external fixator, during the fixation period following distraction, and after apparatus removal. The data compiled using these modalities described alterations in the muscles during lengthening which enabled us to develop algorithms for patient examination during the process of lower extremity lengthening with the aim of solving tactical tasks.