[Comprehensive rehabilitation of patients with osteoporosis after hip arthroplasty]. / Kompleksnaya reabilitatsiya patsientov posle endoprotezirovaniya tazobedrennogo sustava na fone osteoporoza.

Most people who have undergone hip arthroplasty belong to the older age groups, so they often have signs of osteoporosis. A decrease in bone mineral density in combination with a decrease in local blood circulation caused by additional trauma to bone structures and surrounding soft tissues during surgery contributes to osteolysis, early instability of the endoprosthesis and increases the risk of periprosthetic fractures. OBJECTIVE: To study the effectiveness of the developed rehabilitation complex, including the combined effect of a physiotherapeutic factor (increased gravity) and antiresorptive therapy, in patients with osteoporosis who underwent hip arthroplasty. MATERIAL AND METHODS: The study included 40 patients aged 60-75 years with signs of osteoporosis, who underwent total hip arthroplasty, no more than 3 weeks ago. The patients were randomized into two groups: the main group - 16 (40%) people, comparisons - 24 (60%) people. To assess the effectiveness of rehabilitation complexes, orthopedic examination, functional diagnostics of motor pathology of the lower extremities on an automatic hardware-software complex, X-ray densitometry, and indicators of the visual analogue pain scale and Harris scale were evaluated. Patients of both groups were prescribed a rehabilitation complex, including therapeutic exercises, mechanotherapy for training the thigh muscles and electrical stimulation of the thigh muscles, a course of 10 procedures. Patients of the main group were additionally prescribed a course of gravitational and antiresorptive therapy according to our methodology. RESULTS: The intensity of pain before treatment in patients of both groups corresponded to moderate pain syndrome. After 3 months after the course of rehabilitation, the pain intensity in the patients of the main group decreased statistically significantly by 3.1 times, in the patients of the comparison group - by 2.6 times. When assessing the biomechanical data of walking at the beginning of the rehabilitation course, the asymmetry of pressure indices was revealed in patients of both groups, corresponding to the average degree of lameness. After 3 months, the asymmetry coefficient in the patients of the comparison group reached a mild degree, while in the patients of the main group it approached the norm. According to X-ray densitometry, after 12 months, the bone mineral density index only in patients of the main group increased to the level of osteopenia. The indicator of the combined assessments of the Harris scale was statistically significantly different between the groups at 3 and 6 months after the course of rehabilitation. CONCLUSION: The combined use of gravitational therapy and antiresorptive drugs in the treatment and rehabilitation complex in patients with osteoporosis who have undergone total hip arthroplasty helps to reduce pain, reduce signs of osteoporosis, improve the functional parameters of patients' activity, and increase household and social adaptation.

[Surgical treatment of true muscle hernias of the extremities]. / Operativnoe lechenie istinnykh myshechnykh gryzh konechnostei.

An original method of plastic closing the fascial defects with the polymer tissue was used in 5 patients with true muscular hernias of the extremities. In all cases good anatomo-functional and cosmetic results were obtained.

[Optimization of the therapeutic procedure in subcutaneous injuries to the Achilles tendon]. / Optimizatsiia lechebnoi taktiki pri podkozhnykh povrezhdeniiakh akhillova sukhozhiliia.

Curative tactics in operative treatment of not fresh and longstanding injuries of the Achilles tendon with biocompatible artificial materials are discussed. Expediency of performing surgical interventions under conditions of conductive anesthesia is noted when using a Z-shaped access. An original operative technique is described. In 16 patients with subcutaneous ruptures of the Achilles tendon who were treated by the proposed curative method the supporting ability of the foot was recovered within 2-3 months after operation.

[Double fractures of the bones of the crus and their treatment]. / Dvoinye perelomy kostei goleni i ikh lechenie.

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.

[Comparative assesment of methods for the operative treatment of dislocations of the acromial end of the clavicle]. / Sravnitel'naia otsenka sposobov operativnogo lecheniia vyvikhov akromial'nogo kontsa kliuchitsy

During 20 years the authors observed 861 patients with dislocations of the clavicular acromial process, that made 14% in relation to all other types of dislocations. 252 patients (29.3%) were treated surgically. Capron tapes being used most frequently as an alloplastic material. Surgery was performed after the technic elaborated at the clinic. Late results of the treatment were studied in 202 patients within the terms from 1 to 15 years. Good issues were noted in 76.2%, satisfactory in 37%, poor in 5.5% of patients.