25 research outputs found
Remedial sanation arthroscopy in gouty arthropathy of the knee joint
No full textTsel' 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
The experience of arthroscopic treatment of chronic anterolateral instability of the ankle jont
No full textThe article states the concept of chronic lateral instability. There are presented epidemiology, anatomy, ankle, lateral ligaments of the ankle, including the functional significance and anatomical features of each bundle, in details described diagnostics, research methods, including ultrasound, MRI, X-rays, clinical research methods of chronic anterior lateral instability: “front drawer” test, “supination test”, “titltest”, “pronation test”. The artile shows classification of AOFAS scale. Historical background of operational techniques and their various modifications in chronic anterior lateral instability of the ankle are highlighted, showing the results before and after presentated operating procedures. Tactic of conservative treatment is marked. There are presented results of open and closed types of anatomical and nonatomical stabilization damaged front-fibular ligament the talus. The results of operations of the tendon tenodesis short and long tibial muscles and Brostroma operations and their modifications, as well as modern operating arthroscopic surgery of this pathology, are described. Marked are the advantages and disadvantages of the anatomical and nonanatomicalstabilization of damaged front-fibular ligament of the talus. During instability of the ankle joint young patients with high physical activity, involved in sports, with concomitant rupture of the anterior talo-fibular and calcaneal-fibular ligaments - the treatment method is tenodesis of outer ligament complex form the semitendinosus tendon with tunneling in the fibula, calcaneus and talus. For patients with low physical activity, not involved in sports, whose professional activity is not associated with heavy physical work, it is possible to perform the Brostroma-Gould operation - to create duplikatury local fabrics. Non anatomical ankle stabilization operations, including tenodesis tendons, often lead to disruption of gait and foot inversion restriction and are not recommended for widespread use
VALIDATION OF THE RUSSIAN SHOULDER PAIN LEVEL TEST-QUESTIONARY FOR DETECTION OF PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME
No full textDespite multiple available international scales for assessment of anatomical and functional features of shoulder joint, no unified Russian survey for shoulder joint assessment in patients with subacromial impingement syndrome (SIS) has been developed so far.Purpose — to develop and validate a test-questionary for shoulder pain (SSp) to diagnose SIS in patients with chronic pain syndrome in the shoulder joint.Material and Methods. Score for shoulder pain (SSp) was validated based on 252 questionnaires including the group of 144 patients with SIS and control group of 108 patients without SIS. age of patients ranged from 50 to 80 years. clinical diagnosis was established using integral clinical and imaging examinations. Internal consistency of survey was evaluated by calculating the cronbach’s alpha. Significance of each question was assessed by calculation of odds ratio (OR). Sensitivity, specificity, accuracy and validation threshold for SIS diagnostics were determined by measuring the area under curve (auc). Re-testing reliability was evaluated by intra-class correlation coefficient (Icc) in 60 patients with an interval of 1–3 days. convergent validity was assessed with aSeS and VaS scores. Results. Informative value of the full version of SSp was as follows: 97% sensitivity, 90% specificity, 0.96% auc (95% cI 0,93–0,98), р<0,0001. youden’s index (j) equaled 0.88. Validity threshold for SIS diagnostics was above 18. Intra-class correlation coefficient (Icc) was 0,98 (95% cI 0,98–0,99). The authors reported a high inverse correlation with aSeS scale ρ = -0,9498 (r = -0,95; p<0,001) and direct correlation with VaS scale ρ = 0,8279 (r = 0,83; p<0,001). application of a logic regression resulted in a suggested short version of survey which included 13 questions with threshold for SIS diagnosis above 14 scores. This provided for improvement of intra-test reliability up to 0,93 (95% cI up to 0,91) and the level of clinical use of the short survey version.Conclusion. Short version of survey for shoulder pain (SSp) consisting of 13 questions was validated for clinical use and SIS diagnostics in patients of elderly and middle age with chronic shoulder pain
Experience of Endoscopic Transcapsular Axillary Nerve Decompression
No full textINTRODUCTION 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
Experience of endoscopic transcapsular axillary nerve decompression: а series of clinical cases
No full textBackground: 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
Comparison of rheological and viscoelastic properties of hyaluronic acid for intraarticular injections
No full textOsteoarthritis (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
Surgical Treatment of Posterolateral Rotational Instability of the Elbow: a Systematic Review
No full textPosterolateral 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
Clinical Observation of Surgical Treatment of Recurrent Dislocation of the Forearm Bones
No full textAIM OF STUDY. To describe a rare clinical case of surgical treatment of chronic recurrent dislocation of the forearm bones using the method of circular plastic surgery of the elbow joint ligaments. MATERIAL AND METHODS. In the conditions of the Department of Traumatology and Orthopedics on the basis of the Department of Traumatology and Orthopedics of the Federal State Autonomous Educational Institution of Higher Education “Russian Peoples’ Friendship University” in the V. M. Buyanov City Clinical Hospital of the Moscow Health Department, a comprehensive diagnosis and treatment of a 38-year-old patient with recurrent dislocation of the forearm bones was carried out. Clinical and radiological examinations including computed tomography and magnetic resonance imaging of the elbow joint were performed to verify the diagnosis. After a diagnosis of chronic posterior instability of the elbow joint was established, simultaneous plastic surgery of the medial and lateral ulnar collateral ligaments was performed using a single-loop circular autograft from the peroneus longus tendon. RESULTS. At a follow-up period of 12 months, a successful clinical result of surgical treatment with restoration of stability and function of the elbow joint was observed. Pain syndrome on the VAS scale decreased to 1 cm (before surgery 0 cm) with physical activity. The amplitude of active movements in the elbow joint after surgery was: flexion 140° (before surgery 135°), extension 5° (before surgery 5°), pronation-supination 150° (before surgery 160°). After surgery: QuickDASH score 26 (before surgery 44 points), OES score 72 (before surgery 45), MEPS score 85 (before surgery 55). MEPS was score 55, OES was score 45, QuickDASH was 44 points, QuickDASH (work section) was score 75. CONCLUSION. The method of tendon circular plasty of the elbow joint is an effective method of surgical treatment of multidirectional recurrent instability of the elbow joint, helps restore stability and function of the joint and does not lead to limitation of movements
Topographic anatomy of the brachial plexus and possibilities with endoscopic approach (cadaveric study)
No full textRelevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene
space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle.
Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical
trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore
topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus.
Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department
of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021
and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus.
The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced
at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic
anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous
nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm.
The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean
width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies
of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with
endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010),
Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach
to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic
approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and
infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial
plexus at the interscalene space, thoracic aperture and subclavian area
Evaluation of a knee-joint functional rehabilitation after total knee arthroplasty by standart and miniinvasive midvastus approaches
No full textThe article presents comparative results of total knee arthroplasty of two groups of patients for gonarthrosis 3-4 stage perfomed by standart and minimally invasive midvastus approaches (30 knee joints in each group). Advantages and differences of these methods are discussed. Early and late postoperative outcomes are analyzed. Minimally invasive midvastus approach for total knee arthroplasty reduces duration of rehabilitation of the patients with gonarthrosis and improves its results, especially in early postoperative period
