Treatment results for 60 patients with anterior cruciate ligament injuries (ACL) are presented. As a graft either tendons of m. semitendenous and m. gracilis (group 1, 30 patients) or patellar ligament (group 2, 30 patients) were used. Clinical instrumental and roentgenologic examination was performed at least 8 months after surgical intervention. Good and excellent results (85-100 by Lysholm scale) were achieved in 29 (96.7%) patients from the first group and in 27 (92.0%) patients from the second group. However examination on arthrometer KT-1000 showed that in 4 (13.3%) out of 30 patients from the second group anterior shift of the shin exceeded 5 mm. X-ray examination showed early signs of deforming arthrosis in 7 (27.7%) patients from the first and 15 (50%) patients from the second group.
Simultaneous injury of anterior and posterior crucial ligaments is a rare pathology (2-3%) and as rule results from application of force in several planes. This type of injury is one of the most severe traumata of knee joint and could be a block for sports activity on a high level. In athletes with knee ligaments injuries obligatory single-step reconstruction of all injured elements is required. Diagnosis, surgical technique and postoperative rehabilitation course are described.
Actuality of the work was conditioned by wide prevalence of Achilles tendon diseases and considerable number of unsatisfactory treatment results. First native experience in use of high frequency coblation for the treatment of patients with Achilles tendon diseases was presented. Intervention was performed in 26 patients with chronic Achilles tendon paratenonitis and tendinitis, and in 8 patients with tendoperiosteopathy of calcaneal tuber. In all cases treatment results were assessed as good: pain syndrome was completely arrested, restoration of tendon and calcaneal aponeurosis thickness and homogeneity as well as regress of fibrosis were observed. Neither intranor postoperative complications were registered.
Ultrasound examination of 897 patients with injuries and pathology of striated muscles was performed. Ultrasound criteria of muscle diseases and injuries were detected. The evaluation of diagnostic efficacy of ultrasound data relative to data of invasive methods (surgical interventions and diagnostic puncture) was performed. Ultrasound examination of striated muscles is showed to be a highly specific and sensitive method for diagnosis of traumatic muscle tissue lesions. Ultrasound allows to assess the hematoma volume, injury degree of muscle and diastasis length between muscle fibers; regeneration stage and developed scar of injured muscle as well as to detect cystic changes, ossificans myositis, hernia and tumor-like diseases.
In patients with cardio-vascular diseases total replacement of lower extremity large joints possesses high risk of severe hemodynamic complications. Method of combined epidural and general intravenous anesthesia providing minimum depressing influence on myocardium and allowing adequately prevent the patient from operative trauma was elaborated. In early postoperative period prolonged epidural block in combination with nonsteroid anti-inflammatory drugs results in the best anesthesia and stabilizes hemodynamics in patients with concomitant cardio-vascular pathology.
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