Харківська медична академія післядипломної освіти МОЗ України 2 ДУ «Інститут патології хребта та суглобів ім. проф. М. І. Ситенка НАМН України», Харків 3 Національний медичний університет імені О. О. Богомольця МОЗ України, Київ
Objective. To invent the concept of new postural pattern formation in the consequence of severe injury of lower extremities associated with the development of «syndrome of posttraumatic diaphyseal deformities of lower extremities». Methods. The classic model of the development of transformation «health–disease», that was initially worked out in 1960th years, has been used to build up a concept of the returning of patient from trauma to relative health. The idea of this approach was to make analogy of regulatory process under the conditions of disease with emergency control insophisticated technical systems of automatic control. The results of instrumental investigation of patients and mathematic modelling was used. Results. In the case of the development of «syndrome of posttraumatic diaphyseal deformities of lower extremities» in addition to decreased muscular strength, joints stiffness and limb lengthening the complex of following complications occurs: anatomical disarrangements in adjusted joints and muscular imbalance. If the deformity development is accompanied by the saved weightbearing function of the limb a compensatory mechanism in length of time and in a process of walking capacity restitution creates new «body scheme» and stereotypes of walking and standing. Inherent program of movement substitutes with acquired one. If the deformity occurs just on one lower extremity the anatomical disarrangements of the whole skeletal system take place: the tiltof pelvis and spine, hip abduction/adduction contracture, varus/valgus deformity in knee joint, the disturbance of weightbearing capacity of feet with different derangements in ankle and subtalar joints (including varus/valgus deformities). The severity of these secondary changes depends upon the value of deformity, general and psychological status of patient. Outcomes. Invented concept of new postural pattern formation in consequence of severe injuryof lower extremities associated with the development of «syndrome of posttraumatic diaphyseal deformities of lower extremities» allows to assess and understand a locomotor behavior of patient and take it into consideration in treatment planning.
An adequate planning of the curative measures is an important factor providing good functional results in the treatment of consequences of long bones injuries, in particular, malunions (post traumatic deformities). 3D-modeling in the preoperative planing gives an opportunity to assess both deformity itself and joint status. Visualization of injured segment with three-dimensional model manufactured using 3D-print in actual size (1:1 scale) provides additional capacities. Objective. To analyze the capacity provided by the usage of three-dimensional models of damaged segments in scale 1:1 while the planning of corrective surgery. Methods. Practicability of the usage of 3D-models, that was worked out on the base of CT-scanning, was studied in the treatment of 52 patients with different post traumatic extraarticular deformities of femur and tibia, after the fractures with intraarticular extension. Clinical results were evaluated using SF-36 and AOFAS scales. Results. Calculation for 3D-modeling was performed mostly virtually using standard computer programs with 3D-reconstruction, but 3D-print technology was used for 5 patients with the most severe and sophisticated deformities of the lower extremities. Changes in functional outcomes, according to SF-36 and AOFAS, for the patients undergone opera- tive treatment, were positive at 12 month of follow-up. Foreign colleagues expose analogous results of the investigations and suggest that the modeling with 3D-print provides mostly more safe, reliable and standardized clinical decisions for every particular patient. Conclusions. Preoperative usage of 3D-print on the stage of preoperative planing allows the surgeons to simulate different stages of operative intervention on the physical model, thus, help him to realize possible technical problems, choose adequate fixation device and proper instrumentation. It facilitates the shortening of surgery time, elimination of possible complications rate and achievement, in sum, good functional results in the treatment of this kind of patients.
Objective. To clarify the indications and volume of reconstructive surgeries under conditions of knee joint arthritis and to improve the methods of surgical correction of peri-articular deformations using an external rod fixator. Methods. During the last 10 years (2012‒2022), reconstructive surgeries were performed in 45 patients (49 joints). Indications for surgery were based on the study of pain and its localization, peri-articular deformation of the limb, ultrasound (USD) and X-ray examinations. Results. Indications for certain reconstructive surgical interventions on the knee joint are substantiated. The role of pathological changes of the meniscus in the development of knee joint arthritis has been determined. The positive clinical effect of paracapsular resection of the front part of the meniscus with hyperplastic growths of synovial tissue is shown. Deformation of the extremety (43 patients — with varus deformity, 2 — with valgus deformity) limited the function of the limb and caused pain. Surgical treatment in such cases were aimed at eliminating the deformation of the proximal part of the tibia. The types of osteotomies, the features of the author's rod external fixation device application, and the postoperative management of patients are presented. Due to external fixator, it is possible to perform, if necessary, angular correction of the limb axis during the period when the patient begins to walk with partial weight bearing, and the functional load of the limb makes it possible to achieve fusion of fragments within 3.5–4 months. A long-term positive clinical effect was obtained in 42 (93 %) patients. Conclusions. Indications for pathogenetic treatment should be based, first of all, on the identification of the source (or pathogenesis) of the pain syndrome, then on the analysis of the type and magnitude of peri-articular deformation of the limb, signs of functional insufficiency of the limb associated with it. In the third place, the X-ray signs should be analyzed. Elimination of angular peri-articular deformation of the limb has a positive effect on the course of knee arthritis, reduces pain, increases physical activity, and slows down the progression of cartilage destruction.
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