In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB) without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р0,05). VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р0,05). Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS) in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and increased bleeding of the wound. Patients after simple release of ECRB demonstrated minimal postoperative pain which allows early rehabilitation and return to daily and professional activities.
т р а в м а т о л о г и я и о р т о п е д и я р о с с и и 2013-2 (68) Введение Злокачественные новообразования костей скелета составляют большую, но редкую группу так называемых орфанных опухолей, которые встречаются в своём большинстве со второго по четвёртое десятилетия жизни. Исследования, проводимые в последние годы, указывают на рост в 1,5 раза костной онкопатологии по сравнению с прошлыми десятилетиями. По данным литературы, они составляют 1-2% [3, 5, 12-14, 16, 19]. При новообразованиях костей наиболее уязвимым является коленный сустав. По дан
The problem of diagnosis and treatment of chronic anterior-posterior instability of the knee joint in multi-ligamentous injuries remains relevant, both medically and socially. Conservative treatment of patients with this pathology is ineffective due to severe instability and gross violation of the biomechanics of the knee joint. Currently, there is no consensus on the tactics of surgical treatment of this disease, and on the method of plastic replacement of the lost ligamentous apparatus. Objective. To evaluate the clinical results of the modified technique of arthroscopic plastic surgery of both cruciate ligaments of the knee joint. Patients and methods. Based on previous anatomical studies, the authors formulated the basic principles of safe formation of bone tunnels in simultaneous arthroscopic plastic surgery of the anterior (PKS) and posterior (ZKS) cruciate ligaments. An original method of surgery aimed at minimizing the risk of injury to the popliteal artery during the formation of the tibial bone tunnel is proposed. In the period from 2010 to 2017, the Department of endoscopic surgery treated 20 patients with damage to the SCS and SCS using this technique. The results were evaluated 6 and 12 months after surgery. Clinical examination, IKDC and Lisholm-Gillqist questionnaires and the visual analog pain assessment scale (VAS) were used to evaluate clinical results. Results. The average score on the IKDC questionnaire was 34.16±13.31 points before surgery, and 34.89±18.37 points on the lisholm - Gillqist questionnaire. 6 months after surgery - 58.75±6.38 and 69.78±14.10 points according to IKDC and Lisholm-Gillqist, respectively, which is statistically significant (p
Based on the information obtained in the anatomical study, were developed the criteria for selecting the allograft, taking into account its dimensional and strength characteristics. Based on these criteria, the most suitable tednon graft for plasty was chosen, and its mechanical strength was examined on a tensile machine. Various species of tendons, sterilized in the liquid medium of Belyakov, were investigated. The strength properties of the allograft were compared with the similar characteristics of native PCL obtained at the same stage of the study It was revealed that the optimal length and strength characteristics are the tendon of the long fibular muscle, which allows recommending it for alloplasty of the posterior cruciate ligament.
Латеральный эпикондилит, или «локоть теннисиста»-довольно распространенное заболевание в общей популяции. В большинстве случаев консервативные методы лечения данных пациентов весьма эффективны. Однако при нерезультативности консервативной терапии в течение 6 месяцев пациентам рекомендовано оперативное лечение. Анализ современных источников литературы показал, что проблема хирургического лечения пациентов с проксимальным энтезитом разгибателей предплечья артроскопическим способом в настоящее время не решена. Данное исследование проведено с целью формирования алгоритма и оптимизации хода и техники артроскопической операции пациентов с латеральным эпикондилитом плечевой кости путем проведения анализа мировой литературы и оценки результатов лечения пациентов с данной патологией. Проанализированы результаты лечения 40 пациентов с латеральным эпикондилитом, проведенного в отделении № 15 РНИИТО им. Р.Р. Вредена с 2016 по 2018 гг. по разработанному авторами статьи плану. Средний возраст пациентов составил 43±4,5 года. Результаты по шкале функциональной оценки локтевого сустава MEPS улучшены с 60±5,5 балла до 79±2,7 балла. При оценке болевого синдрома у пациентов по шкале VAS результат улучшен с 7,0±0,8 балла до 0,7±0,3 балла соответственно. Ключевые слова: латеральный эпикондилит, артроскопия, короткий лучевой разгибатель запястья, локоть теннисиста, локтевой сустав.
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