The problem of diagnostics and treatment of avascular necrosis of the femoral head is relevant at the present stage. Late diagnostics of this disease leads to a radical operation of hip arthroplasty, which does not always favorably affect the quality of life of young and mature patients, when the primary intervention is not final and the revision arthroplasty is required in the dynamics. Information on modern diagnostic capabilities and a differentiated approach to the choice of treatment methods depending on the stage of avascular necrosis of the femoral head is the purpose of this review. 55 national and international sources have been analyzed in this paper. Data on the etiology and pathogenesis of the disease, classifications, possible variants of clinical manifestations of the process, detailed results of additional survey methods in a comparative perspective, including early stages of the disease and possible methods of conservative and operative treatment depending on the stage of the disease are presented in this review. The introduction into practice of decompression surgical methods of treatment, the use of biocomposite materials, vascularized bone grafts to fill the bone cavity allows us to look optimistically at the prospects of methods development for treating this pathology.
Introduction. In patients with chronic loco-motor system diseases the pain often persists after arthroplasty and does not respond to symptomatic therapy.Purpose of study: to evaluate the efficacy of perioperative use of Meloxicam in patients after hip arthroplasty. Patients and methods. The follow-up covered 120 patients (mean age 64.4±5.23 years) after hip arthroplasty. In the main group (n=60) Meloxicam was given 7 days prior to and 3 weeks after surgery; after intervention narcotic analgesic was used on the request. In control group (n=60) the patients were only on narcotic analgesic on request after operation. Treatment results were assessed by 100-millimeter visual analog scale (VAS) and D’Aubigné-Postel Score.Results. Seven days before the surgery the pain severity in the main and control groups was comparable: 85±2.3 and 84±2.1, respectively. In 2 days after operation the pain relief was more pronounced in the main group — 69±2.1 mm versus 82±3.4 mm in the control group (p<0.05). In 3 months those indices made up 10±2.1 and 35±12.6 mm (p<0.001), respectively. In the main group the result was assessed as the excellent and good in 22 patients, in the rest of patients as satisfactory by d’Aubigné-Postel Score. In the control group the good result was recorded in 9, satisfactory — in 47 and poor — in 4 cases.Conclusion. Meloxicam may be considered as an effective perioperative analgesic in large joints arthroplasty.
This review highlights the social and epidemiological features of osteoarthrosis, with an emphasis on gonarthrosis. It shows the problems of this pathology in the pathogenic, diagnostic, therapeutic and social terms. The social significance of osteoarthrosis is determined by growth of associated invalidity and disability, especially in older age groups, as well as by a sharp decrease of quality of life in this disease. Disability in elderly patients with knee arthrosis is comparable to that of patients suffering from the cardiovascular diseases, and higher than in other diseases in this cohort of patients. Gonarthrosis reduced quality of life of up to 80 % of patients, and disability was diagnosed in 10-21 % of the cases. Timely and effective treatment for osteoarthrosis has enormous social and economic significance.
On the basis of a comparative analysis of medical aid delivery to 114 victims of shock-producing traumas treated at the Arkhangelsk Regional Clinical Hospital (a trauma center of the I-st level) in 2013 and to 104 victims treated in the Arkhangelsk hospitals in 2002, there have been specified determinate medical and social signs in characteristics of gender, age, social position, alcohol intoxication, injury mechanism, comorbidity. The men made up the majority (79.8 %) among the victims. In the structure of injury causes, traffic accidents (46.2 %) and criminal injuries (28.8 ± 5.8) % prevailed, associated pathologies were observed in 15.8 % of the victims. People at the young and most able-bodied age leading an active life suffered shock-producing traumas more often. Thus, the average age of victims in 2013 was (36.6 ± 1.5) years (min = 18, max = 93), including the men - (36.5 ± 1.6), the women - (36.8 ± 3.7) years in comparison with 2002 when the average age was (39.0 ± 1.4) years; rejuvenation of the victims has occurred (2.5 years less). High correlations of traumatism with alcoholic intoxication is a separate social and medical problem. In the state of alcohol intoxication, 35.1 % of the victims suffered traumas, including 42.8 % of the men and 4.3 % of the women, the average alcohol concentration in blood (1.59 ± 0.12) % corresponded to the average degree of intoxication.
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