Introduction: The survey presents three clinical cases of successful treatment of chronic damage to the shoulder girdle and rotator cuff muscles with varying severity in people of working age. The patient with the most severe clinical symptoms of disorders had an episode of thromboembolism of the small pulmonary artery in past medical history. The aim of the study was to demonstrate, using the example of clinical cases, treatment options for patients with post-traumatic neuropathy of the axillary nerve associated with the rotator cuff damage, with improvement of the upper limb function and the patient's quality of life. Materials and Methods: A comprehensive study of the outpatient and inpatient records materials, the results of clinical laboratory methods of patient work-up was carried out, a selected conservative and surgical treatment, a rehabilitation program and drug prevention of thrombus formation are described in detail. Results: 8 months after the end of treatment, there was general, significant improvement of the damaged shoulder joint and limb function in all patients, and in the first two cases with moderate and medium deficiency, the level of complete recovery was almost achieved. The third patient, with the most adverse consequences and hemostatic comorbid pathology, underwent multi-team muscle-fascial transfer. As a result, there was a significant improvement in the right shoulder function. Discussion: A personalized approach to the choice of treatment tactics, depending on the degree of existing clinical disorders, whether a complex conservative treatment solely, or combined with an arthroscopic technique, as well as a reasonable implementation of techniques for transfer of preserved muscles to replace the lost function of damaged muscles in the most complex case was a condition and guarantee for achieving significant progress in the patient's anatomical and functional status. Nevertheless, it seems appropriate to carry out a further search for more rational technologies of restorative reconstruction for the disorders under consideration. Conclusion: An individualized tactical and technical approach to the rehabilitation of such a complicated cohort of patients, correctly selected, taking into account the clinical and instrumental data, allows to improve the upper limb function of and the patients' quality of life, and the reasonable tactics of clotting prevention ensures hemostasis control and the absence of vascular catastrophes.
According to current concepts, the influence of autologous platelet-rich plasma (PRP) and high molecular hyaluronates (HA) on the repair of hyaline cartilage during its inflammatory and degenerative changes has been insufficiently studied yet. The objective of the work was to evaluate the morphological changes in the structure of hyaline cartilage in experimental osteoarthritis after intra-articular injection of PRP and/or HA. Material and methods. The authors used 50 adult rats of Wistar line, weighing 250±2,2 g., distributed into five groups of 10 animals (two control and three experimental groups). An experimental gonarthosis was simulated on four groups of animals. Animals of the first experimental group received intra-articular injection of PRP, the second group – HA, the third – both PRP and HA. Results. No morphological signs of degenerative and inflammatory changes in the first control group were identified. Following osteoarthritis simulation the articular cartilage thinned to 121±20,4 microns (p0,05) and the volume fraction of chondrocyte decreased to 1,2±0,6% (p0,05). The authors observed an uneven coloration of collagen fibers with severe tinctorial properties disorder of the articular cartilage matrix. After the RPR introduction the authors observed tickening of the articular cartilage up to 275±18,9 micron (p0,05) and the volume fraction of chondrocytes up to 18,4±2,0% (p0,05). The contour of the cartilage surface became smoother with the formation of a cell-free zone. Collagen fibers demonstrated a uniform distribution, tinctorial properties of cartilage matrix in all areas were preserved, no signs of inflammation were noted. After HA introduction the authors observed thickening of the cartilage plate up to 264±21,3 microns (p0,05) and the volume fraction of chondrocytes up to 11,6±1,2% (p0,05). The surface of the cartilage featured uneven contours due to multiple areas of pulping. Uneven tinctorial properties of cartilage matrix, thickness and orientation of collagen fibres were retained. No signes of inflammation were observed. After the combined consecutive application of PRP and HA cartilage thickness increased up to 268±15,3 microns (p0,05) and the volume fraction of chondrocytes increased up to 12,7±0,9% (p0,05). Individual portions of pulping on the cartilage surface were observed. Tinctorial properties of the cartilage matrix were preserved; the focal uneven staining of collagen fibers in the basal zone was observed. No signs of inflammation were noted. Conclusion. During osteoarthritis simulation in knee joints of experimental Wistar line rats the authors observed severe structural changes in articular hyaline cartilage including complete destruction accompanied by vascular proliferation and granulomatous inflammation. Intraarticular injections of PRP, HA as well as PRP in combination with HA during the simulation of osteoarthrosis were accompanied by a decrease in the severity of degenerative and dystrophic processes and improval of tinctorial properties of articular cartilage matrix. Sole application of PRP or consecutive application of PRP followed by HA were observed as having the more significant reparative effect on articular cartilage as compared to HA.
1Волгоградский государственный медицинский университет, 2 Волгоградский медицинский научный центр В представленом исследовани изучена динамика активности ММР-1 и ММР-13 гиалиного хряща у крыс с экспери-ментальным остеоартрозом коленного сустава с последующим сопоставлением полученных данных с морфометриче-сикми параметрами.Ключевые слова: остеоартроз, гиалиновый хрящ, металлопротеиназа. The present study investigated the dynamics of the activity of MMP-1 and MMP-13 hyaline cartilage in rats with experimental osteoarthritis of the knee which was followed by a comparative analysis of the data with morphometric parameters. METALLOPROTEINASES 1 AND 13 AS MARKERS OF DESTRUCTIVE AND PROLIFERATIVE PROCESSES IN THE ARTICULAR CARTILAGE IN EXPERIMENTAL OSTEOARTHRITIS
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