Formulation of the problem Dislocation of the femoral component of the endoprosthesis is one of the most frequent complications of total hip replacement. The best option for the “treatment” of dislocation of the hip endoprosthesis is to prevent the development of primary instability. There are cases in which even with the correct installation of the endoprosthesis components, dislocations arise due to the weakness or defect of the capsular–ligament apparatus. Currently, many methods have been developed to strengthen and restore the posterior structures of the capsule of the hip joint with the help of auto- and allomaterials, which differ in both the fixation technique and the characteristics of the materials themselves. In this paper, we propose a method for restoring and strengthening the posterior structures of the capsule of the hip joint using polypropylene-based graft implants. The purpose of this study is to, with the help of specialized software, build a model of the capsule of the hip joint after capsulotomy and to determine the stiffness capabilities of the defect covered with polypropylene mesh. Results The study was performed using a software package based on the finite-element method. As a result of the performed calculations, pictures of the distribution of the stress–strain state in the “head-capsule” system were obtained. To assess the effectiveness of the method of closing the capsule, from the viewpoint of rigidity, as the main characteristics, the values of the opening of the cut are selected. Conclusions Under the kinematic loading of the model, the smallest values of the opening of the section are obtained when it is closed by a grid. In the case of thread fixation, the values were higher by 8.5%. However, the values of equivalent stresses, both in the capsule and in the head, in the model with the grid turned out to be the largest. These stresses were higher by 23.8% in the capsule and by 60.4% in the head than the same values for the thread fixation model. The obtained results indicate that the model with a grid is more rigid in the considered fixation variants.
Background. Ankle fractures are the most common injuries among the damages of ankle joint. The most common complication in such fractures is the damage of the tibiofi bular joint, leading to increase in the duration of treatment and adverse outcomes. Despite the large number of publications, the problem of this type injury treatment is far from solving it. The questions remain open regarding the method of surgical treatment and results evaluation.Aim. To evaluate the results of surgical treatment of ankle fractures, complicated with tibiofi bular syndesmosis injury with the help of hardware-bazometric complex and make a comparison with the existing methods of assessment, such as AOFAS and OMAS.Materials and methods. This study presents an analysis of 80 patients with mentioned fractures surgical treatment results. Patients were divided into 2 groups. The fi rst group (44 patients) was treated with the help of tension band wiring for fi xing tibiofi bular syndesmosis in combination with the original extramedullary plate with polyaxial insertion and blocking of screw for osteosynthesis of lateral malleolus fractures. The second group (36 patients) was treated according to the AO technique. The analysis of results was performed in 3, 6 and 12 months after surgery use of scales AOFAS and OMAS, as well as bazometric and stabilometric assessment using "Bazometr" complex.Results. In 3 and 6 months AOFAS and OMAS results corresponded to data of bazometric and stabilometric indicators. The analysis showed the best results among the fi rst group of patients, especially in the early stages. In 12 months the difference between indicators reduced, but remained signifi cantly better in the 1 st group. Conclusions. The reported data of clinical observations and their analysis demonstrate the effectiveness of the proposed method of ankle fractures with the tibiofi bular syndesmosis injury surgical treatment.Zaporozhye medical journal 2016; №6 (99): 72-76
Èçó÷åíèå ñòåïåíè èíòåãðàöèè ìÿãêèõ òêàíåé â ýëåìåíòû èç óãëåðîä-óãëåðîäíîãî êîìïîçèòíîãî ìàòåðèàëà â çîíå ïåðåõîäà âíóòðåííåé è íàðóaeíîé ñðåäû ïðè èìïëàíòàöèè ýíäî-ýêçîïðîòåçîâ Резюме. Каждый год в Украине выполняется около 600 ампутаций на уровне бедра, требующих дальнейшей реабилитации в виде протезирования утерянной конечности. Стандартным методом крепления протеза к культе бедра является фиксация гильзы протеза вокруг культи. Гильза обеспечивает передачу нагрузки, стабильность и эффективный контроль над протезом. Однако этот метод фиксации часто упоминается как неудовлетворительный из-за ряда осложнений, таких как язвы и раздражения кожи, потливость в гильзе, невозможность ходить по пересеченной местности, ненадлежащий контроль над протезом, снижение диапазона движений бедра и боли в области культи. Альтернативным решением является перкутанное крепление протеза ноги к бедренной кости с помощью остеоинтегрированных имплантатов. Использовались интрамедуллярные стержни с титановым напылением, соединенные с наружным блоком посредством замка, накрытого силиконовой прокладкой, выполняющей функцию разграничения внутренней среды от внешней, что часто приводило к инфекционно-воспалительным осложнениям. Поиск материалов для решения этих проблем остановился на углеродных материалах, в том числе углерод-углеродных композитных материалах (УУКМ), которые являются относительно новыми конструкционными материалами в практике ортопедии. Их успешно используют при остеосинтезе и эндопротезировании костей благодаря комплексу необходимых физико-механических и химических свойств. Целью данной работы было установить степень интеграции мягких тканей и, в частности, кожного покрова в УУКМ. Экспериментальным путем, с использованием лабораторных животных, проведен гистоморфологический анализ изменений тканей в области контакта с имплантатом. Доказана биоинертность материала, а также обоснована перспективность применения имплантатов из УУКМ как покрытия элементов конструкций эндо-экзопротезов для применения в реконструктивной травматологии и ортопедии.
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