Purpose— to evaluate the impact of frontal positioning of prosthesis components after bilateral Tka on short term functional outcomes. Material and Methods. The authors performed a retrospective analysis of teleroentgenograms of 466 patients after bilateral Tka with initial varus deformity. Functional and roentgenological outcomes were evaluated at average in 16,4±2,9 months postoperatively. Mean preoperative varus deformity was 10° (from 5 to 25°), initial angle between the anatomical and mechanical femoral axis (FVa) was 6,7±2° (from 3 to 12°). The neutral axis of both lower limbs (Hka = 180±0,5°) was obtained in 99 (21,2%) out of 466 patients. Residual deformity in one of the limbs above 3° with the neutral alignment of the contralateral limb was observed in 44 (9,4%) patients, bilateral residual deformity – in 32 (6,9%) patients. Other 291 patients demonstrated the deviation from mechanical axis in the range from 1 to 3° (±0,5°). all patients were divided into three groups: first group consisted of 10 patients with neutral axis of one limb and varus deformity of the other limb above 3°; second group — 10 patients with bilateral residual varus deformity above 3°; third group — 12 patients with neutral axis of both limbs (Hka = 180°). The angle of residual deformity averaged 3,7° (from 3,2 to 5,1°).Results.No statistically significant differences between the groups were observed for dynamometric parameters and SF-36 scores, as well as for functional kSS scores (p>0,05). However, the authors reported in patients of the first group a stance phase on the side of residual varus deformity longer at 15% (p<0,05) and transfer phase shorter at 17% (p<0,05) as compared to contralateral limb (with neutral alignment, Hka = 180°), which is indicative of load asymmetry and can have a negative impact at a later stage.Conclusion. Symmetrical residual varus deformity of lower limbs in the rage of 3,2–5,1° has no negative impact of short term clinical and functional outcomes of Tka. Muscular function and gait properties in patients with neutral axis of the lower limbs and in patients with symmetrical residual varus deformity after Tka were similar 16,4±2,9 months postoperatively.
Objective. To analyze clinical picture and composition of pathogens of hematogenous pyogenic vertebral osteomyelitis (PVO) based on the records of a regional clinic admitting patients with this disease. Material and Methods. A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006-2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains-from aspiration biopsy in 32 patients, 21 strains-from blood in 20 patients. Results. The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora. Conclusion. The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common Цель исследования. Анализ клинической картины и состава возбудителей гематогенного остеомиелита позвоночника по данным областной клиники, концентрирующей у себя пациентов с данным заболеванием. Материалы и методы. Проведен ретроспективный моноцентровой анализ медицинской документации пациентов, проходивших лечение с диагнозом «гематогенный остеомиелит позвоночника» в 2006-2017 гг. в областной клинической больнице № 2 (Тюмень). По данным 209 медицинских карт стационарных больных изучен характер выделенной микрофлоры. Консервативно пролечены 68 пациентов, оперированы-141. Из операционного материала у 77 больных выделено 93 штамма бактерий, при пункции очага поражения-у 32 пациентов 20 штаммов, из крови-у 20 человек 21 штамм. Результаты. Возбудитель гематогенного остеомиелита позвоночника идентифицирован у 117 (56,0 %) пациентов, в том числе грамположительная флора-в 56,3 % наблюдений. Основными возбудителями являлись Staphylococcus spp. (53,8 %). S. aureus, чувствительный к оксациллину (MSSA), определен в 35,5 % случаев, его резистентная форма (MRSA)-в 3,3 %. У 26 (12,4 %) больных выявлено два и более возбудителей с преобладанием стафилококковой флоры. Заключение. Наиболее частой причиной гематогенного остеомиелита позвоночника является грамположительная флора с преобладанием S. aureus (38,8 %). Анаэробы идентифицированы в 30,6 % наблюдений. В 26 (12,4 %) наблюдениях выделено более одного возбудителя. Значимых различий по форме заболевания при грамположительной, грамотрицательной флоре и полимик...
Objective.To analyze clinical efficiency of initially stable anterior load-bearing interbody fusion in treatment of thoracic and lumbar spine injuries. Material and Methods. Anterior interbody fusion for thoracic and lumbar spine injury was performed in 86 patients. Out of them 48 patients underwent fusion with cylindrical porous NiTi implants (control group), and 38 patients -initially stable anterior load-bearing interbody fusion (study group). Patients of both groups were matched by age, sex, and injury nature and localization. Clinical and neurological examinations were supplemented by spondylography in coronal and lateral projections in all patients. CT and MRI studies of the injured spinal motion segment were performed to specify the nature of injury. Results. Good treatment results were achieved in 32 (100 %) patients from the study group and in 34 (87.2 %) patients from the control group, and satisfactory result -in 5 (12.8 %) patients from the control group. Suggested method of initially stable load-bearing anterior fusion allowed preventing the implant migration in patients with thoracic and lumbar spine injuries of types A2, A3, B1, and B2 (AO/ASIF classification) and avoiding repeat surgical intervention. Conclusion. Clinical application of initially stable load-bearing anterior fusion proved its high efficiency, allowed preventing the implant migration and avoiding external immobilization even in cases of unstable injury, without increasing surgery time duration and blood loss volume.
Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).
Objective. Basing on experiment biomechanical and clinical studies to determine the optimal method of surgery in patients with vertebral lower thoracic and lumbar fractures using porous NiTi implants. Material and Methods. A method of modeling of comminuted vertebral fractures has been developed. The outcomes after anterior interbody fusion with both porous NiTi implants alone and in combination with pedicle screw fixation and on-bone screw – rod osteosynthesis for comminuted vertebral fractures in thoracic and lumbar spine were analyzed in 61 patients. An antimigration technique for implant stabilization was developed and successfully used in 5 patients with comminuted vertebral fractures predominantly in the lower lumbar spine. Patients of this group underwent stabilometry and X-ray tomography for objective appraisal of treatment results. Results. Results of the experimental studies demonstrated that anterior mono- and bisegmental spinal fusion with onbone screw – rod or transpedicular osteosynthesis provides stable fixation, but firmer fixation is achieved by its combination with anterior spinal fusion. Most patients (87.9 %) have good results after anterior interbody fusion with porous NiTi implants. Conclusion. Combination of anterior interbody fusion with porous NiTi implants and on-bone screw – rod osteosynthesis is advisable for unstable fractures and also for early active rehabilitation of patients without external immobilization. Anterior interbody fusion with titanium antimigration screw is advisable for comminuted vertebral fractures predominantly in lower lumbar spine.
To analyze results of minimally invasive surgery for lower thoracic and lumbar spine fractures. Material and Methods. The method of minimally invasive anterior fusion and percutaneous pedicle screw fixation for treatment of non-complicated fractures of the lower thoracic and lumbar vertebrae was developed and successfully used in 56 cases. In 19 patients with type BI (n = 11) and BII (n = 8) fractures according to AO/ASIF classification the anterior stabilization of the spine was performed in combination with minimally invasive transpedicular fixation. Type AII and AIII fractures were treated by anterior fusion with porous NiTi implant combined with internal fixation (n = 11). A comparative analysis of suggested minimally invasive and conventional methods of anterior fusion and transpedicular fixation was performed. Results. The long-term outcomes of minimally invasive treatment were followed in 31 patients. Good results were achieved in 93.5 % of cases (n = 29), satisfactory-in 6.5 % (n = 2), unsatisfactory results were not registered. Conclusion. Minimally invasive anterior fusion and percutaneous internal transpedicular fixation as compared with conventional methods provided adequate stabilization of fractured spinal motor segment, decrease in surgery invasiveness, and elimination of cosmetic defect. Kew Words: minimally invasive anterior fusion, minimally invasive transpedicular osteosynthesis, fracture of low thoracic and lumbar vertebrae.
Objective. To compare the strength resistance of seriesproduced and modified spinal systems to continuous cyclic loading. Material and Methods. Assembled transpedicular four-screw systems with monoaxial screws of equal configuration were tested. The study group included modified fixation system, and the control group -series-produced domestic fixation systems. All devices were fixed in textolite vertebra models with the account for average pedicle angle and interpedicular distance, with equal interval between vertebrae, and using one transverse connector. The models were exposed to axial cyclic loading. Results. In dynamic loading conditions with 150 kg load (1,500 Newton) and the frequency of 6 cycles per second, the maximum strength of transpedicular fixation system from the study group was at average statistically reliably 22.1 % higher than that from the control group (p ≤ 0,05). Conclusion. The performed study appeared to be a scientific rationale for transpedicular screw modification. Suggested modification statistically reliably increases the maximum strength of fixation system, which reduces complication rate after transpedicular fixation and allows extending indications for transpedicular spinal fusion alone.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.