Saratov JOURNAL of Medical and Scientific Research

Klimov S.S.

Saratov State Medical University n.a. VI. Razumovsky, Department of Traumatology and Orthopedics, Intern

The role of skeletal tissue remodeling markers in the patho-genesis of implant-associated inflammation after primary knee arthroplasty

Year: 2018, volume 14 Issue: №3 Pages: 515-518
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Galashina Е.А., Bondarenko A.S., Ulyanov V.Yu., Klimov S.S.
Organization: Saratov State Medical University
Summary:

Aim: to reveal certain mechanisms of the pathogenesis of implant-associated inflammation by the level of resorption and bone tissue genesis markers in patients who underwent primary knee arthroplasty. Material and Methods. Main group consisted of 40 patients with implant-associated inflammation; first comparison group — of 20 patients with primary aseptic loosening of knee joint implant components; second comparison group — of 20 patients who underwent primary knee arthroplasty without complications in post-operative period; control group — of 20 conventionally healthy individuals. The levels of soluble receptor activator of nuclear factor kappa-B ligand and bone morphogenetic protein-2were defined in blood serum of all subjects by ELISA. Results. In patients of main group we observed more pronounced increase of soluble receptor activator of nuclear factor kappa-B ligand content and significant decrease of bone morphogenetic protein-2 content in blood serum; patients of first comparison group demonstrated activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased levels of bone morphogenetic protein-2 in blood serum; patients of second comparison group did not demonstrate any changes in the studied indexes. Conclusion. The activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased activity of bone morphogenetic protein-2 have leading role in the pathogenesis of implant-associated inflammation.

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Comparative analysis of clinical outcomes of various methods of anterior cruciate ligament arthroplasty in knee joint in complete rupture of the ligament.

Year: 2018, volume 14 Issue: №2 Pages: 251-259
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shormanov A.M., Norkin A.l., Klimov S.S., Chibrikova Ju.A., Ulyanov V.Yu., Bakhteeva N.Kh.
Organization: Saratov State Medical University
Summary:

The aim is to carry out the analysis of outcomes of anterior cruciate ligament arthroplasty undertaken by various methods in patients with complete ligament rupture. Material and Methods. 104 patients diagnosed with complete rupture of anterior cruciate ligament (ACL) in knee joint who underwent knee joint arthroplasty fulfilled by various methods were the object of the present study. Clinical outcomes of the treatment were estimated by clinical signs of ACL failure, the degree of functional impairment of knee joint (IKDC 2000) and motor pathology assessed instrumentally. Results. Significantly better function restoration in knee joint occurring as early as 3 months postoperatively has been stated in the group of patients with two-bundle ACL arthroplasty by synthetic implant "DONA-M" on the basis of IKDC subjective knee indices. Negative Lachman test and Pivot shift test were demonstrated as early as 3 months postoperatively by all patients after two-bundle ACL arthroplasty with synthetic implant "DONA-M", reduced support asymmetry 6 months postoperatively was stated in all patient groups as well as run path and surface area in patients with single-bundle ACL arthroplasty by synthetic implant "DONA-M". Conclusion. The use of single- and double-bundle ACL arthroplasty with synthetic implant and ACL arthroplasty with autograft of semitendinosus (ST) and gracilis allows providing equally full-fledge restoration of injured knee joint, without statistically significant differences between the groups, in great majority of patients up to 12 months of follow-up period which is proved by normalized knee joint function, the absence of ACL failure and motor pathology signs estimated instrumentally. Key words: knee joint, anterior cruciate ligament (ACL), co

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Optimization of surgical treatment tactics at a customary shoulder dislocation

Year: 2018, volume 14 Issue: №2 Pages: 240-243
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Norkin A.l., Klimov S.S., Levchenko K.K., Shormanov A.M., Alieva A.M., Katerusha A.M., Amanova M.M., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

 Saratov Journal of Medical Scientific Research 2018; 14 (2): 240-243. The aim: the optimization of surgical treatment tactics at a customary shoulder dislocation, based on "on-track Hill-Sachs / off-track Hill-Sachs" concept. Material and Methods. The research group consists of 42 patients aged from 19 to 52 years with chronic recurrent anterior shoulder instability, who underwent a surgical treatment to restore previous shoulder anatomic and topographic correlations. Patients were divided into two subgroups according to diagnostic arthroscopy results. The first subgroup includes 14 patients with impaction visualized (off-track Hill-Sachs), the second one — 28 patients with head shoulder stability (on-track Hill-Sachs). Patients of the first subgroup underwent open surgical intervention according to Bristow — Latarjetand shoulder arthroscopic repair was carried out in the second group. Results. One month after the surgical treatment median total estimated figure exceeded by 1.8 times in patients of the first subgroup and by 1.2 times, by Rowe, in patients of the second subgroup and decreased by 2.1 times in patients of the first subgroup and by 1.7 times, by DASH, in the second subgroup in comparison with the indices before the operation, that was illustrative of a good treatment result. Six months after the operation median total estimated figure exceeded by 1.2 times, by Rowe, in patients both of the first subgroup and the second subgroup and decreased by 2 and 2.1 times, by DASH, in patients of the first and the second group, relatively in comparison with the indices found one month after the operation, that was illustrative of an excellent treatment result in the late postoperative period. Conclusion. Patients with anterior shoulder instability caused by a glenoid fossa deficiency less than 25% in combination with off-track Hill-Sachs lesion, the most convenient way is the replacement of the bone loss by coracoid process transposition. In patients with on-track Hill-Sachs lesion arthroscopic repair is preferable.

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Computer modeling of biomechanical systems «femoral bone — endoprosthesis / transplant — tibia» in different methods of anterior cruciate ligament plastics in knee joint

Year: 2017, volume 13 Issue: №3 Pages: 764-768
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shormanov A.M., Ivanov D.V., Norkin A.l., Ulyanov V.Yu., Bakhteeva N.Kh., Klimov S.S., Chibrikova Yu.A.
Organization: Saratov State Medical University
Summary:

The aim: to specify the indices of dislocation (displacement) and effective stress in biomechanical systems «femoral bone — endoprosthesis / transplant — tibia» in different methods of anterior cruciate ligament by computer modeling of a knee joint geometrically, physically and mechanically similar to human. Material and Methods. Steady-state tasks of the stress given on a knee joint after anterior cruciate ligament plastics fulfilled by different methods were resolved numerically by the method of finite elements implemented in the system of finite element analysis. Results. Maximum dislocations comprised 3.45 mm. for the method of single-beam plastics of ACL, 0.35 mm. for two-beam plastics and 0.93 mm. for plastics with semi-tendinous and gracilis tendons. Maximum stress were 1190 MPa for single-beam plastics of ACL, 141 MPa for two-beam plastics and 150 MPa for plastics with semi-tendinous and gracilis tendons. Conclusion. Finite element modeling of different ways of ACL plastics indicates higher stability of synthetic endoprosthesis under rising stress in case of two-beam plastics and transplant of semi tendinous and gracilis tendons compared to the single-beam plastics.

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Neurospecific proteins as markers of nervous tissue regeneration in focal cerebral contusions

Year: 2017, volume 13 Issue: №3 Pages: 720-722
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Galashina Е.А., Ulyanov V.Yu., Vygodchikova G.Yu., Chibrikova Yu.A., Klimov S.S.
Organization: Saratov State Medical University
Summary:

The aim: to study the dynamics of immunological markers of nervous tissue regeneration in patients with focal cerebral contusions in posttraumatic period. Material and Methods. Quantitative content of human NRG1-beta1, GFAP and anti-SGPG in patients with focal cerebral contusions was analyzed on the 1st-4th, 7th, 14th, 21st and 30th day post-injury, and one time only — in patients of control group. Results. In patients with focal cerebral contusions the content of NRG-1beta1 was characterized by two-phase increase on the 7th and 21st day, GFAP — on the 14th day, anti-SGPG — on the 21st and 30th day compared to the patients of control group. Conclusion. Functional restoration of the brain in cerebral focal contusions in the posttraumatic period is based on the significantly intensified axon and peripheral nervous fiber regeneration processes with intercellular structure regeneration being less intensified. The degree and direction of these processes is predicated upon the dynamics of immunocytochemical markers.

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