Saratov JOURNAL of Medical and Scientific Research

Korshunova G.A.

Saratov Scientific Research Institute of Traumatology and Orthopedict, Department of Laboratory and Functional Diagnostics, Candidate of Medical Science

Differentiated approach to surgical treatment of patients with rigid posttraumatic deformities of thoracic and lumbar spine

Year: 2017, volume 13 Issue: №3 Pages: 772-779
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shul'ga А.Е., Zaretskov V.V., Bogomolova N.V., Korshunova G.A., Smol'kin A.A.
Organization:
Summary:

The aim: to investigate the outcomes of surgical treatment of patients with rigid posttraumatic deformities in thoracic and lumbar spine on the basis of the comparative analysis of different approaches to the planning of operative intervention management. Material and Methods. A comparative analysis of the results of surgical treatment of 138 patients (main group) with old injuries of thoracic and lumbar spine was carried out with the help of the proposed surgery managing algorithm and 86 patients (comparison group) — without taking the given algorithm into account. The choice of surgery managing in the main group of patients was based on the study of the spinal deformity degree, pain syndrome intensity and life quality indices of patients before and after surgery. Results. In the main group in 122 (88,4%) patients after the surgery spinal deformity correction exceeding 80% was achieved, pain syndrome regressed in accordance with the visual analog scale up to 3 points and less, life quality indices improved up to the level of 0-25%. Conclusion. The application of the proposed algorithm approach enables surgeons to get persistent positive outcomes in the majority of cases.

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Complex stimulation of peripheral nerve regeneration after deferred neurorrhaphy

Year: 2017, volume 13 Issue: №3 Pages: 732-737
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ivanov A.N., Korshunova G.A., Matveyeva O.V., Ninel V.G., Shutrov I.E., Shchanitsyn I.N., Andronova Т.А., Norkin I.A.
Organization: Saratov Regional Child Clinical Hospital, Saratov State Medical University
Summary:

The aim is to study the complex stimulation effect including skin autotransplantation and electrical stimulation of the sciatic nerve on microcircular, electrophysiological and morphological changes after deferred neurorrhaphy in rats. Material and methods. The experiment was performed in 50 albino rats divided into control, comparative and experimental groups. In the experimental group, on the background of deferred neurorrhaphy, skin autotransplantation and electrical stimulation of the sciatic nerve had been carried out. In the comparative group only deferred neurorrhaphy was performed. Research methods included laser doppler flowmetry, electroneuromyography and morphological analysis of the operated nerve. Results. Complex stimulation including skin autotransplantation and direct action of electrical pulses on the sciatic nerve after its deferred neurorrhaphy causes restoration of bloodstream in the operated limb, promotes intensification of restoration of nerve fibers. Conclusion. Intensification of sciatic nerve regeneration after deferred neurorrhaphy in rats under the influence of complex stimulation including full-thickness skin graft autotransplantation and direct action of electrical pulses substantiates experimentally appropriateness of clinical testing of the given method for treatment of patients with peripheral nerve injuries.

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Comprehensive approach to the assessment of the functional status of patients with degenerative joint diseases of the lower extremities

Year: 2017, volume 13 Issue: №3 Pages: 510-514
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Romakina N.A., Korshunova G.A., Kireev S.I., Sertakova A.V., Norkin I.A.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

Aim: development of an integrated biomechanical index that reflects the state of kinematic and static function in patients who need replacement of large joints as well as evaluation of the myoneural complex of lower extremities activity of category of patients. Material and Methods. 103 patients with osteoarthrosis of the hip and knee joints. A biomechanical survey included podography, stabilometry and dynamometry. An electrophysiological study of the peripheral nerves of the lower extremities with the determination of the amplitude of the muscle response and late neuronal responses was carried out. The level of activity of the gluteal muscles was determined. Results. The most sensitive indicators reflecting the state of biomechanical status were identified, specialized software for the integral biomechanical index calculation was developed. Conclusion. Methods of clinical biomechanics allow specialists to assess the state of kinematic and static function of the musculoskeletal system, matching of the integral biomechanical index with the data of neurophysiological monitoring makes possible to select individual tactics of treatment.

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Algorithm of surgical treatment of pain and spastic syndromes in patients after spinal cord injury

Year: 2015, volume 11 Issue: №3 Pages: 297-302
Heading: neurosurgery Article type: Original article
Authors: Ninel V.G., Smolkin А.А., Shchukovsky V.V., Korshunova G.A.
Organization:
Summary:

Objective: to develop an algorithm for surgical treatment of pain and spasticity in patients with consequences of spinal cord injury. Materials and Methods. The basis of the algorithm initiated a retrospective study of results of surgical treatment of 273 patients with pain and spastic syndromes after spinal cord injury, which consistently met neuromodula-tion techniques and destructive surgery. Results. The developed algorithm tested in 166 patients with pain and spastic syndromes provided positive results in 88.6% of cases with spastic and in 80.4% of observations for pain and spastic-pain syndromes. Conclusion. The proposed algorithm allows systematizing neuromodulation methods and so-called «radical» destructive operations in the treatment of pain and spasticity, and thereby improving the results of rehabilitation of patients with consequences of spinal cord injury.

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Intraoperative neurovisualization in the surgical treatment of peripheral nerve injuries

Year: 2015, volume 11 Issue: №2 Pages: 178-182
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Aitemirov Sh.M., Ninel V.G., Korshunova G.A.
Organization:
Summary:

Objective. The present study examines the value of intraoperative neurovisualization as an imaging tool for decision making in the management of traumatic nerve injuries. Materials and methods. 43 patients with traumatic nerve lesions were examined by electrodiagnostic study, ultrasonography and contrast neurography. Results. A complex intraoperative examination have been used to guide surgical decision making in patients with peripheral nerve injuries of limbs. Conclusion. The results of complex intraoperative examination became the basis of diagnosis and treatment algorithm for surgical treatment of peripheral nerves injuries.

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Evaluationof efficiency of methods of neuromodulation in the treatment of spastic syndromes in patients with spinal cord injury

Year: 2014, volume 10 Issue: №4 Pages: 639-645
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Smolkin А.А., Ninel V.G., Korshunova G.A.
Organization:
Summary:

Objective: to evaluate the efficiency of the neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury. Material and methods: Based on the study and treatment of 105 patients with spastic syndromes after injury of the spinal cord, electrical stimulation of the spinal cord, epidural drug therapy in combination with electrical nerve stimulation and local hypothermia spinal cord have been consistently applied for the treatment of spastic syndrome. Results: Consistent use of methods of neuromodulation in patients with spastic syndromes after spinal cord injuries are given in 88,6% of cases to obtain positive results. Conclusion: The obtained results allow to estimate efficiency of neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury

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Chronobiological aspects of changes in straight electro stimulation of spinal cord for treatment of neurological complications of cervical vertebrae osteochondro-sis

Year: 2012, volume 8 Issue: №2 Pages: 547-552
Heading: Neurology Article type: Original article
Authors: Chekhonatsky A.A., Korshunova G.A., Ovsyannikov D.M., Chekhonatsky V.A.
Organization: Saratov State Medical University
Summary:

Research Goal was to study infuence of treatment seance time, disease duration, and age on effcacy of straight electrostimulation of spinal cord. Materials. Biorhythmological characteristics of optimal time choice for electrostimula-tion séance were studied based on the sample of 32 patients with cervical osteochondrosis, who were subjected to paracentetic electrodes placement on posterior part of spinal cord. Results. Group of patients used morning séance, demonstrated change of clinical manifestations severity in accordance to JOA scale from 8,4±0,2 to 12,8±0,3 points that formed 46,6 %. Séance during daylight hours helped to decrease clinical manifestations severity by 25,1 %; evening séance promoted reduction by 22,1 %. In patients under 40 the average percentage of decrease of posttreatment neurological symptomatology consisted 83,6±3,6 %, in patients aged 60 and upwards this index was 74,6±3,2 %. Decrease of myelopathy severity was marked in the following way: 1 – 4 years of disease duration — by 73,6±4,8 %, more than 10 years — 63,7±2,1 %; estimation was carried out using JOA scale. Conclusion. Maximum effect of straight elec-trostimulation of spinal cord was observed in the morning hours. Clinical effect of isolated use of straight electrostimula-tion of spinal cord in the complex of treating neurological symptoms of cervical vertebrae osteochondrosis decreases while disease duration extends. Effect of electrostimulation reduces in accordance with patients’ age; maximum positive results of this method can be achieved in 1 – 4 years of disease duration.

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Total Knee Arthroplasty in the Combined Contracture

Year: 2009, volume 5 Issue: №3 Pages: 410-414
Heading: Traumatology and Orthopedics Article type: Original article
Authors: M.M Girkalo, М.А. Gavrilov, N.H. Bakteeva, O.J. Voskresensky, G.A. Korshunova, V.V. Kozlov
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics, Saratov State Medical University
Summary:

We have offered modified access to a knee to work out a method for restoration of extensive apparatus of the knee. 91 patients with degenerative damages of the knee were under out su-pervision. All patients were differentiated in groups according to the form of access and pa-thology of the knee. At all stages of studying the following method of investigation were made: goniometry — for estimation of the knee functional condition; electroneiromyography — for reveling deficiency of muscular activity and determination of its kind. Patient's satisfac-tion by operation was defined by means of WOMAC scale subjective indexes. The received digital material was subjected to statistical processing. Thus, it has been proved that applica-tion of the modified access to a knee offered by us in total knee arthroplasty in patients with combined contracture in comparison with traditionally applied technologies of extensive ap-paratus releasing allows in short terms to restore the volume and force of movements in a knee that reduces time of rehabilitation and improves quality of patient's life

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Potentialities Of Tendomyoplasty In Rehabilitation Of Patients With Rough Injuries Of Brachial Plexus Trunks

Year: 2009, volume 5 Issue: №3 Pages: 403-407
Heading: Traumatology and Orthopedics Article type: Original article
Authors: R.P. Gorshkov, V.G. Ninel, I.A. Norkin, S.V. Delinikaitis, G.A.Korshunova
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

To improve functional results after surgical treatment of consequences of brachial plexus trunks rough injuries rehabilitation results of 111 patients with consequences of brachial plexus trunks rough injuries were studied. Thanks to the adequate tendomyoplasty rehabilitation of shoulder abduction, forearm flexion and of hand grasping is obtained in 85% of patients. The suggested method of treatment may be recommended for wide usage in practical health care

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