Traumatology

 

Меликова, Р. Э. Локальные антибактериальные депо-системы в лечении костно-суставной инфекции (обзор литературы) / Р. Э. Меликова, А. В. Цискарашвили // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2024. – Т. 31, № 4. – C. 677–695.

(Local antibacterial depot systems in the treatment of bone and joint infection (review))

 Local depot systems with high antibiotic content are an essential component of combination therapy in osteoarticular infections. These systems are effective against microbial biofilms by providing drug concentrations that surpass the requirements of planktonic bacteria. Currently, there are numerous support matrixes with various properties. Only a few of them are sufficiently studied and actively used in clinical practice. These include polymethylmethacrylate-based bone cement, calcium sulfate, collagen, allografts, etc. However, the vast majority of local systems have only been studied in vitro and in vivo. This review describes currently available depot systems, including their primary properties, advantages, and disadvantages, as well as potential for future use of a specific matrix both for the treatment and prevention of diseases.
Современные представления о целесообразности антибиотикопрофилактики при артроскопических операциях на коленном суставе: обзор литературы / А. А. Прокофьев [и др.] // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2024. – Т. 31, № 4. – C. 697–707.

(Modern ideas about the expediency of antibiotic prophylaxis in arthroscopic knee surgery: literature review)

 Despite advances in aseptic, antiseptic, and surgical techniques, the risk of infectious complications persists. Antibiotics have long been used to prevent these complications, particularly during surgeries involving prosthetic materials, implants, or transplants. However, their use prior to minimally invasive surgeries, such as knee arthroscopy, remains controversial. We reviewed international literature to summarize modern approaches to antibiotic prophylaxis in knee arthroscopy, as well as to determine the prospects of improving rational antibiotic prophylaxis regimens during these surgeries. The search was performed in PubMed/MedLine and eLIBRARY databases. The following search terms were used: “antibiotic prophylaxis in knee arthroscopy,” “antibiotic prophylaxis in ACL reconstruction,” “antibiotics in knee arthroscopy,” and “septic arthritis after knee arthroscopy.” The search yielded 567 studies published between 1986 and 2024. Following screening, 57 eligible studies were selected. All studies were conditionally divided into two groups. The first group included studies addressing routine arthroscopy without grafting. The second group included studies addressing infectious complications and antibiotic use during knee arthroscopy, using tendon allografts and autografts, with anterior cruciate ligament repair as an example. The literature review found that there is no consensus on the feasibility of antibiotic prophylaxis in routine knee arthroscopy. There were no significant differences in the incidence of deep infectious complications between groups of patients with and without preoperative antibiotic prophylaxis. During knee arthroscopy with the use of tendon grafts, antibiotic prophylaxis was performed in all identified studies. There are two commonly used regimens: a conventional regimen that exclusively uses intravenous antibiotics and a combination regimen that includes additional graft exposure to vancomycin solution. The incidence of deep infectious complications was considerably lower in the group where antibiotic prophylaxis was supplemented by graft exposure to vancomycin solution.
Хронический рецидивирующий многоочаговый остеомиелит: аспекты эпидемиологии, патогенеза, клинической картины, диагностики и лечения: обзор литературы / А. А. Очкуренко [и др.] // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2024. – Т. 31, № 4. – C. 709–725.

(Chronic recurrent multifocal osteomyelitis: aspects of epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment: literature review)

 The paper presents a literature review on chronic recurrent multifocal osteomyelitis. This orphan disease, which primarily affects children and adolescents, has a wide range of clinical manifestations and presents various diagnostic, pathological, and therapeutic problems. An analytical review was performed using medical literature databases and PubMed (MEDLINE), Google Scholar, and eLibrary search systems. The review addresses the following: epidemiology, clinical presentation, pathogenesis, diagnosis, treatment, and genetic factors in the pathophysiology of chronic recurrent multifocal osteomyelitis in humans. The review aimed to improve clinicians’ understanding of this disease, allowing for timely diagnosis and appropriate treatment initiation.
Магнитотерапия как эффективная технология медицинской реабилитации / Н. В. Котенко [и др.] // Врач. – 2024. – Т. 35, № 9. – С. 16–21.

(Magnetic therapy as an effective technology for medical rehabilitation)

 Objective. Provide a scientific overview of world research works on the study of the influence of magnetic fields on the human body under various pathological conditions. Materials and methods. The literature review was conducted using the PubMed, Medline, Google Scholar, and Elsevier databases over the past 14 years (2010–2024); only full-text articles were included in the review. Key words used to conduct the search: “Magnetic therapy”, “Magnetic therapy pain”, “Magnetic stimulation”, “Pulsed magnetic therapy”. The criteria for inclusion of articles in the review were: year of publication of the scientific work from 2010 to 2024, full-text articles, papers, systematic reviews, meta-analyses and experimental studies. Exclusion criteria: coincidence of identical works in different databases. Results. This review combines data from 9 modern systematic reviews and meta-analyses for 2010-2024, which consider the use of magnetic fields in clinical practice and 4 experimental studies studying the mechanisms of action of magnetic fields on tissues and metabolic regulatory systems. Conclusion. Based on the results of the analysis of the data obtained, the role of the most significant techniques that are appropriate for use in medical rehabilitation and have a wide range of prescriptions was determined.
Шерматов, К. Р. Летальность при переломах дистального отдела бедренной кости (обзор литературы) / К. Р. Шерматов, М. В. Паршиков, К. М. Меджидов // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2024. – Т. 31, № 1. – C. 101–108.

(Mortality in fracture of the distal femoral bone (review))

 Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged >60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).
Синдром поражения смежных уровней у лиц пожилого возраста. Обзор литературы / В. А. Сороковиков [и др.] // Клиническая геронтология. – 2024. – Т. 30, № 3–4. – С. 38–46. Цель исследования. Изучить особенности эпидемиологии синдрома поражения смежных уровней (СПСУ) у лиц пожилого возраста, а также основные факторы риска его развития и наиболее востребованные классификации. Материалы и методы. Проведен поиск отечественной и иностранной литературы в период с января 1987 г. по октябрь 2022 г. с использованием баз данных: Medline, EMBASE, Cochrane Library и eLibrary. На запрос по ключевым словам в англоязычных источниках получены 4344 статьи, в русскоязычных – 2561 статья. На первом этапе проведен поиск литературных источников с использованием ключевых слов: «adjacent vertebral segments disease», «degenerative lesion of adjacent segments», «consequences of decompressive-stabilizing diseases» для англоязычных баз данных; «синдром поражения смежных уровня», «дегенеративное поражение смежного уровня», «последствия декомпрессивно-стабилизирующих заболеваний» – в русскоязычных источниках. Критерием исключения на первом этапе являлось несоответствие тематики исследования, выявленное при оценки названия статьи. На втором этапе изучены резюме статей с исключением публикаций, не соответствующих критериям исследования. Критерии отбора публикаций: соответствие содержания статьи теме обзора, изданные и рецензируемые в системах РИНЦ, Scopus, Web of science. На третьем этапе проанализированы тексты статей соответствующих критериям включения – 49 публикаций. В раздел «эпидемиология» включено 4 исследования: «патогенез» – 25 исследований, «факторы риска» – 16 исследований, «классификации» -4 исследования. Результаты. Основными факторами риска, способствующим развитию СПСУ, являются нарушение биомеханики, повышение внутридискового давления, изменение подвижности сегмента, нарушение баланса распределения нагрузки между передним, средним и задним опорным комплексом позвоночно-двигательного сегмента (ПДС). Не менее важны и иные причины развития СПСУ: пожилой возраст, женский пол (в основном это связано с постменопаузальным остеопорозом), курение, ожирение, многоуровневая стабилизация ПДС. Анализ публикаций свидетельствует о недостаточной изученности аспектов прогнозирования и профилактики возникновения синдрома поражения смежного уровня. Kraemer и соавторы пришли к выводу, что для поясничного отдела позвоночника используются стандартные клинические и инструментальные параметры оценки степени дегенерации и нет специализированных классификаций, валидных для синдрома смежных сегментов. Для оценки морфологических изменений ПДС и признаков стеноза преимущественно используется шкалы Modic, Pfirrmann и Fujiwara, для определения функциональных исходов оперативного лечения наибольшей специфичностью обладают шкала Ghiselli University of California Los Angeles (UCLA), Hukuda Japanese Orthopedic Association (JOA), а оценка тяжести остеоартроза осуществляется по Weiner или Kellgren and Lawrence. Заключение. Синдром поражения смежного уровня является одной из наиболее распространенных проблем декомпрессивно-стабилизирующих оперативных вмешательств на поясничном отделе позвоночника у пациентов пожилого возраста. Вопросы происхождения, выраженности и валидности оценки СПСУ требуют дополнительных исследований.
Нуржан уулу, У. Обзор диссертационных исследований по изучению эффективности комплексной физиотерапии / У. Нуржан уулу, М. А. Сагымбаев, К. С. Рысбаев // Врач. – 2023. – Т. 34, № 11. – С. 87–91.

(Review of dissertation research on the effectiveness of complex physiotherapy)

 Today, natural and preformed physical factors occupy a special place in medical rehabilitation. For many years, a large number of experimental and clinical studies have been carried out, including dissertations, which have proved the high effectiveness of the use of the above factors in the treatment of patients with various diseases. Objective. To review dissertations that are devoted to the study of the effect of the complex application of physical factors in patients with diseases of the musculoskeletal system, neurological, and urological diseases for the period 2000–2020. Materials and methods. We have analyzed publications in the disserCat scientific electronic library of dissertations and abstracts over the past 20 years, which are devoted to the study of the use of complex physiotherapy in the medical rehabilitation of patients with diseases of the musculoskeletal system,
neurological and urological diseases. Conclusion. Currently, there is a fairly serious evidence base confirming the effectiveness of complex physiotherapy in the medical rehabilitation of patients with diseases of the musculoskeletal system, neurological and urological profile.
Долотин, Д. Н. Проблема двойных грудных идиопатических сколиозов: несистематический обзор литературы / Д. Н. Долотин, В. Л. Лукинов, М. В. Михайловский // Хирургия позвоночника. – 2023. – Т. 20, № 4. – С. 30–45.

(The problem of double thoracic idiopathic scoliosis: a non-systematic literature review)

 Objective. To analyze the current situation in the community of spine surgeons regarding the determination of the zone of posterior spinal fusion for double thoracic idiopathic scoliosis. Material and Methods. The content of 16 publications containing the results of surgical correction of double thoracic scoliotic deformities was analyzed. The number of studied clinical cohorts was 25, of which in 13 groups only the right-sided main thoracic (MT) curve (MT
group) was blocked, and in 12 – both MT and left-sided proximal upper thoracic (PT) curve (MT + PT group). Four parameters were analyzed in both groups: preoperative Cobb angle, preoperative curve mobility, deformity correction, and postoperative deformity progression. Results. Significant differences were found in the MT and MT + PT groups only in two cases: for the initial Cobb angle of the PT curve and the magnitude of its correction (Cobb angle before surgery minus Cobb angle immediately after the intervention). When choosing
the extent of the instrumental fusion zone, the authors of the publications included in the review were guided, first of all, by the initial magnitude of the Cobb angle of the proximal thoracic curve. In the MT + PT group, it averaged 37–40° and was 11–13° more than in the MT group. At the same time, PT curve mobility in both groups is not statistically different. The achieved correction was statistically significantly greater in the МT + РT group, despite a more severe proximal curvature as compared to the MT group. Postoperative dynamics of kyphosis (both T2–T5 and T5–T12) is insignificant. The length of the instrumental spinal fusion zone has virtually no effect on the parameters of the sagittal contour of the thoracic spine. A fairly high frequency of the adding-on phenomenon development (20.6 %) indicates the presence of a connection between this complication and the dynamics of PT curve, but the available data are not enough to formulate a final conclusion. Literature data regarding patients’ self-assessment of quality of life after surgical treatment of Lenke types 1 and 2 scoliosis are scarce, although the majority of those operated on assess the result of treatment as positive. Conclusion. The problem of determining the extent of the instrumental fusion zone for double thoracic scoliosis remains unresolved. Most surgeons focus not so much on the mobility of the proximal curve, but on its magnitude. There is no consensus in predicting the development of the adding-on phenomenon; there is little information about changes in the quality of life of patients after surgery. New research is needed.
Рассекающий остеохондрит мыщелка бедренной кости у детей. Лечение. Современные тенденции / А. Г. Ельцин [и др.] // Вестник травматологии и ортопедии имени Н. Н. Приорова. – 2023. – Т. 30, № 4. – С. 501–512.

(Osteochondritis dissecants of the femur in children. Treatment. Modern tendencies)

 Osteochondritis dissecants is a pathological condition characterized by the manifestation of subchondral osteonecrosis, which subsequently leads to the separation of the cartilage plate from the femoral condyle. It is a serious condition that can significantly affect patients’ quality of life. Despite a significant amount of research, there is still a need to better understand this pathology and to develop effective diagnostic and treatment strategies to achieve optimal clinical outcomes. The aim of this work was to analyze the literature on osteochondritis dissecants of the knee joint and to substantiate modern treatment methods for this disease, as well as to find out the preferred treatment options depending on the age group of patients. Literature sources were analyzed. The search was carried out in the databases RSCI, NCBI Pubmed, Medline for the last 10 years. Osteochondritis dissecants is a disease requiring a modern approach to treatment. With the advent of new technologies and techniques, various
therapeutic options have emerged, such as collagen membrane replacement of the defect, mosaic chondroplasty, etc. However, the question of the preferred treatment method remains relevant, especially in view of the age-related characteristics of
patients. An individualized approach, taking into account their age, stage of injury and clinical features, is an important aspect for effective treatment of osteochondritis dissecants. Further research and clinical follow-up are needed to better define the most effective treatment strategies and prevent complications.
К вопросу об огнестрельных ранениях прямой кишки (обзор литературы) / И. Ю. Ким [и др.] // Военно-медицинский журнал. – 2024. – Т. 345, № 3. – С. 20–28.

(On gunshot wounds of the rectum (Literature review))

 Rectal trauma continues to be a pressing problem in both peacetime and wartime. The results of an analysis of the literature on gunshot wounds of the rectum are presented. The frequency of rectal injuries among gunshot wounds of the abdomen is 5.1–20.5%, extraperitoneal injuries range from 20 to 72%, and intraperitoneal injuries range from 25 to 80%. Complications after colon surgery reach 69.6%. Mortality ranges from 3 to 51.4%. Existing classifications of rectal injuries do not allow comparison of research results because of different approaches to naming injuries. Gunshot wounds of the rectum are almost always combined with other injuries to organs and pelvic bones, which complicates their diagnosis and treatment. Therapeutic tactics for intraperitoneal wounds of the rectum involve performing a Hartmann-type operation; for extraperitoneal wounds, it is necessary to carry out primary surgical treatment of the perineal wound with drainage, the application of a double-barrel unnatural anus to the sigmoid colon with a spur, and washing the caudal part of the rectum.