BIOMECHANICAL FACTORS IN RESIDUAL LIMB FORMATION AFTER AMPUTATION.

OBJECTIVE: The aim: To study the influence of biomechanical factors on the character of morphological disorders in the process of reparative regeneration at the end of the residual limb after amputation. PATIENTS AND METHODS: Materials and methods: 10 series of experiments on 144 rabbits were conducted. We used myodesis with normal, insufficient and excessive muscle tension, their electrical stimulation, tight and leaky closure of the bone marrow canal. Terms of observation 1, 3, 6 months. The method of research - histological with the filling of vessels with inkgelatin mixture. RESULTS: Results: Dense closure of the meduallary cavity and uniform muscle tension during plasty in the first three series of experiments allow to obtain a cylindrical residual limb with preservation of the cortical diaphyseal plate, formation of the bone closing plate, normalization of intraosseous microcirculation, completion of the reparative process. In the majority of observations of the IV-X series there was a reparative regeneration disorder connected with the incorrect tension of muscles and the absence of normalization of intraosseous circulation, the reparative process was not observed to be complete, which led to the pathological reorganization of bone tissue with the formation of stumps of various shapes. CONCLUSION: Conclusions: Uneven muscle tension and lack of closure of the intramedually canal except for microcirculation disorders leads to increased periosteum bone formation, formation of periosteum cartilage exostases, clavate stumps, resorption and fractures of the cortical diaphyseal plate with curvature and stump axis disorders, formation of a conical stump.

Reamputation stumps below knee.

Aim To investigate rehabilitation outcomes of patients with malformed tibial stumps. Methods Observations included 421 patients with residual limb diseases and malformations (extensive inactive scars adhered to the bone, excessively long or short stumps, bone filing, osteomyelitis of the stump, muscle attachment to the skin scar, excessive mobility and deviations of the fibula, improper filing). Four hundred and thirty-six (436) reconstructive surgeries were performed. A follow-up period was from 6 months to 15 years. Radiological, ultrasonic, tensometrical, and histological methods were used. Results Due to the frequent combination of several malformations and diseases in the same patient, non-free skin grafting with displaced dermal-subcutaneous flaps, which cover rather large defects, was widely used. The surgeries were performed simultaneously and allowed for reconstruction without shortening the bone lever stump. Complications in the form of marginal necrosis were obtained in three (0.71%) patients. The improved technique of muscle grafting with the fixation of muscles to the bone provided an elastic stump covering the bone filing. The authors have developed original methods of surgery to create a bone block of the tibia, which make it possible to obtain painless, highly functional stumps using partial support and ensure long-term use of modern prosthesis designs in 100% of cases. Conclusion Non-free dermal plasty with cutaneous-subcutaneous flap is the method of choice for closing skin defects on the residual limb. Muscle-bone fixation permits to eliminate some residual limb defects and to form an elastic muscular residual limb with closed bone filaments. Synostosis formation in different ways considerably improves functional quality of the residual limb.

REPARATIVE REGENERATION AT THE END OF BONE FILING AFTER OSTOPLASTIC AMPUTATION.

OBJECTIVE: The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. PATIENTS AND METHODS: Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. RESULTS: Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. CONCLUSION: Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

The relationship between homocysteine level and vitamins B12, B9 and B6 status in patients with chronic kidney disease.

OBJECTIVE: Introduction: According to present knowledge, hyperhomocysteinemia is one of the risk factors of cardio-vascular pathology. Patients with chronic kidney disease are known to develop hyperhomocysteinemia more often than those in general population. Іmportant cause of hyperhomocysteinemia is the deficiency of vitamins В6, В9 and В12 that are involved in homocysteine metabolism. Vitamins deficiency, we believe, can be one of the causes of hyperhomocysteinemia in the patients with chronic renal failure. The aim: To analyze the plasma homocysteine level in patients with chronic kidney disease and its assosiation with the levels of vitamins B6, B9, B12 in Ukraine. PATIENTS AND METHODS: Materials and methods: The study involved 148 persons with different stagesis of chronic kidney disease who underwent immunoenzyme determination of total plasma homocysteine, B9, cobalamin and vitamin В6 status. RESULTS: Results: It was found that in ukrainian patient population with chronic kidney disease 58.7% of patients have hyperhomocysteinemia. Homocysteine level was shown to increase with the increase of chronic kidney disease stage. Supply of vitamins В6, В9 та В12 in the patients with chronic kidney disease was lower than in apparently healthy persons, but there was significant decrease of folic acid level proportionally to the increase of chronic kidney disease stage. There was close relationship between homocysteine level and folic acid status in the patients with chronic kidney disease, but it appeared to be independent on cobalamin and pyridoxin status. CONCLUSION: Conclusions: The obtained data are promising for finding effective means of correction of hyperhomocysteinemia in patients with chronic kidney disease by normalizing the vitamin status of such patients.