[Efficiency of balance training with stabilizing platform in early postoperative rehabilitation of patients after arthroplasty]. / Effektivnost' vklyucheniya balans-treninga s ispol'zovaniem stabiloplatformy v kompleksnye programmy rannei posleoperatsionnoi reabilitatsii patsientov posle endoprotezirovaniya.

OBJECTIVE: To evaluate the effectiveness of balance training on stabilizing platform (HUBER360) in early postoperative rehabilitation of patients after total knee arthroplasty. MATERIAL AND METHODS: We examined 60 patients after total knee arthroplasty. Mean age of patients was 69.1±9.8 years, mean postoperative period - 3.6±1.4 days. All patients were divided into 2 groups (main group (n=30) and control group (n=30)). All patients received a standard course of treatment, including therapeutic exercises, massage of affected lower in electro-static field limb using a drainage technique, magnetotherapy, mechanotherapy of affected limb in passive motor mode (Artromot device). Duration of rehabilitation course in a round-the-clock hospital was 7 days. In the main group, patients additionally received balance-training procedures on the HUBER 360 multiaxial platform in baseline sitting position. RESULTS: Treatment was followed by positive dynamics in all patients that correlated with significant regression of pain syndrome, edema, improvement of quality of life and 10-meter walk test with external support on crutches. However, additional balance training provided more effective regression of pain, as well as improvement of quality of life and walking after the first procedures. CONCLUSION: We can recommend balance training on stabilizing platform for early rehabilitation after total knee arthroplasty.

[Effectiveness of physical therapy after total hip arthroplasty at the third stage of rehabilitation using a telemedicine program]. / Effektivnost' provedeniya lechebnoi gimnastiki u patsientov posle endoprotezirovaniya na tret'em etape reabilitatsii v forme telemeditsinskikh uslug.

OBJECTIVE: To assess the quality of life and efficacy of telemedicine technologies for rehabilitation after total hip replacement. MATERIAL AND METHODS: The study included 60 patients aged 40-75 years after total hip replacement. All patients were divided into two groups by simple randomization. All patients underwent a 7-day course of complex in-hospital postoperative rehabilitation. At discharge, patients of the main group received an access to telemedicine program for 3-month physical exercises (3 times a week for 30 minutes). In the control group, patients received routine recommendations for rehabilitation procedures and orthopedic recommendations. RESULTS: A course of rehabilitation with telemedicine technologies after total hip replacement was accompanied by significant clinical effect according to EQ5D, SF-36 and STAI questionnaires. CONCLUSION. T: Elemedicine technologies in postoperative rehabilitation after total hip replacement are accompanied by QoL improvement. It is an effective form of medical rehabilitation.

[Modern minimally invasive technologies in spine surgery]. / Sovremennye maloinvazivnye tekhnologii v khirurgii pozvonochnika.

The number of spine surgeries has been annually increasing all over the world. It is associated with high incidence of spinal degenerative diseases, vertebral traumas and different tumors. Minimally invasive surgical techniques are being developed in spine surgery considering extended surgical procedures, long hospital-stay and disability period. These techniques minimize surgical trauma, shorten hospital-stay and disability period.

[Aortic intramural hematoma after transpedicular thoracic spine fusion]. / Intramural'naia gematoma aorty posle transpedikuliarnoi fiksatsii grudnogo otdela pozvonochnika.

A 55-year-old patient M. with compression fractures of Th7-Th8 underwent Th7-Th8 decompressive laminectomy, Th6-Th9 transpedicular spine fusion procedure on January 31, 2017. After that, multiple myeloma was diagnosed at the National Research Center for Hematology. Computed tomography revealed misplacement of a left Th6 screw, its anterior cortical perforation and penetration into the aorta. Signs of intramural hematoma were noticed in this area. The patient was referred to the Petrovsky National Research Center of Surgery. Two-stage surgical approach was preferred. Endovascular repair of the thoracic aorta (TEVAR) was followed by revision of transpedicular fusion system and reinstallation of the screw. Operation was performed on July 14, 2017. Postoperative period was uneventful.

[Surgical treatment of spine injuries]. / Khirurgicheskoe lechenie povrezhdenii pozvonochnika.

The history of spinal fixation started in the 19th century and had an intensive development in subsequent years. Special progress in surgery for spinal traumatic injuries was noted in the Second World War. Last decades minimally invasive spinal surgical techniques are developed and introduced in everyday practice.

[Surgical treatment of pain syndrome in lumbar spine in patients with obesity]. / Khirurgicheskoe lechenie bolevogo sindroma v poiasnichnom otdele pozvonochnika u bol'nykh s ozhireniem.

AIM: To analyze the reduction of pain severity, time of surgery, intraoperative blood loss, incidence of unintentional lesion of dura mater, infectious complications and hospital-stay after lumbar microdiscectomy. MATERIAL AND METHODS: The study included 104 patients aged 24-58 years (37 men and 67 women, mean age 45 years) who underwent lumbar microdiscectomy within January 2015 - June 2016. The main and control groups consisted of 48 and 56 patients with and without obesity respectively. In all cases lumbar microdiscectomy was made. Pain syndrome was assessed by visual analogue scale and Oswestry questionnaire. RESULTS: In 6 weeks, 6 and 12 months after surgery significant improvement of both lumbar and leg pain was observed. Significantly reduced pain was stable and similar in both groups within follow-up although there was a tendency to increased pain in long-term period in group 1. Blood loss and infections were slightly higher in obese group while surgery time and hospital-stay were significantly higher in these patients. CONCLUSION: Features of patients with excessive body weight should be considered prior to elective surgery. Probably, implants are advisable to stabilize spinal motion segment and improve the outcomes among patients with excessive body weight.

[Resistant cytomegalovirus infection in related donor kidney allograft recipients].

AIM: To clarify whether cytomegalovirus (CMV) infection can affect the results of living related donor kidney transplantation. SUBJECTS AND METHODS: A study group included 17 (7.27%) patients (10 men and 7 women; 8 children and 9 adults) aged 3 to 51 years who had developed resistant CMV infection. For comparative analysis, a control group was formed from 113 patients (61 men and 52 women; 40 children and 73 adults) aged 1 to 61 years, whose CMV polymerase chain reaction (PCR) had always been negative, i.e. CMV DNA was absent. The duration of CMV infection episodes was 44 to 232 days. RESULTS: The patients were given valganciclovir in a dose of 450 mg/day. CMV PCR was negative in all the patients at the end of therapy. None of the patients died; one graft was lost. In the control (negative CMV PCR) group, 6 grafts were lost in 113 patients lost and 4 patients died. Statistical analysis showed that the results of related donor kidney transplantation were virtually equal. CONCLUSION: Suppression of resistant CMV infection can be achieved with the longer use of valganciclovir or its higher dose. CMV infection fails to affect the results of related donor kidney transplantation.

[Analysis of dynamic implants use in surgical treatment of degenerative lumbar spine stenosis].

AIM: To improve the results of surgical treatment of lumbar spine stenosis. MATERIAL AND METHODS: Surgical treatment of 84 patients was analyzed. There were 2 groups consisting of 48 and 36 patients respectively. Advanced decompression and fusion were performed in group 1, minimally invasive decompression (flavectomy, marginal arch resection, facetectomy) with implantstion of interspinous dynamic implants DIAM -- in group 2. Patients with isthmic spondylolisthesis were excluded. RESULTS AND DISCUSSION: Both methods did not show difference in efficacy of leg pain relief during follow-up (1.7--8.5 years). 16.7% of patients after fusion of more than 2 segments had pain above and below fusion area in long-term postoperative period. Such pain was not observed in group 2. One patient of the 1st group had fixation system destruction that required repeated intervention. Groups have not difference in back pain severity after surgery on 1 segment. Also less intraoperative blood loss and duration of surgery were established in group 2. CONCLUSION: Minimally invasive decompression with implantstion of interspinous dynamic implants is effective and safe alternative to advanced decompression and fusion in lumbar spine stenosis management.

[The future and the past of surgery for the complicated spine trauma].

The state of art of the spine and spinal cord trauma is highlighted. The thorough literature review was performed. Main trends of the spine surgery, both adopted long ago, and new experimental theories were represented. Problems of medical help organization were also stressed.

[The miniinvasive technologies in surgical treatment of diseases and traumas of the spine].

The analysis of miniinvasive surgery for degenerative and traumatic diseases of the spine was conducted. Such methods as microsurgical diskectomy, dynamic implants, vertebroplasty, vertebrae stenting were featured. The use of miniinvasive methods allow the sunstantioal decrease of the hospital-stay time and fasten the rehabilitation.

[Microsurgical and endoscopic laser diskectomy in osteochondrosis of the lumbar spine]. / Mikrokhirurgicheskaia i éndoskopicheskaia lazernaia diskéktomiia pri osteokhondroze poiasnichnogo otdela pozvonochnika.

Experimental studies have revealed that a pulse surgical laser based on alumo-yttrium garnet with neodymium ensures bloodless diskectomy and evaporation of a pulposus nucleus in the volume sufficient for decompression of the intervertebral disk. Biomechanical studies of spinal resistance following puncture endoscopic laser decompression of the intervertebral disk (PELDID) and microsurgical laser diskectomy (MLD) have demonstrated that these surgical interventions fail to disturb the stability of the spinal portion operated on. A total of 75 patients with radicular syndrome were operated on with the proposed procedures: 32 with PELDID and 43 with MLD. The subsequent studies have shown that 69 (92%) patients returned to previous work at week 7 and 5 (6.7%) at week 9 of postoperation. The major manifestation of radicular syndrome--leg pain--was eliminated in 100% after MLD and in 96.9% after PELDID.

[Matrix endoprostheses for replacement of the tendon-ligament system]. / Matrichnye éndoprotezy dlia zameshcheniia sukhozhil'no-sviazochnogo apparata.

A classification of tendinous and ligamentous implants has been proposed on the basis of their baseline and final strength, taking into account the matrix properties of a material. The experiments on the knee joints and Achilles tendons of laboratory animals have revealed the matrix properties of carbon-containing fiber. Biological reconstruction of tendon ligaments occurs in parallel to the degradation of biodestructive carbon-carbonic fiber (BCF) which is absent in the Vitlana (polymer carbon fiber) implants. The expediency of extra- and intraarticular implantation of the Vitlana and extraarticular one of BCF has been evidenced. The use of the Vitlana implants is found justifiable to replace Achilles tendon defects. Due to the occurrence of complications, it is not advisable to use BCF for intraarticular management of and plastic operations for Achilles tendon defects.

[Reconstructive surgery in complicated trauma of the thoracic and lumbar segments of the spine]. / Rekonstruktivnye operatsii pri oslozhnennoi travme grudopoiasnichnogo otdela pozvonochnika.

The article presents an analysis of reconstructive operations on the spinal cord in 176 patients with traumas of the thoracic and lumbar parts of the vertebral column. The operative treatment in acute period consisted in end-to-end anastomosis of the horse's tail roots, in late period of trauma disease of the spinal cord--in reconstruction of the spinal cord defects with intercostal nerves by the type of "collateral anastomosis" or free transplants from the peripheral nerve. The operations performed resulted in an improvement of sensitivity, movement, functions of pelvic organs in part of the patients.

[Minimal interventions in the surgery of osteochondrosis of the lumbar spine]. / Minimal'nye vmeshatel'stva v khirurgii osteokhondroza poiasnichnogo otdela pozvonochnika.

The authors consider that puncture decompression of the intervertebral disc with using the endoscopic technique and laser evaporation is a method allowing to rapidly and effectively help patients with the root syndrome. All the manipulations are made with local anesthesia. The patients started walking on the second day after operation.