[Osteal scintigraphy in the evaluation of the course of reparative processes after surgical treatment for tuberculous and nonspecific arthritis, by using constrained bone grafting].

Osteal scintigraphy was used to study the course of reparative processes after surgical treatment in 106 patients with large joint lesions, including 76 patients with tuberculous arthritis and their sequels and 30 with nonspecific and dystrophicones before and 2-3 weeks after operations (those with and without articular tissue revascularization (n = 43 and n = 63); mobilizing (n = 64) and stabilizing (n = 42) operations), of them 22 being performed in late periods (1-3 years (n = 16)). It was established that after mobilizing operations with revascularization, the early postoperative period was marked by a significant increase in radionuclide accumulation (by 1.52 times) and after those without revascularization, there was a less significant rise (by 1.34 times); following stabilizing operations with revascularization, hyperfixation was similar before and after surgery whereas following those without revascularization it significantly reduced (by 1.53% in 70% of patients). The late postoperative period was characterized by reduced hyperfixation, which was more evident after mobilizing operations with revascularization. Osteal scintigraphy quantifies the course of reparative processes and determines the efficiency of different operations.

[Bone tissue metabolic features in tuberculous and nonspecific large joint lesions as evidenced by osteoscintigraphy].

Osteoscintigraphy was employed to study the bone tissue in 405 patients referred for tuberculous arthritis and its sequels or suspected tuberculosis. Tuberculous lesion was identified in 228 patients; there were nonspecific arthritides (n = 69), dystrophic diseases (n = 88), tumors (n = 8), and no bone involvement (n = 12). In active tuberculous ostitis, radiotracer hyperfixation (HF) was found to be marked and it was normal when the disease subsided. In tuberculous arthritis in the arthritic phase (synovitis and in full swing) HF was higher than that in arthrosis; in complicated forms (fistulas and abscesses) HF showed 5-to 15-fold increases in 19.5%. An insignificant HF was observed at the stage of subsidence. In nonspecific arthritis and dystrophic arthrosis, HF depended on the activity and stage of involvement. This procedure could provide an objective assessment of bone tissue changes, by substantially supplementing the basic X-ray study in both the examination of patients and the determination of further treatment policy.

[Sociomedical efficiency of reparative operations in progressive tuberculosis of the hip joint].

The disability rates and life quality indices were analyzed in 69 patients operated on for active tuberculous coxitis revealed a clear-cut advantage of early radical operations in their complex treatment. Prolongation of the time of surgical interventions results in progression of destructive processes in the affected joint, shows a 2.5-fold increase in the disability rates and drastically reduces the quality of their life.

[Clinical and neurological evaluation of the efficiency of transspinal magnetic stimulation during surgical treatment of tuberculosis spondylitis].

The clinical and neurophysiological efficiency of high-intensity transpinal rhythmic magnetic stimulation was studied during surgical treatment in patients with tuberculosis spondylitis complicated by neurological disorders. Its highest efficiency was determined in patients with minor neurological disorders, radicular syndrome, and paresis. Magnetic stimulation was shown to affect the regression of neurological symptoms. The use of electric neuromyography allows quantitative assessment of the course of reparative processes in the pathways.

[Changed life quality in patients with tuberculosis and other diseases of large joints after surgical treatment].

The quality of life was studied in 88 patients who had been operated on for tuberculosis and other diseases of the hip and knee joints. Reconstructive surgery was ascertained to considerably relieve painful sensations, to permit the better capacities of patients' movements. Multifactorial analysis of life quality in patients demonstrated the obvious advantages of reparative mobilizing operations on the joints over arthrodesing ones. A comprehensive evaluation of the efficiency of operations should take into account not only the traditional objective clinical and X-ray parameters, but also the subjective criteria for the quality of life in patients.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Osseous-perichondral autoplasty in surgery for tuberculosis of the joints]. / Kostno-peikhondrial'naia autoplastika v khirurgii tuberkuleza sustavov.

The results of 68 reconstruction surgeries made in the hip and knee joints in tuberculosis and concomitant diseases were studied. Advantages of operations involving the component plasty of joint ends (osseous autoplasty, as well as auto-perichondral plasty and their variations), including under the conditions of revascularization of the osseous bed, were proven on the basis of the results of a comparative analysis of clinical-and-functional data and X-ray examinations. The use of the method ensuring additional sources for vascularizing the joint tissues improves the conditions of autograft assimilation; the application of perichondral grafting preserves or expands the joint split, which provides an increased mobility amplitude in a damaged joint. The use of perichondral plasty and of its combination with revascularization of the joint osseous joint tissues secured more favorable results as compared to the implementation of osseous-plasty interventions alone.

[Current reconstructive surgery for tuberculosis of the vertebral column and joints]. / Sovremennaia vosstanovitel'naia khirurgiia tuberkuleza pozvonochnika i sustavov.

There has been recently a rise in the incidence of complicated forms of bone and joint tuberculosis, one of its causes is its late diagnosis. The outcomes of surgical treatment in 390 patients with tuberculosis of the spine and large joints are presented. Vascularization of bone tissues and a graft has been found to substantially increase the efficiency of an intervention used and the use of carbon-carbonic implants and posterior clamps accelerates the time of formation of a bony trochlea and diminishes deformity of a vertebral column part undergone an operation. To improve the functional results of mobilizing surgery for tuberculous arthritis and its sequelae, low-traumatic operations using the arthroscopic devices, perichondrioplasty and endoprosthesis of large joints are being practically introduced.

[Efficiency of plastic surgery for osteoarticular tuberculosis by using revascularization of osseous tissue bed and graft]. / Effektivnost' plasticheskikh operatsii pri kostno-sustavnom tuberkuleze s primeneniem revaskuliarizatsii kostnoi tkani lozha i transplantanta.

The paper provides the results of using original procedures for revascularization of the osseous bed and free bony grafts by transplanting osteovascular complexes in patients with tuberculosis of the hip joint and spine. A total of 20 patients with tuberculous coxitis and 14 with spondylitis were operated on. These interventions were found to have advantages over plastic surgery with bony grafts and mobilizing operations without plasty in similar skeletal lesions, appeared as a great scope of movements in the operated joints is achieved, less time for grafts to adhere with the bed and bony block of vertebrae, and enhanced accumulation of a radioopaque agent in the area to be replaced.

[Experimental rationale and clinical evaluation of perichondroplasty used in surgery for tuberculosis and nonspecific joint diseases]. / Eksperimental'noe obosnovanie i klinicheskaia otsenka primeneniia perikhondroplastiki v khirurgii tuberkuleza i nespetsificheskikh zabolevanii sustavov.

Experiments on 77 rabbits studied the specific features of chondrogenesis during different grafting modifications for the perichondrium. The latter was found to have a high chondroplastic potential. The factors predisposing to cartilaginification and inhibiting this process were identified. Experimental positive results of perichondrial arthroplasty, in tuberculous arthritis as well, were achieved. By taking into account the experimental data, original methods for reparative operations used in patients with tuberculosis and nonspecific diseases of the joints were developed in the clinical setting. Their use in 12 patients yielded positive results, suggesting that the above methods are promising and their further study is advisable.