[High tibial osteotomy with computer navigation for medial gonarthritis]. / Sravnitel'nye rezul'taty lecheniya medial'nogo gonartrita metodom vysokoi tibial'noi osteotomii s ispol'zovaniem komp'yuternoi navigatsii.

OBJECTIVE: To study significance of computer navigation for improving clinical and radiological results of medial gonarthritis treatment compared to non-invasive methods of lower limb axis correction control. MATERIAL AND METHODS: The study included 73 patients who were divided into 2 groups. The main group included 40 patients, the control group - 33 patients. In the main group, high tibial osteotomy was performed using computer navigation, in the control group - using non-invasive techniques. Clinical assessment was carried out according to the KSS, KOOS and VAS scales. We assessed the main reference angles of the lower limb considering X-ray data. RESULTS: Both groups were characterized by postoperative improvement of clinical results according to various scales. Computer navigation provided higher accuracy in most cases. We focused on target correction of 3° valgus. CONCLUSION: High tibial osteotomy with computer navigation or non-invasive techniques is an effective treatment method for medial gonarthritis. There are no significant differences in clinical results according to the KSS and KOOS scales, as well as X-ray data after correction. We found significant differences in VAS scores.

[Ankle distraction hinged motion arthroplasty in the Ilizarov frame]. / Distraktsionnaya artikuliruyushchaya artroplastika golenostopnogo sustava v apparate Ilizarova.

OBJECTIVE: To study distraction hinged motion arthroplasty of the ankle joint in combined treatment of osteoarthritis in terminal stages. MATERIAL AND METHODS: Ankle distraction hinged motion arthroplasty in the Ilizarov frame was performed in 10 patients with terminal post-traumatic osteoarthritis (mean age 54±6.2 years). Surgical technique and design of the Ilizarov frame, as well as additional reconstructive interventions are described. RESULTS: Preoperative VAS score of pain syndrome was 7±2.3 cm, after 2 postoperative weeks - 1±0.5 cm, 4 weeks - 0.5±0.5 cm, 9 weeks or before dismantling - 0±0.5 cm. Arthroscopic debridement of anterior part of the ankle joint was carried out in 6 cases, posterior part - 1 case, anchor reconstruction of lateral ligamentous complex (InternalBrace technique) - 1 case, anchor reconstruction of medial ligamentous complex - 2 cases. Restoration of anterior portion of syndesmosis was performed in 1 case. Pin site infections occurred in 2 cases. In one case, there was a breakdown of the wire fixator holding the pin passed through the talus in 5 weeks after surgery. CONCLUSION: Preliminary results allow us to characterize the proposed design of the Ilizarov frame layout and surgical technique as relatively simple and promising for postponing radical surgery on the ankle joint.

[Clinical and functional outcomes of valgus osteotomy in patients with medial gonarthrosis (preliminary results)]. / Rezul'taty val'giziruyushchei osteotomii u patsientov s medial'nym gonartrozom (predvaritel'nye rezul'taty).

OBJECTIVE: To analyze gait biomechanics before and after corrective osteotomies around the knee joint in patients with medial gonarthrosis. MATERIAL AND METHODS: The study recruited 5 patients (6 surgeries) with medial gonartrosis and varus knee deformity. Gait biomechanics was analyzed in preoperative period and 6 months later. The control group consisted of 20 healthy people. RESULTS: Knee joint biomechanics was almost normal in postoperative period. Amplitude of knee joint flexion was increased. Moreover, hip joint flexion-extension amplitude was increased on both sides and often exceeded normal values. Clinical results showed significant increase in IKS (from 55 to 89.6) and VAS score (from 7.7 to 2.3). Postoperative correction angle varied within 1.5-2° of valgus. CONCLUSION: Corrective osteotomy around the knee joint is effective for medial gonarthrosis. We obtained favorable clinical results and limb axis correction after surgery without significant hypercorrection. Gait biomechanics was also improved.

[Endoscopic sciatic nerve decompression]. / Endoskopicheskii nevroliz sedalishchnogo nerva.

OBJECTIVE: To improve treatment outcomes in patients with sciatic nerve neuropathy. MATERIAL AND METHODS: The first results of endoscopic sciatic nerve decompression in 6 patients with sciatic neuropathy (mean age 47±6.7 years) are presented. The authors developed and described new and unique technique for this procedure. All patients suffered severe neuropathic pain syndrome with neurologic disorders. All patients underwent endoscopic sciatic nerve decompression in prone position. RESULTS: Mean VAS score of preoperative pain syndrome was 7.8±0.37. In 3 months after surgery, this value decreased up to 1.5 scores. Complete regression of pain syndrome and significant reduction of neurologic symptoms were noted in 5 out of 6 patients (83%). CONCLUSION: Primary data characterize the developed method as an easy, minimally invasive and effective procedure for pain relief and fast recovery of lower extremity function in these patients.