Objective. To present a literature review assessing the effectiveness of surgical treatment methods for tethered spinal cord syndrome of secondary origin in spina bifida. Material and Methods. The Pubmed, EMBASE, eLibrary, and Cochrane Library databases were searched for prospective cohort clinical studies published from 2009 to 2024 and evaluating the effectiveness of methods for correcting tethered spinal cord syndrome in spina bifida. The study was carried out in accordance with the guidelines for Preferred Reporting Items for writing Systematic Reviews and Meta-Analyses (PRISMA). Results. During this period, 20 articles were published assessing the effectiveness of surgical methods for correcting tethered spinal cord syndrome. Of these, 15 are pragmatic clinical trials and 5 are randomized clinical trials. The average level of evidence is III. Conclusion. Currently, it can be stated that there is an intra-expert consensus regarding functional radiological criteria for tethered spinal cord syndrome of secondary origin in spina bifida. However, the issue of the effectiveness of surgical intervention directly depends on the availability of objective methods for clinical assessment of the severity of functional deficit and the reversibility of morphofunctional changes in the nervous tissue. Despite the variety of clinical scales and questionnaires, there is no unified assessment system for neurological, urological and orthopedic deficits in patients with tethered spinal cord syndrome. In this context, functional MRI (spinal MR tractography) can be considered a promising method for objectifying the pathological process. However, the phenomena revealed during the examination are not fully studied and require further research.

Creating a unified information system in Russia is not a trivial task. The main difficulty is not in geographical or cultural features, but in the process of digitalization of the existing system. An important transformation tool is the involvement of professionals in the process of setting goals for system design, as well as testing the results.The purpose of the work is to describe the concept of vertically integrated medical information system (VIMIS) “traumatology and orthopedics” as a digital tool for effective management of the provision of care by profile.Materials. The existing projects of a VIMIS, the routing schemes for patients with injuries and diseases of the musculoskeletal system, the level of organization and provision of medical care in the regions are analyzed.Results. The concept of management of medical care by traumatology and orthopedic the management scheme of the VIMIS project for the profile of traumatology and orthopedics (TO) were developed, an agreement was signed on the scientific and methodological interaction of participants. The project is aimed at the digital transformation of the called tasks, increasing the “digital qualification” to solve the search for tasks in the field of quality control of specialized medical care, efficient use of resources, substantiation of scientific problems. The difference between the profile of “traumatology and orthopedics” is determined by the fact that with the help of VIMIS TO a problem of different directions is solved, including indicators that can be incoherent.Discussion. The project to create a vertically integrated medical system in the field of “traumatology and orthopedics” as a digital transformation of specialized care was based on an analysis of the most successful technological and organizational solutions: modern evidence-based models of treatment and care; artificial Intelligence; intelligent planning and treatment risk stratification; remote patient monitoring and the implant technology industry; advanced professional education platform.Conclusion. The effectiveness of the model should be evaluated for the prospect of piloting with the integration of various regions medical information systems and its verification in the regions. Moreover, it is necessary to explore the sharing of large data sets and lay out the features of their use, given the differences in the nature of the cooperation of consortiums.

The interests of society and the modern rhythm of life have shifted the focus towards early rehabilitation, including surgical rehabilitation, and predetermined requirements of functional activity and quality of life in all age groups. The purpose of study – search for ways to optimize the organization of the traumatological and orthopedic service, taking into account the age continuity of nosologies and the inclusion of subgroups of orthopedic diseases of childhood, degenerative diseases, destructive, incl. tumor and traumatic in the model proposed by the authors. Material and methods . Forms of Federal Statistical Observation. The evaluation criteria were data on the prevalence of musculoskeletal diseases for 2019. Results and discussion . An analysis of the primary diagnosis of the orthopedic pathology by regions of the Russian Federation showed extreme variability, and the availability of care does not depend on the population and billing in the regions. The monetary value of the treatment of both planned and urgent pathology has shortcomings in standardization and harmonization between regions. The authors substantiate the new “3DT” organizational concept as the basis for a stable and understandable model of the country’s traumatology and orthopedic service for administrators and the population. The model identifies four areas of directions for assessing the pathology of the musculoskeletal system: “D1” (“children’s” diseases and their outcomes); “D2” (degenerative and involutive pathology); “D3” (destructive diseases of tumor or infectious pathology); “T” (trauma of and its consequences), which have fundamentally different approaches to the organization and planning of medical care. Conclusion . The directions of the “3DT” model require different approaches to the organization of medical care. Groups “D1” and “D2” must be implemented through national (federal) programs, for groups “D3” and “T” the approach of payment for the completed case is applicable. In each sector, it is necessary to indicate the basic, additional and optional amount of assistance. The target indicator for the stability and effectiveness of the model for organizing specialized assistance should be considered to be the provision of a basic level, and the possibility of financing additional assistance cannot be at the expense of providing basic assistance.

The publication highlights the concept of patient executive control (PEC) in pediatric and adolescent orthopedics, as well as the means of achieving it, which is proposed for use in the domestic health care system. The authors identified the key areas of modernization of primary care in the provision of orthopedic and traumatological care to children and adolescents with idiopathic scoliosis. Among them, a special place is occupied by the development and testing of checklists and scales for assessing the orthopedic status for primary care specialists, planning and implementation of a pilot project on early detection of pathology, prescribing and conducting conservative brace treatment in order to reduce the degree of scoliotic deformity of the spine in growing patients, clinical justification for the inclusion of compensation for the costs of implementing this treatment in the compulsory health insurance system (CHI).

This article reports an assessment of direct expenses for surgical treatment of patients with cerebral palsy and secondary orthopedic complications, who have undergone single-event multilevel orthopedic surgeries (SEMLS). It has been demonstrated that modern approach based on SEMLS is substantiated from the medical point of view and at present it is also justified from the point of view of economic assistance for that type of treating activity of a Federal Centre specialized in trauma and orthopaedics. Organization of surgical treatment using multilevel orthopaedic interventions requires selection of implants for specific characteristics and, on expenditure side, not exceeding funding of direct expenses intended for this treating process.

Проблемы организации лечения больных хроническим остеомиелитом и пути их решения на примере создания клиники гнойной остеологии

The review presents the results of diagnostic imaging techniques for evaluation of distractional regenerate bone starting from classical polypositional radiography to modern imaging modalities such as magnetic resonance imaging and computed tomography. There are described the modifications of the known techniques for evaluation of regeneration bone with quantitative and qualitative analysis, the opinions of different authors about possibilities and problems of imaging practices. There are presented the problems and goals for more effective evaluation of new bone at different stages of limb lengthening with the focus on a wider application of modern imaging modalities at medical institutions. The review is based on dissertation work of K. A. Diachkov «Diagnostic imaging for detection of the rules of distractional regenerate bone formation and bone quality during limb lengthening». Literature review was performed using database of PubMed, Medline, Embase 12 Russian journals on traumatology and orthopaedics, diagnostic imaging 2007–2016. All articles on evaluation of distractional bone regeneration were reviewed.

The review presents the results of diagnostic imaging techniques for evaluation of distractional regenerate bone starting from classical polypositional radiography to modern imaging modalities such as magnetic resonance imaging and computed tomography. There are described the modifications of the known techniques for evaluation of regeneration bone with quantitative and qualitative analysis, the opinions of different authors about possibilities and problems of imaging practices. There are presented the problems and goals for more effective evaluation of new bone at different stages of limb lengthening with the focus on a wider application of modern imaging modalities at medical institutions. The review is based on dissertation work of K. A. Diachkov «Diagnostic imaging for detection of the rules of distractional regenerate bone formation and bone quality during limb lengthening». Literature review was performed using database of PubMed, Medline, Embase 12 Russian journals on traumatology and orthopaedics, diagnostic imaging 2007–2016. All articles on evaluation of distractional bone regeneration were reviewed.

Objective. To analyze clinical and radiological features of congenital atlantoaxial dislocations (AAD) in congenital craniovertebral junction malformations. Material and Methods. The data of 26 patients with AAD associated with congenital pathology of the craniovertebral junction, who applied to the Ilizarov Center in 2012–2017, were analyzed. Results. Patients were divided into three groups: with non-syndromic AAD – 6 (23.1 %) patients, with AAD associated with Klippel – Feil syndrome – 11 (42.3 %) and with syndromic AAD – 9 (34.6 %). Odontoid anomalies were observed in 15 (57.7 %) patients, the magnitude of dislocation was determined from the C1 facet displacement relative to that of C2 in different planes. Patients with non- syndromic AAD had local pain syndrome (VAS score 4.20 ± 2.64) accompanied by torticollis and restriction of head movements, and myelopathy. In patients with AAD associated with Klippel – Feil syndrome, the local symptoms prevailed: restriction of neck movements, torticollis, neck pain (VAS score 2.40 ± 2.01), and myelopathy. Myelopathy and unpronounced pain syndrome (VAS score 2.30 ± 1.94) were leading symptoms in patients with syndromic AAD. Conclusion. Patients with syndromic AAD more often have myelopathy, whereas AAD with the Klippel-Feil syndrome and non-syndromic AAD are often manifested by local symptoms.

Background Cervical spine injuries (CSI) are considered to be a major trauma with no well-established criteria for the choice of treatment technique. Objective Determine criteria for the choice of surgical technique to address CSI and review current tendencies in stabilization approaches used for CSI. Design Retrospective review and literature survey. Material and methods Retrospective review included 101 CSI cases with 24 craniocervical and 77 subaxial injuries, 48 CSI publications (9 books and guidelines, and 39 articles). The patients were treated with either anterior (ACDF, ACCF) or posterior fixation using screw constructs, or with 360° stabilization. Results Subaxial spine injury accounts for 75 % of all CSI. C2 vertebra injury is the most severe among craniocervical trauma. Posterior C1–C2 fixation with Harms and Magerl techniques remains the method of choice. SLIC and CSISS scoring systems are mostly used to assess subaxial injury. Anterior fixation is common for unstable subaxial injury. Posterior screw fixation has become more common. Conclusion Injuries to the cervical spine at the С2 vertebra fractures are most challenging, and posterior fixation is the method of choice for the operative stabilization. Subaxial injuries require a thorough assessment of posterior supporting complex integrity. Anterior fixation remains the most common method of treatment. Multipillar subaxial injuries require posterior fixation and 360° stabilization in the majority of the cases.

Literature data were used to present the parameters of integral sagittal balance assessment. It is shown that the assessment of the sagittal balance should be performed taking into account the spatial position of the body and the use of the “cone of economy” concept and gravity line. Cervical spine and the pelvis are the key compensatory mechanisms in correction of the sagittal balance changes. The ratio of PI (pelvic incidence) and LL (lumbar lordosis) is the most significant as far as it correlates with the changes in the quality of life. Clinical interpretation of the changes in the sagittal balance should be conducted on the basis of their integration with a mandatory consideration of clinical manifestations and changes in the quality of life.

An optimal condition for implant osseointegration is its mechanical stability. However, the process of osseointegration depends on numerous other conditions: mechanical stimulation, implant specific geometry, chemical composition of the surface and its architectonics, topology, and the way of surface relief formation.The aim of the investigation was to assess the capabilities of osseointegration of implants from stainless steel, fabricated by means of additive manufacturing technologies, for rabbit tibia replacement.Materials and methods. The experiment has been carried out on 6 chinchilla rabbits aged 6-8 months. Amputation of the shin was performed to all animals under general anesthesia, and implants, made with the help of additive manufacturing technologies, were screwed in. The stumps, abutments and implants were fixed during 6 weeks by Ilizarov apparatus. Investigations were performed using clinical, radiographic and histological methods.Results. The findings obtained testify to the ability of the applied screw construction to osseointegration into the tubular bone structure. Neogenesis of bone tissue on the implant surface after 12 weeks provides formation of a bone-implant block ensuring stable implant position in the tubular bone and capability of enduring mechanical load.

Background: Aortic injuries because of pedicle screw placement are quite rare, consequently management strategies to avoid vascular complications are lacking. Intraoperative or postoperative images to reveal the accuracy of screw placement in scoliotic misalignment with freehanded placed pedicle screws is therefore essential. Case Report: A 13-year-old girl with adolescent idiopathic scoliosis (AIS) was presented at the outpatient clinic of the authors department. Operative correction of the scoliotic misalignment including dorsal pedicle screw and rod placement with fusion from T3 to L4 was performed. Computed tomography scan after surgery showed left T9 screw malposition, accompanied by lateral compression of thoracic aorta. No clinical manifestations of aortic stenosis were noted. To avoid severe vascular complications, the thoracic screw was removed with the help of a specialized team of vascular as well as thoracic surgeons through extrapleural thoracotomy. After the removal of the malpositioned screw, the correction maneuvres were applied without the left T9 screw. No posttraumatic aortic aneurysm and other wall injury were identified after the revision surgery. The patient was discharged after 20 days of inpatient stay without the use external immobilization. The girl was in a good clinical condition after the 1-year follow-up visit without vascular or neurological complications. Conclusions: Malpositioned pedicle screws after dorsal correction in patients with adolescent idiopathic scoliosis might be challenging. Aortic injuries because of malpositioned screws are rare; nevertheless, the presence might be a life-threatening condition despite a clinical asymptomatic patient. As a consequence, the authors recommend to perform routine postoperative computed tomography scans combined with angiography in the case of significant lateral screw positioning.

Дизайн исследования.Описательное исследование, основанное на медицинских данных пациентов с врожденными аномалиями шейного отдела позвоночника.Цель.Гипотеза исследования заключалась в том, что пациентов с врожденными аномалиями шейного отдела позвоночника можно сгруппировать в соответствии с основным патологическим синдромом.Исходные данные.Аномалии шейного отдела позвоночника относятся к эмбриопатиям и представляют собой разнородную группу.Разнообразие вариантов патологии затрудняет создание единой классификации, основанной на морфологическом подходе.Материал и методы.Были проанализированы истории болезни 68 пациентов с врожденными аномалиями шейного отдела позвоночника, которые послужили клиническим материалом для разработки алгоритма лечения.Для уточнения структуры аномалий и предоперационного планирования использовались компьютерная томография, магнитно-резонансная томография (МРТ) и селективная ангиография.Использование функционального позиционирования было важной составляющей всех исследований.У 28 пациентов в возрасте от 2 до 47 лет использовались различные методы хирургического лечения, такие как галотракция, передний и задний спондилодез, декомпрессия головного и спинного мозга, мозговых и позвоночных артерий в шейном отделе, ревизия позвоночного канала, невролиз и менингеолиз.Результаты.Все пациенты были разделены на группы в соответствии с превалирующими патологическими синдромами: нестабильность, стеноз и ишемия головного мозга.В каждой группе выделяли важные подгруппы.Основными хирургическими подходами в лечении сложных врожденных аномалий шейного отдела позвоночника были спондилодез или (и) декомпрессия головного и спинного мозга.Заключение.Выбор доминирующего патологического синдрома или сочетания синдромов -простой и эффективный способ принятия правильного решения при лечении врожденных аномалий шейного отдела позвоночника.Синдромный подход также можно использовать для прогноза

Исследование проведено у 150 пациентов с хирургическими вмешательствами на позвоночнике из заднего оперативного доступа.По инвазивности операций больных разделили на группы.Первая группа -29 человек с грыжами поясничных межпозвонковых дисков.Вторая группа -85 пациентов с дегенеративно-дистрофическими заболеваниями и посттравматическими деформациями поясничного отдела позвоночника на одном-трех позвоночно-двигательных сегментах.Третья группа -37 больных с многоуровневыми деформациями позвоночника.В 1 группе ввиду малоинвазивного характера оперативного вмешательства дренирование послеоперационных ран не применялось.Больные 2 и 3 групп были разделены на подгруппы с использованием и без использования активного дренажа.Для анализа использовались параметры: возраст пациентов, вес, продолжительность операции, величина кровопотери, длина и глубина раны, продолжительность дренирования раны, количество раневого отделяемого, количество пункций ран и объема пунктата, продолжительность пребывания в стационаре после операции, наличие сопутствующих заболеваний (артериальная гипертензия, сахарный диабет, ожирение и другие хронические заболевания в стадии ремиссии), наличие инфекционных осложнений в послеоперационном периоде (поверхностное или глубокое воспаление), проведение гемотрансфузии, неврологические осложнения вследствие эпидуральной гематомы.Использовали метод вариационной статистики: вычисление средней арифметической (М) и ее ошибки (± m), коэффициент корреляции r-Пирсона с оценкой по шкале Челдока, для оценки достоверности различия средних использовали t-критерий Стьюдента с определением показателя статистической достоверности.Результаты и обсуждение.Большинство исследований, проводимых для оценки эффективности использования дренажей, показывает отсутствие различий в заживлении раны, инфекционных осложнениях и эпидуральных гематомах при вмешательствах на позвоночнике.Различные по объему, продолжительности, технике и инструментальным аспектам вмешательства определяют разные требования к дренированию ран.Дискотомиии и одно-трехуровневые декомпрессивно-стабилизирующие операции поясничного отдела позвоночника не требуют дренирования ран.Заключение.Результаты лечения и частота осложнений не зависят от наличия дренажа операционной раны.При многоуровневых стабилизирующих операциях на грудном и поясничном отделах позвоночника с вариантами вертебротомий дренирование раны повышает частоту гемотрансфузий в послеоперационном периоде

The method of multislice computed tomography has been used to study qualitative and quantitative changes in the spine of the Carassius auratus goldfish that featured multiplanar spinal deformity in the areas of truncal and tail vertebrae.

Federal StateBudgetEducationalInstitutionofHigherProfessionalEducationKurgan UniversityОсвещенапроблемаорганизацииоказанияреабилитационнойпомощи пациентамортопедотравматологическогопрофиля в условияхстационаракрупного федерального центра. Проведен анализ зарубежных и отечественных публикаций по данному направлению, а также законодательных документов, регламентирующихозначеннуюпроблему.Предложенпоэтапныйалгоритмпроведенияреабилитационныхмероприятий,определеныметодологические подходы для реализации программ реабилитации. Определены основные звенья системы реабилитации для ее успешного функционирования.Ключевые слова: ортопедия, травматология, реабилитация, законодательная база, методологические подходы, мультидисциплинарное вза-имодействие. The authors covered the problem of organization of rendering rehabilitation care for orthopedic-traumatologicalpatients in the large federal center in-patient setting. They analyzed the foreign publications and those of our country in the given direction, as well as the legislative documents regulating the identifiedproblem. Moreover, they proposed the staged algorithm of performing rehabilitationmeasures, specifiedthe methodologicalapproaches for the implementation of rehabilitation programs.The main units of the rehabilitation system for its successful functioning determined. Keywords: orthopaedics, traumatology, rehabilitation, legislative basis, methodological approaches, multidisciplinary cooperation.

Освещена проблема организации оказания реабилитационной помощи пациентам ортопедотравматологического профиля в условиях стационара крупного федерального центра.Проведен анализ зарубежных и отечественных публикаций по данному направлению, а также законодательных документов, регламентирующих означенную проблему