В статье представлены основные характеристики остеогенетических процессов в зоне дефекта костной ткани при его пластике остеозамещающим композитом с включением синтетического полимера поликапролактона и возможности его использования в хирургии костно-суставного туберкулеза

The objective: to create a reproducible model of chronic tuberculosis peritonitis to study pathophysiological mechanisms of its progression and to develop pathogenetically based therapy.Subjects and Methods. The study was performed using 10 male rabbits of the Chinchilla breed. The animals were administered intraperitoneal culture of Mycobacterium tuberculosis, tuberculosis peritonitis modeling was performed according to the proposed method.Results. In the course of the experiment, it was proved that all animals developed tuberculous peritonitis with lesions of the large omentum and serous integuments of internal organs. Molecular genetic tests of fragments of the omentum and peritoneum detected DNA of Mycobacterium tuberculosis.

В работе представлены основные особенности клинических проявлений туберкулеза суставов, сроки установления диагноза, стадийность специфического процесса, сопутствующая патология и осложнения хирургического лечения. Полученные данные будут важны для правильного планирования лечебнодиагностической стратегии в отношении больных костно-суставным туберкулезом.

A significant role in the pathogenesis of osteoarthritis (OA) belongs to the violation of the natural bioelectrogenesis of bone and cartilage tissue. External correction of bioelectric processes in joint structures by means of an electrostatic electret field is pathogenetically justified and has practical significance in the surgical treatment of degenerative diseases in orthopedics. The article presents an analysis of the results of surgical treatment in 45 patients with stage 2-3 gonarthrosis aged 30 to 70 years using electretes based on tantalum oxide. The results of treatment were evaluated based on the dynamics of the clinical and functional index WOMAC, data from clinical and radiological studies. The positive effect of the electrostatic field of electret in OA was manifested by a decrease in clinical symptoms of the disease, increased functional activity of patients, restraining degenerative changes in joint structures, and improving the quality of daily life during the follow-up period. The positive effect of the electrostatic field of electret is based on the activation of repair of bone-cartilage structures, which allowed to slow down the degradation of subchondral bone and articular cartilage in gonarthrosis.Clinical use of electret stimulators significantly effectively improves joint function which reduces the risk of progression of degenerative changes in the joint especially in patients with the second stage of the disease. The clinical use of electronic stimulators significantly effectively improves joint function which reduces the risk of progression of degenerative changes in the joint especially in patients with the second stage of the disease.The use of electretes in the treatment of patients with stage 3 gonarthrosis can improve the function of the joint for a long time more (2 years) and postpone the endoprosthesis operation.

The article describes the life-path of Eduard N. Bellendir (1926- 2010), his scientific methodology and the system of ideas about the pathogenesis of extrapulmonary tuberculosis, which developed over half a century of experimental study of this pathology.

МИНИ-ИНВАЗИВНОЕ ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ БОЛЬНЫХ ДЕФОРМИРУЮЩИМ ОСТЕОАРТРОЗОМ КОЛЕННОГО СУСТАВА С ИСПОЛЬЗОВАНИЕМ ЭЛЕКТРЕТОВВансович Д.Ю. 1 , Линник С

Мушкин Александр Юрьевич — Хирург с большой буквы. Сегодня он один из ведущих отечественных специалистов по хирургии позвоночника и детской ортопедии, автор более 400 научных работ, в том числе 6 монографий, пяти глав в монографиях, включая AOSpine Masters series «Cranial-cervical infections», 19 патентов, лауреат многих научных конкурсов и премий (European Spine Society, 1997; премии по фтизиатрии им. академика М.И. Перельмана, 2016; премий за лучшие инновационные проекты Санкт-Петербургской выставки инновационных технологий 2011, 2012 г.). Список званий и наград можно было продолжить. Но разве этим измеряется путь хирурга? За многие годы работы им возвращено здоровье тысячам детей. За его профессионализмом приезжают маленькие пациенты не только из глубинки России, но и из стран бывшего СССР. Когда спрашиваешь родственников маленьких пациентов, почему они приезжают в Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии, то слышишь приблизительно одно и то же: «Он у вас один такой».

The structure and physicochemical mechanisms of interaction of bone tissue with titanium implants in tuberculous osteitis have been studied by scanning electron microscopy, X-ray phase analysis, IR spectroscopy and thermal analysis methods. It has been found that the physiological regeneration of bone tissue is accompanied by growth of organic components, embrittlement of the mineral phase of the bone matrix, and its fine disintegration during the treatment of tuberculosis osteitis. The presence of titanium implants during a physiologically normal state contributes to the activation of apatite phase synthesis in the regenerating bone. The main mechanism of implantation osteogenesis in tuberculous osteitis is the formation of the inorganic phase of hydroxyapatite mainly in the areas of destruction of the titanium alloy.

The physicochemical properties and structure of the bone matrix are studied in a case of simulated tuberculous osteitis without treatment and after a full course of specific antibacterial therapy. Using X-ray diffraction, infrared spectroscopy, thermal analysis, and scanning electron microscopy, we revealed that tuberculous osteitis causes fine disintegration of the bone matrix due to an increase in nonstoichiometric hydroxyapatite, formation of amorphous calcium phosphates, and a decrease of the organic phase, which is accompanied by embrittlement of the bone matrix. Excessive growth of carbonate-hydroxyapatite crystals of a mixed AB substitution type leads to excessive osteogenesis, accompanied by the uncontrolled growth of bone trabeculae. The presence of “liming” regions in the crystal lattice of hydroxyapatite increases the “binding” properties of the bone matrix in which mycobacteria are immobilized and removed in the composition of detritus.

Introduction. According to the literature the interest of researchers to the problem of surgical treatment of large joints tuberculosis is not reduced. The issues of the effective use of cement spacers with antibiotics in the treatment of advanced arthritis remain relevant. Objective: to study the effectiveness of articulating antibiotic cement spacers used in reconstructive surgery in staged surgical treatment of tuberculous coxitis. Materials and methods. The results of surgical treatment of 66 patients with stage 3 of tuberculous coxitis were studied and compared. 45 patients (group 1) underwent staged surgical treatment. During surgical debridement the implantation of articulating polymethylmethacrylate spacer impregnated with vancomycin and / or gentamicin was performed. 21 patients (group 2) underwent only surgical debridement without implantation of spacers. Criteria for the inclusion of patients in the study were: verified diagnosis of tuberculous coxitis by bacteriological and / or morphological studies; unity of the surgery place; continuing tuberculosis treatment started no later than 1.5 months before surgery. After 1 month and on average after 7.9 months the intensity of pain in the joint was studied; the duration of surgery; average intraoperative and perioperative blood loss; the frequency of exacerbations of the inflammatory process in the area of the affected joint; changes in the spatial relationship of the femoral and pelvic bones during the treatment stages; hip function by the Harris Hip Score. The results. Before the operation, the intensity of pain in patients of both groups did not differ. The implantation of the spacer in patients of group 1 increased the duration of the operation by an average of 19 minutes and contributed to a significant reduction in the level of pain during all periods of the study. Exacerbations of the inflammatory process in the surgical site were observed in 1 patient in group 1 and 4 patients in group 2, p<0.05. After 7.9 months after surgery, the proportion of patients with disorders recorded by Hartofilakidis G. as types II and III in group 1 was 8.9% (n=4), in group 2 it remained high: 42.9%; (n=9); p<0.05. The increase in the functional rating by the W. Harris scale in patients in group 1 was 3.0 times greater than that in the patients in group 2. Conclusion. The implantation of spacers with antibiotics during the staged surgical treatment of advanced tuberculous coxitis allows to reduce the intensity of pain in the area of the affected joint, reduce the frequency of exacerbations of the inflammatory process, eliminate the existing spatial impairments of the bones of the joint and increase its functional viability, thereby facilitating the implementation of the subsequent operation of total arthroplasty.

The structural and physicochemical mechanisms of interaction of bone tissue with titanium implants under conditions of tuberculous osteitis are studied using scanning electron microscopy, X-ray diffraction analysis, IR spectroscopy, and thermal analysis. Physiological regeneration of bone tissue during treatment of tuberculous osteitis is accompanied by an increase in the organic component, embrittlement of the mineral phase of the bone matrix, and its decomposition to fine particles. The presence of titanium implants under physiological conditions contributes to the activation of the synthesis of the apatite phase in the regenerating bone. The primary mechanism of implantation osteogenesis in tuberculous osteitis is the formation of an inorganic phase of hydroxyapatite mainly in the regions of destruction of the titanium alloy.

The paper presents a rare clinical case of surgical treatment of a patient with a giant invasive schwannoma of the thoracolumbar spine. A single-stage en block resection of the tumor through a combined posteroanterior approach was performed followed by replacement of post-resection interbody diastasis with a carbon implant and by posterior instrumental fixation of the spine. The pain syndrome regressed from VAS scores 7 and 8 (back, lower limbs) to scores 4 and 1, respectively. The follow-up examination was conducted at 6 and 12 months after surgery: there were no signs of relapse. Publications on giant invasive spinal schwannomas were analyzed.

AbstractThe physicochemical properties and structure of the bone matrix are studied in a case of simulated tuberculous osteitis without treatment and after a full course of specific antibacterial therapy. Using X-ray diffraction, infrared spectroscopy, thermal analysis, and scanning electron microscopy, we revealed that tuberculous osteitis causes fine disintegration of the bone matrix due to an increase in nonstoichiometric hydroxyapatite, formation of amorphous calcium phosphates, and a decrease of the organic phase, which is accompanied by embrittlement of the bone matrix. Excessive growth of carbonate-hydroxyapatite crystals of a mixed AB substitution type leads to excessive osteogenesis, accompanied by the uncontrolled growth of bone trabeculae. The presence of “liming” regions in the crystal lattice of hydroxyapatite increases the “binding” properties of the bone matrix in which mycobacteria are immobilized and removed in the composition of detritus.

Введение. По данным литературы не снижается интерес исследователей к проблеме использования цементных спейсеров с антибиотиками в процессе хирургического лечения туберкулеза крупных суставов. Цель исследования: повысить эффективность хирургического лечения туберкулезного коксита путем применения артикулирующих цементных спейсеров, насыщенных антибактериальными препаратами. Материалы и методы. Изучены результаты хирургического лечения 66 больных туберкулезом тазобедренного сустава 3 стадии, из них 45 пациентам (1-я группа) во время этапной санирующей операции на суставе устанавливали спейсер с использованием полиметилметакрилата с ванкомицином и/или гентамицином. 21 пациенту (2-я группа) выполняли только санирующую операцию. Изучали интенсивность боли в суставе, длительность оперативного вмешательства, среднюю интра- и периоперационную кровопотерю, частоту обострений воспалительного процесса, изменение пространственных взаимоотношений бедренной и тазовой костей, функцию тазобедренного сустава по шкале Harris Hip Score через 1 и в среднем через 7,9 мес после операции. Результаты исследования. До операции интенсивность боли у больных обеих групп не различалась. Установка спейсера у пациентов 1-й группы увеличивала длительность операции в среднем на 19 мин и способствовала достоверному снижению болей. Обострения воспалительного процесса в области операции в 1-й группе наблюдались у одного больного, во 2-й группе — у 4 пациентов (p<0,05). Через 7,9 мес после операции доля больных с нарушениями по G. Hartofilakidis как типы II и III в 1-й группе составила 8,9%, во 2-й группе она оставалась высокой — 42,9% (p<0,05). Прирост показателя функциональной оценки по шкале W. Harris у пациентов 1-й группы был в 3,0 раза большим по отношению к аналогичному во 2-й группе больных. Заключение. Применение спейсеров с антибиотиками в хирургическом лечении туберкулезного коксита позволяет уменьшить интенсивность болевого синдрома и частоту обострений воспалительного процесса, устранить имеющиеся пространственные нарушения костей сустава и увеличить его функциональную состоятельность, тем самым облегчить выполнение последующей операции его тотального эндопротезирования.

Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods . The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.

The article describes the statistic rates reflecting the incidence of tuberculosis of various localizations in the Russian Federation during 2001-2016, putting special emphasis on gender and age. The authors demonstrate the impact of HIV infection on the level of tuberculosis incidence. The article also presents and summarizes data on extrapulmonary tuberculosis, describes the difficulties arising during notification of such cases and limiting the reliability of epidemiological analysis, and gives the estimated incidence.

Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.

The article describes the statistic rates reflecting the incidence of tuberculosis of various localizations in the Russian Federation during 2001-2016, putting special emphasis on gender and age. The authors demonstrate the impact of HIV infection on the level of tuberculosis incidence. The article also presents and summarizes data on extrapulmonary tuberculosis, describes the difficulties arising during notification of such cases and limiting the reliability of epidemiological analysis, and gives the estimated incidence.