Background. Malignant tumors of the forearm bones are rare, and remain a problem for orthopedic oncologists. Our study reports on benign locally aggressive and malignant tumors of the forearm bones, and various strategies for surgical removal of tumors, and bone reconstruction techniques. The choice of surgical intervention in case of the diseased forearm bones is determined not only by the degree of bone destruction by the tumor and the nosological entity of the neoplastic process, but also by the ability of the tumor to recur and metastasize. An analysis of the functional and oncological results of the upper limb after comprehensive and multimodal treatment of tumors of the forearm bones was conducted. Purpose. to show the effectiveness of multimodal and comprehensive treatment of benign locally aggressive and malignant tumors of the forearm bones. Materials and methods. Patients (n = 27) with tumors of the forearm bones were under our observation. There were 17 (62.9 %) patients with radial bone tumors and 10 (37.1 %) patients with ulna tumors, 16 (59.2 %) patients had giant cell tumor of bone, while 11 (40.8 %) had malignant tumors. The average follow-up lasted 27 (range 6 to 42) months. All 27 patients underwent surgical interventions within multimodal and comprehensive treatment regimens. Radial bone resection was performed in 17 patients, at that, most often of distal segment (13 patients), of proximal segment (3 patients), and of diaphysis of bone (1 patient). Ulnar bone resection was performed in 10 patients, at that, most often of proximal ulna (5 patients), of distal ulna (3 patients), and of diaphysis of bone (2 patients). The surgical margin of the tumor, after resection of the bone with the tumor, during morphological examination were along the edge of the lesion in 2 patients. Results. Postoperative complications were observed in 3 (11.1 %) patients. Functionality results of the upper limb after organ sparing surgery for tumors of the forearm bones according to the MSTS scale were: after the elbow joint endoprosthesis replacement the function amounted to 74.8 %, after osteoplastic surgery of the proximal ulna using allograft and ceramic material based on Bioactive Glass, the function of the elbow joint amounted to 96.6 %. After resection of the ulna diaphysis, and effecting reinforced metallic osteosynthesis, it amounted to 94.5 %. After resection of the distal ulna with the tumor, the function of the radiocarpal joint amounted to 80.4 %. After resection of the distal radius with tumor, and effecting fibular bone grafting, the function of the radiocarpal joint amounted to 88.3 %. After resection of the distal radius with tumor, and effecting endoprosthesis replacement using a metal-cement implant, the function of the radiocarpal joint amounted to 84.2 %. After resection of the proximal segment of radius with tumor, the function of the upper limb amounted to 78.5 %. After resection of the radial diaphysis, and effecting reinforced metallic osteosynthesis, the function of the limb amounted to 98.4 %. Oncological results: local tumor recurrence was observed in 3 patients (11.1 %), distant metastases were observed in 2 patients (7.4 %). Three-year overall survival of patients amounted to 82.4 ± 7.6 %, three-year recurrence-free survival amounted to 76.6 ± 8.5 %. Conclusions. Bone tumor recurrence is associated with inadequate tumor response to preoperative courses of polychemotherapy and radiotherapy, as well as with non-radical tumor removal (failure to adhere to surgical tumor margins during bone resection). Distant metastases represent a consequence of tumor recurrence after comprehensive and multimodal treatment, and are an adverse prognostic factor for patient survival.

Background. Giant cell tumour (GCT) of the distal radius is a benign, locally aggressive bone tumour characterized by frequent recurrences and certain metastatic potential. Intramedullary or segmental resection of the distal radius affected by GCT results in a defect in the distal radial segment. Main surgical reconstruction techniques for such defects include the use of spongy allo- and autografts, synthetic materials, polymethylmethacrylate, vascularized and non-vascularized bone autografts, osteoarticular allografts, and custom-made endoprostheses. In this study, we evaluated the oncological, surgical, and functional outcomes of distal radius GCT with different surgical interventions and reconstruction methods. Objective: surgical excision of distal radius giant cell tumour, reduction of tumour recurrence risk, and preservation of wrist joint function. Materials and methods. Surgical treatment was performed in 21 patients with distal radius GCT. Their mean age was 28.7 years (range: 18–39 years). Eight patients (38.1 %) with Campanacci grade II/III distal radius GCT underwent resection of the distal radial segment followed by reconstruction using a non-vascularized proximal fibular autograft fixed to the remaining radius with a plate or cerclage wires. Seven patients (33.3 %) with Campanacci grade I GCT underwent intramedullary resection and defect reconstruction using bioactive glass-based biocompo­site material or spongy autograft. One patient (4.8 %) with Campanacci grade II GCT and 2 patients (9.5 %) with recurrent tumours underwent intramedullary resection and reconstruction with polymethylmethacrylate (bone cement). Two patients (9.5 %) with Campanacci grade III GCT and 1 patient (4.8 %) with repeated recurrences underwent segmental bone resection with defect replacement using a proximal fibular autograft, along with wrist arthro­desis. Results. The average follow-up period was 5.5 years (range: 2.8–11.2 years). Complications occurred in 3 patients (14.3 %), all involving dislocation of the fibular autograft in the wrist joint, which was corrected by revision surgery. Tumour recurrence was detected in 3 patients (14.3 %). In the first case, after intramedullary resection and bioactive glass-based reconstruction, the tumour was re-excised, the material removed, and the defect reconstructed with bone cement. In the second case, recurrence occurred after intramedullary resection and spongy autografting, requiring cement reconstruction. In the third case, after recurrence following cement reconstruction, a distal radial resection with arthrodesis using a fibular autograft and plate osteosynthesis was performed. Functional outcomes of the upper limb after organ-preserving surgeries for distal radius GCT accor­ding to the MSTS scale averaged: 98.52 % (97.7–99.9 %) after bioactive glass or spongy autograft reconstruction, and 89.34 % (78.6–92.5 %) after resection and fibular autograft reconstruction. Functional outcomes were assessed in all 21 patients: excellent in 5 (23.8 %), good in 10 (47.6 %), and satisfactory in 6 (28.6 %). The average union time at the fibular-radial junction using a non-vascularized fibular autograft was 7.5 months (range: 3.2–16.1 months). The mean grip strength of the operated limb was 50 % (35–69 %) of the unaffected side, averaging 15 kg compared to 30 kg on the opposite side. The average range of motion included: forearm supination — 47° (31–69°), forearm pronation — 33° (16–55°), palmar flexion of the wrist — 40° (18–67°), dorsal extension of the wrist — 29° (11–52°), during combined movements — 151° (75–180°). Overall, 59 % (24–70 %) of the total motion range was preserved on the ope­rated side compared to the normal side. A total of 85.7 % of patients were satisfied with the treatment outcomes. Conclusions. Intramedullary resection of distal radius GCT with defect reconstruction ­using various grafting materials is the preferred method for Campanacci grade I. Resection of the distal radial segment with fibular autograft reconstruction is effective for grade II/III tumours. Cement reconstruction is the method of choice in recurrent GCT. Wrist arthrodesis using autograft and plate osteosynthesis is preferred in cases of recurrent wrist instability. Tumour recurrence is associated with insufficient ablative and radical excision. Complications after organ-preserving surgery for distal radius GCT are linked to non-compliance with postoperative recommendations.

Background. The use of both individual and modular oncological endoprostheses of the elbow joint is possible with primary and secondary (metastatic) tumor lesions of the bones forming it. The purpose of the study was to assess the effectiveness of restoring the function of the elbow joint and the upper limb and improving the quality of life of the patient after endoprosthesis of the elbow joint due to tumors of the bones forming it. ­Material and methods. The results of the treatment of 14 patients who underwent endoprosthesis of the elbow joint due to tumors of the bones forming it were evaluated. Endoprosthesis was performed in 9 (64.3 %) subjects with primary bone tumors and in 5 (35.7 %) patients with metastatic tumors. Reconstruction of the elbow joint was performed with individual oncological endoprostheses in 10 (71.4 %) subjects and modular oncological endoprostheses in 4 (28.6 %) ones. Reconstruction was primary in 12 (85.7 %) patients and secondary in 2 (14.3 %) ones. Results. Du­ring follow-up, 4 (28.6 %) patients died from the progression of the main disease with an ave­rage follow-up period of 24.8 ± 11.9 months, the other 10 (71.4 %) were alive, with an average follow-up period of 80.8 ± 10.3 months. In the early postoperative period, the following complications were observed: neuropathy of the ulnar nerve in 1 (7.1 %) patient. In the late postoperative period, 1 (7.1 %) patient had an infectious complication after 14 months. 1 (7.1 %) subject developed aseptic loose­ning of the humeral leg of the endoprosthesis 12 months after endoprosthesis. In 1 (7.1 %) subjects with a metastatic tumor, local recurrence of the tumor was observed 9 months after surgery. Mean MEPS and MSTS functional scores were 80 and 72 %, respectively. The patients’ quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 40 points in the preoperative period to 84 points after elbow joint replacement. Conclusions. Endoprosthesis of the elbow joint in the schemes of complex and combined treatment of primary and metastatic tumors of the bones forming it helps to improve the quality of life of this contingent of patients.

Introduction. The use of endoprostheses of the shoulder joint is possible with primary and secondary (metastatic) tumor lesions of the proximal part of the humerus. The possibility of using both individual oncological endoprostheses and modular oncological endoprostheses for tumors of the proximal part of the humerus is reported. Aim. To assess the effectiveness of restoring the function of the shoulder joint and upper limb and improving the patient's quality of life after shoulder joint arthroplasty for tumors of the proximal part of the humerus. Materials and methods. The results of the treatment of 27 patients who underwent shoulder arthroplasty in the conditions of the clinical departments of the "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" for tumors of the proximal part of the humerus from 2014 to 2024 were evaluated. Endoprosthesis was performed in 22 (81.5%) patients with primary tumors of the proximal part of the humerus and in 5 (18.5%) with metastatic tumors. Endoprosthesis of the shoulder joint was performed with individual oncological endoprostheses in 24 (88.9%) patients and modular oncological endoprostheses in 3 (11.1%) patients. Arthroplasty was primary in 25 (92.6%) patients and secondary in 2 (7.4%) patients. Results. During follow-up, 3 (11.1%) patients died with an average follow-up period of 10.3±1.9 months, the other 24 (88.9%) were alive, with an average follow-up period of 88.1±8.7 months. The overall frequency of complications in our study was 6 (22.2%) cases, 3 (11.1%) patients had an infectious complication in the late postoperative period after 12, 24 and 36 months, 1 (3.7%) patient had aseptic loosening of the leg of the endoprosthesis after 36 months, in 2 (7.4%) patients after 5 and 6 months, dislocation of the head of the endoprosthesis from the joint cavity was noted. Local tumor recurrence was observed in 2 (7.4%) patients. The overall mean MSTS total limb functional outcome after shoulder arthroplasty for all 27 patients was 74.2%, and of the 24 patients who survived, the mean limb functional outcome after shoulder arthroplasty was 78.4%. The patients' quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 32 points in the preoperative period to 78 points after shoulder joint replacement. Conclusions. Endoprosthetics is a modern method for reconstructing bone segments in the surgical treatment of tumors of long bones in the limbs. This method allows for the replacement of bone defects of any size (volume) and length. Shoulder joint endoprosthetics within the framework of combination and multimodal treatment of primary and metastatic tumors of the proximal part of the humerus provides restoration of both shoulder joint functions and the upper limb as a whole, thereby improving the quality of life for this group of patients.

Background: Some biochemical indicators in patients with disorders of reparative osteogenesis were described in a sufficient number of studies, but the role of factors affecting the metabolism of bone tissue and the ways of their correction are not sufficiently studied .. For effective prediction of the course of reparative osteogenesis in fractures, it is important to identify early markers of impaired consolidation and, accordingly, its pathogenetic correction. Purpose: to determine biochemical indicators of the course of reparative osteogenesis in patients with multiple and monolocal fractures of the bones of the lower limb. Materials and Methods: 44 patients aged 23 to 47 years were examined. To assess the ratio and intensity of the processes of biosynthesis and breakdown of collagen, as the major structural protein of connective tissue, the following indicators were determined in the blood serum of patients: fractions of hydroxyproline, oxyproline, collagenase, cathepsin B, elastase, proteolysis-antielastase inhibitors. In addition, indicators of mineral metabolism were also determined in the blood serum of patients: the content of calcium, phosphorus, alkaline phosphatase activity. Results: A comparative analysis and comparison of the results of the biochemical examination of patients with closed tibial fractures and multiple fractures revealed that already at the beginning of the research, deviations from the norm in the indicators of both mineral and collagen metabolism were observed. Both groups of the patients are characterized by the presence of disturbances in the ratio between calcium and phosphorus, and in patients with multiple fractures - an increase in the level of alkaline phosphatase. The detected changes in the mineral metabolism in patients with multiple fractures had a more pronounced and intense character due to the multiple injuries and presence of a large number of destroyed cells in the first days after the injury. Conclusions: Indicators of the unfavorable course of reparative osteogenesis in patients with bone fractures are a decrease in the content of calcium/phosphorus in blood serum, an increase in the level of free oxyproline and collagenolytic enzymes (collagenase, elastase, cathepsin B). Besides, there is a decrease in the level of proteolysis inhibitors (antielastase, 2-macroglobulin) and a decrease in suspension stability and antioxidant activity, increase in blood fibrinolytic activity. Our findings justify the need for prophylactic drugs that improve reparative osteogenesis soon after the injury (within a month) in patients with multiple fractures in order to activate the processes of reparative regeneration.

Aim: To justify the choice of a method for fixing unstable proximal tibial fractures (PTF), to conduct computer simulation of stresses on various metal fixators. Materials and Methods: at the initial stage, a solid 3D model of the lower leg has been created using Solid Works, on the background of anatomical models and CT scans. The model contained the following elements: tibia and fibula, interosseous membrane, ligaments of the proximal and distal tibia syndesmosis, and a modeled proximal tibial fracture. We have subsequently studied 4 models of bone fragments’ fixation with LCP plates and an intramedullary blocking metal rod. Further calculations were performed using the finite element method. Results: computer simulations of stresses on various metal fixators applied to fix a PTF convincingly proved that blocked intramedullary osteosynthesis (BIOS) and LCP plates placed bilaterally are feasible for this category of patients. Conclusions: Deformities and loads observed in the metal fixator, bone tissue and ligamentous apparatus run within normal limits. They are statistically significantly (p ≤ 0.05) lower in models of bone fragments’ fixation with IM nailing and bilaterally placed LCP plates. This evidences the adequate stability of bone fragments’ and these methods of osteosynthesis as a whole, compared to the stains in the same elements of modelled fixation using only one plate – medially or laterally. The results of the study may serve as the background for the development of an algorithm for surgical treatment and rehabilitation of patients with PTF.

Relevance: By frequency, tibial bone fractures rank second, accounting for 13% to 21.4% of all musculoskeletal injuries or 64.3%-70% of lower limb bone fractures. The nature of the injury is the result of high-energy trauma and is accompanied by severe soft tissue damage and a comminuted type of fracture. Temporary disability of patients with tibial fractures varies from 8-10 weeks to 5-7 months, and for complex fractures, it can reach 10-12 months. The purpose of the study was to conduct a comparative analysis of the treatment results of patients with tibial bone fractures and to evaluate the effectiveness of different methods of osteosynthesis. Material and methods: Depending on the method of operative treatment, the patients were divided into two groups. The experimental group included 113 patients, mostly with diaphyseal fractures of the tibial bones, who underwent surgery with the use of blocking intramedullary osteosynthesis. The control group consisted of 166 patients with tibial bone fractures who underwent intracortical or trans-cortical osteosynthesis. Results: The use of low-traumatic methods of stable fixation for the patients of the main group, the possibility of early functional rehabilitation, measures to prevent joint contractures since the first days, the possibility of early dosed loading on the operated limb ultimately led to faster healing of tibial fracture and a shorter overall treatment time. In the main group of patients, fusion was observed from 8 to 22 (11.56 ± 2.56) weeks, in the control group - from 12 to 36 (18.68 ± 4.70) weeks. The general treatment period for patients in the main group ranged from 8 to 22 (14.44 ± 2.85) weeks, while for the control group, it was from 13 to 43 (21.23 ± 5.38) weeks. Conclusion: The use of blocking intramedullary osteosynthesis has demonstrated its high effectiveness in the surgical treatment of patients with metadiaphyseal fractures of the tibia, allowing for positive treatment results in 96.66% of patients. The advantage of blocking intramedullary osteosynthesis is the biomechanically justified high stability of fixation and minimal invasiveness, which enables early mobilization in patients with fractures of the tibia bones (FTB) often experience a reduced quality of life and temporary disability, which can last from 8-10 weeks to 5-7 months or even up to 10-12 months for complex fractures. FTBs account for 13%-21.4% of all musculoskeletal injuries or 64.3%-70% of all lower limb fractures. The frequency of diaphyseal tibia bone fractures is 26-32 cases per 100,000 population. The injuries are typically the result of high-energy trauma and are often accompanied by severe soft tissue damage and comminuted fractures. The use of blocking intramedullary osteosynthesis has been shown to be highly effective in the surgical treatment of patients with meta-diaphyseal fractures of the tibia bones, with positive treatment outcomes in 96.66% of patients, providing biomechanically justified high stability of fixation and minimal trauma, allowing for early mobility and reducing the frequency of early and late postoperative complications.

Introduction. Osteoarthritis affects 7 % of the world’s population. The number of affected people worldwide increased by 48 % from 1990 to 2019. At the initial stages of knee osteoarthritis treatment, conservative treatment and corrective osteotomies are used. Corrective osteotomies in the area of the knee joint have shown excellent results for the treatment of limited arthrosis with a predominant lesion of the medial part of the joint in relatively young patients. However, despite the good results reported in the literature, patient satisfaction usually deteriorates over time, and some inevitably require further treatment with total knee arthroplasty in cases of progression of osteoarthritis. The aim of the study. On the basis of a retrospective analysis of surgical treatment of patients with osteoarthritis of the knee joints, justify the differentiated use of surgical interventions. Materials and methods. The article considers a differentiated approach to peri-articular osteotomies and primary endoprosthesis in gonarthrosis, in particular, in the focus of the endoprosthesis selection algorithm, based on related factors, such as the stage of the disease, the patient’s age, and the presence of concomitant complications, including the presence or absence of aseptic necrosis, contractures, instability ligamentous apparatus and defects of the condyles of the tibial bone. 391 knee joints were operated on in 383 patients. Results. In general, good results were obtained in 65 % (210 people) of endoprosthetics. The patients felt well, did not feel pain, did not limp, the range of motion was restored within normal limits, there was no deformation of the joint, the axis of the limb was correct, the joint was stable. Satisfactory results were obtained in 35 % (114 people), the patients felt well, did not feel pain, moderate lameness remained, range of motion was limited to no more than 800, there was no joint deformation, the axis of the limb was correct, the joint was stable. No unsatisfactory results were obtained. Conclusions. The developed differentiated approach to operative treatment of patients with osteoarthritis of the knee joints allowed to obtain 65 % good and 35 % satisfactory results. The prospect of further development in this direction continues due to the improvement of the design of endoprostheses and the technique of surgical intervention

Introduction: In recent years, studies of infrared laser irradiation effect on tumor cells in combination with various chemotherapeutic agents have been developing dynamically. Objective: To study the effect of infrared laser in combination with low doses of doxorubicin on cytomorphological characteristics of MCF-7DOX culture cells and p21 expression level. Materials and Methods: MCF-7DOX tumor cells were cultured in DMEM medium with 10% fetal calf serum (FCT) and 40 μg/ml gentamicin. Doxorubicin was added to the cells to a final concentration of 2 μg/ml and 0.5 μg/ml. Cells were irradiated with infrared laser (Fotonika-Plus, Ukraine) with a wavelength of 810 nm (irradiation time — 5 min, power density — 50 mV/cm², irradiation dose 15 J/cm²). Photomicrographs of cells were taken using a Carl Zeiss microscope, Germany. An immunocytochemical study was also conducted using monoclonal antibodies to the factor p21 (Thermo Scientific, USA). Results: The evaluation of morphological characteristics in micropreparations testifies to the antitumor effectiveness of the combined effect of infrared laser irradiation and doxorubicin. It is noteworthy that the cytotoxic effects of chemotherapy in combination with photobiomodulation were observed when using different doses of doxorubicin: 2 μg/ml and 0.5 μg/ml. When studying the biological activity of cells using immunocytochemistry, it was established that the combination of doxorubicin and infrared laser irradiation led to an increase in the expression of p21, and it is important to note that a similar effect was observed at both concentrations of doxorubicin: as at 2.0 μg/ ml and 0.5 μg/ml. The simultaneous destructive effect on tumor cells and the increase in p21 expression allows us to make a preliminary cautious assumption that the proposed technique of combination of infrared laser irradiation with doxorubicin determines the effect of the p21 factor in the role of a tumor suppressor. Conclusions: The results of the study allow us to consider the use of doxorubicin in combination with infrared laser as a promising method of cytotoxic effect on tumor cells.

Gonarthrosis is one of the topical orthopedic problems. One out of three all orthopedic patients are affected by knee osteoarthritis. Multiple studies demonstrate that this condition occurs most frequently in working-age population. Having studied the results of surgical treatment in 324 gonarthrosis patients, we have elaborated a differentiated approach to knee arthroplasties. A unicondylar arthroplasty is expedient for young patients; if flexion contracture of a knee exceeds 15°, we recommend a PLC non-preserving prosthesis; if a lesion of a tibial process exceeds 10 mm, we used a prosthesis with a tibial extensor; for total instability of knee, we used hinge-type constrained modifications of prostheses.

The study presents the experience of surgical treatment for deforming osteoarthritis of the knee joint of II-III stage, with axial deformations in 75 patients. Supracondylar varus resection osteotomies of the femur and supratuberous valgus osteotomies of the tibia were performed depending on the knee joint deformities. The results of these surgical interventions were evaluated according to the methods developed in our clinic. Good results were obtained in 74% of cases, satisfactory - in 26% of cases.

У статті повідомляється про результати остеосинтезу у 65 хворих із патологічними переломами на фоні метастатичного ураження кістки. Застосовані методики остеосинтезу: черезкістковий остеосинтез апаратом зовнішньої фіксації — у 33 (50,8 %) хворих, армований остеосинтез — у 32 (49,2 %). Остеосинтез застосований у схемах комплексного лікування з використанням поліхіміотерапії, променевої терапії, гормонотерапії, імунотерапії і бісфосфонатів. Внаслідок застосування методик остеосинтезу в схемах комплексного лікування ускладнення спостерігалися у 2 (3,1 %) пацієнтів, рецидиви метастатичної пухлини — у 3 (4,6 %) пацієнтів, нові вогнища метастатичного ураження в кістках і вісцеральних органах у процесі лікування виявлені у 35 (53,8 %) хворих. Трирічна загальна виживаність пацієнтів становила 28,6 ± 1,32 %, п’ятирічна — 14,4 ± 1,96 %. Застосування методик остеосинтезу в комплексному лікуванні хворих із метастатичним ураженням довгих трубчастих кісток дозволяє відновити функцію й опороспроможність кінцівки, зменшити больовий синдром і у зв’язку з цим поліпшити якість життя даної категорії хворих.

he article reports on the effectiveness of various types of surgical interventions for gonarthrosis in the system of staged treatment of patients with osteoarthritis of the knee joint. The first group consisted of 23 patients who underwent arthroscopic revision, debridement of the knee joint with subsequent corrective osteotomy of the tibia or femur due to gonarthrosis. The second group consisted of 22 patients who underwent unicondylar endoprosthesis of the knee joint due to gonarthrosis. The third group consisted of 47 patients who underwent total knee arthroplasty. As a result of surgical treatment of patients with osteoarthritis of the knee joint, it was established that arthroscopy, debridement followed by corrective osteotomy give a good effect and help prepare the joint for further endoprosthetics. Single-condylar endoprosthesis is the operation of choice for patients with an isolated lesion of only one of the knee joints, enabling to preserve enough high level of physical activity. Whereas total endoprosthesis of the knee joint in patients with gonarthrosis III - IV stages allows to achieve positive treatment results in 93.2% of patients and is an effective surgical intervention that allows to significantly reduce the pain syndrome, improve the function of the knee joint and thereby improve the quality of life in this category of patients.

У статті проведена оцінка ефективності хіміотерапії та її ускладнень у 62 хворих з остеосаркомою довгих трубчастих кісток за схемою неоад’ювантної поліхіміотерапії (цисплатин — 60 мг/м2 2 дні, доксорубіцин — 35 мг/м2 2 дні). Хворим основної групи додавали кофеїн (1 г на добу) як модулятор цисплатину. В ад’ювантну поліхіміотерапію додавали метотрексат у високій дозі (12 г/м2), кальцію фолінат (15 мг/м2). Основними ускладненнями після хіміотерапії були алопеція, гастроентерологічна токсичність, лейкопенія, тромбоцитопенія, що залежало від схеми та кількості курсів хіміотерапії. Токсичність хіміопрепаратів ІІІ–IV ступеня (13 % хворих контрольної, 16 % основної групи) призвела до інтенсивного супровідного лікування. Під час введення кофеїну спостерігались оборотні порушення I–II ст. токсичності у вигляді короткочасного порушення сну у 12,5 %, підвищення частоти серцебиття — у 6,2 %, нудоти та блювання — у 4,4 %. Одночасно виявилась тенденція до зниження частоти гематологічної токсичності III–IV ступеня: лейкопенії — на 4,1 %, тромбоцитопенії — на 3,9 % (p > 0,05). Ускладнень або реакцій, що зумовили б призупинення хіміотерапії, не спостерігалось. Застосована методика хіміотерапії була ефективною (повне + часткове регресування за шкалою RECIST) в основній групі (59,3 ± 3,6 %) та контрольній групі (46,2 ± 4,0 %) (р < 0,05), що дозволило виконати органозберігаючі операції у 90,6 і 63 % випадків відповідно. Введення таким хворим із низьким лікувальним патоморфозом іфосфаміду та препаратів другої лінії дозволяє підвищити виживаність хворих.

Мета. Показати можливості комплексного лікування хворих на рак молочної залози з метастатичним ураженням кісток.Матеріали та методи. Проведено комплексне лікування 17 хворих на рак молочної залози з метастатичним ураженням довгих кісток кінцівок. Комплексне лікування хворих складалося з проведення поліхіміотерапії, променевої терапії, бісфосфонатів і хірургічного лікування. Застосовані такі методики хірургічного лікування: ендопротезування суглоба, армований металоостеосинтез, що складався з накісткового або інтрамедулярного металоостеосинтезу із заповненням дефекту кістки кістковим цементом, і металоостеосинтез за допомогою стрижневих апаратів зовнішньої фіксації. Результати. Після лікування у 2 (11,8 %) пацієнток спостерігалися післяопераційні ускладнення та в 1 (5,9 %) хворої розвинувся рецидив пухлини. При проведенні променевої терапії на вогнища метастатичного ураження в кістках у 15 (88,2 %) пацієнток відзначалось зменшення больового синдрому. В динаміці спостереження встановлено, що у 15 (88,2 %) хворих відбулося відновлення функції та опороздатності кінцівки. Якість життя хворих після комплексного лікування поліпшилася до 72,5–94,4 бала. Трирічна загальна виживаність хворих становила 39,28 ± 8,60 %, п’ятирічна — 20,84 ± 8,40 %. Висновок. Проведення комплексного лікування у хворих на рак молочної залози дозволило відновити функцію та опороздатність кінцівки, зменшити больовий синдром, покращити якість життя та збільшити строки виживаності даного контингенту хворих.

In vivo experimental study was conducted to investigate the effect of bone regeneration under the use of a bioactive glass-based composite as well as the use of laser irradiation in the presence of the bioactive glass-based composite. In 16 white non-inbred rats, with a body weight of 300–350 g the bioactive glass-based composite was implanted into the tibial metaphysis. Besides, 90 female rats of the Wistar line weighing 250–270 g underwent laser irradiation on an artificially created tibial bone defect filled with the bioactive glass-based composite. The period of observation lasted respectively 2 and 4 weeks. It was found that application of the bioactive glass promotes bone regeneration, which is noticeably enhanced with the use of low energy laser. The combining effect leads to a significant increase in bone regeneration and the expression of bone tissue metabolic markers: osteocalcin and alkaline phosphatase. The most pronounced effect of the laser on bone regeneration occurred at a wavelength of 810 nm, which opens up prospects for the use of this technique in clinical practice.

Метастатичне ураження кісток є тяжким ускладненням онкологічної хвороби. Метастази в кістки виявляються у 17–50 % хворих із солідними злоякісними пухлинами та є третьою за частотою локалізацією після метастатичного ураження легень і печінки. Основними клінічними проявами метастатичного ураження кісток є біль, патологічні переломи, що виникають у 8–30 % випадків, компресія спинного мозку та гіперкальціємія, що значною мірою визначає тяжкість стану хворого, а в ряді випадків є причиною летальності. Вибір методики остеосинтезу при метастатичному ураженні довгих кісток кінцівок є актуальним у зв’язку з тим, що потрібна надійна фіксація відламків кістки, тому що в більшості випадків зрощення кістки не відбувається. Проведено біомеханічне дослідження з випробуванням на міцність і жорсткість нативної моделі стегнової кістки з наявним порожнистим дефектом у проксимальному її відділі трьома різними варіантами металофіксаторів: проксимальним стегновим стрижнем, накістковою пластиною та апаратом зовнішньої фіксації Костюка. Порівнюючи показники напружень на фрагментах моделі стегнової кістки між собою, слід відмітити, що при застосуванні апарата зовнішньої фіксації Костюка спостерігається зростання значень напружень майже у 2 рази порівняно зі значеннями при застосуванні проксимального стегнового стрижня та накісткової пластини. Значення напружень на кістці при застосуванні апарата зовнішньої фіксації перевищують поріг міцності кортикальної тканини. Показники напружень на елементах фіксації зростають майже у 9 разів при застосуванні апарата зовнішньої фіксації Костюка порівняно із значеннями при застосуванні проксимального стегнового стрижня та у 3 рази при використанні накісткової пластини. Значення напружень на металевих конструкціях при застосуванні апарата зовнішньої фіксації Костюка не перевищують поріг їх міцності. Порівнюючи отримані показники переміщень цілком усієї моделі стегнової кістки, тобто проксимального її відділу відносно закріпленого дистального відділу, можна спостерігати майже рівнозначні показники при застосуванні проксимального стегнового стрижня та накісткової пластини. Показники переміщень при застосуванні апарата зовнішньої фіксації Костюка майже у 2 рази вище, ніж при застосуванні проксимального стегнового стрижня та накісткової пластини. В усіх варіантах фіксації відбувається перерозподіл навантаження на металеві конструкції фіксаторів, тобто основну функцію утримання несе на собі фіксатор, тим самим розвантажуючи саме кістку та ділянку її перелому. В результаті експериментального дослідження встановлено, що більш надійну фіксацію уламків забезпечують проксимальний стегновий стрижень та накісткова пластина. Апарат зовнішньої фіксації Костюка в даних умовах справляється з поставленим завданням гірше. Відбувається значна деформація стрижнів апарата зі зминанням кістки у ділянці перелому та збільшенням рухливості відламків. Дані експериментального дослідження можуть бути розглянуті як варіант вибору методики остеосинтезу у хворих із метастатичним ураженням кісток кінцівок.

В статті повідомляється про моніторинг біохімічних маркерів кісткового метаболізму після застосування препарату групи бісфосфонатів при комбінованому лікуванні хворих із пухлинами кісток. Порівнюються дві групи хворих: група практично здорових пацієнтів і група хворих із доброякісними та злоякісними пухлинами кісток, яким виконано ендопротезування та лікування бісфосфонатами. В результаті дослідження маркерів кісткового метаболізму (Ca2+, TRAP-5b, ендостатин) у хворих із пухлинами кісток встановлено, що нормалізація вмісту Ca2+ в крові, а також інтенсивне зниження активності TRAP-5b та концентрації ендостатину свідчать про довгострокову активацію остеобластів і прискорену мінералізацію кісткового матриксу.

У статті повідомляється про результати обстеження та лікування 50 пацієнтів із метастазами анонімного раку в кістці. Хворим проводилося комплексне обстеження: рентгенографія вогнища ураження в кістці; рентгенографія та комп’ютерна томографія органів грудної порожнини; ультразвукове дослідження, комп’ютерна або магнітно-резонансна томографія органів черевної порожнини, заочеревинного простору та малого тазу; остеосцинтиграфія; комп’ютерна або магнітно-резонансна томографія головного мозку; позитронно-емісійна томографія. З метою верифікації процесу виконана відкрита або трепанобіопсія метастатичного вогнища в кістці. Лікувальна тактика визначалася з урахуванням загального стану хворого, локалізації метастазів, поширеності пухлинного процесу, морфологічної будови метастатичної пухлини, передбачуваної локалізації первинного вогнища. У 41 пацієнта з множинними метастазами при тяжкому загальному стані та відмові хворих від оперативного втручання здійснювали іммобілізацію ураженої метастазом кінцівки гіпсовою пов’язкою. У 6 пацієнтів із відносно задовільним загальним станом виконані органозберігаючі операції. У 3 хворих виконані операції, що калічили (ампутація й екзартикуляція кінцівки). Після проведених діагностичних, консервативних і хірургічних заходів усі хворі продовжили комплексне (поліхіміотерапія, променева терапія, бісфосфонати) або симптоматичне лікування. Вибір схеми поліхіміотерапії в пацієнтів із метастазами анонімного раку визначався гістологічним типом пухлини. У результаті проведеного лікування встановлено, що середня тривалість життя пацієнтів із метастазами анонімного раку, які отримували комплексне лікування, вища, ніж в осіб, лікування яких обмежилося симптоматичною терапією.

In the case of gunshot wounds to the limbs, 7.1% of wounded servicemen are diagnosed with primary defects of bone tissue, which in 79.3% of victims exceed 3 square centimeters. In the treatment of this category of patients, the use of 3D modeling becomes especially relevant. Polyetheretherketone (PEEK) is a polyaromatic semi-crystalline thermoplastic polymer with mechanical properties favorable for biomedical applications. PEEK-based materials are becoming an important group of biomaterials used for bone and cartilage replacement, as well as in a large number of diverse fields of medicine. The possibility of using these materials in the 3D printing process increases scientific interest in them. The PEEK matrix is ​​a 3D printed custom mesh that serves as a container for the plastic material. It is important to note that the chemical inertness of the PEEK surface does not guarantee good interfacial biocompatibility and requires surface modification before its use in vivo. The use of PEEK to replace bone defects, particularly after gunshot wounds to the extremities, requires further scientific research and clinical observations. The analysis of clinical cases presented in the article aims to expand the understanding of orthopedic trauma surgeons about the possibilities of using 3D print PEEK matrix technology and help in making tactical clinical decisions in complex cases where there are significant bone defects.