Issue №2-20, 2020

https://doi.org/10.38025/2078-1962-2020-96-2-84-89

Modern treatment approaches in patients with false joints and lower extremities long bones defects: analytical review

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1 Prokhorova E.S., 2 Urazgildeev R.Z., 3 Eremushkin M.A., 3 Kolyshenkov V.A.

1 Moscow Applied Research Center for Medical Rehabilitation and Restorative and Sports Medicine, Moscow, Russian Federation
2 Central scientific-research Institute of traumatology and orthopedics named after N. N. Priorova, Moscow, Russian Federation
3 National Research Medical Center of Rehabilitation and Balneology, Moscow, Russian Federation


ABSTRACT

Research of effective treatment methods in patients with pseudoarthrosis and lower extremities long bones defectsremains today very relevant. In the structure of traumatological patients general disability it takes up to 33.1% ofcases. Surgical techniques are used, such as: intramedullary osteosynthesis, method of open reposition and bonefragments fi xation by metal structures, method of transcutaneous osteosynthesis. They are recognized as effectivetreatment methods in patients with pseudoarthrosis and lower extremities long bones defects, that greatly improvestreatment outcomes. Unfortunately, when they are used as single intervention, unsatisfactory therapy results occurin up to half of the cases. Concomitant structural and functional changes of the limb – such as regional bloodcirculation insufficiency, presence of extensive cicatrical soft tissues defects, changes in bone segment length, joints contractures, etc. – interferes bone consolidation and requires an application of additional treatment methods. Thus,the generally accepted treatment approach in patients with pseudoarthrosis and lower extremities long bones defectsis a combination of surgery, pharmacotherapy, methods of physical therapy and physiotherapy in order to optimize the processes of osteoregeneration in non-union area.


KEYWORDS: pseudoarthrosis, lower extremities long bones defects, intramedullary osteosynthesis, open reposition technique, transcutaneous osteosynthesis, stimulation of osteogenesis, non-union fracture, osteostimulating drugs

For citation: Prokhorova E.S., Urazgildeev R.Z., Eremushkin M.A., Kolyshenkov V.A. Modern treatment approaches in patients with false joints and lower extremities long bones defects: analytical review. Bulletin of rehabilitation medicine. 2020; 96 (2): 84-89. https://doi.org/10.38025/2078-1962-2020-96-2-84-89



References:

  1. Zhuravlev S.M. Sovremennye problemy travmatizma, ortopedicheskoj zabolevaemosti i ih neblagopriyatnyh posledstvij [Modern problems of traumatism, orthopedic morbidity and their adverse consequences]. Annaly travmatologii i ortopedii, 1996: 2: 5 - 11 (In Russ.).
  2. Vajsman D.Sh., Sorockaja V.N., Nikitina E.S. Analiz smertnosti ot boleznej kostno-myshechnoj sistemy po pervonachal'noj i mnozhestvennym prichi-nam u zhitelej Tul'skoj oblasti [Analysis of mortality from diseases of the musculoskeletal system for primary and multiple causes in residents of the Tula regio]. Nauchno-prakticheskaja revmatologija, 2017: 55(6): 616 - 620 (In Russ.).
  3. Kausto J., Pentti J., Oksanen T., Virta L.J., Virtanen M., Kivimaki M., Vahtera J. Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases: a cohort study of public sector employees. Scand J Work Environ Health., 2017: 43(4): 358 - 366 DOI:10.5271/ sjweh.3643
  4. Folomeeva O.M., Galushko E.A., Jerdes Sh.F. Rasprostranennost' revmaticheskih zabolevanij v populyaciyah vzroslogo naseleniya Rossii i SSHA [Prevalence of rheumatic diseases in adult populations of Russia and the USA]. Nauchno-prakticheskaja revmatologija, 2008: 4: 4 - 13(In Russ.).
  5. Balabanova R.M., Dubinina T.V., Demina A.B., Krichevskaja O.A. Zabolevaemost' boleznyami kostno-myshechnoj sistemy v Rossijskoj Federacii za 2015-2016 gg [Incidence of diseases of the musculoskeletal system in the Russian Federation for 2015-2016]. Nauchno-prakticheskaja revmatologija, 2018: 56(1): 15 - 21 DOI: 10.14412/1995-4484-2018-15-21
  6. Shevchuk Ju.I., Bessmertnyj V.F., Teteruk V.F., Veremij O.A. Osobennosti lecheniya lozhnyh sustavov dlinnyh trubchatyh kostej [Features of treatment of false joints of long tubular bones]. Collection of scientific works of XV Congress of orthopedists-traumatologists of Ukraine. Dnepropetrovsk, 2010: 257 p.
  7. Gajko G.V., Kozak R.A. Faktory riska razvitiya lozhnyh sustavov bedrennoj kosti [Risk factors for pseudoarthrosis of the femur]. Politravma, 2012: 4: 14 - 18
  8. Kotel'nikov G.P., Larcev Ju.V., Borinskij S.Ju. Novoe v konservativnom lechenii destruktivno-distroficheskogo zabolevaniya oporno-dvigatel'nogo apparata [New in conservative treatment of destructive dystrophic diseases of the musculoskeletal system]. Proceedings of the I Plenum of the Association of traumatologists-orthopedists of Russia. Krasnodar, 1994: 184 - 187
  9. Krasnov A.F., Miroshnichenko V.F., Kotel'nikov G.P. Travmatologiya. Uchebnik dlya med. vuzov [Traumatology. Textbook for med. higher educational]. Moscow, 1995: 455 p.
  10. Reshetnikov A.N., Korshunova G.A., Goriakin M.V. et al. Rezul'taty total'nogo endoprotezirovaniya tazobedrennogo sustava u bol'nyh s lozhnymi sustavami shejki bedrennoj kosti [Results of total hip replacement in patients with femoral neck pseudarthrosis]. Genij Ortopedii, 2017: 23(1): 38 - 43
  11. Zagorodnij N.V., Zharmuhambetov E.A. Hirurgicheskoe lechenie vertel'nyh perelomov bedrennoj kosti [Surgical treatment of trochanteric fractures of the femur]. Ros. med. Zhurnal, 2006: 2: 18 - 19
  12. Balajan V.D., Tishkov N.V., Barabash Ju.A., Kauc O.A. Hirurgicheskoe lechenie psevdoartrozov dlinnyh trubchatyh kostej s ispol'zovaniem dopolnitel'nyh ochagov kosteobrazovaniya [Surgical treatment of pseudoarthrosis of long tubular bones using additional foci of bone formation]. Sibirskij medicin-skij zhurnal, 2009: 1(90(7)): 73 - 76
  13. Shitikov D.S., Ardatov C.B. Novyj metallofiksator dlya lecheniya perelomov proksimal'nogo otdela bedrennoj kosti [New metal fixator for treatment of proximal femur fractures]. Vrach-aspirant, 2013: 4.1(59): 194 p.
  14. Abed Jah'ja Senan Al'-Bareda. Osobennosti intramedullyarnogo blokiruyushchego osteosinteza diafizarnyh perelomov bedrennoj kosti i metody repozicii kostnyh otlomkov.Diss. [Features of intramedullary blocking osteosynthesis of diaphyseal femoral fractures and methods of bone fragments reposition. Diss.]. Moscow, 2013
  15. Grass R., Biewener A., Rammelt S., Zwipp H. Retrograde locking osteosynthesis of distal femoral fractures with the distal femoral nail (DFN). Un-fallchirurg., 2002: 4: 298 - 314
  16. Gusejnov A.A. Kostnoplasticheskie sposoby optimizacii lecheniya lozhnyh sustavov [Bone-plastic methods for optimizing treatment of false joints]. Mezhdunarodnyj studencheskij nauchyj vestnik, 2015: 2-1: 22 - 23
  17. Zorja V.I., Skljanchuk E.D., Vasil'ev A.P. Effektivnost' osteokonduktivnyh materialov v lechenii posledstvij perelomov konechnostej. Osteosintez i en-doprotezirovanie [The effectiveness of osteoconductive materials in the treatment of the consequences of limb fractures]. Osteosynthesis and endoprosthesis: proceedings of the international Pirogov scientific and practical conference. Moscow, 2008: 71 p. (In Russ.)
  18. Barabash A.P., Barabash Yu.A., Grazhdanov K.A. Tekhniko-takticheskie aspekty tekhnologii lecheniya bol'nyh s nesroshchennymi perelomami i lozh-nymi sustavami dlinnyh kostej [Technical and tactical aspects of treatment technology for patients with unbroken fractures and false joints of long bones]. Travmatologiya i ortopediya v Rossii: tradicii i innovacii. Sbornik materialov Vserossijskoj nauchno-prakticheskoj konferencii, posvyashchen-noj 70-letiyu SarNIITO, 2015: 28 - 31 (In Russ.).
  19. Bogov A. A., Ibragimov L. Ja., Mullin R. I. Vaskulyarizovannaya kozhnaya plastika nesvobodnymi osevymi loskutami medial'noj poverhnosti goleni pri sochetannyh povrezhdeniyah goleni i stopy u detej. Materialy simpoziuma detskih travmatologov-ortopedov Rossii s mezhdunarodnym uchastiem [Vascularized skin plasty with non-free axial flaps of the medial surface of the tibia in combined injuries of the tibia and foot in children. Proceedings of the Symposium of pediatric traumatologists-orthopedists of Russia with international participation]. St.-Petersburg, 2008: 66 - 67 (In Russ.).
  20. Efremov I.M., Sibaev F.Ja., Shevalaev G.A. Dvuhetapnyj reosteosintez u pacienta s lozhnym sustavom bol'shebercovoj kosti, oslozhnennym hroniches-kim posleoperacionnym osteomielitom [Two-stage rheosteosynthesis in a patient with a false tibial joint complicated by chronic postoperative osteomyelitis]. Travmatologija i ortopedija Rossii, 2018: 1(24): 109 (In Russ.).
  21. Kornilov N.V., Shapiro K.I. Organizaciya i sovershenstvovanie travmatologo-ortopedicheskoj sluzhby Rossii [Organization and improvement of traumatological and orthopedic service of Russia]. Annaly travmatologii i ortopedii, 1996: 3(9): 5 - 7 (In Russ.).
  22. Petrov N.V. Lozhnye sustavy dlinnyh trubchatyh kostej, oslozhnennye osteomielitom, i ih lechenie. Dokt. Diss. [False joints of long tubular bones complicated by osteomyelitis and their treatment. Doct. Diss.]. M., 1993 (In Russ.).
  23. Choi I.-H., Cho T.-J., Lee S.-M., Chung Ch.-Y., Yoo W.-J. Ilizarov treatment of atrophic congenital pseudoarthrosis of the tibia: Refracture and importance of consideration for fibular pseudoarthrosis. 4th Meeting of the A.S.A.M.I. International, held in conjunction with 12rd Meeting of A.S.A.M.I.: Program and Abstracts. Kyoto, 2006: 77
  24. Pisarev V.V., Molchanov O.V. Reologiya krovi pri zakrytyh diafizarnyh perelomah kostej goleni. Materialy Vserossijskoj nauchno prakticheskoj konfer-encii s mezhdunarodnym uchastiem, posvyashchennoj 85-letiyu so dnya rozhdeniya professora N. P. Demicheva «Sovremennye aspekty travmatolo-gii, ortopedii i rekonstruktivnoj hirurgii» [Blood rheology in closed diaphyseal fractures of Shin bones. Proceedings of the all-Russian scientific and practical conference with international participation dedicated to the 85th anniversary of the birth of Professor Demichev N.P. "Modern aspects of traumatology, orthopedics and reconstructive surgery"]. Astrakhan, 2014: 130 p. (In Russ.).
  25. Alekseeva, I.V. Narusheniya reparativnoj regeneracii kostnoj tkani pri gipodinamii i primenenie ksidifona dlya ih korrekcii: avtoref.diss.kand.med. nauk Alekseeva I.V. [Violations of reparative regeneration of bone tissue in case of inactivity and the use of xidiphone for their correction]. M., 1992: 17 p. (In Russ.)
  26. Sveshnikov A.A., Zjuzjukina O.V., Obanina N.F. Vliyanie osteohina na sostoyanie kostnogo regenerata pri lechenii perelomov i udlinenii konechnosti [Effect of osteochin on the state of bone regenerate in the treatment of fractures and limb lengthening]. Osteoporoz i osteopatii, 1998: 1: 41 - 42 (In Russ.).
  27. Rodionova S.S., Kolondaev A.F., Sokolov V.A. et al. Rezul'taty ispol'zovaniya preparata «Osteogenon» u pacientov s razlichnoj patologiej oporno-dvigatel'nogo apparata [Results of the use of the drug "Osteogenon" in patients with various diseases of the musculoskeletal system]. Osteoporoz i osteopatii, 1999: 1: 43 - 45 (In Russ.).
  28. Kuznecova, O.A., Gulnazarova S.V. Mineral'naya plotnost' kosti pri lechenii lozhnyh sustavov: dinamika kostnoj massy i vozmozhnosti ee korrekcii [Mineral density of bone in the treatment of false joints: dynamics of bone mass and the possibility of its correction. The problem of osteoporosis in traumatology and orthopedics: IV conference with international participation], The problem of osteoporosis in traumatology and orthopedics: IV conference with international participation. Moscow, 2009: 86 p. (In Russ.).
  29. Shvarc, G.Ja. Farmakoterapiya osteoporoza [Pharmacotherapy of osteoporosis]. M., Medicinskoe informacionnoe agentstvo, 2002: 368 p. (In Russ.)
  30. Korzh, H.A., Goridova L.D., Leont'eva F.S. Kliniko-metabolicheskie aspekty primeneniya osteogenona v lechenii bol'nyh s perelomami dlinnyh kostej [Clinical and metabolic aspects of the use of osteogenon in the treatment of patients with long bone fractures]. Ortopedija, travmatologija i pro-tezirovanie, 2003: 2: 94 - 99 (In Russ.).
  31. Al' Naddzhar T.M., Maslennikov E.Ju., Taranov I.I., Mycykov R.Ju. Prolongirovannoe lokal'noe vvedenie proteoliticheskih fermentov kak sposob opti-mizacii reparativnogo osteogeneza [Prolonged local administration of proteolytic enzymes as a way to optimize reparative osteogenesis]. Kubanskij nauchnyj medicinskij vestnik, 2010: 3(126): 18 - 22 (In Russ.).
  32. Berchenko G.N., Kesyan G.A, Urazgildeev R.Z. Experimental morphological substantiation of application of the material collapan-S (containing silver nanoparticles) for replacement of bone defects. Tissue Engineering & Regenerative Medicine International Society, European Chapter Meeting. 2014, Genova. Italy. Journal of Tissue Engineering and Regenerative Medicine, 2014: 8(Suppl.l): 430 - 431.
  33. Rusanov A.G., Barabash A.P. Beskrovnaya metodika lecheniya perelomov i lozhnyh sustavov dlinnyh kostej nizhnih konechnostej. Maloinvazivnye tekhnologii v travmatologii-ortopedii i nejrohirurgii [Bloodless method of treatment of fractures and false joints of long bones of the lower extremities]. Sbornik tezisov Vserossijskoj nauchno-prakticheskoj konferencii, 2013: 46 - 48 (In Russ.).
  34. Saks L.A. Primenenie nizkointensivnoj impul'snoj ul'trazvukovoj stimulyacii osteogeneza pri perelomah i lozhnyh sustavah kostej v ambulatornoj praktike [Application of low-intensity pulse ultrasound stimulation of osteogenesis in fractures and false joints of bones in outpatient practice]. Voenno-medicinskij zhurnal: Teoret.i nauch.-prakt. Zhurn, 2013: V. 334(9): 39 - 45 (In Russ.).
  35. Serebrjak T.V., Kolosov N.G. Stimulyaciya ostogeneza metodom transplantacii embrional'nyh kletok kostnoj tkani [Stimulation of ontogeneza method of transplantation of embryo cells of bone tissue]. Klinicheskie aspekty kletochnoj terapii. Omsk, 2000: 171 p. (In Russ.).
  36. Putalova I.N., Batushenko D.E. Drenazhno-detoksikacionnaya funkciya limfaticheskoj sistemy pri stimulyacii osteogeneza v eksperimente [Drainagedetoxification function of lymphatic system at stimulation of osteogenesis in experiment]. Collection of abstracts for scientific and practical conference of young scientists "Actual issues of clinical and experimental medicine". - Saint-Petersburg, 2003: 326 - 328 (In Russ.).
  37. Xu ZH., Jiang Q., Chen DY. et al. International Orthopaedics (SICOT). 2009: 33: 789 p. DIO: 10.1007/s00264-008-0553-8
  38. Sholomov I.I., Reshetnikov A.N., SHolomova E.I., Korshunova G.A., Arutyunyan T.R., Goryakin M.V. Drenazhno-detoksikacionnaya funkciya limfatiches-koj sistemy pri stimulyacii osteogeneza v eksperimente [Assessment of quality of life and ENMG indicators in patients with fractures and false joints of the lower limb bones]. Klinich. Nevrologiya, 2013: 1: 15 - 20 (In Russ.).
  39. Vitenzon A.C., Petrushanskaja K.A., Skvorcov D.V. Rukovodstvo po primeneniyu metoda iskusstvennoj korrekcii hod'by i ritmicheskih dvizhenij posredstvom programmiruemoj elektrostimulyacii myshc [Manual on the application of the method of artificial correction of walking and rhythmic movements by means of programmable electrical stimulation of muscles]. Moscow, 2005: 274 - 277 (In Russ.).
  40. Kochetkov Ju. S. Biologicheskie i hirurgicheskie aspekty stimulyacii osteogeneza (eksperimental'noe issledovanie). Dokt. Diss. [Biological and surgical aspects of osteogenesis stimulation (experimental study). Doct. Diss.]. Kurgan, 2003 (In Russ.).
  41. Reshetnikov A.N., Reshetnikov N.P. Kompleksnoe lechenie bol'nyh s lozhnymi sustavami i defektom trubchatyh kostej nizhnih konechnostej. Posobie dlya vrachej. utverzhdeno UMS MZ i CP RF [Comprehensive treatment of patients with false joints and tubular bones of the lower extremities. Guide for doctors]. Saratov, 2004 (In Russ.).
  42. Kotel'nikov G.P., Jashkov A.V. Gravitacionnaya terapiya [Gravity therapy]. M., Medicina, 2003: 244 p. (In Russ.).
  43. Izmalkov N. S., Kotel'nikov G.P., Bulgakova C.B., Pankratov A.C Realizaciya kompleksnogo podhoda k resheniyu problemy osteoporoza v Samarskoj oblasti. Tezisy IV konferencii s mezhdunarodnym uchastiem «Problema osteoporoza v travmatologii i ortopedii» [Implementation of an integrated approach to solving the problem of osteoporosis in the Samara region. Theses of the IV conference with international participation "the Problem of osteoporosis in traumatology and orthopedics"]. Moscow, 2009: 45 - 46 (In Russ.).
  44. Nedrigajlova O.V. Immobilizacionnye kontraktury [Immobilization contractures]. Avtoref. Diss...dokt. med. H., 1957 (In Russ.).
  45. Kurbanov S.H., Hasanov B.N., Abdulloev M.S., Sharipov A.A. Sluchaj uspeshnogo lecheniya lozhnogo sustava bol'sheberclvlj kosti [A case of successful treatment of a false tibial joint]. Vestnik Akademii medicinskih nauk Tadzhikistana, 2016: 3: 16 - 19 (In Russ.).
  46. Merkulov V.N., Dorohin A.I., Stuzhina V.T., Dujsenov N.B. Sovremennye tekhnologii kompleksnogo lecheniya posttravmaticheskih defektov dlin-nyh kostej u detej i podrostkov. Materialy VIII s"ezda travmatologov-ortopedov Respubliki Belarus' «Razvitie travmatologii i ortopedii v Respublike Belarus' na sovremennom etape» [Modern technologies of complex treatment of posttraumatic defects of long bones in children and adolescents. Materials of the VIII Congress of traumatologists-orthopedists of the Republic of Belarus "development of traumatology and orthopedics in the Republic of Belarus at the present stage"]. Minsk, 2008: 200 - 202 (In Russ.).



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