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

The surgical intervention for the management of frontal sinusitis is required in a large fraction of patients presenting with this condition. The treatment of choice for the pathology in question is endoscopic endonasal frontotomy. Whenever the endoscopic technique is impossible to employ, the surgeon has to resort to an extranasal operation on the frontal sinus. The indications for the application of such strategy include the pathological conditions complicated by the intracranial and orbital processes, the presence of large benign tumours, recurrent post-surgical purulent sinusitis and traumatic frontal sinusitis. For the preservation of the functionally competent frontal sinus during extranasal frontotomy, a frontonasal fistula with all bony walls and maximally spared mucous membrane can be created. In order to remove an osteotoma from the frontal sinus, we applied the osteoplastic approach with the formation of the osteo-periosteal flap from the frontal wall of the sinus. In those cases when it was impossible to restore the frontal sinus and there was a closed bone cavity undergoing purulent inflammation we practiced obliteration of the cavity with the use of a porous carbon implant.

Presented herein are comparative remote results of combined surgical treatment of 121 patients with stage IIB-III lower limb chronic ischaemia (LLCI) by means of indirect revascularization (lumbar sympathectomy--LSE and revascularizing osteotrepanation of the tibial bone--ROT) and gene therapy using the first registered Russian gene therapeutic agent Neovasculgen®. Depending on the LLCI degree and the method of treatment, during 3 years we assessed such parameters as the limb salvage rate, pain-free walk distance (PFWD), ankle-brachial index (ABI) and linear blood velocity (LBV). An increase in the PFWD in patients with initial stage IIB LLCI in the group of gene therapy was considerably higher than in other types of treatment (p=0.0001-0.0004). Using indirect methods of revascularization was accompanied and followed by less positive alterations in the PFWD values which by the end of the third year of follow up were observed to decrease. The values of PFWD after ROT at 2 and 3 years were higher than after LSE (p=0.006). During the first year of follow up the highest increment of the ABI was observed after ROT. At two years, the ABI values after ROT and gene therapy became equal. The worst result during 3 years as compared with other methods of treatment was demonstrated by LSE (p=0.006). Changes in ABI after gene therapy were statistically significant at all terms of follow up (p=0.008-0.02). There were no limb amputations in the remote period of follow up in patients with the initial stage IIB of the disease. Patients with initial stage III LLCI also showed a considerably better result by the increment of increased PFWD after gene-therapeutic treatment (p=0.001-0.0005). A small increment of the PFWD after LSE maintained during 1 year and after LSE during 2 years. The ABI values in all periods of follow up were higher after gene therapy (p=0.01-0.003). During the 2- and 3-year period the increment of this parameter after ROT was more significant than after LSE (p=0.046-0.05). Changes in the ABI after gene therapy at all terms also turned out to be more substantial (p=0.03-0.008). An increase in the LBV during the first and second years after ROT turned out more significant as compared to LSE (p=0.05). The limb salvage rate in patients with initial stage III LLCI during the whole period after gene therapy amounted to 78%, after ROT being 54% and after LSE equalling 45%.

Results of the use of the biocomposite nanostructured material "KollapAn" in the treatment of 374 patients with osteomyelitis were followed up. 412 operations were performed, depending on the stage of the inflammatory process and clinical picture. Majorly, operation was performed on the 5-7th day after primary necrosequestrectomy. Good early anatomic results were achieved in 86% patients. All patients demonstrated the good functional results of the treatment; the wound healing was on-time. The lethality rate was 1.2%; all these patients had severe sepsis. The long-term follow up (1.5 years) revealed the complete substitution of the bone defect by the autobone; no cases of the osteomyelitis recurrence were observed.

The author presents his experience of surgical treatment of 63 high congenital dislocations of the hip in schoolchildren. Osteotomy of the pelvis after Salter in combination with shortening osteotomy and open reduction of the hip has been used. Aseptic necrosis of the femoral head in the postoperative period has been revealed in almost 80% of the cases; the results were good during the first 10 years of observations in 28.5% and bad in 31% of the cases; after 10 and more years the percentage of good results fell to 18%. However, the patients gave a higher estimation of the treatment results as the period of clinical compensation of the operated joints lasted 10 to 12 pears, which made easier their contacts with schoolmates and family creation in future.

The paper is devoted to the surgical treatment of the children with dysplastic pre- and coxarthroses, namely to the reconstruction of the supraacetabular area of the hip joint by means of incomplete semicircular osteotomy, which has allowed to reduce the terms of the treatment, to exclude a further recurrence of the deformation and to interrupt the phenomena of arthrosis that are present. In all the cases of the 50 patients who had been operated (aged 3 to 14 years with the follow-up period up to 10 years) there were good anatomical and functional results. The average mark according to the CITO scale was 4.6.

The authors compare the intensities of nociceptive stimulation and blood loss volumes in children subjected to radical uranostaphyloplasty involving the use of all the elements of the technique and to its sparing modifications. The level of pain aggression, blood loss volume, and mean length of the operation were lower with the sparing methods than with the traditional one, this leading to a conclusion on the lower traumatism of the sparing uranostaphyloplasty technique for the body.

While analysing the results of 118 operations for extrafocal compression, distraction and compression-distraction osteosynthesis with the G. A. Ilizarov apparatus in 116 patients showing nonunion of fractures and pseudarthrosis of the tibia, the author observed 53 various complications among 40 operations (33.9%). 78 operations were without any complications (66.1%). The greatest number of complications was noted while using a distraction method. Some recommendations on the treatment and prophylaxis of such complications are given.

The results of 91 supra-acetabular osteotomies of pelvic bones in children followed up for 6 years is presented. It was found that total anatomical and functional rehabilitation of the coxa was noted only in children who underwent supra-acetabular osteotomy of pelvic bones, associated with detorsion-varisation osteotomy of the femoral bone or antero-exterior tilt of its greater trochanter. Supra-acetabular osteotomy of pelvic bones in small children could result in a premature closure of a U-shaped cartilage, asymmetric growth of the bones and subsequent deformation of the pelvis with its oblique position.