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Relevance . The main goals of successful prosthesis remain ensuring the osseointegration and infectious safety of implants. The purpose of the study — the comparative analysis of osseointegration of titanium and steel additive manufactured implants in the rabbit tibia under additional fixation by Ilizarov apparatus. Materials and Methods . The study was performed on 20 chinchilla male rabbits. The animals of the first group (n = 8 ) were implanted a stainless steel product EOS PH1 (EOS, Germany), the animals of the second group (n = 12) — a titanium alloy Ti6Al4V product. The implant was additionally fixed by Ilizarov apparatus. The implants were processed with additive technology by selective laser fusion at the EOSINT M 280 installation (EOS, Germany). The survival and safety of the implants were assessed using clinical, histological, laboratory and statistical methods. Results . The implant fall due to chronic inflammation was found in 2 animals of group 1 and none in group 2. The formation of weakly mineralized bone tissue on the surface of the implant was noted in 3 weeks in all cases. The bone became more mineralized by the 12 th week of the experiment. However, in group 2, the calcium content and Ca / P ratio of the newly formed bone tissue at the 3 rd and 12 th week after implantation were significantly higher than in the animals of group 1. This indicated the greater maturity of the bone tissue in animals of group 2 at all stages of the experiment. In group 1, the compact plate osteoporosis and calcium-phosphorus balance disturbance were greater. Conclusion . The results of the study indicate that the survival rate (osseointegration) and safety of the product made of the titanium alloy were higher compared with the stainless steel product.

Background. Stimulation of osteogenesis in the treatment of certain orthopedic and trauma pathologies is a necessary element to ensure the best clinical outcome. The purpose of the present analytical review is to analyze the literature data in respect of evaluating the approaches and possibilities to stimulate osteogenesis using direct current. Methods. The search for literature data was performed in the open electronic databases of scientific literature PubMed and eLIBRARY under the following keywords and their combinations: “osteogenesis”, “reparative osteogenesis”, “direct electric current”, “orthopaedics”, “traumatology”, “electric current” (in Russian as well as in English language ). Results. According to some fundamental research, the stimulating effect of direct current lies is both in stimulating differentiation and proliferation of osteoblasts, and in stimulating differentiation of stem cells, mainly mesenchymal stem cells of bone marrow and adipose tissue, in the process of osteogenesis. The following stimulating technologies were developed and clinically tested to date: 1 — direct exposure of bone to the direct current; 2 — capacitive coupled stimulation; and 3 — inductive coupled (electromagnetic) stimulation. Analysis of clinical practice demonstrated that the first technology is most effective in terms of osteoreparation, but less safe than technology 2 and 3. It should be noted that there are no clear indications and modes of application for the abovementioned methods. Based on the data collected in the present analysis, technology 1 is considered by authors as the most promising. Safety of technology 1 can be enhanced by application of metal implants as electrodes in case those are planned to be used for medical reasons: wires, rods, staples, fixators, etc. Conclusion. Use of electric current to stimulate bone formation is a promising method which requires clarification in respect of indications and application modes.

The number of cases with extensive and complex bone defects undergoing revision endoprosthetization continues to increase. We tested a reendoprosthetization method for hip joints with severe bone tissue deficits using individualized endoprosthesis components in four patients. Clinical data showed that use of a personalized approach to reendoprosthetization of hip joints with severe bone tissue deficit provided complete filling of defects in the acetabulum.

This review analyzes and assesses the existing methods and approaches to prediction and control of the course of distraction osteogenesis (DO). The analysis of the literature revealed few works that recommended specific predictors or methods for prognosis of the course of distraction osteogenesis at the stages of limb lengthening. The authors identified some diagnostic criteria for assessing the distraction regenerate as potential criteria for predicting its development and maturation. It was found that all available predictors and potential diagnostic criteria for assessing the state of the distraction regenerate in clinical practice are used to further correct the distraction regime (respectively, at the stage of distraction) and to determine the timing of the removal of the apparatus, as well as prognosis of recurrence, fracture, and deformity of the regenerate in the non-apparatus period. It was shown that all known diagnostic methods can be applied for the assessment and prediction of the DO course: radiological, physiological, ultrasound diagnostics, laboratory tests. It is stated that a quantitative assessment of the informative value of most of the known predictors of DO disorders is necessary from the point of view of the evidence-based medicine. Difficulties and problems of the development and application of prognostic tests for assessing DO are described. The directions to the development of this topic are proposed. Predicting the DO course is an essential element for monitoring the tissue repair of the segment under lengthening. Prediction and subsequent prophylaxis of DO disorders is a promising solution for optimizing and improving the quality of treatment of patients with orthopedic diseases by using the Ilizarov method of transosseous distraction osteosynthesis.

Objective The purpose of the study was to explore bone formation processes and survival of percutaneous implants under various external compression of the bone. Material and methods 30 chinchilla male rabbits were used in the study. Tibia of the species was amputated at the upper third and an implant was surgically implanted with the distal part extending through the skin. A compression device was attached to the implant and loading provided to the bone next day after surgery. Five magnitudes of compression loading were used for animals subdivided into 5 groups comprising 6 species in each of the groups. Compression device with constantly maintained loading was attached to the limb during 6 weeks. Results Animals of groups I and II showed no case of the implant falling out throughout the whole period of observation. An implant fell out of the bone in one species of Group III after 56-day implantation, two and four species of Groups IV and V, correspondingly, 3 to 4 days after removal of compression device. Osseointegration was shown to improve in species of Groups I and II due to active angiogenesis in peri-implantation area. Conclusion Therefore loads of greater than 105260 Н/m2 applied to the bone result in decreased implant osseointegration whereas less intensive loading tends to improve osseointegration.

Purpose To study concentrations of metabolites and growth factors as well as hematological parameters in patients with delayed lower limb fracture healing Material and methods Concentrations of several metabolites and growth factors as well as hematological parameters were studied in 13 patients with a delay in healing of femoral and tibial fractures after 7 to 11 months following injury. Seven patients with consolidated diaphyseal femoral and tibial fractures examined 10 to 12 months after the injury were a control group. Ten healthy subjects that did not have any history of fractures were a reference group. Results Unlike individuals of control and reference groups, patients with delayed fracture healing showed significantly higher concentrations of lactate, triglycerides, TGF-α and TGF-β2 in their serum while IGF-1 levels were significantly lower. Hematology tests did not show differences between the groups. Conclusion Local hypoxia, acidosis and expression of GFs that support osteolysis were the main pathophysiological processes that could cause the delay in long-bone fracture healing.

Acute spherical cavity defects in the distal metaphysis of the femur were created and filled with a mesh implant made of titanium nickelide wire in 15 mature adult male Wistar rats. Analogous defects were created in animals of the control group (n = 15) but were not filled. Filling of the defect in rats of the experimental group was noted 90 days after implantation, but did not occur in rats of the control group. No differences were seen in the clinical picture or pathomorphological or biochemical investigation results between animals of the experimental groups.

Purpose Search for laboratory criteria of pathological process monitoring in patients with chronic osteomyelitis of the tibia at the stages of its management using the method of transosseous distraction osteosynthesis. Materials and methods Biochemical parameters of blood serum were studied in 15 patients with chronic posttraumatic osteomyelitis of the tibia. Sequester necrectomy with subsequent osteosynthesis of the tibia with the Ilizarov apparatus was performed in all patients at the first stage. At the second stage, the defect was filled in with distraction regenerate according to Ilizarov. Depending on the bone defect size, the patients were divided into two groups. The defect size was from 3 to 5 cm in patients of the first group (n = 7, mean age 42.4 ± 6.9 years). In the patients of the second group (n = 8, mean age 37.5 ± 7.8 years) the size of the defect was from 7 to 12 cm. Results It was found that the changes in the activity of the bone isoenzyme of acid phosphatase (TRAP), alkaline phosphatase, creatine phosphokinase, lactate and C-reactive protein (CRP) did not differ significantly between the groups during their treatment. At the same time, the concentration of CRP, sialic acids and the activity of TRAP in the first stage perids of treatment was significantly increased in patients of both groups relative to the reference norm. In patients of the second group, the concentration of sialic acids was higher than the values of group 1 and the reference group in the periods of 7-21 days of fixation. Nevertheless, at the beginning of the second stage of treatment (distraction), the level of all the studied parameters was not significantly different from the norm. Conclusion Normalization of TRAP activity, concentration of CRP and sialic acids values can be attributed to additional diagnostic features on the basis of which it is possible to start the second stage of treatment (distraction) in patients with chronic osteomyelitis of the tibia.

The study examined the content of bone metabolism in the blood serum of 15 girls with the usual level of physical activity, the descendants of migrants of the first generation of markers living in the territory of KhMAO-Yugra (age 18-24). We detected two signs indicating the change of the regulatory systems of the bone metabolism in girls surveyed, which were shown as: reducing the concentration of the active form of vitamin D, and increase the concentration of osteolysis markers - C-terminal telopeptide and parathyrin serum. From these data we can conclude that the marked changes in bone metabolism and its regulatory systems linked to the climatic conditions of the subjects live.

Purpose A retrospective analysis of clinical efficacy and safety of using the external fixation apparatus of G.A. Ilizarov's design. Materials and methods Analysis and evaluation of clinical data was performed using 107 literary sources. 4.200 clinical cases were studied to evaluate effectiveness, and 6.274 cases to assess safety. Results The analysis revealed a high clinical efficacy of using the Ilizarov apparatus for external fixation (various assemblies) in solving a wide range of practical problems in the field of traumatology and orthopedics. According to the results of the study, its high clinical treatment effectiveness was confirmed both on the use of the method in general (about 95 % of positive outcomes), and in specific nosological groups of patients (not lower than 90 % of positive outcomes). After having assessed the available data on the safety in the application of the Ilizarov apparatus for external fixation (various assemblies), we can conclude that the rates of adverse events, recorded in the literature analyzed, can be considered acceptable. Among all those events, the events classified as adverse effects of the product amounted to 17.03 % (5 ÷ 95 % CI: 16.11 ÷ 17.97 %). © Soldatov Yu.P., Stogov M.V., Ovchinnikov E.N., Gubin A.V., Gorodnova N.V., 2019. © 2019 Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics.

Analysis of the carbon nanostructured implants (CNI) safety and efficacy for the treatment of bone pathology was performed at different clinics of the Russian Federation. Devices showed their efficacy at substitution of intervertebral disc and vertebral body defects as well as at plasty of long bone defects of various etiology. The rate of effect absence did not exceed 6.1%. No serious adverse effects were recorded. It is concluded that CNI possesses the number of characteristics (osteoinduction, bioinertia, safety) that allow using it in traumatology and orthopaedics.

The article analyzes a clinical cases of cardiac arrhythmia and amiodarone-induced thyrotoxicosis (AIT) in a patient with coronary artery disease (CAD). The article discussed the causes of cardiac arrhythmia and the treatment approach for CAD based on coronary angiography (CAG), as well as the efficacy of revascularization by coronary artery bypass grafting. The importance of hormonal tests and thyroid ultrasound before routine CAG is considered, and at least once in 6 months during amiodarone therapy. Differential diagnosis to clarify the type of AIT is carried out, as type I AIT is treated with tireostatics, and type II AIT with glucocorticosteroids. Comorbidity of somatic diseases in cardiological practice is one of the most crucial prognostic factors defining the outcome of the underlying disease. The article considers the choice of treatment approach for patients with CAD based on clinical tests.

Dynamics of concentration of the products of protein, carbohydrate, lipid and mineral metabolism in serum and daily urine was studied in 60 patients with multiple closed fractures of the extremities treated by Ilizarov technique. In the period of early traumatic disease complications alkaline phosphatase activity, calcium and hydroxyproline excretion, intensity of hypoproteinemia, hypocalcemia, hypocholesterinemia and hypotriglyceridemia increased in proportion to injury severity. Maximum changes in metabolic status during the period of early traumatic disease complications were observed in patients been operated on 2 nd - 3 rd days after injury. At early terms of traumatic disease the criteria for evaluation of multiple injury severity were the following: increase in alkaline phosphatase level, marked hypocalcemia and hypercalciuria. Long-term preservation of hypocalcemia and hypercalciuria on the background of blood urea increase at traumatic disease stages confirms the disturbance of osteoreparation and requires medicamental correction.

The article presents the analysis of efficiency of medical services support related to laboratory analyses in case of alteration of system of Federal clinic financing. The analysis was implemented using the example of functioning of three departments of endoprosthesis replacement of the Federal State Budget Institution "The Academician G. A. Ilizarov Russian Research Center 'Restorative Traumatology and Orthopedics' " in 2013-2015. It is established that during examined period in the structure of laboratory analyses of the Center decreasing of total number of prescriptions to all types of laboratory analyses occurred. The observed decreasing of laboratory analyses had no impact to quality of treatment of patients of the departments of endoprosthesis replacement. In particular, percentage of post-surgery complications among patients of these departments was decreasing during the examined period. The study demonstrated that to the end of 2015 decreasing of average costs in rubles per patient of departments of endoprosthesis replacement related to laboratory analyses occurred up to 20.28% as compared with 2013. The proposals were made concerning structuring of laboratory analyses for patients with endoprosthesis replacement of large joints.

We propose an in vitro method for studying permeability of spinal cord dura mater for components of autological serum using an original device. Sixty native samples of the spinal cord dura mater obtained from 12 mongrel dogs were used for testing of the device. The coefficient of permeability variation (V) for blood serum substances did not exceed 5% in most cases excluding lactate (V=8.03%). Analysis of spinal cord dura mater permeability in vitro for various substances using the developed device provides reproducible results with acceptable variability (5-10%).

The research of the properties of the complex alumínate solutions obtained through Bayer process or sintering process, will enable to determine the optimal parameters for the process, to increase the efficiency of the production and will be instrumental in high quality alumina production. The key stages of the alumina production through Bayer process which define its efficiency are digestion and decomposition processes. The main properties of the obtained products and amount of losses of the commercial components are established on these stages.

Цель. Проанализировать изменение биохимических показателей сыворотки крови у пациентов, которым произведено удлинение голени в проксимальной трети с целью увеличения роста, в зависимости от величины удлинения. Материалы и методы. Биохимические исследования сыворотки крови проведены у 45 пациентов, которым произведено удлинение голени в проксимальной трети с целью увеличения роста. В сыворотке крови определяли концентрацию общего белка, альбумина, лактата, а также активность креатинкиназы (КК). Всех пролеченных разделили на три подгруппы в зависимости от величины удлинения. В первой подгруппе величина удлинения в среднем составила 10,9±2,83 % от исходной длины сегмента, во второй – 17,5±1,49 %, в третьей – 23,2±2,48 %. Результаты. Установлено, что на этапе дистракции во всех подгруппах незначительно снижался уровень общего белка. Активность креатинфосфокиназы на этапе дистракции достоверно возрастала у всех обследованных пациентов, принимая наиболее высокие значения у пациентов третьей подгруппы. На этом же сроке у пациентов 3-й подгруппы статистически значимо возрастал и уровень лактата в сыворотке крови. Заключение. Процесс удлинения костей голени более чем на 20 % от исходной длины приводит к более значительному изменению системных и местных реакций организма, чем при меньших величинах удлинения. Ключевые слова: голень, удлинение, аппарат Илизарова, сыворотка крови, общий белок, альбумин, лактат, креатинкиназа. Purpose. To analyze the change in blood serum biochemical parameters in patients who underwent leg proximal third lengthening in order to increase their height, depending on the amount of lengthening. Materials and Methods. Blood serum studied biochemically in 45 patients who underwent leg proximal third lengthening in order to increase their height. The concentration of total protein, albumin, lactate was determined in blood serum, as well as creatine kinase (CK) activity. All the patients treated divided into three subgroups depending on the amount of lengthening. On the average the amount of lengthening was 10.9±2.83 % of the initial length of segment in the first subgroup, in the second one – 17.5±1.49 %, and in the third – 23.2±2.48 %. Results. The level of total protein established to increase slightly at the stage of distraction in all the subgroups. Creatine phosphokinase (CPK) activity increased significantly at the stage of distraction in all the patients examined, with the highest values in the third subgroup patients. Lactate level in blood serum significantly increased statistically as well in the third subgroup patients in the same period. Conclusion. The process of leg bone lengthening by more than 20 % of initial length leads to more significant change in organism’s systemic and local reactions comparing with lower amounts of lengthening.

Despite the widespread clinical use of distraction osteogenesis for limb lengthening, the cellular and molecular mechanisms by which this surgical treatment promotes new bone formation in humans are not well understood. The aim of the research was to study the levels of growth factors (GFs) in the serum of patients that were undergoing tibial lengthening with the Ilizarov method of distraction osteogenesis. Those were patients with unilateral congenital discrepancy of the tibia (n = 12), unilateral posttraumatic tibial shortening (n = 7), and healthy patients that underwent cosmetic bilateral tibial lengthening (n = 10). The study established that unlike the congenital group, the posttraumatic group and healthy subjects showed a significantly evident increase in the levels of angiogenic GFs in their serum on day 10 of distraction. In the congenital group, the changes were not significant at this time point. The levels of TGF-α, TGF-β1, and TGF-β2 tended to decrease on day 10 of distraction and on day 30 of the post-distraction period in the cosmetic and posttraumatic groups while they grew in the congenital group. Most dynamic changes in the GFs levels during tibial lengthening were noted in the subjects undergoing cosmetic lengthening, and the least ones were in the congenital group.

Aim - to study the dynamics of the recovery of energy resources in the tibialis anterior (TA) in dogs after shin fractures. Material and methods. The concentration of energy metabolism substrates, the rate of glycolysis and glycogenolysis in TA in 25 dogs during the treatment of tibial fractures by Ilizarov were studied. The values parameters in the experimental animals were compared with values in the intact (non-operated) dogs. Results. The level of glycogen and glucose decreased in TA within 14 days of fixation. On the 28th day of fixing the level of these metabolites corresponded to the level in intact animals. By the end of fixation the rate of glycogen utilization in TA of experimental animals was significantly reduced relative to intact animals, and the rate of glucose utilization was unchanged, though all glucose was almost entirely utilized by aerobic way. A month after treatment there was an increase of glycogen levels in the TA and activity of lactatedehydrogenase MM-isoenzyme. When glycogen solution added to the cell-free culture of muscle the its considerable utilization and the pyruvate accumulation were found. Conclusions. Anaerobic energy metabolism of in the TA of injured segment have prevailed before the 14-th day after the injury, the aerobic energy metabolism - after 28-days. The phenomenon of growth of anaerobic energy metabolism in TA of injured segment within three months after treatment was revealed.

Aim of the study the characteristics of changes of serum biochemical parameters in dogs with delayed maturation of the distraction regenerate after surgical lengthening the leg bones by Ilizarov. The comparative analysis of biochemical changes in blood serum of animals with delayed regenerated bone osteogenesis after surgical leg bone lengthening according to Ilizarov has been made in the work. The development of persistent and marked hypocalcemia, significant accumulation of blood serum nonoxidized degradation products during limb bone surgical lengthening according to Ilizarov have been revealed to be adverse signs evidencing of the high probability of the disorder of further formation of the regenerated bone and its subsequent maturation at the stage of fixation.

Experimental and clinical studies have shown that a skeletal trauma causes a whole complex of pathophysiological disorders, both local and systemic. The main factors determining the severity of the trauma, as well as the nature of the course of the post-traumatic period, are the degree of hypoxia (acidosis), hypercoagulation and immune disorders. To influence these pathophysiological disorders in the patients presenting the with skeletal traumas, various approaches have been proposed, including the use of antihypoxants and antioxidants, the methods and means for the stimulation and support of the immune system, medications to regulate hemostasis. According to the literature publications, terahertz-frequency therapy is presently regarded as a promising method the minimally invasive interference in the metabolic processes proceeding in the tissues of the musculoskeletal system. The analysis of the literature data and clinical observations indicate that electromagnetic waves of the terahertz range are efficient in the treatment of many chronic diseases when applied both as monotherapy and in combination with other physical methods and medications strengthening and consolidating the therapeutic effect of the latter. The electromagnetic waves of the terahertz range are currently used in medicine as a biophysical factor for the correction of the microcirculatory disorders. It has been shown that the use of these waves for the combined restorative treatment of the patients suffering fractures of the limb bones not only improves the dynamics of fracture consolidation symptoms but also contributes to the prevention of posttraumatic complications (thrombosis, ossification of soft tissues). However, the experience with the application of the electromagnetic waves of the terahertz range waves in clinical traumatology and orthopedics is rather modest. The analysis of the results of fundamental research and experience with the application of electromagnetic waves in the terahertz range has shown that the systemic effects produced by the waves of this range promote the correction of such pathophysiological disorders as hypoxia, hypercoagulation, and impaired immunity. Given that these disorders develop during the post-traumatic period in the patients presenting with severe multiple and combined traumas, it can be assumed that the use of electromagnetic waves of the terahertz range for the the combined treatment of these patients provides a very promising tool for the stimulation of the reparative processes especially bearing in mind that the first results described in the literature, look quite optimistic. The investigation into the mechanisms regulating the regenerative capacity of connective tissue, the creation of the scientifically-sound foundations for its management with the help of the modern electronics devices is a promising task for the developers of the new biomedical technologies.Многочисленными экспериментальными и клиническими исследованиями показано, что скелетная травма вызывает целый комплекс патофизиологических нарушений как местного, так и системного характера. Основными факторами, определяющими тяжесть травмы, а также обусловливающими характер течения посттравматического периода, являются степень гипоксии (ацидоза), гиперкоагуляция и иммунные нарушения. Для воздействия на данные патофизиологические нарушения у пациентов со скелетной травмой были предложены различные способы: применение антигипоксантов и антиоксидантов, методов и средств, стимулирующих и поддерживающих иммунную систему, препаратов, регулирующих гемостаз. По данным литературы, в настоящее время перспективным методом малоинвазивного воздействия на обменные процессы в тканях опорно-двигательной системы является терагерцовочастотная терапия. Анализ данных литературы и клинические наблюдения свидетельствуют, что эти волны эффективны при многих хронических заболеваниях как в качестве монотерапии, так и в комбинации с другими физическими методами и медикаментозными средствами, усиливая и закрепляя лечебное действие последних. Электромагнитные волны терагерцового диапазона в настоящее время применяются в медицине главным образом как биофизический фактор коррекции микроциркуляторных нарушений. Показано, что применение данных волн в комплексном восстановительном лечении пациентов с переломами костей конечностей способствует не только улучшению динамики признаков сращения перелома, но и профилактике посттравматических осложнений (тромбоз, оссификация мягких тканей). Однако опыт применения волн данного диапазона в клинической травматологии и ортопедии достаточно скромен. Анализ проведенных фундаментальных исследований и опыт применения электромагнитных волн терагерцового диапазона показали, что системные эффекты, оказываемые волнами данного диапазона, обеспечивают коррекцию таких патофизиологических нарушений, как гипоксия, гиперкоагуляция и снижение иммунитета. Учитывая, что данные нарушения развиваются в посттравматическом периоде у пациентов с тяжелой множественной и сочетанной травмой, можно полагать, что применение электромагнитных волн терагерцового диапазона в комплексном лечении таких больных является достаточно перспективным методом стимуляции у них репаративных процессов, тем более первые результаты, описанные в литературе, выглядят вполне оптимистичными. Исследование механизмов регуляции регенерационной способности соединительной ткани и создание научных основ ее управления с помощью приборов современной электроники являются перспективными задачами в области разработки новых биомедицинских технологий.

Concentrations of insulin-like growth factors 1 and 2 (IGF-1 and IGF-2), stem cell factor (SCF), vascular endothelial growth factor (VEGF), and transforming growth factor β1 (TGF-β1) were measured in the blood serum of dogs subjected to experimental lengthening of shin bones. In animals subjected to shin bone lengthening at a rate of 1 mm/day in 4 steps, the concentrations of SCF and TGF-β1 significantly increased in the middle of distraction and IGF-1 concentration increased by the end of distraction. In animals subjected to lengthening at a rate of 1.5 mm/day in 6 steps, the levels of IGF-1 and TGF-β1 significantly increased in the middle of distraction and the concentration of IGF-2 at the end of distraction. In animals subjected to lengthening at a rate of 3 mm/day in 120 steps, the concentrations of IGF-1 and TGF-β1 significantly decreased in the middle of distraction and concentrations of IGF-1, VEGF, and TGF-β1 increased by the end of distraction.

Sixty five patients with closed diaphysial tibia fractures were examined during transosseous osteosynthesis. Postoperatively 52 patients underwent HBO-therapy. Blood serum activity of alkaline and acid phosphatase, lactate dehydrogenase, content of total calcium, inorganic phosphorus, lactic and pyruvic acids were evaluated. HBO-therapy was shown to effect the metabolism of skeletal muscles and reparative process.