Objective. To analyze outcomes of surgical treatment of patients with compression fracture of lower thoracic and lumbar vertebra by posterior spine fixation with shape-memory / super-elastic alloy constructs.

Material and Methods. The bench tests of 30 tightening clamps (lamellar, spiral, and biplanar) with shapememory property were performed. Results of clinical trial of 183 patients with uncomplicated thoracic and lumbar compression fractures have been summarized. Patients of the study group (n = 116) underwent posterior spine fixation with shape-memory clamps, while patients from the control group (n = 67) were treated conservatively with gradual reclination in a hummock according to A.V. Kuplan’s method followed by a subsequent brace treatment.

Results. Long-term outcomes in study group patients (good in 85.2 %, satisfactory in 14.8 % of cases) were markedly better than those in patients after conservative treatment (unsatisfactory results in 13.4 %, satisfactory — in 52.3 %, and good — in 34.3 % of cases). Posterior fixation of the injured motion segment with tightening biplanar clamps appeared to provide stability and significant decrease in the rate of posttraumatic deformity.

Conclusion. Posterior fixation with tightening shapememory clamps essentially enhances the efficacy of multimodal treatment of patients with lower thoracic and lumbar spine compression fractures.

Objective. To analyze the method of laboratory prognosis of inflammatory complications of the spine osteosynthesis with external fixation apparatus.

Material and Methods. Blood analysis was performed in 92 patients. Out of them 29 (32 %) patients had a soft tissue inflammation around screw rods of the external fixation apparatus. Clinical blood test parameters, phenotyping of lymphocytes, functional-metabolic activity of neutrophiles, immunoglobulin level, cytokine concentration, and acute phase proteins were assessed before operation and at different postoperative terms.

Results. Multivariate linear regression analysis identified the function, which allows for prognosis of inflammatory complications before and on the second to fourth days after operation. Analysis of preoperative prognosis results revealed the method efficiency being 91.1 %.

Conclusion. Suggested method allows identification of prognostic function of inflammatory complications and optimization of treatment protocol at the stages of surgical treatment of patients with spine fractures.

Literature review presents an analysis of publications on diastematomyelia – a rare spine and spinal cord abnormality. Studies performed during the period of 1970–2006 were devoted to vertebral, orthopaedic, urological, and neurosurgical aspects of the given pathology. Absolute indications for surgery are described in the review. The attitude of surgeons to prophylactic spinal septum resection for diastematomyelia without neurological deficit is presented.

The paper presents definition of such notions as «device efficacy» and «correction result» used in the study of conditions, which determine the obtaining of objective assessments and elimination of existing controversies. An actual factor space of brace treatment is presented as a condition for construction of prognoses of deformity development, high-quality indication of conservative treatment methods, decision making in issues of surgical treatment and efficacy assessment of currently used corrective devices. The opportunities in correction (slowing down of development) of deformity with external device «Uzor» are presented in the context of consideration of basic issues of brace treatment estimation.

Objective. To study and compare variants of surgical treatment for unstable lumbosacral osteochondrosis.

Material and Methods. The study group included 65 patients who had undergone surgery for unstable lumbar osteochondrosis associated with intervertebral disc herniation. There were 30 males and 35 females at the age of 19 to 64 years. Patients were operated on by anterior coupled wedging-and-stabilizing corporodesis. The study group was compared with sex- and agematched control group, which included 60 patients who had undergone discectomy and conventional wedging anterior intervertebral fusion with bone autograft according to Ya.L. Tsivian.

Results. In the study group 38 (58.4 %) patients had excellent, 22 (33.8 %) – good, and 5 (7.6 %) – satisfactory results. Unsatisfactory result (ineffective surgery or patient’s condition deterioration) was not observed in any of 65 operated patients. Intervertebral corporodesis with coupled autografts (study group) provided reducing a duration of hospital stay and terms of bone block formation, and better treatment result as compared with control group.

Conclusion. Anterior coupled intervertebral corporodesis is very effective and can serve as a method of choice for treatment of unstable lumbar osteochondrosis.

Objective. To analyze results of surgery for symptomatic vertebral hemangioma, which is rare in clinical practice.

Material and Methods. The study included eight patients having symptomatic vertebral hemangioma with local pain syndrome as a main clinical manifistation. Diagnosis of vertebral hemangioma was confirmed by neurovisualization findings in all cases. Patients were operated on by use of percutaneous bilateral transpedicular vertebroplasty.

Results. All patients had a regression of pain syndrome, increase in physical activity, and return to their usual mode of life after surgery. In five patients pain was arrested at the first day after operation, and in three patients – in five days. The follow-up period after percutaneous vertebroplasty was 6 to 54 months.

Conclusion. Percutaneous vertebroplasty when correctly indicated and perfectly performed is effective and minimally invasive method of treatment for symptomatic vertebral hemangioma.

Objective. To prove a significance of a diagnostic table for effective diagnosis and evaluation of spinal cord injury in children.

Material and Methods. Retrospective analysis of 191 case records of children with spinal cord injury without the evidence of hemorrhage or compression was performed. Specific clinical manifestations were analyzed using Wald’s statistical sequential analysis with calculation of diagnostic factor informative value in accordance with A. Kulback.

Results. Diagnostic value of clinical signs was calculated on the basis of statistically analyzed data of initial examination. The analyzed incidence of clinical signs became the ground for diagnostic table used for differential diagnosis of spinal cord injury in children.

Conclusion. Functional outcome of the spinal cord contusion in children can be good; and application of the suggested diagnostic table improves the quality of spinal cord injury diagnosis.

Objective. To describe morphometric parameters obtained from MRI scans of the intact craniovertebral junction.

Material and Methods. The study included 50 patients without any clinical symptoms and radiological abnormalities of the spine and spinal cord. The age of the examined patients was 21–30 years to assure a normal anatomy. All patients were examined using MRI-tomograph with 0.2 T magnetizing force of specialized receiving-transmitting coil designed for the brain investigation.

Results. Original method for scanning developed on the basis of standard methods of MRI examination of the cervical spine and brain allows obtaining maximum possible information on the craniovertebral junction status during minimally short time. Morphometric parameters were measured on MR tomography scans, compared with X-ray evidences in literature. Besides, we defined sizes of structures which were not visualized on X-rays.

Conclusion. The advantages of MR tomography used in craniovertebral junction diagnosis, besides opportunity to visualize soft tissues and cerebrospinal fluid, include the absence of necessity for a special positioning of a patient and absence of radiation load. Data of MRI scan measurement correspond to those obtained from lateral and direct projections on craniogramms. In some cases MRI examination does not only complement radiological one, but replaces it.

Objective. To substantiate the efficacy of MRI assessment in diagnosis of craniovertebral junction injury and to develop an examination protocol.

Material and Methods. The study included 50 patients (24 males and 26 females) with injury of the craniovertebral junction. MRI assessment was performed using a low-field MR tomograph with a specialized receiving-transmitting coil. X-rays of craniovertebral junction were taken from all patients. Ten patients were additionally examined using multislice spiral computer tomography.

Results. Standard and expanded protocols for MRI examination of the craniovertebral junction were developed. Method of scan obtaining was improved. The advantage of MR tomography was shown, which include visualization of not only bone, but also soft tissue components and CNS elements, and opportunity to measure linear-angular parameters, and differentiate between acute and chronic injuries.

Conclusion. MR tomography examination of patients with spine injuries is a valuable method of non-invasive diagnosis providing a complex assessment of the spine and spinal cord status. Basic morphometric parameters of the craniovertebral junction measured in X-rays correspond to those measured in MRI scans.

Objective. To determine the prevalence of low bone tissue mineral density (BTMD) in Novosibirsk city population of children, adolescents, and youth.

Material and Methods. The study population included 1524 individuals between 6 and 20 years of age. BTMD was evaluated by dual x-ray absorbptiometry (DEXA) with bone densitometer and using pediatric software version and US sex and age reference database.

Results. Diagnostic screening using x-ray bone densitometry determined 28.6 % prevalence of osteopenia and osteoporosis among practically healthy residents of Novosibirsk city at the age of 6–20 years. Osteopenia (a moderate decrease in BTMD), was observed in 371 (23.8 %) subjects among all examined, being more frequent in girls than in boys (13.4 % and 10.4 %, respectively), though this difference is not reliable. Osteoporosis (a high-grade decrease in BTMD) was observed in 74 (4.8 %) subjects, they were 56 (3.6 %) girls and 18 (1.1 %) boys. These findings do not exceed parameters obtained in other regions of Russia, which are within 10–30 % depending on the age of examined subjects.

Conclusion. Persistent stable tendency to a rise in prevalence of low BTMD among child’s population of Russia suggests the inefficacy of currently practiced measures for prevention of osteoporosis and its complications. One of the promising directions is a development of principles for risk group formation basing on the analysis of clinical, biochemical, and densimetric findings with regard for prognostic value of each risk factor or their combination.

Objective. To study pathogenetic changes in bone tissue under a chronic impact of technogenic environmental factors in the experiment.

Material and Methods. Study was performed in 2-monthaged OXYS and Wistar male rats. Osteotropic effect was taken by water solution of natrium dibutilditiophosphoratum administered intragastrically during four months. Bone tissue specimens from rats of both lines were studied by means of osteodensitometry, morphology, and biochemistry in the course of experiment.

Results. In chronic administration of natrium dibutilditiophosphoratum in maximum allowable dozes the bone tissue of OXYS rats was characterized by alteration in remodeling process without coupling of bone absorption and new bone formation, resulting in inhomogeneous and mosaic structure observed in histological study. Histomorphometry proved disintegration of bone remodeling processes due to the inadequate bone building. These changes predominantly occur in trabecular bone, though they are also observed in the cortical tissue, and in some cases even more evidently.

Conclusion. Long-term exposure to technogenic substance can cause disturbance in bone tissue remodeling. Genetic disposition to osteoporosis could be enhanced by a negative effect of technogenic environmental factors, which change bone balance disturbed by decline in osteoplastic functions, and cause indirectly an activation of bone resorption.

The paper presents the experience in internal audit at Novosibirsk Research Institute of Traumatology and Orthopaedics including main tasks, criteria, methods, and stages of audit, documentation necessary for its planning and fulfillment, and a procedure for analysis and application of information obtained in the course of audit. The Institute developed and introduced the procedure of conducting of quality management system audit with the account of International Standard requirements for quality management system organization, specificity of structure and production processes in medical setting providing specialized care to patients with spine pathology. Application of the method of internal audit conducting significantly reduced the number of process inconsistencies which in its turn positively influenced the effectiveness of the process and the quality management system as a whole.

Objective. To evaluate the actual incidence of orthopaedic diseases in children in the areas with low population density (illustrated by the example of the Tyva Republic) and substantiate the ways to optimize and upgrade the system of traumatologic and orthopaedic medical assistance for children with the account of regional peculiarities.

Material and Methods. Examination included 26,000 children at the age of 0 to 17 years residing in various settlements of the Tyva Republic. Clinical and radiological methods, automated system of preventive screening of population, plantography, ultrasound examination, and nuclear magnetic resonance tomography (if indicated) were used. The norms developed for children population of the Tyva Republic were applied. The in-depth investigation of revealed pathology was performed in 1,075 children of different age (607 boys and 468 girls). Examination data were analyzed depending on ethnicterritorial identity, age, nationality, and sex.

Results. In-depth examination of children revealed congenital musculoskeletal pathology in 7.4%, acquired pathology in 9.3%, static musculoskeletal deformities in 75.4%, and other orthopaedic pathology in 7.9% of cases. Among congenital pathologies the aplasia of gluteal muscles which is typical only for children of indigenous Tyvan nationality was detected in 57 children.

Conclusion. The study and analysis of actual incidence of orthopaedic diseases in children create prerequisites for improving the system of specialized medical assistance for children with musculoskeletal pathologies in the area with low population density.

This paper extends the analytical review of surgical treatment for thoracic and lumbar spine injuries, which are one of the most crucial problems of the modern spine medicine. It presents consequent grounds for indications and choice of optimal conservative or surgical treatment of patients with thoracic and lumbar spine injuries. Biomechanical reasoning behind the surgical stabilization of injured segments in the thoracic and lumbar spine is disclosed. Issues of the posterior stabilization of the spine and transpedicular fixation technique are discussed in detail. Anterior methods of surgical intervention are described. The peculiarities of surgical treatment of thoracic and lumbar vertebral body fractures in osteoporosis using percutaneous vertebroplasty and kyphoplasty are presented. The paper is concluded with issues of surgical treatment of the most severe chronic injuries of the thoracic and lumbar spine with unreduced high-grade deformity.