Osteoarthritis (OA) is the most common joint disease. Searching for new treatment methods and regimens for OA is relevant.Objective: to evaluate the efficiency and safety of therapy with a symptomatic sustained-release drug (Alflutop) in combination with intra-articular hyaluronic acid (HA) injection versus monotherapy with HA in patients with knee OA in routine clinical practice.Patients and methods. A post-registration open-labeled prospective comparative randomized study was conducted to assess the results of treatment in 76 patients (31 men and 45 women; mean age, 49.3±8.5 years; body mass index, 28.4±0.8 kg/m2 ) in two clinical centers in Yekaterinburg and Perm. The patients were randomized into two equal groups, were homogeneous in terms of gender, the frequency of comorbidities, and vital signs (blood pressure, heart rate, and respiratory rate).Group 1 patients received Alflutop as 1-ml daily intramuscular injections (a total of 20 injections) + 2 ml of 1% intraarticular (IA) HA solution injections three times at 1-week intervals; Group 2 patients were given 2 ml of 1% intraarticular HA solution injections three times at 1-week intervals. As an additional therapy, the use of meloxicam 7.5–15 mg/day was permitted, and, if non-steroidal anti-inflammatory drugs were contraindicated, paracetamol 1–3 g/day might be used.Results and discussion. During treatment, both groups of patients showed improvement (compared to the baseline levels). At the same time, evaluating the intergroup values revealed clear differences: a more pronounced decrease in all WOMAC indicators in Group 1 patients: pain scores, 2 [1; 3] vs. 4 [2; 5] in Group 2 (p<0.001); stiffness, 1 [0; 2] vs. 2 [1; 4] (p<0.001); functional insufficiency, 8 [3; 12] vs. 15.5 [12; 20] (p<0.001); and total WOMAC scores, 12 [7; 13] vs. 21.5 [15; 28] (p<0.001). Pain-intensity assessment using the visual analogue scale also showed the more pronounced positive effect of the combination therapy in Group 1 (p<0.001).Alflutop used in combination with HA was shown to be more preferable than HA monotherapy, which was confirmed by the results achieved for all WOMAC indicators. At 6 months, by the last visit, there were pronounced positive changes in all the analyzed parameters in both groups. At the same time, the most significant changes were recorded in the Alflutop + HA group than in the HA group (p<0.001). Perhaps, the mechanism in exhibiting the found synergistic effect of these drugs lies in their different effect on the pathogenesis of the disease. However, further study of this issue is required in multicenter randomized controlled trials.The good safety of the drugs was confirmed: not a single adverse event was revealed.Conclusion. The patients receiving the combination therapy with Alflutop + HA had the best treatment results in all the parameters assessed.

Своевременная диагностика паразитарных заболеваний опорно-двигательного аппарата представляет определенные сложности, обусловленные редкостью данной патологии. В статье представлено клиническое наблюдение-случай дирофиляриоза влагалища разгибателя пальца кисти у 49-летней женщины, госпитализированной с диагнозом «гигрома тыльной поверхности кисти». правильный диагноз заболевания был поставлен только после извлечения паразита во время операции. Обсуждены проблемы дифференциальной диагностики данного заболевания и гигромы тыла кисти. Для уточнения диагноза предложено использовать предоперационное узИ мягких тканей кисти.

Цель. Произвести качественный анализ металлического имплантата, погруженного в кость, определить тактику лечения при воспалительном процессе в послеоперационном периоде металлоостеосинтеза. Материалы и методы. Проведен анализ лечения 1325 больных с развившимся посттравматическим остеомиелитом верхних и нижних конечностей за 10 лет (с 2004 по 2014 г.) в отделении осложнен ной травматологии ГКБ № 6 и травматологических отделениях г. Перми. Результаты. Металлоз отмечен у 227 (17,2 %) человек, он проявлялся нагноением и образованием свища в области винта через 2-3 месяца после оперативного лечения перелома у 177 (76,3 %) боль ных, а у 50 (27,7 %) пострадавших имел вид острого гнойного воспалительного процесса непосредст венно после операции. У 34 (15 %) пациентов при исследованиях с помощью компьютерной и маг нитно резонансной томографии отмечены вкрапления металла в кость. Всем этим 227 (17,2 %) боль ным были удалены металлоконструкции. Послеоперационные раны после удаления металлоконструкций с кости зажили первично у 152 (66 %) пациентов; вторичное заживление отмече но у 75 (44 %) человек. Отдаленные результаты изучены в течение трех лет у 189 (83 %) человек. Развитие послеоперационного остеомиелитического процесса, связанное с поздним удалением металло конструкции, наблюдалось у 8 (4,4 %) человек; образование ложного сустава -у 1 (0,5 %) больного с пе реломом большеберцовой кости. Хороший отдаленный результат достигнут у 180 (95,2 %) человек. Выводы. Своевременно поставленный диагноз, правильно выбранный метод лечения позволяют обеспечить полное восстановление структуры и функции и тем самым добиться положительной ме дицинской и социальной реабилитации данной категории больных. Ключевые слова. Остеомиелит, металлоостеосинтез, переломы конечностей, металлоз.

Aim. To improve the results of treatment of periarticular tissue diseases and degenerative arthropathies at the expense of differential use of modern technologies. Materials and methods. During the period of 2010–2017, examination and treatment of 10608 patients, suffering from the locomotor diseases, was carried out. There were 5792 (54,6 %) patients with degenerative arthropathies and 4816 (45,4 %) patients with tendinites and enthesites of different localization. Results. The long-term results of treatment with chondroprotector Alflutop, used in complex therapy of 1969 (33,9 %) patients with arthropathies were studied for the period from 1 to 3 years. Pain syndrome was arrested after 4–5 injections. After 8–9 injections of this preparation, no pain syndrome was revealed, movement amplitude in the joint increased, patients returned to their previous work, Lequesne index declined and varied within the range of 3–6 scores. When using hyaluronic acid, pain syndrome was arrested in most cases after 2 injections. After the third injection of preparation, no pain factor was registered, movement amplitude in the joint increased, patients returned to their previous work, Lequesne index declined and varied within 3–6 scores. The long-term results from 1 to 5 years were studied in 1179 (20,3 %) patients. Conclusions. One-year remission with combined application of chondroprotector and hyaluronic acid was 76,5 %. Two-year and longer remission was 47,6 %. Diagnostic algorithm for locomotor diseases was developed and approach to conservative therapy was differentiated.