Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Министерства здравоохранения Российской Федерации, г. Москва, Россия Metabolic bone tissue disorders in patients with long bone fractures complicated by chronic osteomyelitis

Clinical guidelines are an algorithm adapted for use in our country, based on the works systematized by the level of evidence, reflecting current approaches to the diagnosis and treatment of aseptic bone necrosis (osteonecrosis) of various localizations. Purpose of the study Creation of an algorithm for diagnosis and treatment of osteonecrosis based on the assessment of the evidence level of literature data. Material and methods The Guidelines are a systematized algorithm based on the level of evidence for the management of patients with osteonecrosis, reflecting current approaches to diagnosis, treatment and rehabilitation, which are based on literature data and the authors' own experience. Electronic databases of Medline, Embase, Web of Science, and Cochrane Library platforms were searched for related sources. Preference was given to the works with high levels of evidence. References to information sources are given in the order of their appearance in the text. The search depth was 50 years due to the availability of systematic literature reviews in the framework of previous international clinical guidelines. When specific medical procedures related to the diagnosis, conservative or surgical treatment of osteonecrosis were included in the clinical recommendations, their level of evidence was reliability, the appropriateness of their use, taking into account the unified scale for assessing the quality of evidence and the strength of the recommendations for application of medical technologies GRADE. Results The Guidelines reflect aspects of clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the location of the process and disease stage. Conclusion Clinical recommendations on the medical assistance to patients with aseptic osteonecrosis have been compiled according to the requirements imposed on clinical recommendations developed by medical professional non-profit institutions

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To analyze the effect of developed methods of diagnosis and treatment on the improvement of outcomes in patients with secondary spinal deformities associated with hereditary systemic skeletal diseases. Material and Methods. The treatment experience of 36 patients with spinal deformity associated with hereditary systemic skeletal disease is presented. Individual diseases causing secondary scoliosis are characterized. The algorithm of examination and tactics of these patients are presented. Particularities of posterior, anterior, and multifunction surgical approaches are described. Results. The use of combined approaches and new instrumentation provides good outcomes in patients with spinal deformities associated with hereditary systemic skeletal diseases. The mean deformity angle before operation was 105 degrees, after operation-47 degrees. Mean correction in the postoperative period reached 56 %. Conclusion. Wide introduction of the modern segmental instrumentation allowing for multiplane correction of spine deformity along side with application of anterior, posterior, and combined approaches, as well as cooperation of specialists in hereditary systemic skeletal diseases and specialists in spine medicine provide good outcomes in these patients.

Objective. To summarize the experience of surgical treatment of patients with secondary spinal deformities. Materials and Methods. Forty one patients with kyphoscoliotic postlamynectomy and iatrogenic III-IV grade spinal deformities were treated. Secondary deformities developed after spinal cord tumor removal in 28 patients, and after surgical intervention for spinal injuries and tumors-in other patients. After the estimation of deformity mobility and all examinations the surgery planning was performed including selection of surgical approach and definition of correction level. Results. Average magnitude of scoliotic deformity at admission was 103 degrees, that of kyphotic deformity-87 degrees. Correction after surgical treatment was 46 % for scoliotic deformity, and 67 %-for kyphotic one. Conclusion. The use of combined approaches and modern instrumentation in conjunction with comprehensive examination of patient and thorough preoperative planning allows to recieve good treatment results.