Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Омский государственный медицинский университет» Министерства здравоохранения Российской Федерации, г. Омск, Россия; 2 БУЗОО «Клинический медико-хирургический центр МЗ Омской области», г. Омск, Россия; 3 Федеральное государственное бюджетное учреждение «Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А. Илизарова» Министерства здравоохранения Российской Федерации, г. Курган, Россия; 4 Федеральное государственное бюджетное образовательное учреждение высшего образования «Тюменский государственный медицинский университет» Министерства здравоохранения Российской Федерации, г. Тюмень, Россия Morphological assessment of osteointegration of various implants for management of long bone defects (experimental study

Objective To study morphological and radiological parameters of facet joints depending on the grade of the intervertebral disk degeneration. Materials and methods To study the facet joints of the lumbar spine in 145 patients with various grades of degeneration according to Pfirrmann and treated using rigid fixation and TLIF technology, MSCT in 2-energy mode and morphological investigation of the intraoperative material were performed. Results In Pfirrmann grade 2, an increase in the volumetric content of chondrocytes, Hounsfield density of the cartilage plate, and the level of Ca in the facet joints was visualized. They indicate that the joint remains functional. In Pfirrmann grade 5, deep pathological changes occurred with violation of the architectonics of the cartilage formations of the facet joints, formation of bone elements and connective tissue growth into the cartilage and bone structures of the joint, which correlated with the results of MSCT. Conclusion The data obtained show that there is a close relationship between morphological and radiological changes in the facet joints. Modulating the data obtained allows us to obtain objective criteria for evaluating the grade of pathological processes in facet joints and use them as a diagnostic component when planning decompression and stabilizing operations in patients with degenerative diseases of the lumbar spine.

The effects of Stimbone-1, a complex of growth factors deposited by osteal tissue, on maturation of distraction regenerative substrate are studied in dogs. At the end of distraction, the preparation is injected into the regenerative connective tissue interlayer. Roentgenological, biochemical, and quantitative morphological data show that Stimbone-1 stimulates reparative osteogenesis. Key Words: growth factors; d&traction osteosynthesis; reparative osteogenesisShortening of medical treatment of orthopedic patients is an important problem. Elongation of extremities and repair of the tubular bone defects by perosseal osteosynthesis according to Ilizarov requires more than half of the treatment period for maturation and mineralization of the osteal regenerative substrate obtained by distraction [7]. A new preparation was developed in our Center, which is a complex of growth-regulating noncollagenous proteins of mature osteal tissue [2]. Previously, we reported that systemic administration of this preparation modifies reparative osteogenesis [3]. In this work we examined the effects of this preparation named Stimbone-1 on maturation of the distraction osteal regenerative substrate (DORS) after local administration into the connective tissue interlayer that separates the ossified subdivisions of the regenerative substance. MATERIALS AND METHODSExperiments were carried out on 24 adult mongrel dogs subjected to distraction of the tibia using the G. A. Ilizarov Russian Research Center for Reparative Traumatology and Orthopedics, Kurgem Ilizarov apparatus. "Severe" conditions for distraction osteosynthesis were created to reduce osteosynthetic activity and to provide the background against which preparation could exhibit the highest activity. To this end transverse osteotomy was performed in the median third of the tibia with cutting the bone marrow and intraoste'al vessels. Distraction was started 3 days after operation at a late of 1 ram/day (4 times by 0.25 lnm) and stopped after 28 days. During the first 3-4 days of fixation, the preparation (2 ml) was injected into the median interlayer of regenerative substrate. Control dogs received 0.15 M NaCI (2 ~N). During the 28-day distraction period and 6-and 12-week frxation periods, the activity of osteogenesis was estimated by roentgenological data: size of DORS cross-section, height of the connective tissue interlayer, its crossing and replacelnent by trabecular ghosts, formation of cortical plate (CP) and bone marrow lumen (BML), by optical density, and using a 5-point scale.The animals were euthanized 6 or 12 weeks after fixation. DORS were divided into two parts in the sagittal plane. The lateral half was studied by biochemical methods [4] with determination of collagen, noncollagen protein, calcium, and nonorganic phos-

administration of corticosteroids or blood diseases. Early diagnosis is difficult, there is no conservative treatment protocol with proven effectiveness, and the organ-preserving surgical treatments which have been used may not always postpone hip arthroplasty. Arthroplasty provides good results in the short and long-term postoperative period, but the prevalence of this disease among young people requires developing new methods of conservative and operative treatment. Objective To determine the problems of diagnosis and treatment of aseptic necrosis of the femoral head; to study the experience of current approaches and concepts in the diagnosis and treatment of ANFH; determine the range of the most effective methods for treating this pathology; to establish the relevance of further research on this issue. Materials and methods Literature review was conducted of the sources from PubMed and Google Scholar databases. The material was selected that corresponded to the stated purpose of the research topic. For describing some aspects of the aetiology, pathogenesis and development of methods for diagnosing and treating ANFH, earlier publications (2009–2014) were also used. Results The main views on the aetiology and pathogenesis of ANFH have been studied. Classical and current diagnostic methods for ANFH were reviewed as well as current operative and conservative approaches to the treatment of this pathology. A review of the main classifications was conducted. Discussion Early detection and examination of at-risk patients plays an important role in the diagnosis of ANFH. The results of clinical trials on the use of bisphosphonates seem mixed, as the meta-analysis in five randomized clinical trials (RCTs) in 2016 showed no statistically significant improvement in patients with ANFH. Hyperbaric oxygenation reduces interstitial ischemia by increasing extracellular oxygen concentration and shows encouraging results. Core decompression is recognized as the standard care in the early stages of ANFH. At present, the use of combined treatment with bisphosphonates, core-decompression and mesenchymal stem cells has been investigated. Combined therapy may be effective in slowing the progression of collapse at an early stage of ANFH, but further research is needed to have long-term results. Conclusion Aseptic necrosis of the femoral head is a severe polyetiological disease that has not been sufficiently studied. For its diagnosis, it is necessary to take into account the possible risk factors and to ensure an early MRI study. At present, there is no data on a conservative method of treating the early stages of ANFH, which would have high evidence and effectiveness not only in the immediate, but also in the long-term follow-up. It is necessary to conduct additional prospective randomized clinical trials to determine the effectiveness of already known and developed methods of cell therapy in the treatment of ANFH.

Государственное бюджетное образовательное учреждение высшего профессионального образования «Омская государственная медицинская академия» Министерства здравоохранения Российской Федерации, г. Омск