Остеосинтез (osteosynthesis; греч. osteon (кость) + synthesis (соединение)) — это хирургическое соединение отломков костей в правильном положении с целью стабильной фиксации до полной их консолидации (костного сращения) и восстановления целости и функции кости. Обследовано 34 больных в возрасте 17–58 лет с гнойными осложнениями после остеосинтеза при переломах длинных костей, в том числе у 29 мужчин и 5 женщин. В сыворотке кpови больных определяли следующие биохимические показатели: активность коллагеназы, фpакции гидpоксипpолина, гликозаминогликаны, кальций, фосфор и электролиты (Na+, K+, Ca++).Результаты исследования показывают, что у больных с гнойными осложнениями после остеосинтеза длинных костей при рецидиве воспалительного процесса усиливается катаболическая фаза метаболизма основных компонентов органической основы костной ткани. Об этом свидетельствуют показатели, отражающие синтетическую и катаболическую фазы метаболизма основных компонентов соединительной ткани — коллагена и гликозаминогликанов. Данные, полученные при исследовании минерального обмена, отражают нарушения минерализации костной ткани, что подтверждается показателями содержания общего кальция, ионизированного кальция, фосфора и электролитов.

No abstract

Summary. In 77 patients (37 men and 40 women) of different age groups who underwent hip joint replacement, the content of calcium, phosphorus, creatinine, alkaline phosphatase and hydroxyproline in blood serum was determined. The results of a study of biochemical markers showed the predominance of osteoporotic processes in patients of elder age groups, as is evidenced by an increase in the level of free hydroxyproline and a decrease in protein-bound hydroxyproline in blood serum, as well as by an increase in the level of hydroxyproline in daily urine excretion compared with reference indices. A decrease in calcium excretion with age both in men and women can be associated with a decrease in calcium intake and its absorption in the gastrointestinal tract, which is typical for the elderly. Calcium has the greatest importance in metabolic disorders of bone tissue. Maintaining the normal state of bones in adults is associated with continuously ongoing process called “bone remodeling”. Violation of remodeling in the direction of increasing bone resorption and reducing bone formation is considered as the main reason for the development of osteoporosis. The processes of bone formation and resorption are displayed in the blood and urine at the level of various enzymes from bone tissue, by products of bone matrix synthesis or cell destruction products. Biochemical markers of osteoporosis manifestations are specific, expressing bone synthesis and resorption processes. The violations of bone metabolism reflect most objectively not the absolute indicators of mineral metabolism and metabolites of the main bone tissue protein (collagen), but the coefficient of their ratios.

Aim. Research aim was to find statistical differences of biochemical indicators of blood and morphometric indicators of crural tissue lesion and relationships between them in patients with traumatic osteomyelitis of the tibia with trophic disturbances in extremity. Material and methods. The work material includes data from 28 patients with traumatic osteomyelitis which was combined with trophic tissue disturbances of different manifestation degree. The levels of procalcitonin, lactate dehydrogenase and acetylcholinesterase of blood serum were estimated. In crural tissues quantitative biochemical, gradual morphometric indicators, frequencies of occurrence of different manifestation degree cases and relationships “clinic – biochemistry – pathomorphology” were defined histologically. Results. Average values of procalcitonin, lactate dehydrogenase and acetylcholinesterase in patients with traumatic osteomyelitis of the tibia, combined with trophic disturbances in crural tissues, are significantly higher, than average values of these indicators in intact donors. In the majority of the patients with chronic traumatic osteomyelitis in crural tissues pathological changes were found out, which by clinical estimations are considered as trophic disturbances. They represent a combination of discirculatory, ischemic-necro­tic, exsudative, productive-inflammatory, and also reparative processes which in total create a composite picture of complex lesion and can persist for many years. As closest relations, according to values of association coefficient, concerning certain biochemical indicators, can be noted such clinical indicators: “degree of bone fragments non-consolidation” and “severity of trophic disturbances in bone tissue (by clinical estimation)”, concerning defined morphometric indicators – such biochemical indicators: “level of procalcitonin” and “level of lactate dehydrogenase” in blood serum. Among morphometric lesion indicators the closest relations concerning biochemical indicators were revealed: in bones – “the form of the pathological focus of traumatic osteomyelitis” and “presence of sequesters”, in soft tissues – “exsudative inflammation in internal membrane of a focus capsule”. Conclusions. In chronic traumatic osteomyelitis combined with trophic disturbances of crural tissues, there are relationships between some clinical, biochemical and morphological indicators of the extremity tissues condition. A deviation of metabolism indicators from norm can serve as biochemical markers in definition of severity degree and efficiency of treatment in patients.

Infectious arthritis was modeled on white male Wistar rats by injecting a suspension of Staphylococcus aureus microorganisms into the knee joint of animals, and the effects of the synthetic hormone flosteron were also studied. At the same time, the content of acute-phase proteins (ceruloplasmin, haptoglobin, C-reactive protein (CRP)) and procalcitonin (PCT) as markers of the development of the inflammatory process and bacterial infection was studied in the blood serum of rats. Determination of the content of haptoglobin, ceruloplasmin and CRP was carried out on a Cobas 311 biochemical analyzer, the PCT concentration on a Cobas 411 analyzer using Roche Diagnostics test systems. Analysis of the results showed that when flosteron was administered, the concentration of CRP increased by 1.7 times already on the 3rd day, and by more than 4 times on the 14th day. The content of ceruloplasmin and haptoglobin also increased. The PCT concentration was at the level of the control values. Under the conditions of modeling infectious arthritis, changes in the content of acutephase proteins were observed. The greatest deviations from the reference values were found on the 14th day in animals that were injected with the hormone and S. aureus: the concentration of both CRP, the most objective biochemical marker of the inflammatory process, and PCT exceeded the physiological norm 12 times and more than 7 times, respectively. This indicates that the hormonal drug enhances the inflammatory process, which is confirmed by data that reflect changes in the content of acute-phase proteins. It can be assumed that the use of hormonal drugs contributes to the development of postoperative complications.