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Актуальность. Внедрение КТ сканирования и интраоперационной 3D визуализации показало, что визуальная и рентгеноскопическая оценка результата репозиции внутрисуставного оскольчатого компрессионного перелома пяточной кости не соответствует действительности. При переломах II типа по Sanders частота неполной репозиции достигает 26,1%, III типа -35,2%-47%. Наиболее сложна репозиция многооскольчатых переломов IV типа по Sanders при которой ряд исследователей предпочитают первичный подтаранный артродез. Цель: определение наиболее эффективного метода репозиции внутрисуставного оскольчатого компрессионного перелома пяточной кости со вдавлением, импрессией суставной фасетки и деформацией внешней конфигурации пяточной кости. Стратегия поиска. Произведен обзор публикаций доступных в базах данных PubMed, Medline, Embase, Cochrane Library, а также русскоязычных статей опубликованных с 1990 по март 2022 года. А также взяты для анализа источники раннее 1990 г., содержащие концептуальную информацию. Поиск литературы производился двумя исследователями, которые оценивали результаты репозиции на основе рентгенологической, артроскопической и 3D визуализации и отдаленные клинические исходы лечения, осложнения. Результаты. Из 262 рецензируемых статей в данный обзор включены 64 полнотекстовые статьи, в которых отражена методика репозиции внутрисуставного оскольчатого перелома пяточной кости, ее результаты и её воздействие на исходы лечения, частоту осложнений. Выводы. Адекватная анатомическая репозиция импрессированной задней суставной фасетки при внутрисуставном переломе пяточной кости достигается открыто из минидоступа либо из расширенного латерального под контролем рентгенологической, артроскопической либо 3D визуализации. Для восстановления анатомической конфигурации тела пяточной кости наиболее эффективны интраоперационные малогабаритные репозиционные аппараты внешней фиксации. Используемые в настоящее время интраоперационные репозиционные аппараты имеют существенные недостатки и не обеспечивают в полном объеме восстановление внешней конфигурации пяточной кости., Relevance.The introduction of CT scanning and intra-operative 3D imaging showed that the visual and fluoroscopic assessment of the result of reposition of an intra-articular comminuted calcaneal compression fracture is untrue. In type II fractures according to Sanders, the frequency of incomplete reposition reaches 26.1%, type III - 35.2% -47%. The most difficult is the reposition of multi-fragmented type IV fractures according to Sanders, in which a number of researchers prefer primary subtalar arthrodesis. The purpose of this study was to determine the most effective method of repositioning an intra-articular comminuted calcaneal compression fracture with depression, articular facet impression, and deformity of the calcaneus external form. Search strategy. The publications review available in the databases PubMed, Medline, Embase, Cochrane Library, as well as Russian-language articles published from 1990 to March 2022. In addition, articles published before1990 were included in review because they contain conceptual information. Two researchers who evaluated the results of reposition based on X-ray, arthroscopic and 3D imaging and long-term clinical outcomes of treatment and complications, carried out the literature search. Results. Out of 262 peer-reviewed articles, 64 full-text articles are included in this review, which reflect the technique for repositioning an intra-articular comminuted calcaneus fracture, its results and its impact on treatment outcomes, and complication rates. Conclusion. Adequate anatomical reposition of the impressed posterior articular facet in case of an intra-articular fracture of the calcaneus is achieved openly from a mini-approach or from an extended lateral approach under the control of X-ray, arthroscopic or 3D imaging. To restore the anatomy of the calcaneus, the most effective intra-operative small-sized repositioning devices for external fixation are most effective. The intra-operative repositioning devices, which are currently in use, have significant disadvantages and do not fully restore the calcaneus external form., Өзектілігі. Актуальность. КТ сканерлеуді және 3D операцияішілік бейнелеуді енгізу буынішілік ұсақталған өкшесүйеккомпрессиялық сынуының репозициясының нәтижесінвизуалды жәнерентгенокопиялық бағалаушындыққажанаспайтынын көрсетті. Sanders бойынша II типті сынықтардатолық емес репозиция жиілігі 26,1%, III типті - 35,2% -47% жетеді. Sanders бойынша IV типті көпжарқыншақтысынықтарды репозициялау ең қиыны болып табылады, ондайда бірқатар зерттеушілер біріншілік топайасты артродезді қалайды. Буынішілік ұсақталған өкшесүйеккомпрессиялық сынуын өкшесүйектің буын фасеткасының импрессиясымен және сыртқы конфигурациясының деформациясымен батыңқы етіп репозициялаудың ең тиімді әдісінанықтау аталмыш зерттеудің мақсаты болып табылады. Іздеу стратегиясы. PubMed, Medline, Embase, Cochrane Library дерекқорларында қолжетімді басылымға, сондай-ақ 1990 жылдан бастап 2022 жылғы наурызға дейін жарияланған орыс тіліндегі мақалаларға шолу жасалды. Сонымен қатар, тұжырымды (концептуалды) ақпараттары бар 1990 жылдан ерте шыққан әдебиеттер талдауға алынды. Әдебиеттерді іздеуді екі зерттеуші жүргізді, олар рентгендік, артроскопиялық және 3D бейнелеуге және емдеудің ұзақ мерзімді клиникалық нәтижелеріне, асқынуларға негізделген репозиция нәтижелерін бағалады. Нәтижелер. Рецензияланған 262 мақаланың ішінде бұл шолуға 64 толық мәтінді мақалалар кіреді, оларда буынішілік ұсақталған өкшесүйек сынуын репозициялау әдістемесі, оның нәтижелері және оның емдеу нәтижелеріне әсері және асқыну жиілігі көрсетіледі. Қорытындылар. Буынішілік ұсақталған өкшесүйектің сынуы кезінде импрессияларған артқы буындық фасеткасының барабар анатомиялық репозициясы рентгендік, артроскопиялық немесе 3D бейнелеудің бақылауымен шағын немесе кеңейтілген латеральды қол жеткізу арқылы жасалады. Өкшесүйек денесінің анатомиялық конфигурациясын қалпына келтіру үшін сыртқы бекітудің операцияішілік шағын өлшемді операцияішілік аппараттары ең тиімді болып табылады. Қазіргі уақытта қолданылатын операцияішілік репозициялық аппараттарының едәуір кемшіліктері бар және өкшесүйектің сыртқы конфигурациясын толық көлемді қалпына келуін қамтамасыз етпейді., Наука и здравоохранение, Выпуск 5 (24) 2022, Pages 188-195

Тема выпускной квалификационной работы: «Разработка модели пяточной кости с применением CDIO Ð¿Ð¾Ð´Ñ Ð¾Ð´Ð°Â».Данная работа посвящена разработке модели пяточной кости из пластика для дальнейшей печати и использования в Ñ€ÐµÐ°Ð»ÑŒÐ½Ñ‹Ñ Ð¾Ð¿Ñ‹Ñ‚Ð°Ñ .В результате работы была изучена анатомия стопы человека и пяточной кости, в частности. Используя метод ÐºÐ¾Ð½ÐµÑ‡Ð½Ñ‹Ñ ÑÐ»ÐµÐ¼ÐµÐ½Ñ‚Ð¾Ð², было проведено моделирование ударной нагрузки на стопу с использованием модели скелета. Полученные результаты показали непригодность данной модели. Изучены более точные модели. Проведено повторное моделирование на найденной модели при Ñ€Ð°Ð·Ð½Ñ‹Ñ Ð½Ð°Ñ‡Ð°Ð»ÑŒÐ½Ñ‹Ñ ÑƒÑÐ»Ð¾Ð²Ð¸ÑÑ . Изучены разные виды пластика. В дальнейшем произведена замена костного материала пятки на пластмассовый материал. Проведены аналогичные расчёты. Анализ Ð¿Ð¾Ð»ÑƒÑ‡ÐµÐ½Ð½Ñ‹Ñ Ñ€ÐµÐ·ÑƒÐ»ÑŒÑ‚Ð°Ñ‚Ð¾Ð² показал ÑÑ Ð¾Ð´ÑÑ‚Ð²Ð¾ в поведении Ð´Ð²ÑƒÑ Ð¼Ð¾Ð´ÐµÐ»ÐµÐ¹ с разными материалами. Кроме того, построены сравнительные графики силы реакции заделки, на ÐºÐ¾Ñ‚Ð¾Ñ€Ñ‹Ñ Ð²Ð¸Ð´Ð½Ð¾ аналогичное поведение ÐºÑ€Ð¸Ð²Ñ‹Ñ .Цели для продолжения исследования:1. Достижение более точного совпадения с использованием более ÑÐ»Ð¾Ð¶Ð½Ñ‹Ñ ÑÐ²Ð¾Ð¹ÑÑ‚Ð² материала для большего числа костей;2. Печать полученной модели для дальнейшего использование уже в Ñ€ÐµÐ°Ð»ÑŒÐ½Ñ‹Ñ Ð¾Ð¿Ñ‹Ñ‚Ð°Ñ ., The subject of the graduate qualification work is «Development of the model of the calcaneus using CDIO».This work is devoted to the development of a transfer model of the calcaneus for further printing and use in a small experiment.As a result of the work, the anatomy of the human foot and the calcaneus, in particular, was investigated. a simulation of the impact load on the foot was carried out using a skeletal model. The obtained results of measuring the unsuitability of this model. More accurate models have been studied. Re-simulation was carried out on the basis of the found model in different initial conditions. Various types of plastic have been studied. Subsequently, the bone material of the heel was replaced with a plastic material. The following calculations were carried out. Income analysis showed similarities in the presentation of the two models with material. In addition, comparable graphs of the dynamics of the embedding reaction were constructed, on which a similar behavior of the curves is observed.Goals for continuing research:1. Achieving a more accurate match using more complex material properties for more bones;2. Printing the resulting model for use already in a small experience.

Aim. To assess the morphometric characteristics of Achilles tendons in patients with familial hypercholesterolemia (FH) and to identify factors associated with an increase in their size.Материал и методы. Totally, 100 patients included, with severe primary hyperlipidemia, defined as an increase in total cholesterol ≥7,5 mM/L and/or lowdensity lipoprotein cholesterol ≥4,9 mM/L. All patients underwent duplex scanning of carotid arteries. Ultrasound examination of the Achilles tendons was carried out on an expert class ultrasound equipment Samsung Medison EKO 7 (Japan) with a linear sensor, frequency of 7-16 MHz. Thickness of the Achilles tendon (anteriorposterior dimension (APD)) was measured during scanning in the longitudinal section, width (transverse dimension (TD)) — scanning in the cross section. The measurements were made 2 cm proximal to the calcaneus.Results. Among the participants, 32 (32,0%) had definite/probable diagnosis of FH. In patients with definite/probable FH the mean values of APD were significantly higher in comparison with patients scored 5 or less points (DLCN) — 5,50 (4,70-6,10) mm vs. 5,00 (4,50-5,40), respectively (p=0,04). TD of Achilles tendons among this category of patients was also statistically significantly higher in comparison with the rest of patients — 14,0 (12,9-15,4) mm and 13,2 (12,2-14,2) mm, respectively (p=0,04). In correlation analysis, the relationship between the growth of patients and the APD of the Achilles tendons (r=0,34, p=0,001), the TD of the Achilles tendon (r=0,28, p=0,009), CIMT and TD of the Achilles tendons (r=0,21, p=0,05), amount of carotid plaques and TD of the Achilles tendon (r=0,26, p=0,01), total percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,27, p=0,01), maximum percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,28, p=0,007). According to regression analysis, factors associated with an increase in thickness of the Achilles tendons for more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and high-density lipoproteide cholesterol.Conclusion. In patients with definite/probable FH, mean values of width and thickness of the Achilles tendons were significantly higher in comparison with the rest of the patients. According to regression analysis, the factors associated with the increase in thickness of the Achilles tendons fro more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and HDL high-density lipoproteide cholesterol.

Background.The foot is a special anatomical structure in its complexity. A large number of articular and ligamentous structures provide effective amortization and adaptation to surface features when walking. At the same time, if it is damaged, restoration of its anatomic structure is significantly difficult for a surgeon and may cause a number of complications and consequences. These issues are significant in patients with multisystem and multiple trauma.Aim of study.To identify the most common causes of unsatisfactory outcomes of treatment for foot injuries in patients with isolated, multiple and multisystem trauma.Material and methods.Treatment of 216 patients was analyzed. We revealed 129 fractures of the calcaneus, 25 fractures of metatarsal bones and/or toes of the foot, 21 fractures of the talus, 18 Lisfranc lesions, 13 fractures of midfoot bones, and 10 multiple trauma of the foot. The multisystem trauma occurred in 38.4% of cases, isolated trauma of the foot was revealed in 36.7% and multiple injuries were observed in 24.9%. When evaluating the results, early and late complications were taken into account, and the functional outcome was determined by the Foot Function Index (FFI) after 6, 12 and 24 months.Results.Among patients with closed fractures of the calcaneus, the problems of healing of the postoperative wound appeared in 3.5% of cases in operative treatment. The frequency of secondary displacements was 5.8%. By 24 months in patients after surgical and conservative treatment, similar functional outcomes were observed. Among patients with open fractures, skin necrosis occurred in 7 out of 25 cases and wound infection was observed in 15 cases. When fixing with wires, secondary displacement was observed in 4 cases out of 18. The average FFI score by 24 months was 59.5. In patients with forefoot fractures, wound healing complications occurred in 2 cases. The average score on the FFI scale was 93.7±8.1. In patients with fractures of the talus, wound complications were not noted, avascular necrosis (AVN) developed in 9 patients, osteoarthrosis (OA) developed in 15 cases. The average FFI after 2 years was 93.2±5.5 in patients without AVN and OA, and 63.6±23.1 in patients with AVN and/or OA. Among patients with midfoot trauma, infectious complications and secondary displacement were not observed. Osteoarthrosis occurred in 13 patients, including 8 patients with lesions of the Lisfranc joint. The difference in functional outcomes between patients with developed osteoarthrosis and without it differed in mean values, but was not statistically significant.Conclusion.The causes of unsatisfactory outcomes of treatment for foot trauma are wound complications against the background of open fractures of the calcaneus, avascular necrosis of the talus and posttraumatic arthrosis of the foot joints. It is advisable to continue research to find the best algorithm for treatment in these cases.

Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of mechanical damage of bundles and inflammation. In prolonged impingement the intensity of inflammation decreases, but the connective tissue degeneration of the tendon continues with lipoid infiltration.

One of the most common complications associated with the treatment of calcaneus fracturesis, a necrosis of the edges of the surgical wound and as a result – chronic nonhealing ulcers of the heel region and osteomyelitis of the calcaneus. In the structure of skeletal lesions osteomyelitic chronic osteomyelitis of the calcaneus occurs in 3.1–14.8% of cases, and in relation to the bones of the foot – up to 51%. At the same time after open fractures of the total incidence of deep infection from soft tissue even higher than that for the surface (12.2% vs. 9.6%). The traditional approach to the treatment of osteomyelitis of the calcaneus is often accompanied by poor performance with recurrent osteomyelitis process and high subsequent disability of working age. Objective : to identify opportunities and assess the effectiveness of the use of reconstructive microsurgery techniques in the treatment of patients with superficial forms of osteomyelitis of the calcaneus, accompanied by the presence of soft tissue defect. Materials and мethods. The results of treatment of 28 patients with superficial forms of osteomyelitis of the calcaneus, which in the period from 2006 to 2013 in RNIITO them. R.R.Vredena were performed reconstructive plastic surgery using microsurgical techniques. Defects covering tissues were located on the sole (20) and back-side surfaces (8) of the calcaneus. Scope of interventions included the radical surgical treatment of osteomyelitis focus, marginal resection of the affected heel bone and tissue replacement of defect cover flap with axial blood supply. Results. With the localization of the defect cover tissues to non-reference surface of the heel region was carried out free plastic ray skin-fascial flap (9 cases). When the location of the defect on the plantar surface of the heel region favored medial plantar flap (10 cases). However, the presence of scarring and damage to the medial plantar artery was performed two-step replacement of defect prefabrikovannym flap medial arch of the foot (9 cases). Complications were observed in 7% of cases (2 patients) in 1 patient who had undergone plastic free radial flap in 1 case – after replacing a defect medial plantar flap. In both cases they were associated with impaired blood supply to the flap and ended necrosis of transplanted grafts. In the remaining cases (93%) failed to achieve full engraftment. Long-term results were followed up in 78,5% (n = 22) of patients in the period from 1 to 8 years after the end of treatment. In four cases, the plantar surface of the calcaneus formed edge wound defects, require additional surgical treatment. on the AOFAS scale results averaged 85 points, that, given the severity of the disease, regarded as a good result. Conclusions. The use of microsurgical techniques for the treatment of patients with superficial forms of osteomyelitis of the calcaneus, including the presence of soft tissue defect, achieves sustained remission osteomyelitic process and restore support ability of the injured limb. Thus the support surface for the replacement of the heel region is expedient to use grafts comprising the plantar surface of the foot skin.

Clinical observation of patients with posttraumatic deforming arthrosis of subtalar joint resulted from calcaneus fracture and preoperatively diagnosed closed old dislocation of left foot peroneal tendons is presented. The necessity of thorough examination of patients with hindfoot injuries and expediency of surgical interventions not only on the bony but also on the soft tissue structures is substantiated. Such interventions will provide for the restoration of the normal anatomical position of peroneal tendons.

Enhanced core compression-distraction device reduces the time of treatment and rehabilitation of patients with injuries of explosives, it contributes to a more rapid and complete recovery of function of the hip joint. Using the author device, allows to make an early activation of the patient on the 2nd day after the operation, which contributed to the recovery of BMD 22 (78.6 %) of the 28 studied.