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Secondary degenerative disabling changes in the hip joint often develop in the long term after surgical treatment of hip fractures. A well-founded differential approach to the selection of endoprosthesis components and additional means of stabilizing bone fragments is necessary. Objective. To investigate changes in relative deformation values in a hip joint model with a acetabulum fractures 62-B1.3 type by AO/ASIF classification under the conditions of its endoprosthesis using various osteosynthesis options. Methods. A basic finite-element model of the pelvic girdle of a person with a fracture of the bottom of the cruciate ligament type 62-B1.3 (АО/ASIF) was developed, on which 7 variants of endoprosthesis of the left hip joint were modeled: without fracture (1); without osteosynthesis of fragments (2); fixation of a fragment of the acetabulum back wall with two screws (3), two screws and a bone plate (4), two screws and a bone plate with a Jumbo cup implantation (5); 5 case, long screw in the front column (6); option 5, long screws in the front and rear columns (7). Results. When using a large-sized Jumbo cup, the relative deformations of the bone regenerate in the center of the bottom of the KZ were reduced to 1.0 %, regardless of the osteosynthesis option. Around the free fragment of the short circuit, the largest relative deformations (3.0 %) were found in version 5 of the model. The use of long rods in the columns led to decrease in the relative deformations of the bone regenerate around the free fragment of the KZ to 2.0 %. Conclusions. Mathematical models proved that an increase in the number of osteosynthesis tools under the conditions of the total hip endoprosthesis replacement, 62-B1.3 (АО/ASIF) type KZ fracture leads to a decrease in the relative deformations of the bone regenerate along the entire fracture line. The use of a large-sized Jumbo cup makes it possible to reduce the level of relative deformations of the bone regenerate in the central part of the KZ. [ABSTRACT FROM AUTHOR]

There are various methods of restoring the integrity of the pelvic ring, after surgery in patients with tumor lesions of the pelvic bones, allowing to keep the limb with good oncological and functional results. A new stage in the development of organ conservation treatment in this group of patients is the use of modular endoprostheses based on the conical leg. The development of postoperative complications leads to an unsatisfactory result of treatment, despite the radical surgery and technically correct endoprosthesis. This, in turn, leads to repeated surgical interventions, namely to remove metal structures, or to perform a crippling operation.Purpose. To analyze postoperative complications and methods of their treatment in patients after modular endoprosthesis replacement of the acetabulum.Patients and methods. From 2011 to 2018, surgical treatment of endoprosthesis using modular metal structures based on a conical leg was performed in 30 patients. There were 13 men (43%) and 17 women (57%). The median age was 45 years (23–63 years). Primary malignant tumors of pelvic bones were in 19 (63%) patients, 5 (17%) had a giant cell tumor. Two (7%) patients had solitary metastases of kidney cancer and one (3%) with synovial sarcoma, and 3 (7%) had relapses after previous surgical treatment.Results. The average follow-up period was 36 months. Progression of the disease in terms of 6 to 40 months was revealed in 10 patients (33%), 8 (27%) of which died, the remaining 22 (67%) are alive with no signs of progression. In the postoperative period, 11 (37%) patients developed complications with predominance (up to 30%) of infectious. The average functional result on the MSTS scale was 59%.Conclusion. The use of modular prostheses on the basis of a conical leg in patients with tumors of the pelvic bones allow to perform safe operations with a satisfactory functional and oncological result. The result obtained in our study is comparable with the data of world literature.

Surgical treatment of patients with tumoral defeat of pelvic bones, of preacetabular region, in particular, is one of the most challenging topics of modern oncorthopedics. Currently, one of the most modern methods of reconstruction of the pelvic bones is the use of modular endoprostheses based on the conical leg, the advantage of which is the ability to intraoperatively simulate an endoprosthesis that best meets the specific clinical situation. Purpose of research. To assess the benefits of modular endoprosthesis of the acetabulum in patients with tumoral defeat periacetabular region.Patients and methods. Within the period of 2011–2018 30 patients underwent surgical treatment in form of periacetabular resection with a modular endoprosthesis reconstruction in P.Hertsen Moscow Oncology Research Institute – Branch of National Medical Research Radiological Centre of Ministry of Health of Russian Federation. There were 13 men (43%) and 17 women (57%). The median age was 45 years (23–63 years). Primary bone cancers were in 19 (63%) patients, giant cell tumors in 5 (17%), locally advanced soft tissue sarcoma in 1 (3%), solitary metastases of kidney cancer in 2 (7%), and recurrent sarcomas after previous surgical treatment in 3 (10%) patients.Results. The average duration of the operation was 310 min (145–520 min), the volume of intraoperative blood loss was 5520 ml (600–20 000 ml). The positive edge of resection according to the results of the planned morphological study was revealed in 3 (10%) patients. The average follow-up period was 36 months (4-73 months). Disease progression in terms of 6 to 40 months was revealed in 10 (33%) patients. 8 (27%) patients from disease progression. Complications of different types were diagnosed in 11 (37%) patients, among whom infectious complications prevailed 9 (30%). The average value of the functional results on a scale MSTS accounted for 59% (15 to 82%). Conclusion. The use of modular systems of endoprosthesis replacement of the acetabulum and hip joint in tumor lesions is a promising surgical technique that allows to achieve adequate functional results with a comparable number of postoperative complications.

Inter-ileal abdominal dissection (IIAD) is one of the most traumatic maiming operations, which implies removal of the lower limb with a single block with an adjacent half of the pelvic ring. Taking into account the low overall incidence of locally advanced bony and soft tissue sarcomas localized in the projection of the pelvic bone and hip joints, and a small number of clinics with sufficient experience in performing such operations, modern specialized literature has a limited number of publications on the IIAD.Purpose. Presentation of the experience in the implementation of the IIAD in patients with locally advanced sarcomas of bones and soft tissues.Patients and methods. The analysis of results of treatment of 26 patients with locally advanced sarcomas of bones and soft tissues is presented. There were 14 men (54%), women 12 (46%). Patients with primary malignant tumors of bones 23 (88%) prevailed among patients. Depending on the morphological structure, 16 (61%) had chondrosarcoma, 4 (15%) had osteosarcoma and 3 (11%) had a malignant fibrous histiocytoma. Three (11%) patients had locally advanced softtissue sarcomas. In 2 (7.5%) synovial sarcoma and in one (3.5%) malignant tumor from the shells of peripheral nerves. The primary tumor process was in 21 (81%) patients. The clinical stage was established as IIb in 14 (54%), Ib in 3 (11%), IVa 1 (3.5%) and IVb in 3 (11%) patients, respectively.Results. The average duration of the operation was 4.1 hours (2.7–6 hours). The volume of intraoperative blood loss is 3400 ml (500–9000 ml). The margin of resection was evaluated as positive in 4 (15%) patients. The recurrence of the tumor after the IIAD performed by us was in 4 (15%) patients with a negative edge of R0 resection.Conclusions. Postoperative complications were noted in 5 (19%) patients. Four (80%) had wound purulent-septic com-plications: partial flap necrosis — 2, total necrosis of the flap — 1, edge necrosis of the wound — 1 patient. The overall 5-year survival rate of patients treated in the clinic by the treatment was 40%. The results of the functional status of patients after the operation were 45% on the MSTS scale, which correlates with the data of other authors.

Background. Currently, the major purpose for pelvic surgery is to conduct a locoregional radical procedure while preserving a good quality of life. When performing periacetabular resections, the acetabulum and the hip joint are the most difficult areas to reconstruct. According to some authors, the acetabulum and hip joint reconstruction with modular endoprostheses for patients with periacetabular tumors would lead to better clinical outcomes. The paper presents our experience using this surgical technique.Methods. Between 2011 and 2015, a total of 23 patients underwent periacetabular resection with the acetabulum and hip joint reconstruction using a modular endoprosthesis. There were 10 (44 %) male and 13 (56 %) female patients aged from 20 to 64 years with a median of 44 years. The histological types were as follows: 12 (52 %) chondrosarcomas, 4 (17 %) giant-cell tumors, 2 (8 %) osteosarcomas and 1 Ewing’s sarcoma, 1 malignant fibrous hystiocytoma, 1 synovial bone sarcoma, 1 solitary metastasis from renal cell and gastric carcinomas. Stage Ib bone sarcoma was diagnosed in 8 patients and stage IIb in 6 patients.Results. In accordance with Enneking classification, type I-II-III resections were performed in 14 (61 %) patients and type II-III-IV resections in 7 (30 %) patients. The median duration of surgery was 320 min (240–520 minutes). The median intraoperative blood loss was 5 200 ml (1 000–20 000 ml). Negative resection margins (R0) were achieved in 20 (87 %) patients. Positive resection margin (R1) was observed in 3 (13 %) patients with G-I chondrosarcoma. The median follow-up was 32 months (3–48 months). Disease progression was diagnosed in 7 (30 %) patients at a follow-up from 6 to 18 months. The functional outcome after surgery was assessed according to the MSTS score, with the median value of 48% (15–78 %). Postoperative complications were diagnosed in 10 (43 %) patients.Conclusion: The use of the modular acetabulum and hip joint replacement systems allows one to achieve favorable functional outcome in the postoperative period and to reduce the time of postoperative rehabilitation.

The article presents the results of scientific fundamental and applies researches of Tatyana Dmitrievna Zyryanova on the problem of study of pelvic bones and coxal cavity fractures complicated and non-complicated with bladder, urethra and rectum injuries. T.D. Zyryanova studied and systematized problems on the statistics of this incapacitating pathology, its clinic and diagnostics. She determined indications for conservative and surgical treatment of certain pelvic bones and pelvic waist injury and an algorithm of rehabilitation measures after the treatment. T.D. Zyryanova and co-authors proposed system of transport immobilization at the injuries of pelvic bones and concomitant injuries of internals of cavity of the lesser pelvis.

After total joint replacement in patients with dysplastic coxarthrosis, a significant number of negative results are observed. One of the ways of solving the problem of primary stability of the endoprosthetic cup is its mediation by deepening the acetabulum in the z one of its a natomical c enter. Objective: top erform a comparative biomechanical evaluation of the stability of the cups that are fastened and screwed up, in the event of their mediation performed under the conditions of joint replacement in patients with dysplastic coxarthrosis. Methods: with the help of mathematical modeling, the relatively strong characteristics of the pelvic bone in the area of the acetabulum and the quality of fixation of cup and cup after their mediation and immersion in the zone of the anatomical center of the depression. The total displacement of the head of the femoral component of the implant is analyzed. Results: it was found that using scintillating cup under the condition of dysplastic coxarthrosis provides total displacement in (2.2 ÷ 2.4) times greater than in the situations of its application without defect of the acetabulum. When the cup is pressed, the total displacement is 4.7 times larger than the screw cup. In these cases, hip replacement with the use of pressed cups is accompanied by a high risk of their primary instability. Conclusions: the use of screw-in cups in the case of their mediation under the conditions of total joint replacement in patients with dysplastic coxarthrosis provides a more reliable primary stability than the ones pushed into cups. The level of tension in the pelvic bone of the acetabulum is influenced by the depth of the cup setting, with the increase of which there is a significant destruction of bone tissue. It is advisable to carry out the hip joint replacement in the case of dysplastic coxarthrosis using a screw-in cup. Key words: dysplastic coxarthrosis, total joint replacement, hip component, mediallization, cotyloplasty. [ABSTRACT FROM AUTHOR]

Urethral destruction in women is a rare pathology which is result of traumatic damage of the urethra during pelvic fractures, sexual trauma, iatrogenic effects (operative vaginal delivery, prolonged catheterization of the bladder, complicated surgical interventions on the urethra, etc.). The main symptom of urethral destruction is involuntary urinary incontinence. The relevance and complexity of this problem are determined by the fact that the choice of surgical treatment for urethral destruction is still unsolved. This requires such kind of intervention, which will be aimed not only at restoring of the anatomy, but also at correcting urinary incontinence - often in several stages. This article describes two clinical cases of urethral destruction in women with iatrogenic damage to the urethra.

Aim: To decrease disability and mortality in patients with severe combined pelvic and abdominal trauma via applications of new progressive treatment tactics., Material and Methods: Retrospective and prospective analysis included 1033 patients with severe combined traumas (SCT) who were treated at the Clinical Hospital #3 in 2009-2015. Patients were divided into 2 groups - control (2009-2010) and main (2011-2015) group. Treatment in control group was similar to conventional approaches. In main group severity of injury was determined according to AİS (Abbreviated İnjury Scale) and İSS (İnjury Severity Scale) scales. 'Damage control' principle was applied in these patients., Results: In the main group 'damage control' principle with programmed multi-stage surgical approach was followed by mortality near 36.4% vs. 45.5% in the control group. Any surgical procedures are possible in patients with pelvic injuries type A and ISS score 17-26. In patients with pelvic injuries type A and ISS score 26-40 urgent surgery is advisable along with resuscitative assistance. Emergency surgery is performed for fractures type B and life-saving interventions for fractures type C. These operations are carried out simultaneously with pre- and intraoperative blood transfusion and vital functions stabilization. Life-saving procedures alone may be performed in patients with advanced injury and ISS score 41-49 and up to 75 regardless type of trauma.

The objective was to show the importance of external beam radiotherapy (EBRT) to increase the effectiveness of treatment and improve the quality of life of patients with generalized prostate cancer (PC). From 1992 to 2005 at our institution 205 patients with morphologically verified generalized (stages T1-4N0-1M1b) PC received EBRT. EBRT was conducted against the background of hormone therapy. Irradiation was begun with segmental pelvic irradiation with consistent reduction in the volume of exposure to locoregional and local irradiation of the prostate. The total tumor dose on the prostate was adjusted up to therapeutic level (66-72 Gy). In case of PC generalization with a primary lesion of the pelvis and lumbosacral spine, palliative EBRT according to the proposed method was justified. EBRT not only improved the quality of life of patients but also increased its duration.

Comparative assessment of posthumous and intravital methods of morphometric study of the pelvis in adult persons was performed in 110 embalmed anatomical specimens and in 81 patient. It was proved statistically, that magnetic resonance tomography and spiral computer tomography (SCT), performed following definite algorithm, appear to be highly informative methods for the evaluation of pelvimetric parameters. They permit to define various osseous landmarks with high precision and to perform the measurements of linear metric pelvic parameters. On the basis of the data obtained, various pelvimetric indices that characterize bony pelvis shape, could be reliably calculated. Moreover, SCT together with shade surface reconstruction in different projections permits to demonstrate visually the 3D shape of the pelvis or its separate fragments and to evaluate the symmetry, presence or absence of bone structural deformations.

The results of treatment in 177 patients with chronic osteomyelitis of the pelvis are reported. The diagnosis was clarified and the patients' general status was assessed by comprehensive examination (roentgenography, tomography, fistulography, scintigraphy, bacteriological, immunological, and laboratory studies). A procedure of complex preoperative preparation, rational detoxication and immunocorrection, intraoperative blood loss replenishment (autohemotransfusion) and volemic disturbances correction was developed. This permits expansion of indications for surgery, whose basis is bone resection. Taking into account the localization of a pathologic process, the authors consider bone resection within the normal tissue limits to be a main component of surgical treatment of chronic pelvic osteomyelitis.

The role of computed tomography in multimodality radiation diagnosis was assessed in the treatment of chronic osteomyelitis of the lower extremity and pelvis in 218 patients (128 with posttraumatic osteomyelitis, 46 with hematogenic osteomyelitis of long bones, and 19 with chronic pelvic osteomyelitis) aged 16-78 years. Computed tomography was used to specify the symptomatology of chronic osteomyelitis, to define indications for radical surgical treatment. The soft tissues of the shin were studied in patients with chronic osteomyelitis versus lymphedema in 103 patients, post-thrombophlebitic syndrome in 17, acute wound infection in 9. The symptomatology of osseous regenerate in distraction osteosynthesis was studied (120 computed tomograms). It has been indicated that computed tomography is effective in studying the chronic osteomyelitis-inflicted extremity and pelvis in the pre- and postoperative periods.

During 14 years the authors observed 52 newborn infants with acute hematogenic osteomyelitis of pelvic bones and proximal femoral portion, complicated with coxitis in 43 patients, pathological dislocation - in 32, phlegmon with burrowing in 37. A septicopyemic form of the disease was noted in 33 subjects, local-focal in 19. The symptomatics and an early topic diagnosis depending on a stage of the process are described in detail. The treatment includes timely surgical intervention on the pathological focus, intensive genaxis and treatment of pathological dislocation of the femur. An early diagnosis and timely complex therapy within recent 5 years provided the opportunity to reduce the mortality and the percentage of disability due to this disease.

The interilio-abdominal amputation was fulfilled in 62 patients for the period from 1960 to 1979. The postoperative mortality was 6,4%. General five-year survival was 24,3% +/- 5,6. The survival terms were dependent first of all on the tumor type. The advances of anesthesiology, reanimatology and operative oncology have considerably reduced the danger of interilio-abdominal amputation. So, indications for the operation can become wider even in the cases when it has a palliative character.

The time of life of 219 patients with primary malignant tumors of bones of the pelvis were analyzed in order to study the influence of different factors on the survival rate of the patients. It was shown that a considerable improvement of some results in the treatment of chondrosarcomas and chordomas was achieved after ablative removal of tumors, in reticulosarcoma and Ewing sarcoma--after a combined chemo-radial treatment with prophylactic courses of the therapy during 2 years. The combination of operation and radiotherapy for the treatment of chordomas gave a reliably higher survival of the patients within 5 years of observation. Prognosis in osteogenic sarcoma and angiosarcoma are extremely unfavorable regardless of the method of treatment.

The deformities of the locomotor system in patients, who suffered from osteomyelitis of the pelvis and proximal femur in childhood, are described. The drawbacks, occuring in the treatment of osteomyelitis, are analyzed. The authors suggest some recommendations on the organization of the treatment.