THE STUDY OF BLOOD FLOW DYNAMICS IN TIBIAL SUBCHONDRAL EPIPHYSEAL ZONE OF PATIENTS WITH GONARTHROSIS AFTER TUNNELIZATION AND INFUSING AUTOLOGOUS BLOOD WITH BONE MARROW ELEMENTS

Abstract

Introduction. The knee osteoarthrosis leads to a significant reduction of working ability. as well as to disability of working-age people. Arthroplasty is dominated the main method in treatment of such patients. However, many orthopedists are more and more inclined to the surgeries which allow to preserve the knee anatomic-and-functional integrity and to delay the surgery of the knee total replacement for later periods. Subchondral tunnelization with infusing autologous blood with bone marrow elements is one of such methods. of treatment for the patients of this category.Purpose to study the dynamics of the blood flow in the tibial epiphyseal subchondral zone after tunnelization and infusing autologous blood with bone marrow elements and its effect on the rehabilitation process of patients with gonarthrosis.Material and methods. The work was based on the results of studying 26 patients with Degree grade 2-3 gonarthrosis. Surgical treatment included performing tunnelization of femoral and tibial condyles with infusing autologous blood containing bone marrow elements. Circulation of tibial subchondral epiphyseal zone was studied in the operation room, before surgery, after tunnelization and after infusing autologous blood. Blood flow registered using high-frequency ultrasonic Dopplerography. The patient functional condition and the pathology severity analyzed using complex index score.Results. The significant (42-108%, р0.05) increase in blood flow registered in tibial subchondral epiphyseal zone in patients with gonarthrosis after tunnelization of femoral and tibial condyles in 46.2% of cases, and the increased blood flow persisted after infusing autologous blood with bone marrow elements in 58% of the patients from this group. In patients with significant blood flow increase the index score rate of gait, muscle strength and mean rehabilitation criterion was reliably 23% (р0.05), 21% (р0.05) and 17.4% (р0.05) more, respectively, comparing with the group of patients without the pronounced increase. The proportion of patients with the increase in the index score of gait, muscular strength, joint deformity, function, quality of life was also higher in the group of patients with blood flow rate increase.Conclusions. The significant increase in blood flow of tibial subchondral epiphyseal zone after tunnelization and infusing autologous blood with bone marrow elements contributed to the improvement of joint function and quality of life in patients with gonarthrosis.