Functional Results Of Surgical Treatment Research Articles

Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method

Purpose: to assess the functional results of surgical treatment of macular holes (MH) using the authors’ developed technology preserving the internal limiting membrane (ILM) and compare them with the results of traditional surgery technology involving ILM peeling.Material and methods: 150 MH patients aged 50 to 82 were divided into 2 groups: the main group who underwent surgical MH treatment with ILM preservation and the control group, whose traditional surgical treatment involved ILM peeling. After vitrectomy, the main group patients’ macular areas were treated with a bacterial collagenase solution (1 kU) for three minutes, whereupon it was washed out, the vitreal cavity was dried and treated with platelet-rich plasma. In the control group, ILM was stained and removed, whereupon platelet-rich plasma was applied in the air medium. The anatomical result was assessed by optical coherence tomography data. To assess the functional results, the patients were tested for the best corrected visual acuity (BCVA) and subjected to microperimetry. The observation period was 24 months.Results: in all cases, a significant increase in BCVA was achieved after surgical treatment. After 6 months, the control group showed a tendency to a BCVA decrease, while in the main group BCVA remained stable. In the main group, not a single case showed a decrease in the total retinal photosensitivity below the threshold level of the norm of 24 dB, whilst in the control group, 35 cases (47 %) revealed a retinal sensitivity decrease below 24 dB. The total retinal sensitivity turned out to be significantly lower in the control group as compared to the main group over the entire observation period (p < 0.05). Postoperative scotomas were significantly more frequent after ILM peeling. Absolute scotomas were detected in 7 control group cases, whilst in the main group they were not noted in any case.Conclusion. The developed technology makes it possible to practically eliminate the formation of absolute scotomas and to significantly reduce the formation of relative scotomas in the postoperative period, as well as improve functional results against the traditional method of surgical treatment of MH with ILM peeling.

Анализ функциональных результатов хирургического лечения рака почки

Анализ функциональных результатов хирургического лечения рака почки

Prediction of late results of surgical treatment of traumatic retina detachment in eye injury of multiple origin

Purpose. To evaluate the possibility of predicting the anatomical and functional results of surgical treatment of traumatic retinal detachment (RD) in trauma of various geneses, taking into account the clinical picture and the severity of the proliferative syndrome based on large clinical data.Materials and methods. A comprehensive analysis of the clinical picture (using 22 features) and long-term results of surgical treatment of 427 patients with traction traumatic RD (TRD) after open and closed eye injury was carried out. The patients were divided into 7 groups depending on the mechanism of injury. The observation period was 5 years.Results. The most severe proliferative syndrome was observed in TRD after an open injury: OEI A (contusions with scleral rupture), OEI D (double puncture wound) and OEI E (explosive trauma with scleral rupture), when both the process of mooring and PVR are present, as well as with CEI A (contusion) in the event that after the first operation PVR continued to progress. We found a direct dependence of PVR activity in TRD on the area of the detached retina and the presence of a traumatic cataract, and the inverse dependence on the presence of intraocular foreign body (IFB), its size and the ability of IFB to cause metallosis. A direct dependence of long-term functional results of treatment on the PVR stage, the area of detached retina and the diagnosed retinal rupture during the first vitreoretinal surgical intervention was established.Conclusion. In order to make the surgical treatment of TRD more effective, it is worth using antiproliferative drugs intravitreally during vitreoretinal surgery, especially in OEI A, OEI D and OGI E, when the proliferative syndrome is caused both by PVR and mooring, as well as in CEI A in the case of a pronounced PVR stage.

Анатомічні та функціональні результати після хірургічного лікування поєднаної лейоміоми матки з генітальним пролапсом

More than 41% of women aged 50-79 suffer from pelvic organ prolapse. Genital prolapse is combined with uterine leiomyoma in approximately 20% of cases, which necessitates a differentiated approach to the treatment. Purpose - to compare the anatomical and functional results of surgical treatment of women with uterine leiomyoma combined with genital prolapse, who underwent hysterectomy with and without prolapse correction. Materials and methods. 80 patients with genital prolapse combined with uterine leiomyoma were examined and divided into three groups. In the Control (I) Group (n=40), hysterectomy was performed without correction of genital prolapse, in the other two groups - hysterectomy and correction of genital prolapse using a mesh implant by the method of pectopexy (the Group II, n=40) or lateral fixation (the Group III, n=40). Anatomical and functional outcomes were assessed 6 and 12 months postoperatively using the POP-Q and the questionnair PFDI-20 and PISQ-12. Statistical analysis was performed with SPSS Version 21.0. Results. In women of the Groups II and III, POP-Q parameters significantly improved 6-12 months after surgery compared to the initial level, while in patients of the Group I, 1 year after surgery, negative dynamics of changes in points Aa, Ba and indicators of pb and Tvl were established. Anatomical success, which is POP-Q stage 0-1 one year after surgery and does not require further surgical treatment, was 82.5% in the Group II and 85% in the Group III. The frequency of improvement of pelvic functions according to PEDI-20 and the state of sexual function according to PISQ-12 6 months after the operation was significantly higher among women of the Groups II and III comparing to the Group I. Conclusions. The obtained data testify to the anatomical effectiveness of simultaneous hysterectomy and correction of genital prolapse using mesh implants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Method of Extended Primary Microsurgical Treatment of Extensive Penetrating Scleral Wounds

Purpose: to expand and modernize the technology of primary microsurgical treatment of extensive scleral wounds due to simultaneous subtotal vitrectomy, primary treatment of retinal and choroid wounds, filling of tissue defects with autologous conditioned plasma (ACP), tamponade with silicone oil or C3F8 gas.Methods. 15 patients (15 eyes) with extensive penetrating scleral and corneoscleral wounds ranging from 8 to 15 mm in length, with concomitant complex injuries of various structures of the eye: traumatic cataract, wound of the ciliary body, injury or loss of the iris, subtotal/total hemophthalmos, retinal detachment were monitored. All patients underwent primary surgery according to the original extended technique.Results. The functional results of surgical treatment in patients, taking into account the severity of the injury, were high: in the early postoperative period, 1 month after primary surgery, visual acuity with correction ranged from 0.02 to 0.5. Signs of proliferative vitreoretinopathy were not observed in any case.Conclusion. The proposed method of extended primary microsurgical treatment for extensive penetrating scleral and corneoscleral wounds with severe concomitant damage to intraocular structures is effective and has a number of advantages: early prevention of severe complications in the form of proliferative vitreoretinopathy, shortening the rehabilitation period. The method allows to achieve high functional results in the most severe cases of penetrating eye injury.

Surgical treatment of elderly and senile patients with transtrochanteric fractures of the femur

+ The aim of the work was to analyze the functional results of surgical treatment in elderly and senile patients with transcavitary fractures depending on the method of osteosynthesis. Materials and methods. 134 elderly and senile patients with transtrochanteric fractures of the femur type 31A1.1-A1.3 according to AO/ASIF were examined (average age - 72.4±9.3 years). The patient underwent osteosynthesis with a DHS fixator, a PFNA rod and a Gamma nail according to indications. The functional result of the treatment was determined by radiographic signs of fusion, the Harris scale, and complications detected during the period of 1, 3, 6, and 12 months of examination. Results and their discussion. The functional result according to the Harris scale dramatically prevailed in the first six months after surgical treatment with intramedullary osteosynthesis. For the DHS fixator, the indicator improved from 29.8 points in the first month to 57.7 at the sixth month, for the PFNA rod - from 50.7 points to 76.9, and for the Gamma nail from 50.1 to 76.7, respectively. Consolidation of a transtrochanteric fracture in treated elderly and senile patients was observed in 83.33 % of cases after extramedullary osteosynthesis, and in 90.22 % of cases after intramedullary osteosynthesis. Complications of extramedullary osteosynthesis included instability of the fixator with migration and fracture of the fixator, during intramedullary osteosynthesis – migration of the cervical blade "cut-out" and fracture of the rod. Conclusions. The functional result in elderly and senile patients with transtrochanteric fractures after intramedullary osteosynthesis has advantages over extramedullary osteosynthesis. The results of the calculation of the Harris scale indicators, among which the evaluation of the restoration of gait, movements and resistance of the injured limb were decisive, are significantly higher in osteosynthesis with a Gamma nail and a PFNA rod in comparison with a DHS fixator. Complications that occurred in the three groups of the study coincide with the average international indicators and are not significantly low with intramedullary osteosynthesis. Improvement of surgical treatment methods is urgent and requires the search for complex treatment approaches in elderly and senile patients with transtrochanteric fractures

Results of a differential approach to surgical treatment of proximal humerus fractures in patients with osteoporosis

Objective. To conduct a comparative retrospective analysis of the anatomical and functional results of surgical treatment of proximal humerus fractures AO/OTA 11-B, 11-C using different methods in patients over 50 years old with osteoporosis to justify a differential approach. Methods. The study included 102 patients aged 50 years and older with osteoporosis and proximal humerus fractures AO/OTA 11-B, 11-C. The patients were divided into three groups: I — 50 (16 men, 34 women) whom were performed open reduction and internal fixation (ORIF) with the PHILOS plate; II — 44 (8 men, 36 women) — ORIF with the PHILOS plate and using 3D polylactide (PLA) porous implants were applied; III — 8 (2 men, 6 women) whom were performed primary reversed total shoulder arthroplasty (RTSA) with developed total reversible endoprosthesis. The results of treatment were evaluated according to the Constant-Murley Shoulder Score system after 3, 6, 12 months. The results. Positive results in the first group were obtained in 72.0 % of patients (the average Constant-Murley Shoulder Score after 12 months was 78.4 points); in the second — in 81.8 % (88.0 points); in the third — 75.0 % (82.0 points). A differentiated approach to the choice of surgical treatment of patients aged 50 years and older with fractures AO/OTA 11-B, 11-C is proposed. The clinical trial of the reverse total modular shoulder endoprosthesis developed by us using porous 3D titanium parts, manufactured by additive technologies, showed positive short-term results. The design features of the device increase the reliability and durability of proposed endoprosthesis. Conclusions. RTSA in the case of unstable proximal humerus fracture or in the case of metal structure migration after primary ORIF in patients with low bone mineral density is the effective surgical intervention that allows to achieve satisfactory functional results in up to 3 years.

Surgical Correction of Rectocele Via Transvaginal Access: Optimization Option, Immediate and Long-Term Outcomes

Introduction. The transvaginal technique with application of patient's proper tissues is considered the most suitable for the surgical correction of the lower and middle rectocele. However, despite the complete anatomical correction, functional results are not satisfactory in 7-20% of patients.The aim of the study was to improve functional results of surgical treatment of rectocele via transvaginal access.Materials and methods. The study included 45 female patients who were randomly divided into two groups. In the control group, patients underwent posterior colporrhaphy and anterior levatorplasty using the conventional technique. In patients of the main group the operation was performed with the creation of the connective tissue layer between the levator ani muscles. The results of treatment were clinically assessed immediately after surgery, in one year and in 3 years after surgery by performing defecography and anorectal functional tests.Results. According to a ten-point scale the pain syndrome was 3.60.8 points in the main group and 4.10.7 points in the control group (P=0,639). No purulent complications were observed in patients. Defecography evidenced that in patients of both groups, rectocele correction was achieved after a year and corresponded to stage 0-I in 3 years, the results achieved were preserved in most patients. The rate of barium evacuation approached the norm and was 5.30.7 g/sec in the main group and 5.20.6 g/sec in the control group (P=0,913), in 3 years - 5.40.6 g/sec and 5.10.5 g/sec (P=0,701), respectively. According to the study terms, there were almost normal parameters of the residual volume of barium after emptying in both groups: 18.55.2% and 21.65.5% (P=0,683) and 19.15.3% and 21.14.1% (P=0,766). Evaluation of the reflex function of the rectum demonstrated an improvement in its sensitivity to small volumes of filling and a decrease in the volumes that cause the urge to defecate in the main and control groups, which persisted over the long-term follow-up. 18 patients of the control group noted a feeling of discomfort in the perineum during the first year after surgery and dyspareunia. In 3 years, 10 out of 18 patients noted a feeling of discomfort, dyspareunia persisted in 8 of them. The patients of the main group did not make these complaints.Conclusions. The proposed method of rectocele correction with the creation of the connective tissue layer between the muscles allowed the authors to avoid negative effects with simultaneous restoration of normal anatomical and defecatory function.

Сравнительный анализ хирургического лечения регматогенной отслойки сетчатки с нижней локализацией разрывов с тампонадой витреальной полости газом или силиконом

Purpose. To perform a comparative evaluation of the efficacy and functional results of surgical treatment of rhegmatogenous retinal detachment (RRD) with breaks in the lower hemisphere using gas or silicone tamponade of the vitreal cavity. Material and methods. Seventy-eight patients (78 eyes) with RRD and the location of breaks in the lower hemisphere were examined. Depending on the nature of retinal detachment patients were divided into 2 groups: without macular detachment («Macula-on») – 36 patients (36 eyes) and with retinal detachment in the macular area («Macula-off») – 42 patients (42 eyes). Each group included two subgroups «Gas» and «Silicone» depending on the type of final vitreal tamponade performed with gas (12% gas-air mixture with perfluoropropane C3F8 ) or silicone (Densiron), respectively. The type of tamponade was chosen randomly. Results. Subgroups of patients with different types of tamponade did not differ from each other in clinical and demographic characteristics. In the postoperative period, a complete retinal attachment was achieved in 75 patients (96%). At 6 months postoperatively, retinal light sensitivity (total and in central point) in the Macula-on group was significantly higher after treatment with gas tamponade compared to the final tamponade with silicone. For other parameters in the Macula-on group, the type of tamponade did not play a significant role. In the Macula-off group, neither functional parameters nor optical coherence tomography data at 6 months depended on the type of tamponade. Conclusion. The use of tamponade with an air-gas mixture and silicone in RRD patients with localization of breaks in the lower hemisphere is equally effective in achieving a high frequency of retinal attachment. Patients with RRD without macular involvement had significantly higher retinal light sensitivity (total and in central point) after treatment with gas-air tamponade compared to final tamponade with silicone. Gas-air tamponade has the advantage of not requiring a second surgical intervention and can be recommended for wide use in RRD patients with breaks in the lower hemisphere without significant proliferative vitreoretinopathy. Key words: rhegmatogenous retinal detachment, inferior hemisphere break, gas tamponade, silicone tamponade, photosensitivity

Анализ среднесрочных результатов оперативного лечения пациентов с нестабильными переломами лодыжек аппаратом Илизарова

Introduction The aim of the study was to analyze the functional results of surgical treatment in patients with unstable ankle fractures with the Ilizarov method (controlled retrospective cohort monocenter non-randomized study; Level of evidence II). Materials and methods Fifty-three patients, 15 males and 38 females, in the mean age of 48 years, with ankle fractures met the inclusion criteria. The patients were divided into three groups according to the principle of dominant lesion location and according to the number of damaged bone structures. The patients underwent surgical interventions comprising closed reduction and external fixation with the Ilizarov apparatus bridging the ankle and subtalar joints. The study period was 34.6 months after surgery. Functional outcomes were evaluated based on the data of the AOFAS questionnaire. Results The average AOFAS score for Weber type A fractures was 95.25 ± 6.84 (SD), 93.77 ± 6.85 (SD) for type B, and 93.57 ± 4.03 (SD) for type C. In the patients with isolated fractures of the lateral malleolus it was 93.44 ± 8.38 (SD), in bimalleolar fractures – 94.09 ± 6.41 (SD), and in trimalleolar fractures – 93.71 ± 6.39 (SD). There were no significant differences between the groups of patients with different (Weber) types of ankle fractures. There was tendency to worse outcomes in patients whose surgical treatment was carried out 7 days or more after the injury. Conclusion Ankle osteosynthesis with the Ilizarov apparatus in unstable ankle fractures demonstrates excellent mid-term (range, 2 to 4 years) functional outcomes. The number of damaged bone structures of the ankle joint and the location of the dominant injury are not predictors of an unfavorable outcome in unstable ankle fractures in case of definitive fixation with the Ilizarov apparatus. There is a tendency to worse functional outcomes in delayed surgical treatment if the time from injury to surgery is more than seven days.

Anatomical and functional results of surgical treatment of familial exudative vitreoretinopathy in children

Familial exudative vitreoretinopathy (FEVR) is a rare hereditary disease characterized by abnormal angiogenesis, presence of avascular zones on the periphery of the retina, and clinical manifestations ranging from an asymptomatic course to total retinal detachment. Surgical interventions are performed to eliminate vitreoretinal traction, epiretinal membranes, and retinal detachment. Studies of the surgical treatment outcomes of patients with FEVR are limited and findings are ambiguous
 AIM: To analyze surgical treatment outcomes of different stages of FEVR in childhood.
 MATERIAL AND METHODS: From January 2012 to October 2021 at the Helmholtz National Medical Research Center of Eye Diseases, surgical treatment was performed in 35 eyes of 33 patients aged 11 months15 years (average, 7 years). The effectiveness of treatment was evaluated 12 months after the treatment, and patients were examined every 36 months for 15 years (average 2 years).
 RESULTS: Аfter the primary surgery, a decrease in retinal traction in the posterior pole and periphery was achieved in all cases. Complete and incomplete reattachment was achieved in 30% and 70% of the eyes at stage 3 and in 12.5% and 87.5% of the eyes at stage 4, respectively. The long-term effectiveness rates of the intervention in stages 2, 3 (including complete and incomplete reattachment), and 4 were 100%, 87.5%, and 73.3%, respectively.
 Increases in the best-corrected visual acuity (BCVA) were observed in 83%, 50%, and 28.6% of the eyes in stages 2, 3, and 4, respectively. In other cases, successful surgical treatment allowed the preservation of visual functions. During the follow-up, visual acuity of 0.1 or more was maintained in 100%, 85.7%, and 36% of the eyes at stages 2, 3, and 4 of FEVR, respectively.
 CONCLUSION: Аnatomical and functional results of surgical treatment of FEVR correlate with the disease stage: the efficiency is greater in stage 2, and it was organ-preserving surgery in stage 5. To increase the effectiveness of treatment, early diagnosis of FEVR, laser coagulation of avascular zones, and active vessels are necessary, which makes it possible to stop the progression of the early stages of FEVR in 70%100% of cases and enables regular monitoring of patients for the timely detection of indications for additional laser coagulation or surgical intervention.

Long-term anatomical and functional outcomes of surgical treatment of retinal complications in children and adolescents with Stickler syndrome between 2004 and 2021.

Stickler syndrome (STL) is an inherited progressive connective tissue collagen disorder. STL is the most common hereditary cause of retinal complications, retinal tears, and the development of retinal detachment (RD) in childhood. The aim of the study was to evaluate the long-term anatomical and functional results of surgical treatment of retinal complications in children and adolescents affected by STL. A retrospective, single-center study was performed a cohort of children with STL who underwent retinal surgery between 2004 and 2021. The study group consisted of nine children; the mean age at the time of the retinal tear with/without retinal detachment was 7.2 (2-10) years, and the mean follow-up period was 9.6 (5-16) years. Pathogenic variants COL2A1 (5 children) and COL11A1 (3 children) were confirmed in our cohort. In total, we operated on 13 eyes, 11 eyes with complicated RD and two eyes with multiple retinal defects, but without RD. At the end of the follow-up period, an attached retina was achieved 77% (10 eyes) with or without silicone oil tamponade: cryopexy alone was successful in one eye (10%), scleral buckling (EB) in five eyes (50%), and vitrectomy with silicone oil tamponade combined with EB in four eyes (40%). The mean number of surgeries was 2.3 per eye. The resulting best corrected visual acuity ranged from 0.03 to 0.1 in one eye, from 0.16 to 0.4 in two eyes, and from 0.5 to 1.0 in 7 eyes. Repair of retinal tears with/without retinal detachment in patients with Stickler syndrome often requires multiple surgeries with combinations of cryopexy, scleral buckling, and/or vitrectomy with silicone oil tamponade. Treatment of the ocular complications arising from STL requires long-term comprehensive care.

Anatomical and functional results of surgical treatment of olecranon fractures in adults

Anatomical and functional results of surgical treatment of olecranon fractures in adults

Analysis of long-term functional results of surgical treatment of spondylolisthesis in middle-aged and elderly patients

BACKGROUND: Insufficient attention has been paid to the analysis of the use of instrumental methods of examination in assessment the long-term results of surgical treatment of spondylolisthesis in middle-aged and elderly patients. AIM: To show the peculiarities of strength characteristics of lower limb muscles and temperature and pain sensitivity in the dermatomes of the cauda equina roots in middle-aged and elderly patients in the distant terms after surgical treatment of spondylolisthesis depending on the etiology of the disease. MATERIALS AND METHODS: An analysis of the results of functional studies of 21 patients with spondylolisthesis aged 41 to 74 years (12 with degenerative, 9 with isthmic) is presented. The research done before treatment and 7599 months after surgery. The following research methods were used: analysis clinical (neurological status), visual analog scale (VAS), Oswestry Disability Index (ODI), radiology (functional X-ray examination), magnetic resonance imaging, anthropometry, the lower limb muscles dynamometry, esthesiometry, statistical. RESULTS: In the long term after surgical treatment, patients with isthmic spondylolisthesis had a predominant increase in the moment of force in all muscle groups (3975% of cases). Negative dynamics prevailed in the group of patients with degenerative spondylolisthesis a decrease in muscle strength characteristics in 5094% of cases. According to esthesiometry, more pronounced negative changes in the values of temperature and pain sensitivity thresholds were observed in patients with degenerative spondylolisthesis. CONCLUSION: The analysis of muscle strength characteristics and esthesiometry data determined a different degree of compensation and recovery during surgical treatment of patients with spondylolisthesis, depending on the etiology of the disease.

Pedobarography — monitoring method of functional restoration of unstable ankle joint injuries

The pedobarography method makes it possible to objectify the dynamics of restoring the functional capacity of an injured limb. The value of the method is gaining popularity in determining the functional results of surgical treatment of the patients with ankle joint injuries. The details of pedobarographic monitoring during the treatment allow to obtain digital indices, which with careful statistical analysis can significantly improve not only the diagnostic process, but also control the process of functional recovery of the patients with injuries of the lower extremities. Changes in quantitative digital static and dynamic indices of pedobarography mean progress in the functional restoration of the injured limb or the need in the correction of the rehabilitation process. However, there is a problem in the interpretation and specification of the known indices and indices in accordance with the pathology. A review of the scientific publications based on the Scopus, Web of Science and The Cochrane Library databases is designed to analyze the possibilities of using the pedobarography method in the diagnosis of ankle joint injuries, tibial bone fractures, which in accordance with quantitative indices make 20-28 % of all fractures of human bones. The kinematic features of the human body in normal and pathological conditions should be carefully analyzed and practically used in the monitoring process of the recovery of walking during the rehabilitation period in the patients with ankle joint fractures and not only. Control and detection of the deviations of pedobarographic indices should be analyzed in details with the aim of early detection of an unresolved problem before the appearance of clinical signs of chronic instability. The literature search proves that the analysis of the entire range of static and dynamic indices of pedobarography of damaged and healthy limbs during the period of postoperative recovery of walking makes it possible to evaluate the effectiveness of rehabilitation measures aimed at functional restoration of unstable injuries of the ankle joint.

Medium-term results of application of a new method of osteosynthesis in a patient with comparated fracture of the patella (clinical example)

In the structure of injuries among patients with fractures of the patella, patients of working age prevail, placing high demands on the functional results of surgical treatment and terms of recovery. Given the low incidence of this pathology in the structure of all injuries of the musculoskeletal system, the authors are of the opinion that patients with patella fractures should receive specialized care that meets the requirements for certain types of fractures in trauma hospitals of any level. The described clinical example describes the medium-term results of treating a patient using a patented method of osteosynthesis of the patella that meets both the requirements of patients and the basic principles of osteosynthesis of intra-articular fractures. The data provided is characterized as good, the use of the patented method is regarded as expedient.

Модифицированный метод инвертированного клапана внутренней пограничной мембраны в хирургии макулярных отверстий большого диаметра

Purpose. To evaluate the anatomical and functional results of surgical treatment of patients with large macular holes using the developed modification of the method of inverted internal limiting membrane flap. Material and мethods. The study included 72 patients (72 eyes) with a diagnosis of “full thickness macular hole” with a macular defect diameter of more than 400µm. The patients underwent a complete ophthalmological examination, including optical coherence tomography and microperimetry. The average age of patients was 67.8 ± 4.7 years The average diameter of macular holes according to OCT was 561.6 ± 123.6µm, the best-corrected visual acuity 0.12 ± 0.08. Results. All patients underwent endovitreal intervention by one surgeon according to the developed method. According to optical coherence tomography, in 98.6 % of cases (71 out of 72 patients), macular holes closure was observed 2 weeks after surgery. All patients noted an improvement in visual functions in the postoperative period. The best corrected visual acuity 2 weeks after the operation was 0.4 ± 0.08, as a rule, the maximum visual acuity was achieved after 6 months (0.5 ± 0.08). Conclusions. The proposed method showed high efficiency in the treatment of patients with large macular holes, which was confirmed by the data of optical coherence tomography, visometry and microperimetry. Keywords: large macular hole, internal limiting membrane peeling, inverted in-ternal limiting membrane flap.

Комплексное лечение пациентов с протяженным рубцовым стенозом гортани и шейного отдела трахеи

Improving the methods of reconstructive plastic surgery, the emergence of new algorithms for managing patients, the development of pharmacology have significantly improved the results of treatment of patients with cicatricial stenosis of the larynx and cervical trachea; however, the problem continues to be relevant since the outcome of treatment is not always satisfactory. The presence of chronic respiratory failure (which often accompanies cicatricial stenosis of the respiratory tract) as well as the lack of supporting viable cartilaginous structures of the larynx and trachea aggravates the course of the disease and requires a differentiated approach to the treatment of extended cicatricial laryngotracheal stenosis. The article analyzes the effectiveness of an integrated approach to the treatment of patients with extended laryngotracheal cicatricial deformity of the lumen using allogeneic graft as well as the correction of respiratory disorders and post-hypoxic tissue changes using inhalations of a heated helium-oxygen mixture in the perioperative period. The study included 20 patients with an age interval of 20–65 years and a disease duration of 1–12 years. At the outpatient stage, the necessary clinical and radiological, endoscopic, and functional examination was carried out. To detect chronic respiratory failure, the gas and acid-base composition of the blood was studied. In the hospital, all patients underwent reconstructive plastic surgery using allogeneic graft. All patients at the pre- and postoperative stage received inhalations with a heated helium-oxygen mixture according to the developed algorithm. The study showed that an integrated approach to the treatment of patients with extended laryngotracheal cicatricial stenoses is an effective method leading to good functional results of surgical treatment, reducing the time of postoperative wound regeneration and improving the quality of life of patients.

Functional Results of Cephalomedullary Nail Osteosynthesis of Transtrochanteric Fractures in Elderly Patients

Summary. Relevance. Despite many surgical techniques that use modern metal fixators, treatment of elderly patients with fractures of the proximal part of the hip still remains relevant.
 Objective: to evaluate the functional results of surgical treatment of elderly patients with transtrochanteric fractures of the femur using a cephalomedullary locking nail (PFNA).
 Materials and Methods. The study involved 193 elderly patients (mean age 76.2±10.3 years) with transtrochanteric fractures of the femur type 31 A1-A2.1-1.3 (AO/OTA) after osteosynthesis by PFNA cephalomedullar fixator. The functional outcome of the treatment was determined after 1, 3, 12, and 36 months by Harris Hip Score (HHS), radiographic signs of bone union, and the presence of complications. The risk of recurrent trochanteric fractures over the next 10 years was calculated by adapted FRAX scale.
 Results. Positive changes were found by HSS, in the dynamics: 51.6 after 1 month, 60.2 after 3 months, 79.7 after 12 months, and 84.4 after 36 months. Within 6 months after the surgery, the following changes were found: secondary displacement of bone fragments with the “cut-out” eruption of the cervical blade in 2.3% (n=3), migration of the cervical component outward in 4.7% (n=6), and inflammation of surgical wound in 3.9% (n=5) of cases. Retrospectively, the average FRAX score was assessed (22.12±1.76).
 Conclusions. Stable functional osteosynthesis of transtrochanteric fractures of the femur using PFNA combined with early dosed loading on the injured limb allowed to obtain satisfactory functional results in 95.4% of cases. Secondary displacement of bone fragments with the “cut-out” effect requires a detailed analysis of all possible endo- and exogenous factors and identification of the most significant ones. The 10-year risk of recurrent fractures in patients with trochanteric fractures significantly increases over the age of 70, especially in females, and accounts for the majority of osteoporotic fractures.

Метод хирургического лечения сквозных макулярных разрывов малого и среднего диаметра с сохранением фовеальной ВПМ (предварительное сообщение)

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.