Oliinyk Y. Fibrous dysplasia of long bones of the lower extremities (diagnostics, treatment and prevention complications)

The dissertation is devoted to the improvement of diagnostics and surgical treatment of patients with fibrous dysplasia of long bones of the lower extremities. The results of clinical and radiological studies indicate that the main clinical manifestations of this disease were pathological fractures, bone deformities and pain syndrome. It was determined that the greatest number of pathological fractures related to the proximal part of the femur (76.7%). It was found out that the factors of the risk of fractures of this localization belonged to the type of defeat with fibrous dysplasia (total defeat of the proximal part of the femur - type 1 or lesion of the neck in intertrochanterica region - type 3) and the age of the child 9-14 years (pre- and puberty age). It has been proved that in the case of inadequate diagnosis and inadequate treatment, fibrous dysplasia of the proximal part of the femur can be complicated by a variegated sheath strain, requiring mandatory surgical correction. Based on the developed biomechanical model of monostotic fibrous dysplasia of the proximal femur, "critical" load and deformation zones that were localized on the upper and lower parts of the neck. The obtained data indicated the need for preventive surgical interventions to strengthen the bone area in order to prevention of pathological fractures. According of the biomechanical research on mathematical modeling and determination of indicators of the stress-strain state of the created models, the stresses, the objective advantage of the LCP plate for the proximal femoral and the femoral locking rod above the corner plate have been proved. The conducted experimental researches with the test load with the destruction of models with metal fixator confirmed the strength of these metal fixators and their ability to maintain maximum loads with sufficiently stable fixation. Based on the received data of biomechanical research objectively confirmed the need for preventive synthesis of the proximal femur in patients with fibrous dysplasia. The efficiency of applied modern intramedullary metal fixator, including those that "grows" in patients with fibrous dysplasia of long bones of the lower extremities, has been proved, which allowed to prevent complications (fractures and deformations) and to reduce the terms of restorative postoperative period. The algorithm of the differentiated approach to the choice of the method of surgical treatment of fibrous dysplasia of long bones of the lower extremities with pathological fractures and deformations (reconstructive surgical interventions) depending on the form of the disease and age of the patient with the use of modern skeletal and intramedullary fixator, which will increase the effectiveness of treatment, is developed.