Khmyzov S. Guided osteosynthesis with pin systems in pediatric traumatology and orthopaedics

Object of research - processes of biomechanical interaction of pin systems with the damaged (injured), short or deformed sites of a skeleton, processes of controlled correction of deformities of a skeleton. The purpose of research: to prove and develop techniques of application of new pin systems for correction of deformities and fixation of bones in children and adolescents . Methods of research - biomechanical: a line of researches for definition of stability in vitro systems of the most widespread external fixators (EF) was carried out (in comparison among themselves and with the offered designs) by means of modeling process of treatment of fracture and limb lengthening (bench biomechanical model), properties offered transpedicular systems for treatment of diseases and damages of the spine are investigated; radiological: the analysis of variants of development of deformities; clinical: the analysis of results of application EF for all segments of extremities - both at treatment of fractures, and atcorrection of deformities and lengthening various aetiology, and also to summ of experience of use of pin systems for treatment of consequences of traumas and diseases of the spine in children and adolescents. New knowledge: for the first time requirements to pin systems for treatment of fractures, deformities and shortenings of extremities are proved; the biomechanical ground is given to use of pin systems for treatment of fractures, lengthening and correction of extremities deformities, and also correction of some deformities of the spine in children; opportunities of deformity correction of extremities and the spine are determined by different systems of a controlled osteosynthesis; for the first time features of development of deformities of extremities in patients with the uncompleted growth are revealed; for the first time are revealed prognostically significant factors and it is given a substantiation for develop ment of algorithm of calculation for optimal parameters of deformity correction of extremities in patients with the uncompleted growth; requirements for transpedicular systems for treatment spine diseases in children are proved. For the first time in the Ukraine the expediency and efficiency of operative correction of some deformities of the spine with use as devices EF (halo-fixation), and transpedicular pin systems is clinically proved. Theoretical value: opens a way to the subsequent studying patterns of deformities development in children and adolescents. The carried out theoretical, experimental and clinical researches have proved and have confirmed a correctness of the developed concept of strategy of planning and performance of operative correction of deformities of extremities in children and adolescents that will help of formation of correct representations for orthopaedc surgeons all about features of development of deformities of extremities and a processes of their correction. The new system of devices of the external fixing, based on essentially new approaches for correction of deformities and shortening of extremities is developed in details with the technology of operations at various clinical situations for different segments of a skeleton. Experience of clinical application of this group of devices is analysed at treatment of fractures, shortenings and deformities of bones of extremities at 477 patients (737 operations on 538 segments). For the first time, factors of progress of deformities limbs in children with the uncompleted growth are revealed and systematized, and also the algorithm of calculation of optimal parameters of correction of deformities at these patients is developed. Requirements implanted for transpedicular systems for treatment of the spine diseases in children are proved, is developed, and tested biomechanically, are determined the indication for operative treatment of some spinal deformities with the use of transpedicular systems and EF (halo-traction). On the base of results of treatment of 15 patients with spinal deformities it is appreciated efficiency of clinical use of pin systems for correction of spinal deformities. Results of research are intpinuced into clinical practice: three clinics of Institute Spine and Joint pathology named after prof. M.I.Sitenko АМS Ukraine; traumatological and orthopaedic units of the Kharkov regional clinical traumatological hospital; city hospital of Yalta; emergency hospital and regional children's hospital of Nikolaev; the Kremenchug central regional hospital; city emergency hospital of Simferopol; Ukranian Scientific research institute of prosthetics, and restoration of serviceability (Kharkov); orthopaedic and traumatology unit of Volynsk regional children's territorial associations (Lutsk); children's orthopaedic sanatorium named after N.K.Krupskaya (Evpatoria). Materials of the dissertation are included to the plan of teaching at courses faculty of orthopedy of traumatology, Kharkov academy for advanced doctors. Traumatology and orthopaedics