Spinal osteochondrosis takes one of the first places among all chronic diseases, and every second osteochondrosis patient has dystrophic and degenerative changes in the spine in the cervical region. Manifestations of osteochondrosis of the cervical spine are diverse, which often interferes with the diagnosis and subsequent treatment. In osteochondrosis of the cervical spine, clinical symptoms may occur associated with insufficient blood supply to areas of the brain and that would require diagnostic methods that are not included in the standards for diagnosing the disease. In order to study the bioelectrical activity of the brain in 25 patients of the Department of Neurosurgery of Irkutsk Scientific Centre of Surgery and Traumatology with osteochondrosis of the cervical spine with cerebrovascular syndrome; a comparison was made of EEG indicators with a group of healthy volunteers that is representative by sex and age. Encephalogram indices were recorded using an EEG-21/26 Encephalan-131-03 encephalograph (Taganrog) with a standard installation of scalp EEG electrodes using the "10-20"system. An analysis of the rhythms of the bioelectrical activity of the brain in the clinical comparison group revealed a normal zonal distribution with an alpha rhythm dominating the EEG, which generally reflects a high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the main group, EEG indicators significantly differed from the values of the norm and indicators of the control group. Analysis of the bioelectrical activity of the brain of patients with osteochondrosis of the cervical spine was characterized by disorganization of cortical rhythmics with a combination of moderate and diffuse disorders of varying severity. There was a shift in the frequency of bioelectric activity towards slow waves, which is a characteristic of dyscirculatory encephalopathy. Thus, the study of brain biopotentials (EEG) in patients with osteochondrosis of the cervical spine has diagnostic and prognostic significance, as well as a measure of the current clinical condition of the patient.

Background. The dynamic balance between the immune and neuroendocrine systems and their mutual regulation provide the formation of protective reactions of the body in conditions of pathology and various stress-inducing effects. The aim of the research was to establish the nature of the relationship between the indicators of the immune status and hormonal profile in patients with coxarthrosis before and after hip replacement.

Material and methods. The study involved 73 patients with stage HI dysplastic coxarthrosis, who, using cluster analysis according to immunological parameters, were divided into two groups. The first clinical group included 46 patients, the second - 27 patients. The control group consisted of 28 clinically healthy individuals.

Results. In the preoperative period, correlations between indicators of the immune status and hormonal profile were different in patients of the 1st and 2nd groups and depended on the level of hormones. Moreover, in patients of the 1st group, the hormones of the stress-limiting system made the greatest contribution to this dependence, and in patients of the 2nd group - peripheral thyroid hormones. After endoprosthetics, the correlation dependence in patients of the 1st group differed from the initial one in a number of indicators of the immune status and hormonal profile, which reflects the coordinated work of these body systems under the influence of stress factors. In patients of the 2nd group, the spectrum of these indicators was limited, which indicates the failure ofmechanisms, in particular, limiting the intensity ofinflammatory reactions after surgery.

Conclusion. The relationship of the studied parameters in patients of the 1st group indicates the adaptive nature of the immune and endocrine reactions in response to surgery. In patients of the 2nd group, they reflect disadaptive rearrangement, which leads to an increased risk of postoperative complications.

Background. Mechanisms are known that allow partial local regulation of the thyroid status of tissues using peripheral conversion of iodothyronines, which determines the local level of metabolic activity. The molecular mechanisms of degenerative-dystrophic changes in the ligamentum flavum are not well understood; only a few studies on the expression of genes in this substrate have been published.

The aim of the study was to identify key factors in the peripheral conversion of iodothyronines in ligamentum flavum in patients with stenosis of spinal canal and dural sac in the lumbar spine and to evaluate the features of the expression of deiodinase genes depending on the severity of ossification processes of ligamentum flavum.

Methods. A group of patients with stenotic processes of the spinal canal was examined: 31 people (15 men, 16 women). The average age was45.73 ± 1.95years. In intraoperatively collected samples of ligamentum flavum, the expression ofdeiodinase genes (real time PCR) was studied and the severity of ossification processes was evaluated using a histopathological study.

Results. The key factors of peripheral conversion of iodothyronines in intraoperative bioptates of the ligamentum flavum of patients (n = 31) with stenosis of the spinal canal at the lumbar level were revealed. Information was obtained on the local level of metabolic activity in the focus of pathology. The intensity and variability of deiodinase gene expression in ligamentum flavum samples were evaluated. The distribution of deiodinase gene expression patterns in groups formed on the basis of presence/absence of ossification of ligamentum flavum was found. Various variants of peripheral conversion of iodothyronines in biopsy samples of the yellow ligament of the operated patients were determined and the frequency of their occurrence was estimated.

Conclusion. The key factors ofperipheral conversion of iodothyronines in intraoperative biopsy samples of the ligamentum flavum of patients with degenerative diseases of the spine were revealed for the first time. The reasons for the differences in tissue metabolism of iodothyronines and the place in the pathogenesis of stenotic processes are yet to be found.

Osteoporosis and osteochondrosis have common clinical manifestations: poor posture, reduced flexibility and mobility of the spine, joint pain, fatigue, weakness; both diseases appear most often in old age. Having a lot in common in symptoms, osteoporosis and osteochondrosis differ in etiology, treatment and prognosis.

The development of osteoporosis is based on impaired bone remodeling, but it has been established that this process is also important in the pathogenesis of osteochondrosis. The results of previous studies indicate that there is a relationship between the functional state of the neuromotor apparatus and the violation of the structure of bone tissue in the spinal canal stenosis of the lumbar spine. There is data on the study of the nerve conduction and bone mineral density in patients with osteochondrosis of the cervical spine in a small sample.

To study the functional state of peripheral nerves and the presence of disorders of bone tissue structure in 2018, 25 patients of the neurosurgical department of Irkutsk Scientific Centre of Surgery and Traumatology were observed with the diagnosis "Dorsopathy, Osteochondrosis of the cervical spine" (М50.1) and 25 volunteers of the control group, representative of the main sex and age. As a result of the examination, all patients of the main group showed sufficiently deep afferent-efferent dysfunctions of the segment apparatus of the cervical spine, while in the control group changes in ENMG indicators showing initial changes in the function of the neuromotor apparatus were observed in 20 % of the examined. The change in bone density was observed in most of the main group examined (72 %), in the control group the decrease in bone density was less frequent (54 %, of which 29 % registered osteopenia). The results of the examination indicate the existence of a relationship between osteochondrosis and osteoporosis - the more symptoms of sensory-motor dysfunction of the root increase in osteochondrosis of the cervical spine, the more often the change in bone density - osteoporosis or osteopenia - is diagnosed.

The article analyzes the data of 58 sources of literature on the treatment of cervicobrachial syndrome in patients with cervical osteochondrosis. The anatomical and topographic features of the cervical spine, which are predisposing factors for the development of the studied pathology, namely, the small size of the vertebral bodies and their increased mobility are noted in the work. A high incidence of degenerative-dystrophic diseases of the cervical spine was found in persons over 60years old (50 %) and aged 60years and older (75 %) with a predominance of the development of the pathological process at the level of the C_V-C_VI vertebral motor segment. According to the literature, the attitude to the problem of treating this pathology is contradictory. The main points of application of conservative treatment are the elimination of pain and muscle spasm, an increase in the volume of movements in the cervical spine. Despite the fact that significant progress has been achieved in recentyears in conservative treatment of patients with pathology of the cervical spine, many tasks remain unresolved and require further analysis, and therefore the problem of improving diagnosis and treatment remains relevant, socially significant and timely.

This paper presents the analysis of diagnostic policy of 72 patients with cervical osteochondrosis and cervicobrachial syndrome. All patients were examined according to a single program, which included a specially designed questionnaire containing address data, diagnosis, history of life and illness, patient complaints, with a mandatory examination by a neurologist for the presence of compression of neural structures of the cervical spine with a detailed description of the local status and clinical and neurological syndromes. Patients underwent general spondylography of the cervical spine in the anteroposterior and lateral projections. For the diagnosis of segmental instability, functional spondylography was performed in the position of maximum flexion and extension and functional spondylography with burdening, which is based on mathematical modeling of the distribution of the vector force load system in the cervical spine under conditions of inclination of the head at an angle of 45° (flexion) and 15° (extension) with the weight on the head weighing up to 500 grams (putting a special device on the head). A mathematical formula for calculating the index of instability of the vertebral motor segment in the cervical spine is proposed. Sagittal balance of the cervical spine was studied with the correlative dependence of its indicators with the intensity of the pain syndrome according to standard spondylography and magnetic resonance imaging. Identified marker indicator of electroneuromyographic studies of the upper extremities - F-wave. Based on the obtained fundamental knowledge, an algorithm for diagnosing osteochondrosis of the cervical spine and cervicobrachial syndrome has been developed and scientifically substantiated.

The aim of this research was to study the most important problems in diagnosing a socially significant problem - osteochondrosis of the cervical spine. According to some authors, in the structure of disability and disability associated with pathology of the spine, diseases of the cervical spine occupy one of the leading positions.

The paper analyzes data from 41 sources of literature on the pathogenesis and diagnosis of osteochondrosis of the cervical spine. Due to the complexity and ambiguity of the approaches to the diagnosis of osteochondrosis of the cervical spine, this paper analyzes the most important research methods in the diagnosis of this pathology. Attention is focused on the main pathogenetic prerequisites for the occurrence of pain.

According to literature data, the main attention in the diagnosis of osteochondrosis of the cervical spine is given to the basic methods: clinical and neurological examination, where the severity of the disorders is determined using scales that include not only an assessment of the intensity of the pain syndrome, but also the determination of a number of neurological disorders. The authors propose the use of a DN4 questionnaire, LANSS scales, neurological impairment scales (N1S); radiation research methods, such as survey spondylography of the cervical spine in direct and lateral projections, functional spondylography of the cervical spine in the position of maximum flexion and extension, multispiral computed tomography, magnetic resonance imaging data, and neurophysiological studies. Radiation research methods can determine pathological changes in the bone tissue itself. Magnetic resonance imaging indices make it possible to assess the degree of pathological changes in the soft tissue anatomical structures of the spinal canal and intervertebral discs. According to the literature, much attention is paid to functional research methods, in particular, electroneuromyography, which allows to assess the level and degree of damage to nerve fiber, the dynamics of the pathological process. Attention is paid to the allocation of marker indicators. All methods are significant, evidence-based, objective and modern and do not exclude the possibility of using data from other research methods.

The analysis of the presented literature once again convinces clinicians of the ambiguity and heterogeneity of approaches to the issues of pathogenesis and diagnosis of the cervical spine, which requires further improvement of the proposed methods for clarifying and objectifying the pathological process. An important andjustified is a pathogeneti-cally grounded approach to their study.

The paper presents the experience of surgical treatment of 58 patients with discogenic lumbosacral radiculitis.

The aim of the surgical treatment was to eliminate the compression of the spinal roots of the herniated disc with the subsequent stabilization of the spinal-motor segment with implantable interspinous system COFLEX.

Indications for surgical treatment were persistent radicular pain syndrome, which was not stopped by conservative methods of treatment, and disco-radicular conflict in the area of the interested vertebral-motor segment, confirmed by radiation research methods. In the diagnosis, the following research methods were used: clinical and neurological examination, survey and functional spondylography of the lumbar spine, computed tomography with contrast myelography, morphometric and statistical methods. The effectiveness of treatment was evaluated in 49 patients (84 % of operated) one and a half years after surgery. All patients showed complete regression of neurological deficit and satisfactory standing of the implanted interstitial dynamic system COFLEX in the operated vertebral-motor segment. Thus, the use of the implantable COFLEX dynamic system for the above indications is the choice method for operating surgeons, in which it is assumed that the function of the interested vertebral-motor segment is preserved.

 

Aseptic necrosis of a femoral head - severe chronic orthopedic pathology (1.2-12 %), diagnostics of which presents considerable difficulties. Problems of fast diagnostics, identical clinical symptoms, rapid development of the disease leads to disability. Risk group includes young and middle-aged men. The cause of the disease is unknown, the possibilities of conservative treatment are applied only in the early stages with doubtful efficiency, and among surgical none is the best. The research is performed in the traumatology center of Khabarovsk - clinical base of a Postgraduate Institute for Public Health Workers. During 2014-2019, retrospective analysis of treatment results was carried out on the basis of statistical data of 97 medical maps of patients diagnosed with aseptic necrosis of a femoral head, pathomorphological study of 49 preparations of the femoral head; laboratory analysis of immunological indicators of cellular immunity and thyroid hormones in the operated group of patients was carried out. Detected immunological changes indicate the systemic nature of the disease. Method of minimally invasive two-stage decompression of femoral neck is developed. Minimum injury of the developed method of treatment provides undeniable advantages in contrast to previous methods of surgical treatment. The technique has been applied in 17 cases, with positive medium-term clinical results. Aseptic necrosis of a femoral head is a pathology with a polymorphologicpicture, diagnosis of which presents considerable difficulties, associated with high risk of development atyoung age, is a current problem and demands further studying for the purpose of achievement of permanent long remission, and, perhaps, and an absolute recovery of the patient.

The article presents the case of the patient having an infectious complication in the area of the endoprosthesis after performing revision knee replacement. Revision surgery was performed six months after the primary knee replacement due to the instability of the components of the endoprosthesis. In analyzing the case of an infectious complication, a six-point risk factor for the development of infectious complications was given taking into consideration the following factors: body mass index; ASA physical status evaluation; the presence of diabetes mellitus, concomitant systemic diseases; the presence of allergic reactions; the presence of previous operations on the joint; index of the ratio of segmented neutrophils and monocytes.

The analysis made it possible to establish that the patient had a high risk of infectious complications before the surgery of the endoprosthesis replacement and determine the list of necessary preventive and therapeutic measures (glycemia correction, bacteriological examination of the knee joint puncture, rehabilitation of existing and possible foci of chronic infection, examination and treatment at the center of osteoporosis) that had not been held. The implementation of surgical treatment - revision knee replacement - against the background of a high risk of infectious complications led to the development of the infectious process. To stop the infection process, surgical treatment was performed, including necrectomy, debridement, drainage of the knee joint, without removing the components of the endoprosthesis. Remission was achieved.

The clinical case of an infectious complication of revision knee arthroplasty is of interest, as it shows the importance of assessing adverse prognostic factors, establishing the degree of risk of infectious complications, and conducting the necessary preventive and therapeutic measures in the preoperative period to reduce the risk of developing an infectious process in the endoprosthesis area.

Dupuytren disease is widespread among the population of different countries (3 %) and affects the working-age male population to a greater extent.

The progressive nature of the course of Dupuytren disease causes a persistent and significant decrease in the functional capabilities of the hands of patients and leads to a limitation of fine and high-precision activity on average in 67 % of patients, and in 3 % causes disability.

The problem of treating patients with Dupuytren's contracture remains relevant despite the achievements ofhand surgery. A large number of applied methods speaks of both the urgency of the problem and the possibility of a comprehensive approach to treating patients with this disease at different stages and with varying degrees of severity of contracture of the fingers. Many techniques for treating Dupuytren's contracture and their modifications are described. These are extensive surgical interventions, which involve the complete excision of the palmar aponeurosis, and selective open interventions, which involve the removal of only macro-modified areas - the bundle of the palmar aponeurosis through one large or several small accesses. With the development of minimally invasive techniques, needle-based aponeurotomy methods have spread, which do not imply the removal of pathologically altered tissues, but only relieve tension in the tissue by dissecting it and thereby increase movements in the joints of the fingers. With the development of pharmacology, methods for the enzymatic destruction of the bundle of pathologically altered palmar aponeurosis have appeared.

The evolution of approaches to the treatment of Dupuytren's contracture is visible in a gradual transitionfrom complete excision of the palmar aponeurosis to selective techniques, and from them to partial dissections and further to needle and enzymatic methods. However, despite the abundance of methods and good results in treating patients with this pathology, there remains a percentage of relapses, complications and adverse outcomes, the reduction of which is the purpose of developing a modern understanding of this pathology.

The consequences of ankle fractures are a leading cause of disability among injuries of the musculoskeletal system. The problems of treating patients with this pathology have been of interest to researchers throughout the entire period of development of ankle joint surgery. However, numerous attempts to define terminology and classify chronic ankle joint injuries were unsuccessful. It can be argued that the consequences of ankle fractures are a symptom complex that includes traumatic deformity and pseudoarthrosis of the ankles, subluxation of the foot, contracture and arthrosis of the ankle joint. Today, for the surgical treatment of chronic injuries of the ankle joint, a number of surgical techniques are used, the indications and contraindications for each of them are not completely determined. In addition, longterm results are also the subject of a debate. There is a need to develop an improved approach to the treatment of the pathology under consideration, to create a decision-making algorithm in each specific clinical case. There is no doubt that preference should be given to organ-preserving operations.

Based on a review of world literature, data were obtained on the epidemiology, medical and social significance of the effects of ankle fractures, and the evolution of researchers' views on the treatment of patients with this pathology and their development prospects were examined.

Fractures associated with osteoporosis, due to the high prevalence and high percentage of related complications, are a serious problem for modern traumatology and orthopedics. Among all injuries of the upper extremities, fractures in the proximal humerus occur in 32-65 % of cases. Fractures of the proximal humerus account for 4-5 % of all fractures and 50 % of fractures of the humerus. The aim of the research was to develop a new method for the surgical treatment of fractures of the proximal humerus against the background of osteoporosis and to evaluate the clinical effectiveness of the new method. A pilot study was conducted to evaluate the clinical efficacy and safety of surgical treatment of patients with a fracture of the proximal humerus. The results showed that the new "Method for the surgical treatment of patients with a fracture of the proximal humerus" is clinically effective and safe. Additional intramedullary bone stabilization of the proximal humerus with a fibular autograft allows for more rigid and stable fixation of fragments, especially in the presence of critical osteoporosis. The early restoration of passive and active movements in the shoulder joint made it possible to fully restore the function of the limb in a severe fracture of the proximal section.

Researches performed in the past 20 years show the necessity of the restoration of anatomic position of anterior cruciate ligament as the main stabilizing structure of the joint in combination with the restoration of other injured elements and correction of deformities, which affect the outcomes of the treatment.

Complexity of the restoration of anatomic position of torn anterior cruciate ligament is caused by its wide area of contact in combination with relatively small sectional area through the joint cavity. More detailed study of topographic anatomy of anterior cruciate ligament allowed the researchers to explain this phenomenon, which pushed them closer to the solution of the problem.

Systemic anatomy of anterior cruciate ligament include two bundles - anteromedial bundle and posterolateral bundle. Double bundle plasty of anterior cruciate ligament restored anatomy to its nearly normal condition, but single bundle plasty is used much more often because of its simpler technique. However, the researchers still cannot reach a consensus in the choosing of single or double beam plasty at the restoration of anterior cruciate ligament.

Background. Traditional methods of surgical treatment of severe Hallux valgus (HV) lead to a large number of complications and poor results. In order to avoid complications and improve the quality of treatment, an original technique of double osteotomy of the first metatarsal bone has been proposed.

The aim of the study was to conduct a comparative assessment of the results of applying the original technique in the treatment of patients with severe Hallux valgus.

Materials and methods. A retrospective analysis of the treatment of 95 patients operated on at the Seversk Clinical Hospital for severe Hallux valgus in the period from 2008 to 2016 was performed. The study group included 60 patients who underwent surgery according to the original method. In a comparison group of 35 people, Logroshino's surgery was performed. Clinical, radiological, surgical and statistical research methods were used.

Results. The final assessment of the results 1 year after the operation showed an unacceptably high number of Hallux valgus relapses, complications, and unsatisfactory results in the comparison group. The use of original approachesfor osteotomy of the first metatarsal bone in patients of the study group allowed to significantly improve treatment results and achieve good results in 85 % of cases.

Conclusion. The proposed surgical technique is effective and shows statistically significantly better results 1 year after surgery. Application of the original technique will improve the results of surgical correction of the severe degree of Hallux valgus, which consists in reducing the number of complications and improving functional indicators.

The article presents an analysis of the results of treatment of 62 patients with deep periprosthetic infection of the hip and knee joints who underwent revision arthroplasty. The age of the patients is from 37 to 81 years (mean age 62.7 ± 3.21 years). Men made 51.6 % of all patients. Periprosthetic infection after hip replacement occurred in 34 patients, knee joint - in 28 patients. There were 67 completed revision interventions.

The analysis showed that the use of revision endoprosthetics for periprosthetic infection made it possible to stop the infection process in 68.7 % of cases. In case of one-stage revision endoprosthesis replacement, unsatisfactory results in terms of stopping the infection process amounted to 31.8 % of cases. Of these, subsequently in 8 patients (57.1 %) the endoprosthesis was removed with the subsequent formation of ankylosis of the knee joint and neoarthrosis of the hip joint. An unsatisfactory result of two-stage revision endoprosthetics was obtained in 38.9 % of cases. Of these, in 6 cases (85.7 %), the infectious process was not stopped at the stage of spacer installation.

The analysis of cases of unsatisfactory results of revision endoprosthetics was carried out taking into account the method we developed for determining the surgical tactics of revision endoprosthetics of large joints in case of infectious complication, based on establishing the degree of risk of maintaining the infectious process. In addition, adverse factors that prevented the relief of periprosthetic infection were identified. As a result of the analysis, it was revealed that the reason for the unsatisfactory result of one-stage revision endoprosthetics in 12 cases was the wrong choice of the type of revision intervention. When planning a two-stage revision endoprosthesis replacement, it is necessary to take into account factors such as an allergy to antibacterial drugs, multiple surgical interventions on the affected joint, and extensive bone defects in the endoprosthesis area.

Over the past decades, the problem of treating multiple fractures of the limb bones has been the focus of attention of most orthopedic traumatologists in our country and abroad. The urgency of the problem is also determined by the fact that the nature of injuries and their consequences changes with a tendency to increase. Qualitative changes in the structure of injuries are due to an increase in the level of multiple and associated injuries. The use of sequential osteosynthesis in patients with fractures of the long tubular bones of the extremities implies primary stabilization of bone fragments with an externalfixation device and repeated immersion osteosynthesis, when it is possible to achieve stabilization of the patient's condition. There are various rod and pin devices for fixation, some of them are for fixing (which are necessary to remove before the operation), some for preliminary reposition of the fracture during the operation (necessary to remove the skeletal traction or plaster cast and apply the apparatus, which only adds steps to the procedure). The proposed technique is notable for its simple assembly and application, as well as its ease of construction, which ensures patient mobility and allows the patient to stabilize without imperfections and perform final immersion osteosynthesis.

Introduction. The proportion of injuries of the rotational cuff is from 65 to 84 % of all injuries of the shoulder joint. This pathology is more often registered in people over 60 years old. It is far from always that during initial visits, patients are given the correct diagnosis. Most patients are treated conservatively with short-term improvement or without dynamics. The main diagnostic method is an MRI of the shoulder joint, where we can see soft tissue structures. The proportion of massive rupture of the tendons of the supraspinatus muscle is 10-40 % of all ruptures of the rotator cuff.

The more time passes from the moment of injury to surgical treatment, the more pronounced are the retraction and degenerative changes in tendons. A special category is occupied by patients with chronic rupture of the tendon of the supraspinatus muscle with a retraction of more than 5 cm (Patte grade III) and Thomazeau grade 3 fatty degeneration.

In this category of patients, it is not possible to re-insert the tendons of the rotational cuff of the shoulder.

Objective: to evaluate the clinical effectiveness of surgical treatment of a patient with retinal tendon retraction (Patte grade III) and Thomazeau grade 3 fatty degeneration.

Materials and methods. The clinical case is presented: a man with a chronic total rupture of the tendon of the supraspinatus, infraspinatus muscle (Patte grade III) and Thomazeau grade 3 fatty degeneration. Secondary upper subluxation of the head of the humerus is revealed. The patient underwent surgical treatment: transposition of the latissimus dorsi muscle on the large tubercle of the humerus.

Results. Six months after the operation, the patient restored the function of the upper limb, pain was stopped. Conclusion. Given the functional result, transposition of the latissimus dorsi tendon can be considered the technique of choice for inoperable tendon rupture of the supraspinatus muscle.

The article presents the case of successful surgical treatment of a female patient with severe deformities of the toes arising from rheumatoid arthritis. After clinical and radiological examination the patient was diagnosed with a hallux valgus deviation of the first toe, with 64 degrees of valgus deviation angle, and a valgus-hammered deformity of the II, III, IV toes with a dislocation of the III and IV toes. There was a violation of the stato-dynamic function of the foot, severe pain. Two techniques of joint-preserving surgical treatment were selected. Correction of deformation of the first toe was carried out according to the author's technology, to correct the deformation of other toes, the Helal technique was used in the author's modification. The result of the treatment was the achievement of correction of the deformation of the first toe and the elimination of the deformation of the second, third, and fourth toes. The patient is satisfied with the outcome, the appearance of the left foot, its function, the ability to walk without pain and wear ordinary shoes.

This clinical case of surgical treatment of severe deformities of the toes with rheumatoid arthritis shows the possibility and importance of joint-saving operations to obtain a good cosmetic and functional result. Performing osteotomy of the metatarsal bones in the proposed modifications allows to correct the hallux valgus deviation of the first toe and deformation of the other toes. As a result of using these technologies, it is possible to maintain metatarsophalangeal joints, eliminate dislocations and subluxations, restore joint function, form an arch of the transverse arch of the foot, relieve pain, thereby improving the anatomical and functional state of the entire foot.

Adhesive disease of the abdominal cavity remains one of the unresolved problems of abdominal surgery. The clinical picture of the pathological process is diverse, treatment of patients is not always effective, and decision-making on the use of certain medical methods is often difficult.

The aim of the research was to assess the severity of the adhesive process and the likelihood of complications in patients with adhesive disease of the abdominal cavity.

Materials and methods. We performed the retrospective analysis of 160 case histories of patients for the period 2006-2010, who, according to emergency indications, were admitted to the surgical department of the Irkutsk Regional Clinical Hospital with a clinic of acute adhesive intestinal obstruction against the background of adhesive disease. To assess the severity of the adhesive process, our own scale for assessing the adhesive process of the abdominal cavity was developed and tested in clinical conditions. To assess the likelihood of developing postoperative unformed intestinal fistulas, a prospective analysis of the treatment of 36 patients with acute adhesive intestinal obstruction was performed.

Results. The severity of the adhesive process in the operated patients was 13 (10-15) points, which indicates a pronounced adhesive process. In patients operated repeatedly for commissural intestinal obstruction, the severity of the adhesion process according to the proposed scale was 14 (14-15) points, which corresponds to pronounced adhesion of the abdominal organs. Based on the proposed scale, the probability of developing postoperative unformed intestinal fistulas was calculated. The sensitivity and accuracy of the probability scale was 71 % (CONSORT). Thus, an intraoperative assessment of the severity of the adhesive process allows us to predict the likelihood of postoperative external intestinal fistula.

Many years of experience in identifying patients with various pathologies of the adrenal glands using multispiral computed tomography are presented. Multispiral CT is a highly informative method of choice in the diagnosis of adrenal tumors. Multispiral CT in the perfusion version of the tumor of the adrenal gland increases the accuracy of diagnosis, which optimizes the tactics of treatment. Improving the algorithm for assessing perfusion indices of the adrenal gland incidentalomas using multispiral CT will allow to evaluate the histological nature of the pathological process. It is justified to conduct perfusion MSCT studies in patients with volumetric adrenal masses with the purpose of differential diagnosis of hyperplastic and tumor processes in them. An attempt was made to develop an algorithm for MSCT diagnostics of the adrenal glands and determine its effectiveness. The radiological characteristic of the adrenal glands incidentalomas is a reflection of their morphological structure. There are statistically significant differences in aldosterone-producing and cortisol-producing adenomas in size and CT density. Morphological signs of adrenal tumor degeneration correlate with functional activity. Surgical treatment is absolutely indicated for patients with incidentalomas corresponding to the radiological phenotype of malignant tumors, as well as for patients who have revealed hormonal activity during a comprehensive examination. Dynamic observation is indicatedfor patients with hormonal-inactive incidental small-sized (< 4 cm) in the absence ofradiological signs of malignancy. In patients with an extremely high risk of surgical treatment, endovascular interventions aimed at suppressing adrenal hyperfunction are advisable. The main prognostic factors for adrenal glands incidentalomas are: radiological phenotype, hormonal activity, duration of the disease, the choice of adequate treatment tactics. In surgical treatment, the prognosis depends on the morphological characteristics of adrenal gland incidentalomas.

The paper presents an experimental model of the development of degenerative-dystrophic processes in the intervertebral disc at LVI - St level, worked out by specialists of Irkutsk Scientific Centre of Surgery and Traumatology. For the purposes of the research we used the techniques of laminectomy and LVI facetectomy.

Materials and methods. The experiment was conducted on ten Wistar male rats using microsurgical instruments and binocular optics with a 6-fold magnification. The reliability and effectiveness of the obtained model were evaluated by X-ray and histological research methods. Spondylograms assessed the level, volume of surgical intervention and the likelihood of LVI spondylolisthesis occurrence relative to St against the background of impaired spinal support function created surgically on the day 15 of the experiment. The histological picture of degenerative changes in the intervertebral disc was assessed on the week 16 and 24 after the animals were sacrificed.

Results. An X-ray examination on the day 15 revealed LVI spondylolisthesis relative to SI in 4 out of 10 experimental animals. To assess the nature of degenerative-dystrophic changes in the intervertebral disc, five rats were sacrificed at the 16th week and five - at the 24th week. When analyzing the obtained histological data, we noted the progression of degenerative-dystrophic changes in the intervertebral disc occurring by the 24th week.

Conclusion. The designed model for the development of degenerative-dystrophic changes in the intervertebral disc is in direct correlation with the violation of the integrity of the posterior supporting complex with the subsequent formation of spondylolisthesis and instability in this segment. Histological studies in the intervertebral disc reliably confirmed the formation and progression of degenerative-dystrophic changes in the intervertebral disc at the LVI-SI level from the 16th to the 24th week of the experiment. The obtained experimental model of the formation of degenerative-dystrophic changes without mechanical damage to the intervertebral disc will allow clinicians to obtain information about the primary changes in the intervertebral disc, to study the mechanisms of development and the course of degenerative changes in the intervertebral disc on the model of disturbance of the back supporting complex with pathological changes in the biomechanics of the spine after laminectomy and facetectomy. Understanding and knowledge of the pathogenesis of degenerative-dystrophic disease of the spine will allow specialists to exercise an etiopathogenically reasonably approach to the issues of prevention and treatment.

According to modern literature, a sufficient number of studies have been carried out to determine the mechanical strength of transplants from the tendon of the semitendinous and gracilis muscles, the autologous ligament of the patella, the broad fascia, peroneus longus tendon, each of which has unique characteristics, but at present, transplants prepared by original (new) methods are understudied.

In the period from November 5 to December 17,2018 we conducted an experimental study to determine the mechanical strength of a transplant from a tendon of a semitendinosus muscle taken from cadaveric material. The transplants were prepared by original and well-known (Graft-Link technique) methods.

The experimental study was approved by the Ethics committee of Irkutsk Scientific Center of Surgery and Traumatology. The material for the study was prepared on the basis of the Irkutsk Regional Bureau of Forensic Medical Examination.

After sampling the cadaveric material being studied, the main stages of the experimental study were carried out at the materials resistance department of the Irkutsk State Technical University. Studies of the mechanical properties of the transplant were carried out on a Shimadzu testing machine registered in the State Register of Measuring Instruments and approved for use in the Russian Federation.

As a result of the study, we obtained the following data. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in an original way is on average 607.8 ± 101.2 N/mm. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in a traditional manner (Graft-Link technique) is on average 351.8 ± 133.0 N/ mm.