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Вестник КозНЛЛУ № I - 2020
E. Nabiyev, S. Alkhodzhayev, K. Tezekbayev, Y. Duisekeev, R. Roziyev, B. Tleunazarov, O. Amirshe, Z. Zhetpisbayev, N. Turgaraev
Asfendiyarov Kazakh National medical university
SURGICAL TREATMENT OF TROCHANTERIC FEMORAL FRACTURES
Resume: The article presents the results of surgical treatment of 72 patients with trochanteric fractures of the femur treated during the period from 2017 to 2019. 42 patients made up the control group. They performed surgical treatment to them by using the proximal femoral nail - PFN, postoperative rehabilitation was carried out by the traditional method. The main group consisted of 30 patients who performed osteosynthesis of the femur using a new device (patent RK №33450 dated 02/11/2019), postoperative rehabilitation was
carried out according to a new technique (patent application RK). The use of a new device for osteosynthesis of trochanteric fractures of femor provided positive results (good and satisfactory) in 96.5% of cases. In the control group, the positive treatment outcome is 88.6%. Unsatisfactory treatment results in the main group were recorded 3.2 times less compared to the control group (3.5% versus 11.4%) (p <0.001). Keywords: trochanteric fractures, proximal femur, immersion osteosynthesis, proximal femoral nail
УДК 616-08; 616.72-001.6.717.2
Y. Nabiev, S. Alkhojayev, D. Dauletbayev, S. Kozhakov, R. Maxutov, A. Chovdyrbaev, D. Kemelov, N. Khalmuminov, M. Shoraev, E. Duisekeyev
Asfendiyarov Kazakh National medical university
COMPLEX TREATMENT OF PATIENTS WITH FRACTURES OF HUMERUS
Rationale. Treatment of patients with fractures of the proximal humerus (FPH) of the different age groups remains an actual problem of modern traumatology and orthopedics [Минаев А.Н., 2010; Набиев Е.Н., 2012; Лазарев А.А., 2015; Lind T. et al., 2004; Machani B. et al., 2006]. According to the literature, the fractures of a like nature make up 4-5% in the structure of the fractures of bones of sceleton [Лазарев А.А., 2015; Machani B. et al., 2006], and according to some sources up to 12% [Елдзаров П.Е. и соавт., 2010; Court-Brown C.M., et al., 2008], and among the fractures of humerus - 45-80% of cases [Коломиец А.А., 2006; Батпенов Н.Д. и соавт., 2017; Russo R., 2005]. For osteosynthesis of FPH uses a lot of contractures and methods osteosynthesis, however they are not without flaws. So, extramedullary osteosynthesis by existing plates can lead to the development of rotator cuff syndrome, the migration of screws, and also the presence of aseptic necrosis of the head of the humerus [Неверов В.А. и соавт, 2006; Лазарев А.А., 2015; Wanner G.A. et al., 2003; Sporer S.M. et al., 2006]. The use of closed blocking intramedullary fixation (CBIF) is associated with appearance of rotator cuff syndrome , damage to nerve structures in the proximal and distal parts of the shoulder with screws. [Макарова С.И., 2010; Ruedi T.P. et al.; 2001; Janotti J., 2003]. External fixation devices for osteosynthesis of POPOK are rarely used due to the complexity of manipulation, the risk of damage to blood vessels and nerve structures, the development of soft tissue inflammation in the spokes [Макарова С.И., 2007; Набиев, Е.Н. 2014; Lungershausen W. et al., 2003; Martin S.D., 2005]. The method of closed repositioning of bone fragments followed by fixation with spokes does not exclude secondary dislocations of fragments, damage to the vasculature and the migration of the spokes [Панков И.О., 2002; Набиев, Е.Н. 2013; Mellado J.M. et al., 2004; Keener J.D. et al., 2007]. According to the researchers, the incidence of unsatisfactory outcomes in the operative treatment of FPH is observed in 1.6% -57.1% of cases [Лоскутов А.Е. и соавт., 2004; Janotti J., 2003].
Table 1 - Distribution of patients with FPH by age and sex
Goal of research.
Improvment the results of surgical treatment of patients with fractures of the proximal part of humerus by developing devices for stably-functional osteosintesis and rehabilitation method of patients in post-operation period. Materials and methods of clinical research. Present study based on the analysis of results of operative therapy of 136 patients with subcutaneous fracture and dislocation-fracture of bones of shoulder girdle at the age of 17 to 75 years , which pretreated in the traumatology departments of the RSE "Scientific - Research Institute of Traumatology and Orthopedics" of MHSD of KR in the period from 2002 to 2010. 82 (60.3%) patients of the 136 (100%) patients with FPH made up a control group. Patients of the control group were treated with known methods. After blockade, the place of fracture with novocaine solution was conservatively treated by applying skeletal traction. In the absence of the effect of the treatment, an operative method of correction using known fixatives was used. In the postoperative period, a "Dezo" bandage or a thoracobrachial bandage for 4-5 weeks was used as an immobilization. After removal of the immobilization, the patients were prescribed physiotherapeutic procedures, exercise therapy and muscle massage of the shoulder girdle.
The main group included 54 (39.7%) patients who underwent osteosynthesis with new devices and used the developed technique of rehabilitation in the postoperative period. Age grouping of patients with FPH in groups was carried out according to the recommendations of the symposium on establishing age limits (Leningrad, 1962) and the seminar of the WHO Regional Office for Europe (Kiev, 1963). Thus, the patients were divided into the following age groups: I - people of young age (under 45 years), II - middle-aged people (45 to 60 years), III - elderly (60 to 74 years), IV - old people (from 75 to 89 years) and V - long-livers (from 90 years and above). Table 1 shows the distribution of patients by age and sex.
Age Sex Total
Men Women abs. number %
abs. number % abs. number %
Under 44 years old 38 27,9 29 21,3 67 49,2
From 45 to 59 years old 18 13,2 26 19,1 44 32,3
From 60 to 75 years old 9 6,7 16 11,8 25 18,5
Total: 65 47,8 71 52,2 136 100,0
VeStnik KQzfimU № I - 2020
According to the data in Table 1, it is seen that of the 136 patients with FPH male there were 65 (47.8%), women - 71 (52.2%). Their ratio was 1.0: 1.1. The data obtained are responded to with the data of many researchers, who note the predominance among female patients with FPH. This trend is explained by hormonal changes in the female body, beginning in the post-menopausal period. Among the victims under the age of 44, 38
(27.9%) were male. In the group of patients older than 45 years, the ratio of women and men was 1: 1.6.
The average age of the operated patients with FPH was 48.0 ± 2.4 years.
Table 2 shows the distribution of patients by age and clinical groups.
Table 2 - Distribution of patients with FPHby age and by clinical groups
Age Main group Control group Total
abs. number % abs. number % abs. number %
Under 44 years old 26 19,1 41 30,1 67 49,2
From 45 to 59 years old 18 13,2 26 19,1 44 32,3
From 60 to 75 years old 10 7,4 15 11,1 25 18,5
Total: 54 39,7 82 60,3 136 100,0
As can be seen from Table 3, the absolute majority of patients in the clinical groups were individuals up to 44 and up to 59 years old (49.2% and 32.2%), these are people of the most able-bodied age who are responding to the data given in the literature. Damage to the proximal left humerus was recorded in 63 (45.5%) patients, right - in 73 (53.5%) patients.
The social status of patients with FPH is as follows: workers -23.0%, pensioners - 22.6%, employees - 15%, students - 12%, temporarily unemployed - 26.0% and disabled persons - 1.4%. The distribution of patients with FPH, depending on the type of injury, is presented in Table 3.
Table 3 - The distribution of patients with POPC depending on the type of injuries
Вид травмы Number of patients
Abs.number %
Home accident 51 37,5
Outdoor injury 36 26,5
Road traffic accident 38 27,9
industrial accident 7 5,1
athletic injury 4 3,0
Total : 136 100,0
As can be seen from Table 3, the main cause of fractures was a home accident (37.5%) and road traffic accident (27.9%). The overwhelming majority of pensioners were injured in everyday life and rarely - as a result of road accidents and do not get injured at work.
Street injury took place in 26.5%, and the share of industrial and sports injuries was 5.1% and 3.0% respectively. Patients with combined trauma were 28 (20.5%) people. The ratio of men and women was 3:
1. For the analysis of FPH, we used the universal classification AO / ASIF Switzerland (M.E.Muller etc.., 1996) (Table 4).
Таблица 4 - Distribution of patients with FPH by classification AO/ASIF
Type of fracture (AO/ASIF) Number of patients %
abs. number
A A1 5 80 58,8
A2 28
A3 47
B B1 6 42 30,9
B2 24
B3 12
C C1 3 14 10,3
C2 5
C3 6
Total : 136 100,0
Among the fractures, type A fractures were most common in 80 (58.8%) patients, 28 in A2 patients (impacted with valgus and varus deformities), 47 with type A3 (non-impacted, metaphyseal fractures with displacement ), much less oftentypes A1 (in 5 patients). The second place was occupied by fractures of type B in 42 cases (30.9%), including fractures of type B1 (impacted
with angular displacement of fragments) were observed in 6 patients, type B2 (non-impacted, with metaphyseal dislocation) -24, B3 (dislocation-fractures) in 12 patients. Fractures of type C were observed only in 14 (10.3%) patients. According to the anamnesis, patients applied for specialized care in the following terms (Table 5).
Table 5 - Distribution of patients with FPH on the timing of seeking specialized care
Time Patients Total
Main group Control group
abs. number % abs. number % abs. number %
Up to 3 days 33 24,3 45 33,0 78 57,3
3-7 14 10,3 26 19,1 40 29,4
8-14 5 3,7 6 4,4 11 8,1
BecmHUK Ka3H/V\y № I - 2020
After 14 days 2 1,5 5 3,7 7 5,2
Total 54 39,8 82 60,2 136 100,0
An analysis of the timing of treatment of patients for specialized care showed that the absolute majority of patients in the main and control groups appealed up to 3 days after the injury (24.3%, respectively, 33.0%).
Of the 136 patients with POPOK, 38 (27.9%) had comorbid diseases, mostly elderly and senile. The remaining part of the
patients - those of young and middle age were physically healthy - 98 patients (72.1%).
For osteosynthesis of fractures, both traditional fixators and devices developed by us were used. Table 6 provides information on the types of construction used for osteosynthesis of fractures.
Table 6 - Distribution of patients with FPH, depending on the structures used
Constructions Patients Total
Main group Control group
abs. number % abs. number % abs. number %
T-and L-shaped plates - - 49 60,0 49 60,0
Needles, wire - - 28 34,0 28 34
Plate type LСP - - 4 4,8 4 4,8
Clover leaf - - 1 1,2 1 1,2
New devices 54 39,7 - - 54 39,7
Total 54 39,7 82 60,3 136 100,0
For osteosynthesis of POPOK in patients of the main group, new devices for bone osteosynthesis were developed, developed in the clinic, which underwent experimental and mathematical substantiation. Patients of the control group for osteosynthesis used traditional fixatives. In this case, T-shaped and L-shaped plates of AO-49 (60.0%) were most frequently used, the second most common is osteosynthesis with spokes and wire in combination - 28 (34.0%). This situation is due to the prevalence of T and L - shaped plates, cheap implants such as knitting needles and wire. At the same time, the fixator, which proved to be the best from abroad, and which is practically the implant of choice - the LCP-plate was used only in 4 cases (4.8%), which is explained by the absence of these implants in the territory of the republic until 2010 and their high market cost. And one more used a "spoon-like" plate (1.2%).
In the research work we used clinical, roentgenologic, electromyographic and statistical methods of investigation. All patients underwent a clinical assessment of the general condition, the status of the local status for the diagnosis of the lesion, the definition of indications and contraindications to surgical treatment. Be sure to inspect the distal parts of the upper limb, tk. in the literature damage to the neurovascular bundle was described in patients with POPOK, especially in elderly and elderly patients, against the background of atherosclerotic vascular lesions.
To confirm the diagnosis of admission of patients with FPH in the hospital performed actinogramof the shoulder joint in a frontal t and axial projections. Execution axial actinogram of the shoulder joint with these fractures is impossible due to severe pain syndrome and severe limitation of movements in the shoulder joint.
Electromyographic examination with NeuroScreen electromyograph (TOENNIES, Germany) with computer processing of data using a measuring and computing complex
was performed to determine the functional state of the neuromuscular apparatus of the injured limb, as well as to evaluate the restoration of the bioelectrical activity of the muscles of the shoulder girdle. Electromyography of the muscles of the shoulder girdle was performed on the second day, 6-8 weeks after the operation and after fracture of the fracture or removal of the device of the clinic.
Global electromyography was used, bioelectrical activity (BEA) of the muscles of the shoulder girdle was analyzed. The ratio of the amplitudes of the biopotentials of the muscles of the injured limb to the amplitude of the biopotentials of the muscles of the healthy limb. The results of the study were compared in the main and control groups of patients. The results obtained during the study were subjected to statistical processing using the Student's test. The difference in the indices was considered reliable at p <0.05. Electromyographic data of conduction disturbances of the bioelectrical activity of muscles are given in the clinical examples in accordance with the figures. The analysis of the clinical material took into account the sex, age, type of injury, the nature of the fracture, the method of surgical intervention, the time from the moment of injury, the amount of intervention, complications, the timing of inpatient and outpatient treatment, the recovery period of ability to work and the function of the injured limb.
The material was processed by the variational statistics method and included determination of the arithmetic mean, mean square deviation, mean error of the arithmetic mean. Reliability of differences was determined by the Student's test with accuracy up to 0.05.
To improve the results of surgical treatment of FPH, we developed and introduced into clinical practice a new device (Preliminary patent of the Republic of Kazakhstan for invention No. 14977 of 15.11.2004), a general view of which is shown in Figure 1.
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■ © ©,
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a) b)
a - the device in assembled form; b - the device disassembled Figure 1 - General view of the device for bone osteosynthesis PPOPK (Preliminary patent of the Republic of Kazakhstan for
invention No. 14977 dated 15.11.2004)
Results and discussion.
Preparation of patients for surgery and anesthesia
Operative interventions for patients with FPH were carried out in an urgent and planned manner. Execution of urgent intervention for elderly and senile patients, in the absence of
Table 7 - Timing of osteosynthesis in patients with FPH
contraindications, contributed to their early activation and prevention of hypostatic complications.
The distribution of patients with FPH in terms of the timing of osteosynthesis is presented in Table 7.
Group of patients The time from the time of receipt to the operation (in days)
1-3 4-7 8-14 15-21 22 and more Total
abs % abs % abs % abs % abs % abs %
Main 4 3,0 18 13,2 22 16,2 8 5,8 2 1,5 54 39,7
Control 7 5,0 23 17,0 34 25,0 14 10,4 4 2,9 82 60,3
Total: 11 8,0 41 30,2 56 41,2 22 16,2 6 4,4 136 100,0
From Table 7 it follows that the majority of patients (92.0%) were operated in a planned manner. There are no differences in patient groups. 52 (38.2%) patients osteosynthesis was performed during the first week, 78 (57.4%) - at a period of more than 1 week up to 22 days, which is explained by the presence of injuries of internal organs and brain in these patients. Six patients (4.4%) osteosynthesis was performed at a later time (after 22 days) because of a severe severe polytrauma. Of the 136
patients, 26 (19.2%) had additional injuries to the musculoskeletal system, internal organs, or craniocerebral trauma; these were almost all patients who had osteosynthesis after 2 weeks from hospitalization.
In the vast majority of cases, intravenous anesthesia was used for osteosynthesis of FPH. Data on the methods of anesthesia used for osteosynthesis of FPH are presented in Table 8.
Table 8 - Types of anesthesia used in osteosynthesis of FPH
Group of patients Types of anesthesia
phlebonarcosis intubation narcosis Total
abs % abs % abs %
Main 48 35,3 6 4,4 54 39,7
Control 67 49,3 15 11,0 82 60,3
Total : 115 84,5 21 15,5 136 100,0
Table 9 shows that the majority of operations (84.5%) were performed under intravenous anesthesia, less frequently, intubation anesthesia was used (15.5%), they were patients with polytrauma, when osteosynthesis of other segments of the musculoskeletal system was performed in addition to ososcopy. Osteosynthesis of FPH with new devices is indicated for type A, B fractures according to AO / ASOF classification, diaphyseal fractures of humerus at the border, upper third and middle third And also the device is recommended to be used as a fixative for uncomfortable and slow consolidating fractures, false joints of this localization. Damage to vascular neuropathy in the shoulder region is an absolute indication for the emergency surgery. In elderly and senile patients, osteosynthesis should be performed
according to urgent and urgent indications, bypassing the stage of skeletal traction, early activation prevents decompensation of the functions of vital organs and systems.
Contraindications to osteosynthesis are: fresh myocardial infarction, stroke, cardiac decompensation, renal failure and senile dementia. Also, osteosynthesis is contraindicated in the presence of inflammatory skin lesions of the shoulder joint region. Osteosynthesis with the proposed devices is relatively contraindicated for type C fractures. For such fractures, it is advisable to use sparing synthesis with spokes or to raise the question of endoprosthetics of the shoulder joint. In the course of treatment, complications were observed in both clinical groups, the analysis of which is presented in Table 9.
Table 9 - Frequency of patients with FPH who had complications during treatment
Clinical Number of Complications
group of patients patients Abs. number P (%) p between P1 H P2
Main group 54 3 5,7 p<0,001
Control group 82 13 19,0
Complications in the main group were 3.3 times less than in the control group (p <0.001). Of the 3 patients in the main group, in all cases, complications were noted in patients with fractures of type B3, C2, with a trauma of over 14 days. In 2 (3.8%) cases, a contracture of a leading nature was observed, in 1 (1.9%) chronic postoperative osteomyelitis of the proximal humerus was developed against the background of a fused fracture (Table 10).
Thus, complications in the patients of the main group were mainly observed in type B2, C2 fractures because of technical difficulties during osteosynthesis, late hospitalization in hospital. At the same time, the complex approach developed by us in the treatment of FPH allowed us to achieve good clinical results in the majority of patients.
Вестник КозНЛЛУ № I - 2020
Table 10 - Types of complications in patients with the main and control groups
Fate Main group Control group
Abs.number % Abs.number %
adduction contracture in shoulder joint 2 3,8 7 10,3
асептический некроз головки плечевой кости - - 2 2,9
false joint - - 3 4,4
Osteomyelitis of the proximal humerus 1 1,9 1 1,4
Total 3 5,7 13 19,0
In patients of the control group, the contracture of the shoulder joint developed in 7 (10.3%), of them in grades 5 - 2, in 2 - grade III. The high frequency of this complication in the control group of patients with traditional treatment (immobilization of 4 weeks with subsequent development) indicates that this tactic is inappropriate, especially in patients with a duration of injury of more than 2 weeks. Aseptic necrosis of the head of the humerus was seen in 2 (2.9%) patients, and 3 (4.4%) had a false joint with the failure of the metal structures and their migration. In one (1.4%) case, after osteosynthesis, the A-shaped osteomyelitis of the humerus developed.
Анализ осложнений, развившихся в процессе лечения наших больных, shows that the regime of immobilization after stable osteosynthesis of the fractures of the PH is necessary to
reconsider. Osteosynthesis of B2, C2 fractures is often difficult due to the technical difficulties of repositioning and stable fixation. The study of our material convincingly showed the advantages of complex treatment of patients with FPH with the use of new devices for osteosynthesis and the expediency of a unified method of rehabilitation in the postoperative period. The results of surgical treatment were evaluated according to the scheme of E.R. Mattis [20], this scheme is universal and can be used to study the outcome of treatment of FPH. The system includes 16 indicators, estimated on a 5-point scale, the last indicator (recovery of limb function) is estimated on a 25-point scale.
A comparative analysis of the outcome of treatment of patients in both clinical groups is presented in Table 11, in Figure 10.
Table 11 -
Fate Main group Control group
Good :
Number of patients 37 35
Frequency in % 71,2 51,5
p between Рl h Р2 р<0,001
Satisfactory:
Number of patients 12 20
Frequency in % 23,1 29,5
p between P1 h P2 р<0,001
Unsatisfactory :
Number of patients 3 13
Frequency in % 5,7 19,0
p between P1 h P2 р<0,001
Total 52 (100,0%) 68 (100,0%)
In the main group, the rate of good outcomes (71.2%) was higher than in the control group (51.5%), i.e. almost in 1.4 times (p <0.001). Such a positive result was achieved due to the use of new devices for osteosynthesis of FPH and a new rehabilitation technique in the postoperative period that allow for stable synthesis and early rehabilitation of patients, which created optimal conditions for fusion of fractures and rehabilitation of our patients in comparison with the traditional method. The frequency of good outcomes for patients in the control group who used known fixatives for osteosynthesis and the traditional postoperative rehabilitation was less than in the main group because of the late (3-4 weeks) use of functional treatment after osteosynthesis. Despite the long rehabilitation, the full restoration of the shoulder joint function did not occur in all patients. In addition, long-term rehabilitation significantly increased the duration of incapacity for work. Through this indicator, there was also a decrease in the number of patients with a good outcome of treatment and an increase in satisfactory outcomes. An increase in the number of patients with satisfactory outcomes in the control group was also caused by cases complicated by contracture of the shoulder joint. The frequency of satisfactory outcomes in the treatment of patients in the control group exceeded the baseline by 3.3 times, which was statistically significant (p <0.001).
An unsatisfactory outcome of treatment in the main group was recognized in 3 (5.7%) patients, of whom 2 (3.8%) patients with a fracture of type B3, C2 developed a stable contracture of the shoulder joint, in 1 (1.9%) the case developed chronic postoperative osteomyelitis of the PH on the background of a fissured fracture of the surgical neck of the humerus. In the control group, an unsatisfactory outcome was associated with the development of the contracting humerus contracture,
which was observed in 7 (10.3%) patients, most often due to the preservation of the angular displacement of the bone fragments, the development of the impingement syndrome. Aseptic necrosis of the head of the humerus developed in 2 (2.9%) patients, in 3 (4.4%) a false joint of the surgical neck of the humerus formed, in all cases the development of the false joint was accompanied by the failure of the metal structures, their migration. In 1 (1.4%) patients with a fracture of the surgical neck of the humerus after osteosynthesis by the T-shaped plate, the osteomyelitis of the proximal humerus developed. The number of patients with unsatisfactory outcomes in the control group is 19.0%, which is 3.3 times greater than the main group (5.7%) (p <0.001). Thus, the comprehensive treatment of patients with POPOK, developed by devices and methods of rehabilitation in the postoperative period, provided good and satisfactory results in 94.3% of cases, in the control group it is 81.0%. Unsatisfactory results of treatment in the main group are almost 3.3 times less than in the control group (5.7% and 19.0%). Conclusion:
1. For osteosynthesis of fractures in the proximal humerus, biomechanically based devices have been developed (Prepatent of the Republic of Kazakhstan for invention No. 14977 of 15.11.2004), allowing to ensure stable fixation of bone fragments before consolidation of the fracture and carry out early recovery treatment of patients.
2. The developed technique of treatment of patients with fractures and fractures of the bones of the shoulder girdle in the postoperative period using a special device and method (Innovative Patent of the Republic of Kazakhstan No. 21923 of December 15, 2009, Certificate for the rational proposal No. 463/2002 of 21.03.2002) -65% of the amplitude of movements in the shoulder joint during the immobilization period and a
VeStnik KQzfimU № I - 2020
more intense liquification of the remaining restriction of movements.
3. Clinical approbation of the proposed treatment program for patients
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with FPH increased the frequency of good treatment results by 1.3 times, reduced the frequency of satisfactory results by 1.2 times, unsatisfactory results - 3.3 times compared with the traditional method of treatment.
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УДК 616.75-001
У.А. Абдуразаков1, Е.Н.Набиев2, А.Р.Байзаков1
1АО «Казахский Медицинский Университет Непрерывного Образования» 2Казахский Национальный медицинский университет имени С.Д. Асфендиярова
АНАТОМО-ФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ МЕНИСКОВ И ПРИЧИНЫ ИХ ПОВРЕЖДЕНИЙ
В статье приведен обзор литературных источников, касающийся анатомии, функции менисков коленного сустава.
Приведены особенности кровоснабжения менисков, механизмы их повреждения, а также разновидности разрывов, которые должны
учитываться при выборе способа лечения разрывов мениска.
Сложная структура коленного сустава, особенности кровоснабжения менисков указывают на необходимость проведения углубленного исследования в этой области.
Дальнейшая оптимизация существующих методик лечения разрывов менисков с учетом анатомо-функциональных особенностей и тяжести повреждения, биомемеханики данного сустава является перспективным направлением развития хирургии коленного сустава.
Ключевые слова: коленный сустав, медиальный мениск, латеральный мениск, анатомия коленного сустава, повреждения менисков
Коленный сустав (КС) является наиболее часто всех травм коленного сустава [3,4], причем повреждения
травмируемым суставом скелета и его повреждения медиального мениска отмечаются 3-10 раз чаще (83-93%
встречаются до 50% травм всех суставов, а также до 24% случаев) [5,6].
травм нижней кончености [1,2]. Высокая частота повреждения коленного сустава прежде
К частым повреждениям коленного сустава относятся всего связана с его анатомо-функциональными
повреждения менисков (ПМ). Они наблюдаются от 55-84,8% особенностями. По данным Американского
