Peculiarities in treatment of patients with false joints of long bones in conditions of hyperhomocysteinaemia and associated states

Authors

DOI:

https://doi.org/10.15674/0030-5987201325-14

Keywords:

pseudarthrosis, hyperhomocysteinemia, genetic polymorphism, treatment, Tivortin, Dekamevit, Osteogenon

Abstract

The purpose of the present work was to improve the treatment of reparative osteogenic disorders on the basis of study of the effect of hyperhomocysteinaemia (HHcy) and associated metabolic and molecular-genetic factors in the formation of false joints of long bones. The efficacy of surgical treatment was assessed in 153 patients with false joints of long bones against a background of HHcy and associated states. HHcy and metabolic disorders were diagnosed in 81, HHcy and molecular-genetic disorders in 72 patients. It was revealed that, against a background of HHcy and associated metabolic and genetic disorders, surgical treatment of false joints was complicated by inflammatory and thrombus obliterating diseases of vessels. The course of reparative osteogenesis was characterized by a sharp inhibition of the osteoinductive potential of the bone tissue with progression of local and systemic osteoporosis, development of an instability in fixing structures, delays in the formation, mineralization and organotypical reconstruction of distraction regenerate, appearance of refractures. A combination of HHcy and polymorphism of 677-TT MTHFR and 786 SS-NOS genes created the most unfavorable conditions for osteoreparation. Treatment of false joints against a background of HHcy depended upon the clinical-radiological type of a false joint, polymorphism of MTHFR C677T and eNOS Ò786Ñ genes, state of trophism of bone fragments and their spatial position, consisting in use of the rational surgical technique, an active management of the pre- and postoperative periods, involvement of metabolic and osteotrophic therapies.

References

  1. Andrushko I. I. Hyperhomocysteinemia as a factor in the pathogenesis of atherosclerosis and coronary heart disease; genesis of proaterogenic action: avtoref. dis. … doctor. med. nauk: special. 14.01.11 «Kardіologіya» / I. I. Andrushko. — Kyiv, 2012. — 34 р.
  2. Bezsmertnyi Y. A. Biochemical indices of rats blood in different terms of reparative osteogenesis at hyperhomocysteinemia / Y. A. Bezsmertnyi // Orthopaedics, Traumatology and Prosthetics. — 2012. —№ 1. — Р. 66–71.
  3. Bezsmertnyi Y. A. Genetic polymorphism of methilentetrahydrofolate-reductase C677T in patients with pseudarthrosis long bones: relationship with lipid profile and endothelial function / Y. A. Bezsmertnyi // Bukovinsky Medical Journal, 2013, Vol. 17, №1 (65). — Р. 11–15.
  4. Zaichko N. The prevalence of mutations in factor V Leiden, prothrombin G20210A and metylentetrahidrofolatreductase C677T in healthy subjects and in patients with venous thrombosis Podolsk region / N. Zaichko // In the book Proceedings of employees NMAPE named P. L. Shupyk — 2008. — Issue 17, Vol. 3. — P. 169–177.
  5. Korzh N. A., Deduh N.V. Reparative bone regeneration: a modern approach to the problem. Regeneration stage / N. A. Korzh, N. V. Deduh // Orthopedics, Traumatology and Prosthetics. — 2006. — № 1. —Р. 76–84.
  6. Korzh N. A. Reparative bone regeneration: a modern approach to the problem. Local factors affecting the fracture healing / N. A. Korzh, L. D. Goridova, K. K. Romanenko // Orthopaedics, Traumatology and Prosthetics. — 2006. — № 2. —Р. 99–105.
  7. Korzh N. A. Reparative bone regeneration: a modern approach to the problem. Systemic factors that affect fracture healing / N. A. Korzh, N. V. Deduh, O. A. Nykolchenko // Orthopedics, Traumatology and Prosthetics. — 2006. — № 2. —Р. 93–99.
  8. Shevtsov V.I., Borzunov D., Peter's N.V. Substitution problem of extensive defects of the long bones, solutions / V. I. Shevtsov, D. Borzunov, N. V. Peter’s // Modern technologies in traumatology and orthopedics. — 2004. — P. 194–195.
  9. Cysteine, homocysteine and bone mineral density: a role for body composition? / A. K. Elshorbagy, C. G. Gjesdal, E. Nurk el al. // Bone. — 2009. — Vol. 44, № 5. — Р. 954–958.
  10. Diwan A. D. Nitric oxide modulates fracture healing / A. D. Di¬wan, M. X. Wang, D. Jang // J. Bone Miner. Res. — 2000. — № 2. — P. 342–351.
  11. Hyperhomocysteinemia induces a tissue specific accumulation of homocysteine in bone by collagen binding and adversely affects bone / M. Herrmann, A. Tami, B. Wildemann et al. // Bone. — 2009. — Vol. 44, № 3. — Р. 467–475.
  12. Saito M. Poor bone quality in diabetes and arterioscelerosis / M. Saito // Clin. Calcium. — 2009. — Vol. 9. — P. 1257–1268.
  13. Shiraki M. The synergistic effect of bone mineral density and methylenetetrahydrofolate reductase (MTHFR) polymorphism (C677T) on fractures / M. Shiraki, T. Urano, T. Kuroda // J. Bone Miner. Metab. — 2008. — № 6. — P. 595–602.
  14. The effects of shockwave on bone healing and systemic con¬centrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions / C. J. Wang, K. D. Yang, J. Y. Ko et al. // Nitric Oxide. — 2009. — Vol. 20, № 4. — Р. 298–303.
  15. Yilmaz N. Homocysteine oxidative stress and relation to bone mineral density in post-menopausal osteoporosis / N. Yilmaz, E. Eren // Aging Clin. Exp. Res. — 2009. — Vol. 21 (4–5). — P. 353–357.
  16. Transforming growth factor (TGF)-β1 as a marker of delayed fracture healing / G. Zimmermann, P. Henle, M. Kusswetter et al. // Orthopedics, traumatology and prosthetics. — 2009. — № 1. — С. 57–65.

How to Cite

Korzh, M., & Bezsmertniy, Y. (2013). Peculiarities in treatment of patients with false joints of long bones in conditions of hyperhomocysteinaemia and associated states. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 5–14. https://doi.org/10.15674/0030-5987201325-14

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Section

ORIGINAL ARTICLES