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Eng
There is no better understanding of the level of development of medicine than the quality of people’s life. The diagnosis, which a hundred years ago meant an inevitable disability, today, with proper treatment, is not an obstacle to an active and full life. Endoprosthesis – the replacement of a diseased joint with an artificial one – has turned from science fiction into a conventional operation. Highly qualified doctors and innovative equipment make it possible to put patients with the most complex pathologies of the musculoskeletal system on their feet. Strong and durable joints made of modern materials relieve pain and discomfort for decades to come. Odessa National Medical University is convinced that such assistance should be available to every Ukrainian. We ask the Honored Doctor Yurii Sukhin, Head of the Department of Traumatology and Orthopedics of ONMedU what is necessary for it.
Yurii Vitaliyovych performed the first shoulder arthroplasty in 1995 under the guidance of his teacher Valentyn Oleksandrovych Babosh. Today he performs up to 200 joint surgeries a year and trains future doctors himself. The Department of Traumatology and Orthopedics works at ONMedU for high-quality training of students. Over the last year, equipment has appeared here that has no analogues even in private clinics. “This is the medicine of the future, which our students will master by the time they graduate from university,” said Yuri Sukhin.
You have been operating since the mid-1990s. Who is your patient?
Mostly older people. For example, with fractures of the femoral neck – over 60 years of age. Interestingly, in Ukraine, the hip joint ranks first in the number of operations, while in the world – the knee. Why so? The main reason is the low standard of living and, accordingly, the issue of access to medical care. Unfortunately, our people tolerate the latter, drink Nimesil and turn up when they can’t get out of bed. In more developed countries, people have prosthetics as soon as they begin to feel constant pain. Therefore, I would formulate two global tasks of arthroplasty: active life of the patient with arthroplasty and, if it came to surgery, its availability.
Athletes who have suffered injuries to large joints: rupture of the meniscus, anterior cruciate ligament, lateral ligaments – this is in relation to the knee joint. In the shoulder joint: ruptures of the rotator cuff and all pathologies associated with it, patients with dislocation of the shoulder. In the hip joint, these are different stages of osteoarthritis and ruptures of the articular lip as well as patients with fractures of the upper and lower extremities. The best experts work on the basis of our department that allows to carry out surgical interventions of various complexity.
How to solve these problems?
In recent years, medicine has been steadily moving towards minimally invasive surgery. That is, short access surgery, without extensive tissue dissection. Such operations on, say, the organs of the gastrointestinal tract are called laparoscopic, and on the joints – arthroscopic. For a long time now, we have not opened the joint, but operated through a small wound or puncture: we insert a thin instrument into it, see the operating area with the help of a camera and perform the necessary actions. The main advantage here is minimal trauma during the operation and the fastest possible rehabilitation, the patient recovers faster and returns to normal life.
Surgery in general is one of the most technological areas. The equipment is being improved, engineers are looking for the best solutions for patients and Odessa Medical university is betting on it?
This is the policy of the university. Why teach students to work with devices of the 70’s, if they disappear from clinics before their graduation, right? We try to acquaint them with what will be relevant in the future. This is the position of the Rector Valerii Zaporozhan, and as a practitioner who has had much to learn, I can say that this is the right approach. The equipment we have received over the last year and which we are really proud of, helps to perform high-tech operations, teach interns new methods of surgical treatment, and acquaint students who choose another specialty with current opportunities in orthopedics and traumatology. Do not make mistakes and guarantee the patient a minimum recovery time. This is the most important thing in a doctor’s job.
What kind of equipment is this?
We have made a big step in cell technology. The centrifuges we obtained will help to prolong the “life” of the joints in the initial stages of osteoarthritis, to overcome chronic inflammation in the musculoskeletal system and even to cure spontaneous aseptic necrosis. Today we have the opportunity to use for treatment such cell types as PRP, ACP, cPRP, SVF and even centrifuge the bone marrow.
The advantages are: the ability to delay joint replacement in the early stages of degenerative-dystrophic changes (osteoarthritis), quality treatment of chronic inflammatory diseases of the musculoskeletal system, treatment of delayed fracture healing and even spontaneous aseptic necrosis, and all without surgery.
Just the other day we received a unique navigation system for knee and hip arthroplasty. At the end of 2020, there were about 20 such systems in the world. There is one in Ukraine, in a private clinic in Cherkasy, and another in our country. In short, this system helps to install a prosthesis with an error of up to 1 mm, which was previously impossible, which, accordingly, guarantees long-term service of the joint and the closest approximate biomechanical movement of the joint.
Minimally invasive treatment of joints with arthroscopy is performed in our country with the help of equipment of 2020 with the most complete set of tools for such surgical interventions. This allows the surgeon to perform the operation as accurately as possible and reduce recovery time for the patient.
The operating room is also equipped with an orthopedic Hawley table, with a full set of nozzles for different tasks and types of operations. For some types of fractures, we can even put together the fracture before surgery with the help of a special table, and the surgeon only has to make a synthesis, which helps to significantly speed up the operation and reduce unnecessary soft tissue damage during the operation. We also have a portable digital X-ray machine to diagnose immediately after the operation and in the patient’s ward, so there are no more trips to the X-ray room. And in the operating room there is a C-Ray arc of 2020, which allows diagnosis and control during the operation.
For more precise control of the surgical wound, there are headlights with cameras, for the surgeon it improves visualization in the wound, and students can see the entire operation live on the screen.
There is also equipment for coagulation, bleeding control, vacuum suction and all power tools (medical drills, screwdrivers, clamps, etc. from the companies Aesculap and Arthrex), all of 2019-2020.
For the treatment of purulent-inflammatory wounds, we have the opportunity to use an ultrasonic cavitator to synthesize even an open fracture without the risk of suppuration. Previously, such types of fractures were operated only with the help of external fixation devices.
All equipment is sterilized in the latest autoclaves and pre-treated and washed in ultrasonic sinks. This makes it possible to manage patients with minimally invasive surgery using a single antibiotic during the surgery. Previously, this was impossible.
The 2020 densitometer and ultrasound machine help diagnose soft tissue injuries and assess bone density to diagnose osteoporosis. In this way it is possible to better plan the tactics of treatment of the patient and take measures for a better outcome of treatment.
Have any of the novelties already been tested in practice?
Since last year, we have been using the Arthrex arthroscopic rack both in training and for operations. When you perform such an operation, the camera plays a very important role – it becomes your eyes and not only of the operating doctor’s ones, but also of students’ who are nearby and have to study. This rack has the ability to expand the 4K image, the image can be enlarged 4 times and displayed on any monitor. A digital X-ray machine and a C-Ray arc can take a picture at any time and print it out on paper or film. There is a densitometer – the device determines the density of bone tissue and makes it possible to predict the consolidation (fusion) of the fracture: whether to accelerate it with any drugs or change the type of osteosynthesis. An ultrasound machine helps to assess soft tissue damage in joints and muscles. All this helps to choose an individual approach to treatment for each patient and perform the operation with the best accuracy, speeds up the operation time, reduces the labor costs of the doctor. This gives confidence in the outcome of each operation.
Aesculap navigation system, as well as the tools of this company. The navigation system is used to install knee and hip endoprostheses.
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