From Big Medical Encyclopedia

MEANIE OF OPERATION ( R. R. Vreden is HARMFUL , the Soviet surgeon and the orthopedist, 1867 — 1934) — a number of the original operative measures offered in various years by R. R. Vreden. R. R. Vreden possesses a priority in development and deployment in clinical practice apprx. 30 operations. All of them differ in reasonableness and simplicity of the surgical equipment. The majority of the operations connected with a name of R. R. Vreden are specially orthopedic and represent operational methods of correction of the inborn and acquired deformations of a musculoskeletal system.

From among all-surgeries the greatest practical value represents the «new way of amputation of foot» (1895) directed to establishment of a calcaneus between anklebones thanks to what the patient has an opportunity to step on a stump and on calcaneal area; two operations on elimination of insufficiency of the locking device of a rectum (1895, 1928).

Three operations are offered by R. R. Vreden for treatment of hernias (1906, 1922, 1924). R. R. Vreden developed technology of operations of substitution of defect of a nose by means of change of the left fourth finger (1902) and two-stage operation of elimination of asymmetry of the person because of paralytic deformations (1928).

A number of operational offers was made by P.P. It is harmful to elimination of deformations of a tubercular origin. In 1912 at a spinal tuberculosis it applied osteoplastic fixing by its autograft from a crest of a tibial bone: the autograft is stacked in the basis of the trench created after a skusyvaniye of tops of acanthas and strengthened seams to the soft tissues containing the dissected-away tops of acanthas. Operational fixing of a backbone as a method of treatment of a tubercular spondylitis is applied in various modifications both with auto-, and from gomotransplantata. At tuberculosis IV, V lumbar vertebrae R. R. Vreden recommended operation of «cross unloading» (1926) by means of the massive autograft stacked on the refreshed crests of ileal bones under an acantha of the III lumbar vertebra, and at tubercular damage of the IX—XII chest and I—III lumbar vertebras — «slanting unloading» of a backbone (1926). Poyele a Z-shaped section of skin from X chest to the I sacral vertebra and amotio they in the parties are skusyvat by acanthas at the basis throughout all section on the one hand, keeping their connection with muscles. Two autografts carry out from crests of ileal bones to canals under lumbar muscles and establish cross-wise under an acantha of the X chest vertebra; below transplants stack in fillets on crests of ileal bones. As «cross», and «slanting unloading» of a backbone is applied seldom.

At an anchylosis of a hip joint R. R. Vreden offered an arthroplasty as a nearthrosis with interposition of a wide fascia of a hip on a leg and with formation of a bone canopy over a head of a hip (1927).

At tuberculosis of a shoulder joint para-articular fixing of its (1917) is offered them. From the outer edge of a shovel chip off a rafter, turn it on the bone and periosteal bridge under an upper part of a humeral bone and immerse in the trench of a marrowy cavity, establishing an extremity in assignment at right angle to an axis of a trunk with removal it on 25 — 30 ° forward. At last, R. R. Vreden developed so-called operation of a hitch (1928), edges consists in careful introduction of an autograft to the joint affected with inertly current tubercular process. Further this operation was not widely adopted.

At contractures and ankiloza of a knee joint of a tubercular origin R. R. Vreden applied the original operation of an osteotomy in metadiaphyseal distal department of a hip called by it a metaplasia (1908). Section from side surfaces of condyles of a hip to upper torsion cut skin, soft tissues and a periosteum; the educated triangular rag is otslaivat with a periosteum distally to an epiphysis of a hip. On border of an epiphysis in a metaphysis do a small trench; on 2,5 cm proksimalny its front surface of a hip nadpilivatsya to a half of width of a circle of a hip. On 0,5 cm proksimalny trenches the front surface of a hip is sawn. The end of a hip which is sawn off half is broken away, and other end is pointed in the form of a thorn, to-ry implemented in the trench in a metaphysis at the straightened position of an extremity. On roentgenograms in the remote terms full reorganization of bone beams according to new conditions of a statics and loading is noted that allowed the author to apply the specified name of operation. Operation of a metaplasia is widely applied in all orthopedic clinics as at us, and abroad.

The group of operative measures is described by R. R. Vreden for elimination of various inborn deformations. In 1925 he suggested to create at unreducible congenital dislocations of a hip a neoarthrosis by drilling of a new hollow of a kzada from true where implement the head of a hip shrouded in a bag. At congenital nadatsetabulyarny dislocations of a hip in the presence of a new joint hollow R. R. Vreden developed an arthrorisis by introduction of an autograft without periosteum through an outer surface of a hip on an axis of a neck to the upper edge of a new hollow. At an inborn clubfoot at children it applied taking out of spongy substance from cubical and collision bones with the subsequent redressment of foot (see. Redressment ). At inborn scoliosis because of a dysplasia of lumbosacral department of a backbone it described a technique of osteoplastic fixing of lumbosacral department two transplants to prevent development of deformation in overlying departments of a backbone.

R. R. Vreden paid much attention also to improvement of operational methods of treatment of deformations of a static origin. Its separate operational offers in this direction kept practical value. So, in 1924 at a 0-shaped curvature of a neck of a hip it described operation of a semicircular osteotomy of a hip with a myotomy of adductors of a hip, edges eliminated a symptom of Trendelenburga (see. Hip joint ) also normalized a cervical and diaphyseal corner; at a H-shaped curvature of a knee joint developed operation of a kondiloklaziya (1908), edges consists in taking out of spongy substance of an entocondyle of a hip with the subsequent its compression. Operation eliminates deformation, without breaking growth of an extremity. At a metatarsus latus R. R. Vreden (1929) developed the technique of change of a long razgibatel of a thumb on a head II or III plusnevy bones eliminating their omission and recovering the correct form of front department of foot. At hallux valgus it offered and described operation of a resection of a head of the I plusnevy bone, operation is applied seldom.

The author made several offers in treatment of effects of poliomyelitis. Operation of suspension of foot in three base points at paralysis of all of a razgibately shin and at well remained sgibatel is applied also in a crust, time. Methods of an artificial ankylosis separately for each joint are offered also (1927) at the dangling joints because of poliomyelitis (1908 — 1910).

At an artificial ankylosis, except refreshing of joint surfaces, operation was supplemented couple - or intraartikulyarny fixing with autografts (in a hip joint as a transplant serves a part of a big spit, in a knee joint — a patella, in other joints — transplants from a crest of a tibial bone). These operations in various modifications are applied widely.

Kept the practical value and such operative measures developed by R. R. Vreden as operation of a partial resection of nervous trunks at spastic contractures of upper extremities (1924), edges is in excision on a small ellipse from median and elbow nerves in an average third of a shoulder that reduces spasticity of muscles. At fractures of a patella R. R. Vreden used the method of plastics of a part of own ligament of patella with simultaneous suture on area of a change and on the side copular device.

Operation of boiling down of the joint end of proximal or distal departments of the femoral or tibial bones affected with a tumor with the subsequent change and their fixing on the former place was the last proposal of R. R. Vreden (1930). This operation also kept the value.

Bibliography: R. R. K is harmful to a question of operational treatment of heavy scolioses, Vestn, hir. and frontier. Region, t. 4, book 10-11, page 5, 1924; it, Formation of strong not arthrosis without opening of a joint at congenital unreducible dislocation of a hip, in the same place, t. 5, book 13, page 3, 1925; about N e, Osteotomia subtrochanterica and its specific versions, Ortop, and travmat., book 1, page 9, 1927; it, Practical guidance on orthopedics, page 363, etc., L., 1936, bibliogr.; Kozlowski A. A. To a question of an etiology and treatment of scolioses, Vestn, hir. and frontier. Region, t. 9, book 26-27, page 253, 1927; Nikiforova E. K. Operational treatment of flexion contractures and ankiloz of a knee joint of a tubercular origin by a method of professor of P.P. Vredena, Is new. hir., t. 2, century 1, page 39, 1926; Epstein G. Ya. To a question of operational treatment of a heavy side rachiocampsis, in the same place, page 48, bibliogr.; Yusevich M. S. Fixing of foot in three base points at «Pes equinus paralyticus», Zhurn. sovr, hir., t. 2, century 5, page 1111, 1927.

E. K. Nikiforova.