5 research outputs found
Optimal treatment methods of infectious complications in cases of large joint replacement arthroplasty in modern conditions
Research objective: to choose optimal treatment methods in conditions of Federal Centers of high-technology medical carebased on the analysis of infectious complications in cases of large joint replacement arthroplasty. Materials and methods. In the Federal State Publicly Funded Institution βFederal Center of Traumatology, Orthopedics and Replacement Arthroplastyβ in Cheboksary city in the period from 2009 to 2014 there weremade 20761 large joint replacement operations. The incidence rate of deep infectious complicationsamounted to 0.3%. The average age of patients who had infectious complications was 61.2Β± 12.3 years old, and the male to female ratio was 1:2. Infectious complication risk factors have been evaluated using the continuous method, and the species composition of selected microflora have been studied. Based on the analysis of surgical intervention approaches the optimal method of surgical treatment has been determined. Results. The main predisposing infectious complication risk factors were chronic infection sites, diabetes, obesity, systemic inflammatory diseases, previous intra-articular administration of medicines, blood transfusions, repeated surgical manipulations in the area of the planned surgical intervention, as well as hematomas in the periprosthetic area identified in the postoperative period. The main germ of infectious complications is represented by gram-positive organisms, and the leading role belongs to staphylococci (52%). When identifying infection in the operated jointat the Center, such priority treatment strategiesas a two-stage replacement arthroplasty with long interval" (70.5%), single-stage revision surgery (23.5%), and three-stage revision surgery (6 % ) were used. Two-stage replacement arthroplasty with βlong intervalβ is an efficient treatment, as well as it is economically feasible. It is necessary to take into account the duration of an antibioticrelease from the cement spacer. Reduction of the period between reimplantations significantly reduces the proportion of re-revisions (from 9% to 4.5% , p<0.05), improves long-term results and increases the treatmentmotivation of patients.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π°Π½Π°Π»ΠΈΠ·Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΡΠΈ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΡΡΠΏΠ½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ² Π²ΡΠ±ΡΠ°ΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΡ
Π¦Π΅Π½ΡΡΠΎΠ² Π²ΡΡΠΎΠΊΠΎΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π€ΠΠΠ£ Β«Π€ Π¦ Π’ΠΠ Β» ΠΠΈΠ½Π·Π΄ΡΠ°Π²Π° Π ΠΎΡΡΠΈΠΈ (Π³. Π§Π΅Π±ΠΎΠΊΡΠ°ΡΡ) Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2009 ΠΏΠΎ 2014 Π³Π³. Π±ΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ 20 761 ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΠΏΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΡΡΠΏΠ½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ². Π§Π°ΡΡΠΎΡΠ° Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ Π³Π»ΡΠ±ΠΎΠΊΠΈΡ
ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 0,3%. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 61,2+12,3 Π³ΠΎΠ΄Π°, ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΌΡΠΆΡΠΈΠ½ ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½ 1:2. Π‘ΠΏΠ»ΠΎΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΎΡΠ΅Π½ΠΊΠ° ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΠΈΠ·ΡΡΠ΅Π½ Π²ΠΈΠ΄ΠΎΠ²ΠΎΠΉ ΡΠΎΡΡΠ°Π² Π²ΡΠ΄Π΅Π»Π΅Π½Π½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠ»ΠΎΡΡ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π°Π½Π°Π»ΠΈΠ·Π° ΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΉ ΠΌΠ΅ΡΠΎΠ΄ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠ½ΠΎΠ²Π½ΡΠΌΠΈ ΠΏΡΠ΅Π΄ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°ΡΡΠΈΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠΈΡΠΊΠ° Π² ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠ²ΠΈΠ»ΠΈΡΡ ΠΎΡΠ°Π³ΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΡΠ°Ρ
Π°ΡΠ½ΡΠΉ Π΄ΠΈΠ°Π±Π΅Ρ, ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅, ΡΠΈΡΡΠ΅ΠΌΠ½ΡΠ΅ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²ΡΡΡΠ΅Π΅ Π²Π½ΡΡΡΠΈΡΡΡΡΠ°Π²Π½ΠΎΠ΅ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΡΡΠ΅Π΄ΡΡΠ², Π³Π΅ΠΌΠ°ΡΡΠ°Π½ΡΡΡΠ·ΠΈΠΈ, Π½Π΅ΠΎΠ΄Π½ΠΎΠΊΡΠ°ΡΠ½ΡΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ°Π½ΠΈΠΏΡΠ»ΡΡΠΈΠΈ ΠΎΠ±Π»Π°ΡΡΠΈ ΠΏΠ»Π°Π½ΠΈΡΡΠ΅ΠΌΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π°Π»ΠΈΡΠΈΠ΅ Π³Π΅ΠΌΠ°ΡΠΎΠΌ Π² ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ Π·ΠΎΠ½Π΅, Π²ΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅. ΠΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΡΠ°ΠΌΠΌ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΌΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ°ΠΌΠΈ, Π²Π΅Π΄ΡΡΠ°Ρ ΡΠΎΠ»Ρ ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
ΠΏΡΠΈΠ½Π°Π΄Π»Π΅ΠΆΠΈΡ ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠ°ΠΌ (52%). ΠΡΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠ΅ΡΡΠ° Π² ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΌ ΡΡΡΡΠ°Π²Π΅ ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½Π°Ρ ΡΠ°ΠΊΡΠΈΠΊΠ° Π»Π΅ΡΠ΅Π½ΠΈΡ Π² Π¦Π΅Π½ΡΡΠ΅ ΡΠΎΡΡΠΎΡΠ»Π° Π² Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Ρ Β«Π΄Π»ΠΈΠ½Π½ΡΠΌ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»ΠΎΠΌΒ» (70,5%), ΠΎΠ΄Π½ΠΎΡΡΠ°ΠΏΠ½ΠΎΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 23,5%, ΡΡΠ΅Ρ
ΡΡΠ°ΠΏΠ½ΠΎΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ - 6%. ΠΠ²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Ρ Β«Π΄Π»ΠΈΠ½Π½ΡΠΌ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»ΠΎΠΌΒ» ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΡΠΌ. ΠΡΠΈ ΡΡΠΎΠΌ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΡΡΠΈΡΡΠ²Π°ΡΡ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π²ΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊΠ° ΠΈΠ· ΡΠ΅ΠΌΠ΅Π½ΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠ΅ΠΉΡΠ΅ΡΠ°. Π‘ΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠΊΠ° ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ΅ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡΠΌΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΡΠ½ΠΈΠΆΠ°Π΅Ρ Π΄ΠΎΠ»Ρ ΡΠ΅ΡΠ΅Π²ΠΈΠ·ΠΈΠΉ (Ρ 9% Π΄ΠΎ 4,5%, Ρ<0,05), ΡΠ»ΡΡΡΠ°Π΅Ρ Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ, ΠΏΠΎΠ²ΡΡΠ°Π΅Ρ ΠΌΠΎΡΠΈΠ²Π°ΡΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ
Diagnostically significant differences septic and aseptic instability of endoprosthesis components during arthroplasty of large joints
The purpose of the work is to analyze the results of laboratory, microbiological and instrumental studies to search for screening criteria for the difference between aseptic and septic instability of endoprosthesis components after knee and hip joint arthroplasty. The materials contained 146 cases of revision arthroplasty of the knee and hip joints, performed under the conditions of Federal State Budgetary Institution Federal Center of Traumatology, Orthopedics and endoprosthesis replacement of Ministry of Health of the Russian Federation (Cheboksary) for a 3-year period, including cases of aseptic instability - 69, septic instability-77. By methods for laboratory diagnosis were used to evaluate the blood levels of leukocytes, stab neutrophils, ESR, C-reactive protein (CRP), presepsin, procalcitonin, D-dimer, interleukin-6. Using ultrasound (ultrasonic) examination of the periprosthetic zone, the presence of fluid, granulation tissue in the joint cavity, altered lymph nodes was determined. Before the operation, the level of cytosis and cellular composition were determined in the synovial fluid; tissue bioptates, removed components of implants (after ULTRASONIC treatment) with sowing on the microflora were studied intraoperatively. Intraoperative tissue biopsies were used to make smears-prints on the glass, with gram staining, estimating the number of leukocytes and neutrophils in the field of vision. Results. Determination of indicators of ESR, presepsin and interleukin-6, the level of which goes beyond the generally recognized normal values in the presence of infection, can be recommended as a screening test in the diagnosis of the infectious nature of instability of the components of the endoprosthesis of large joints. The second stage of differential diagnosis of septic and aseptic instability can be the detection of lymphadenopathy. The third (final) stage of determining the infectious nature of instability is an invasive technique to determine the level of cytosis with the calculation of neutrophils in the synovial fluid.Π¦Π΅Π»Ρ ΡΠ°Π±ΠΎΡΡ - Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
, ΠΌΠΈΠΊΡΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ Π΄Π»Ρ ΠΏΠΎΠΈΡΠΊΠ° ΡΠΊΡΠΈΠ½ΠΈΠ½Π³-ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΠΎΡΠ»ΠΈΡΠΈΡ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π° ΠΏΠΎΡΠ»Π΅ Π°ΡΡΡΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
ΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ². ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Π°ΠΌΠΈ ΠΏΠΎΡΠ»ΡΠΆΠΈΠ»ΠΈ 146 ΡΠ»ΡΡΠ°Π΅Π² ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ Π°ΡΡΡΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
ΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ², Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΠΎΠΉ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π±ΡΠ΄ΠΆΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ Β«Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠΉ ΡΠ΅Π½ΡΡ ΡΡΠ°Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΠΎΡΡΠΎΠΏΠ΅Π΄ΠΈΠΈ ΠΈ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡΒ» ΠΠΈΠ½ΠΈΡΡΠ΅ΡΡΡΠ²Π° Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ ΡΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ (Π³. Π§Π΅Π±ΠΎΠΊΡΠ°ΡΡ) Π·Π° 3-Π»Π΅ΡΠ½ΠΈΠΉ ΠΏΠ΅ΡΠΈΠΎΠ΄, ΠΈΠ· Π½ΠΈΡ
ΡΠ»ΡΡΠ°Π΅Π² Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ - 69, ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ - 77. ΠΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΡ Π² ΠΊΡΠΎΠ²ΠΈ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ², ΠΏΠ°Π»ΠΎΡΠΊΠΎΡΠ΄Π΅ΡΠ½ΡΡ
Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ², Π‘ΠΠ, Π‘-ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π±Π΅Π»ΠΊΠ° (Π‘Π Π), ΠΏΡΠ΅ΡΠ΅ΠΏΡΠΈΠ½Π°, ΠΏΡΠΎΠΊΠ°Π»ΡΡΠΈΡΠΎΠ½ΠΈΠ½Π°, Π-Π΄ΠΈΠΌΠ΅ΡΠ°, ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½Π°-6. Π‘ ΠΏΠΎΠΌΠΎΡΡΡ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ³ΠΎ (Π£Π) ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ Π·ΠΎΠ½Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΆΠΈΠ΄ΠΊΠΎΡΡΠΈ, Π³ΡΠ°Π½ΡΠ»ΡΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ Π² ΠΏΠΎΠ»ΠΎΡΡΠΈ ΡΡΡΡΠ°Π²Π°, ΠΈΠ·ΠΌΠ΅Π½Π΅Π½Π½ΡΡ
Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ². Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π² ΡΠΈΠ½ΠΎΠ²ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΆΠΈΠ΄ΠΊΠΎΡΡΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΡΡΠΎΠ²Π΅Π½Ρ ΡΠΈΡΠΎΠ·Π° ΠΈ ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΉ ΡΠΎΡΡΠ°Π²; ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π»ΠΈΡΡ ΡΠΊΠ°Π½Π΅Π²ΡΠ΅ Π±ΠΈΠΎΠΏΡΠ°ΡΡ, ΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΎΠ² (ΠΏΠΎΡΠ»Π΅ Π£Π ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠΈ) Ρ ΠΏΠΎΡΠ΅Π²ΠΎΠΌ Π½Π° ΠΌΠΈΠΊΡΠΎΡΠ»ΠΎΡΡ. ΠΠ· ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΡΠΊΠ°Π½Π΅Π²ΡΡ
Π±ΠΈΠΎΠΏΡΠ°ΡΠΎΠ² Π΄Π΅Π»Π°Π»ΠΈ ΠΌΠ°Π·ΠΊΠΈ-ΠΎΡΠΏΠ΅ΡΠ°ΡΠΊΠΈ Π½Π° ΡΡΠ΅ΠΊΠ»Π΅, Ρ ΠΎΠΊΡΠ°ΡΠΈΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΠΎ ΠΡΠ°ΠΌΡ, ΠΎΡΠ΅Π½ΠΈΠ²Π°Ρ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ² ΠΈ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² Π² ΠΏΠΎΠ»Π΅ Π·ΡΠ΅Π½ΠΈΡ. ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π‘ΠΠ, ΠΏΡΠ΅ΡΠ΅ΠΏΡΠΈΠ½Π° ΠΈ ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½Π°-6, ΡΡΠΎΠ²Π΅Π½Ρ ΠΊΠΎΡΠΎΡΡΡ
Π²ΡΡ
ΠΎΠ΄ΠΈΡ Π·Π° ΠΏΡΠ΅Π΄Π΅Π»Ρ ΠΎΠ±ΡΠ΅ΠΏΡΠΈΠ·Π½Π°Π½Π½ΡΡ
Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½ΠΎ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³-ΡΠ΅ΡΡΠ° ΠΏΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΡΠΈΡΠΎΠ΄Ρ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π° ΠΊΡΡΠΏΠ½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ². ΠΡΠΎΡΡΠΌ ΡΡΠ°ΠΏΠΎΠΌ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΌΠΎΠΆΠ΅Ρ ΡΠ»ΡΠΆΠΈΡΡ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ Π»ΠΈΠΌΡΠΎΠ°Π΄Π΅Π½ΠΎΠΏΠ°ΡΠΈΠΈ. ΡΡΠ΅ΡΡΠΈΠΌ (Π·Π°ΠΊΠ»ΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌ) ΡΡΠ°ΠΏΠΎΠΌ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΡΠΈΡΠΎΠ΄Ρ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½Π°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΡΠΎΠ²Π½Ρ ΡΠΈΡΠΎΠ·Π° Ρ ΠΏΠΎΠ΄ΡΡΠ΅ΡΠΎΠΌ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² Π² ΡΠΈΠ½ΠΎΠ²ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΆΠΈΠ΄ΠΊΠΎΡΡΠΈ
The role of culture-negative infection among infectious complications after total knee arthroplasty
Introduction Diagnosis of chronic periprosthetic joint infection (PJI) is difficult with the clinical signs of periprosthetic inflammation showing
no growth of microorganism in the biomaterial. The frequency of culture-negative infection can reach 42.1 %. The objective of the study
was to analyze outcomes of two-stage treatment of chronic PJI of the knee joint depending on the etiology of the infectious process.
Material and methods A retrospective analysis of outcomes was produced for 103 patients: group I (n=30) showing no growth of microorganisms
and group II (n = 73) demonstrating positive growth of pathogens. Knee PJI was diagnosed according to the 2018 ICM criteria. A favorable
outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, βlife with a spacerβ without
signs of infection. Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive
antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in
group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. Recurrence of infection was 3.4 % in group I
and 16.9 % in group II (p = 0.0928), the two-stage treatment was successful in 96.7 % and 74 %, respectively (p = 0.0064). Discussion Causes
for the lack of growth of microorganisms in biological materials included previous antibiotic therapy, wound drainage, violations of the rules
for sampling of biological material, absence of media for the growth of atypical microorganisms and the ability of microorganisms to form
biofilms on implant surfaces. An emergency histological examination of the affected tissues was practical during surgery in doubtful situations
for adequate surgical approach. The results of a meta-analysis (2023) showed that the replacement of an infected endoprosthesis was more
effective for the treatment of a culture-negative infection compared to debridement and preservation of implant. Conclusion The culture-negative
infection group in our series showed better success rate of a two-stage treatment of PJI using implant replacement and broad-spectrum empiric
antibiotic therapy at a two-year follow-up period. The negative microbiological result in the group could be caused by antibacterial drugs
administered prior to diagnosis of PJI
Evaluation of diagnostic criteria and choice of treatment tactics for patients with infectious spondylodiscitis based on a case series
Objective. To present a brief description of a series of clinical cases of infectious spondylodiscitis with an assessment of the used diagnostic criteria in terms of their influence on the choice of sanifying treatment tactics.
Material and Methods. A continuous retrospective study of 39 cases of spondylodiscitis was carried out. Level of evidence is IIIC. The level of ESR, serum C-reactive protein, the results of the study of biopsy materials, and CT and MRI data were evaluated. Criteria of neurological deficit, instability of the spinal motion segment, and recommendations for assessing the clinical and radiological severity of the disease were used to select the treatment tactics. Treatment success was defined as primary wound healing, absence of recurrent infection and/or death, and satisfaction with treatment according to the EQ-5D and EQ-VAS scales at a follow-up period of 22.5 months.
Results. The average age of patients was 57.4 years. Primary spondylodiscitis accounted for 82 %, the predominant localization of the pathological focus was the lumbar spine (56.4 %), and staphylococci were predominant etiologic agents (59.1 %). On average, the increase in ESR was 45 mm/h, C-reactive protein β 57 ng/l, and D-dimer β 1235 pg/ml. The level of pain before sanation according to the VAS scale was 6.79 points, after the operation it was 2.3 points (p < 0.05). Instability of the spinal motion segment according to the SINS scale was revealed in 36 cases, paravertebral abscess according to MRI β in 51.3 % of cases, and neurological deficit β in 38.5 % of cases. Severe spondylodiscitis according to the SponDT scale was noted in 53.8 %, moderate β in 43.6 %, and mild β in 2.6 % of patients. According to the clinical and radiological classification of infectious spondylodiscitis severity (SSC), grade I was present in 2 patients, grade II β in 21,
and grade III β in 6. Compliance of the chosen treatment tactics with current recommendations was noted in 94,9 % of cases. Recurrence of infection was observed in 7.7 %; lethal outcome β in 5.1 %. Satisfaction with the quality of life according to EQ-5D was 0.74 points, and according to EQ-VAS β 73.88 points.
Conclusions. The integrated use of criteria for neurological deficit, instability of spinal motion segments, and severity of the disease according to the SponDT classification with the account of Polaβs recommendations on treatment tactics made it possible to choose the optimal treatment tactics and achieve satisfactory results in the sanation of patients with infectious spondylodiscitis
Linear-Chain Nanostructured Carbon with a Silver Film Plated on Metal Components Has a Promising Effect for the Treatment of Periprosthetic Joint Infection
Background: Due to the aging of the world population, the number of joint diseases, along with the number of arthroplasties, has increased, simultaneously increasing the amount of complications, including periprosthetic joint infection (PPI). In this study, to combat a PPI, we investigated the antimicrobial properties of the new composite cover for titanium implants, silver-doped carbyne-like carbon (S-CLC) film. Methods: The first assay investigated the antimicrobial activity against Pseudomonas aeruginosa and releasing of silver ions from S-CLC films into growth media covered with S-CLC with a thickness of 1, 2, and 4 mm. The second assay determined the direct antibacterial properties of the S-CLC film’s surface against Staphylococcus aureus, Enterococcus faecalis, or P. aeruginosa. The third assay studied the formation of microbial biofilms of S. aureus or P. aeruginosa on the S-CLC coating. Silver-doped carbyne-like carbon (S-CLC)-covered or titanium plates alone were used as controls. Results: S-CLC films, compared to controls, prevented P. aeruginosa growth on 1 mm thickness agar; had direct antimicrobial properties against S. aureus, E. faecalis, and P. aeruginosa; and could prevent P. aeruginosa biofilm formation. Conclusions: S-CLC films on the Ti surface could successfully fight the most common infectious agent in PPI, and prevented biofilm formation