8 research outputs found
ΠΡΡΡΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ (ΠΌΠ΅ΡΠ°Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΡ ΠΊΠΎΠ³ΠΎΡΡΠ½ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ)
Acetabular defects are a major obstacle to achieving good outcomes after revision hip arthroplasty. One way to deal with this problem is to use acetabular augments. We aimed to describe mid-term outcomes of revision hip arthroplasty using acetabular augments.Materials and methods. We analyzed 85 cases (83 patients) of revision hip arthroplasty using acetabular augments performed during 2012-2018 period: 53 women and 30 men with average age of 57Β±13 years (25-79). Distribution of acetabular defects was: 51 cases β Paprosky IIIA, 17 cases β Paprosky IIIB, 12 cases β Paprosky IIB, 5 cases β Paprosky IIC. 14 patients had chronic pelvic discontinuity. Aseptic loosening was indication for the operation in 83 cases, periprosthetic hip fracture β 1, dislocation β 1. The amount of previously undregone ipsilateral hipsurgeries was 1 in 35 cases, 2 in 25 cases, 3 and more in 25 cases. Average follow-up period was 38Β±19 months (1-79).Results. The average HHS score improved from 37Β±7 preoperatively to 73Β±9 after 3 months and to 80Β±11 after 12 months postoperatively (p = 0.001). Average VAS score improved from 7Β±2 preoperatively to 4Β±1 after 3 months and to 3Β±1 after 12 months postoperatively (p = 0.001). Stable acetabular fixation was achieved in each case according to X-ray findings at final follow-up. However, radiolucent lines were present around the cup in 10 cases (11.8 %) followed by no clinical evidence of aseptic loosening. Hip center of rotation was restored from 26.40Β±18.38 mm (4-75) preoperatively to 4.78Β±5.02 mm (0-20) postoperatively relatively to 0 point. Complications manifested in 9 out of 85 cases (10,6%). Distribution of complications was: periprosthetic joint infection in 6 cases, recurrent dislocation β 2, periprosthetic hip fracture β 1.7 patients required implant removal and exchange.Conclusions. Good mid-term outcomes can be achieved using acetabular augments during hip revision surgery in setting of acetabular defects. Acetabular augments are a reliable option in case of Paprosky IIIB, IIIA defects and chronic pelvic discontinuity, providing good mechanical stability.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΈΡΡ, Π²Π»ΠΈΡΠ΅Ρ Π»ΠΈ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΡΡΡ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°, Π½Π° Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΈ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΠΎΠ±ΡΠ΅ΠΌ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ, ΡΠ°ΡΡΠΎΡΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ².ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ°ΠΌΠΈ Π±ΡΠ» Π²ΡΠΏΠΎΠ»Π½Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ½ΡΡ
ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠ², ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΈΠ· Π±Π°Π· Π΄Π°Π½Π½ΡΡ
PubMed, EBSCO, Cochrane, WanFang ΠΈ CNKI (ΠΠΈΡΠ°ΠΉΡΠΊΠ°Ρ Π½Π°ΡΠΈΠΎΠ½Π°Π»ΡΠ½Π°Ρ ΠΈΠ½ΡΡΠ°ΡΡΡΡΠΊΡΡΡΠ° Π·Π½Π°Π½ΠΈΠΉ). Π ΠΌΠ΅ΡΠ°Π°Π½Π°Π»ΠΈΠ· Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ 24 ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΎΡ
Π²Π°ΡΡΠ²Π°Π»ΠΈ 156 914 ΡΡΠ°ΡΡΠ½ΠΈΠΊΠΎΠ², ΠΈΠ· Π½ΠΈΡ
46 782 ΡΡΡΠ°Π΄Π°Π»ΠΎ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΈ ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΠΌ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ. ΠΡΠ΅Π½ΠΊΠ° ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ Revman 5.3.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ’30 ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π·Π°Π½ΠΈΠΌΠ°Π»ΠΎ Π±ΠΎΠ»ΡΡΠ΅ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ, ΠΈΠΌΠ΅ΡΡΠΈΠΌΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠΠ’: WMD = -5,14 (95% ΠΠ -8,13 ... -2,14) (ΠΌΠΈΠ½), Ρ0,001. Π§Π°ΡΡΠΎΡΠ° Π²ΡΠ²ΠΈΡ
ΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° RR = 0,07 (95% ΠΠ = 0,59-0,84) Ρ0,001, ΡΠ°ΡΡΠΎΡΠ° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ RR = 0, 56 (95% ΠΠ 0,50-0,62) (p0, 001) ΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ WMD = -181,39 (95% ΠΠ = -293,26 ... -69,52) (ΠΌΠ»), p = 0,001. ΠΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΡΠΊΠ°Π»Ρ Π₯Π°ΡΡΠΈΡΠ° ΡΠ΅ΡΠ΅Π· 5 Π»Π΅Ρ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΠΎΡΡΠ°ΠΆΠ°ΡΡΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΈΠΌΠ΅Π»ΠΈ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΈΠ΅ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ, ΡΠ΅ΠΌ ΠΏΡΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΌ ΠΠΠ’; WMD = 2,85 (95% ΠΠ 1,04-4,66), p = 0,002. Π‘ΡΠΎΠΊΠΈ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΡΠ΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅, Π½Π΅ ΠΈΠΌΠ΅Π»ΠΈ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΠ°Π·Π½ΠΈΡΡ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΠΌ ΠΈ Π°Π½ΠΎΠΌΠ°Π»ΡΠ½ΡΠΌ Π²Π΅ΡΠΎΠΌ ΡΠ΅Π»Π° WMD = 0,30, (95% ΠΠ 0,34-0,95) (Π΄Π½Π΅ΠΉ), p = 0,36.ΠΡΠ²ΠΎΠ΄Ρ. ΠΠ·Π±ΡΡΠΎΡΠ½ΡΠΉ ΠΎΠ±ΡΠ΅ΠΌ ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΠΎΠΉ ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ ΡΠΎΠ·Π΄Π°Π΅Ρ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ ΠΏΡΠΈ ΡΡΡΠ°Π½ΠΎΠ²ΠΊΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π°, ΡΡΠΎ, Π² ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΌ ΡΡΠ΅ΡΠ΅, ΡΠΊΠ°Π·ΡΠ²Π°Π΅ΡΡΡ ΠΊΠ°ΠΊ Π½Π° ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΡΠ°ΠΊ ΠΈ Π½Π° ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ. ΠΡΠΈ ΡΡΠΎΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠΌ ΠΠΠ’ Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π΅Ρ ΡΠ°ΡΡΠΎΡΠ° ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
Π²ΡΠ²ΠΈΡ
ΠΎΠ², ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΡΠ½ΠΈΠΆΠ°ΡΡΡΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ. Π ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΌ ΠΈΡΠΎΠ³Π΅, ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎ Π²Π»ΠΈΡΠ΅Ρ Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΡ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ²
Background. The presence of extensive bone defects significantly complicates the possibility of stable fixation and correct spatial positioning of the revision endoprosthesis components. The primary task of revision surgery is to restore the lost bone. The use of modern implants makes it possible to replace large metaphyseal defects of the tibia and femur, including AORI type 2B ΠΈ 3 bone defects.
The aim of the study was to evaluate the long-term results of surgical treatment of patients with extensive bone defects (2B and 3 according to AORI) of the proximal tibia and/or distal femur using custom-made implants for revision knee arthroplasty.
Methods. A retrospective clinical study was performed in 24 patients who underwent revision arthroplasty using individual implants (9 femoral and 18 tibial) made on a 3D printer in the period from 2017 to 2021. T3 defect according to AORI classification was diagnosed in 12 patients (50%), F3 defect in 1 (4.17%), F2B in 8 (33.3%), T2B in 6 (25%). All patients before surgery and 3, 6, 12 months after surgery were surveyed according to the international scales VAS, KSS, WOMAC and SF-36.
Results. At the follow-up examination 12 months after the surgery, 9 out of 24 patients (37.510%) walked without additional means of support, 10 out of 24 (41.710%) with a cane, 4 out of 24 (16,78%), walkers 1 out of 24 (4.210%). There were no periprosthetic fractures during surgery and in the postoperative period. When evaluating the functional state of the knee joint, an excellent result was registered in 45.810% and 33.310%; good in 37.510% and 54.210%; satisfactory in 16.678% and 12.57% according to the KSS and WOMAC scales, respectively. When assessed on the VAS scale, there was a positive trend in the form of statistically significant decrease in pain in all patients (p0.01).
Conclusion. The use of individual implants made using additive 3D printing technologies in revision knee arthroplasty in the presence of extensive bone defects (2B and 3 according to AORI) allows to perform an organ-preserving surgery without loss of the statodynamic function of the lower limb. This study has limitations due to the small sample size. We believe that it is promising to study the long-term results of surgical treatment of patients with extensive bone defects (2B and 3 AORI) of the proximal tibia and /or distal femur using individually manufactured implants for revision knee replacement and a comparative analysis of these results with those using conventional implants.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ°Π»ΠΈΡΠΈΠ΅ ΠΎΠ±ΡΠΈΡΠ½ΡΡ
ΠΊΠΎΡΡΠ½ΡΡ
Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ² ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½ΡΠ΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΡΠΈΠΊΡΠ°ΡΠΈΠΈ ΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ·ΠΈΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΡΡ
ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π°. ΠΠ΅ΡΠ²ΠΎΡΡΠ΅ΠΏΠ΅Π½Π½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΠΎΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΎΠ±ΡΠ΅ΠΌΠ° ΡΡΡΠ°ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ² ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π·Π°ΠΌΠ΅ΡΠ°ΡΡ Π±ΠΎΠ»ΡΡΠΈΠ΅ ΠΏΠΎ ΠΎΠ±ΡΠ΅ΠΌΡ ΠΌΠ΅ΡΠ°ΡΠΈΠ·Π°ΡΠ½ΡΠ΅ Π΄Π΅ΡΠ΅ΠΊΡΡ Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΉ, Π²ΠΊΠ»ΡΡΠ°Ρ Π΄Π΅ΡΠ΅ΠΊΡΡ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ AORI-ΡΠΈΠΏΠ° 2B ΠΈ 3.
Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±ΡΠΈΡΠ½ΡΠΌΠΈ ΠΊΠΎΡΡΠ½ΡΠΌΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠ°ΠΌΠΈ (2B ΠΈ 3 ΠΏΠΎ AORI) ΠΏΡΠΎΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»Π° Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΈ/ΠΈΠ»ΠΈ Π΄ΠΈΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»Π° Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΉ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎ ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½Π½ΡΡ
ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ² Π΄Π»Ρ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ 24 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2017 ΠΏΠΎ 2021 Π³. Π±ΡΠ»ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ² (9 Π±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
ΠΈ 18 Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΡΡ
), ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½Π½ΡΡ
Π½Π° 3D-ΠΏΡΠΈΠ½ΡΠ΅ΡΠ΅. ΠΠ΅ΡΠ΅ΠΊΡ ΡΠΈΠΏΠ° T3 ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ AORI Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ Ρ 12 Π±ΠΎΠ»ΡΠ½ΡΡ
(50%), T2B Ρ 6 (25%), Π΄Π΅ΡΠ΅ΠΊΡ F3 Ρ 1 (4,17%), F2B Ρ 8 (33,3%). ΠΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΈ ΡΠ΅ΡΠ΅Π· 3, 6, 12 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΎΡΡ Π°Π½ΠΊΠ΅ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΡΠΌ ΡΠΊΠ°Π»Π°ΠΌ VAS, KSS, WOMAC ΠΈ SF-36.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ° ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΌ ΠΎΡΠΌΠΎΡΡΠ΅ ΡΠ΅ΡΠ΅Π· 12 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π±Π΅Π· Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΡΠ΅Π΄ΡΡΠ² ΠΎΠΏΠΎΡΡ ΠΏΠ΅ΡΠ΅Π΄Π²ΠΈΠ³Π°Π»ΠΈΡΡ 9 ΠΈΠ· 24 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (37,5%), Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΡΠΎΡΡΠΈ 10 ΠΈΠ· 24 (41,7%), ΠΊΠΎΡΡΡΠ»Π΅ΠΉ 4 ΠΈΠ· 24 (16,7%), Ρ
ΠΎΠ΄ΡΠ½ΠΊΠΎΠ² 1 ΠΈΠ· 24 (4,2%). ΠΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΡΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΈ Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ Π½Π΅ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° ΠΎΡΠ»ΠΈΡΠ½ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ Π±ΡΠ» Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ Ρ 45,8% ΠΈ 33,3%; Ρ
ΠΎΡΠΎΡΠΈΠΉ Ρ 37,5% ΠΈ 54,2%; ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Ρ 16,67% ΠΈ 12,5% ΠΏΠΎ ΡΠΊΠ°Π»Π°ΠΌ KSS ΠΈ WOMAC ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ VAS ΠΎΡΠΌΠ΅ΡΠ°Π»Π°ΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° Π² Π²ΠΈΠ΄Π΅ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° Ρ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
(Ρ0,01).
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΏΡΠΎΠΈΠ·ΠΎΡΠ»ΠΎ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΏΠΎ SF-36, KSS, WOMAC ΠΈ VAS. ΠΡΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Ρ 23 ΠΈΠ· 24 Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΡΡΡΡΡΠ²ΠΎΠ²Π°Π»ΠΎ ΡΠ°ΡΡΠ°ΡΡΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π°. Π£ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±ΡΠ»ΠΎ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΠΎ ΠΏΡΠ΅ΡΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠ΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠ° ΠΊΠΎΡΡΠ½ΠΎΠΌΡ Π΄Π΅ΡΠ΅ΠΊΡΡ. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ², ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½Π½ΡΡ
Ρ ΠΏΠΎΠΌΠΎΡΡΡ Π°Π΄Π΄ΠΈΡΠΈΠ²Π½ΡΡ
ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ 3D-ΠΏΠ΅ΡΠ°ΡΠΈ, Π² ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΠΎΠ±ΡΠΈΡΠ½ΡΡ
Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ² ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ (2B ΠΈ 3 ΠΏΠΎ AORI) ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π²ΡΠΏΠΎΠ»Π½ΠΈΡΡ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½Π½ΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ Π±Π΅Π· ΠΏΠΎΡΠ΅ΡΠΈ ΡΡΠ°ΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ
Π‘ΠΎΡΡΠΎΡΠ½ΠΈΠ΅ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ ΠΈΡΡΡΠ³ΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π² Π ΠΎΡΡΠΈΠΈ: ΠΎΡΠ΅Π½ΠΊΠ° Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΎΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠΏΡΠΎΡΠ° Π²ΡΠ°ΡΠ΅ΠΉ
Background. Hip arthroscopy is a minimally invasive surgical technique most commonly performed to correct femoroacetabular impingement (FAI). Currently, it is widely used by worldwide; in addition, there are a significant number of english-language publications on this topic. The number of hip arthroscopy performed in Russia is unknown. Information about this surgical technique is also very limited in our country.
The aim of the study was to assess the level of hip arthroscopy in Russia.
Methods. A total sociological survey of orthopaedic surgeon with experience in performing hip arthroscopy was conducted. The questionnaire was posted on the Google Forms platform and consisted of 13 questions of closed, semi-closed and open types. The survey included 54 surgeons from Russian clinics, 45 people filled out the questionnaire.
Results. Among the respondents, doctors with experience in performing arthroscopic operations on the knee and shoulder joints predominated (100.000.00% and 93.300.03%, respectively). The majority of specialists (73.300.06%) were trained in hip arthroscopy during the primary course in one of the clinics in Russia. More than half of the respondents (68.800.06%) are currently engaged in this surgical area, however, in 45.160.07% of them, the number of operations does not exceed 5 per year. For surgeons who have completed two or more training courses, the volume of operations performed is higher (p0.05); 51.110.07% of doctors perform arthroscopy using an alternative technique. There are 2.5 time more specialists doing just bone resection, than surgeons who apply any kind of reconstruction technique while treating FAI (p0.05). Fifteen respondents (48.390.08%) perform debridement as an attempt to delay arthroplasty. The most common difficulties faced by surgeon are problems with the diagnosis of FAI (no patients) (40.000.02%), lack of the necessary tools (40.000.02%) and sufficient time to master the technique (33.300.07%). Only three (6.600.07%) respondents believe that they manage to achieve the planned results of the operation, 93.300.03% of surgeons said that it is not always possible to achieve the desired outcomes.
Conclusion. Hip arthroscopy in Russia is not very common, the volume of such interventions is insignificant. Doctors with minimal skills in arthroscopic hip surgery predominate. Factors that impede the development of this area in our country are related to teaching methods, problems with FAI diagnostics, the lack of necessary instruments for performing operations, and the lack of time for specialists to master surgical techniques.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΌΠ°Π»ΠΎΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ½ΡΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ, ΠΊΠΎΡΠΎΡΡΠΉ ΡΠ°ΡΠ΅ Π²ΡΠ΅Π³ΠΎ Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΡΡΡ Π΄Π»Ρ ΡΡΡΡΠ°Π½Π΅Π½ΠΈΡ ΡΠ΅ΠΌΠΎΡΠΎΠ°ΡΠ΅ΡΠ°Π±ΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΠΈΠΌΠΏΠΈΠ½Π΄ΠΆΠΌΠ΅Π½ΡΠ° (Π€ΠΠ). Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΎΠ½Π° ΡΠΈΡΠΎΠΊΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΠΌΠΈ Π²ΡΠ°ΡΠ°ΠΌΠΈ; ΠΈΠΌΠ΅Π΅ΡΡΡ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΠΈΡΠ»ΠΎ Π°Π½Π³Π»ΠΎΡΠ·ΡΡΠ½ΡΡ
ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΉ ΠΏΠΎ Π΄Π°Π½Π½ΠΎΠΉ ΡΠ΅ΠΌΠ°ΡΠΈΠΊΠ΅. ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠΌΡΡ
Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π½Π° ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΌ ΡΡΡΡΠ°Π²Π΅ Π² Π ΠΎΡΡΠΈΠΈ Π½Π΅ΠΈΠ·Π²Π΅ΡΡΠ½ΠΎ. ΠΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΎ Π΄Π°Π½Π½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅ ΡΠ°ΠΊΠΆΠ΅ Π²Π΅ΡΡΠΌΠ° ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π° Π² Π½Π°ΡΠ΅ΠΉ ΡΡΡΠ°Π½Π΅.
Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΎΡΠ΅Π½ΠΈΡΡ ΡΡΠΎΠ²Π΅Π½Ρ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π² Π ΠΎΡΡΠΈΠΈ.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠΏΠ»ΠΎΡΠ½ΠΎΠ΅ Π°Π½ΠΊΠ΅ΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠ°Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΎΠ²-ΠΎΡΡΠΎΠΏΠ΅Π΄ΠΎΠ², ΠΈΠΌΠ΅ΡΡΠΈΡ
ΠΎΠΏΡΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΠΉ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. ΠΠ½ΠΊΠ΅ΡΠ° Π±ΡΠ»Π° ΡΠ°Π·ΠΌΠ΅ΡΠ΅Π½Π° Π½Π° ΠΏΠ»Π°ΡΡΠΎΡΠΌΠ΅ Google Forms ΠΈ ΡΠΎΡΡΠΎΡΠ»Π° ΠΈΠ· 13 Π²ΠΎΠΏΡΠΎΡΠΎΠ² Π·Π°ΠΊΡΡΡΠΎΠ³ΠΎ, ΠΏΠΎΠ»ΡΠ·Π°ΠΊΡΡΡΠΎΠ³ΠΎ ΠΈ ΠΎΡΠΊΡΡΡΠΎΠ³ΠΎ ΡΠΈΠΏΠΎΠ². ΠΠ»Ρ ΠΎΠΏΡΠΎΡΠ° Π±ΡΠ»ΠΈ ΠΏΡΠΈΠ³Π»Π°ΡΠ΅Π½Ρ 54 Ρ
ΠΈΡΡΡΠ³Π° ΠΈΠ· ΡΠΎΡΡΠΈΠΉΡΠΊΠΈΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊ, ΠΈΠ· Π½ΠΈΡ
Π°Π½ΠΊΠ΅ΡΡ Π·Π°ΠΏΠΎΠ»Π½ΠΈΠ»ΠΈ 45 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠ΅Π΄ΠΈ ΡΠ΅ΡΠΏΠΎΠ½Π΄Π΅Π½ΡΠΎΠ² ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»ΠΈ Π²ΡΠ°ΡΠΈ Ρ ΠΎΠΏΡΡΠΎΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π½Π° ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠΌ ΠΈ ΠΏΠ»Π΅ΡΠ΅Π²ΠΎΠΌ ΡΡΡΡΠ°Π²Π°Ρ
(100,000,00% ΠΈ 93,300,03% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). ΠΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²ΠΎ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ² (73,300,06%) ΠΎΠ±ΡΡΠ°Π»ΠΈΡΡ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π½Π° ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΌ ΠΊΡΡΡΠ΅ Π² ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· ΠΊΠ»ΠΈΠ½ΠΈΠΊ Π ΠΎΡΡΠΈΠΈ. ΠΠΎΠ»Π΅Π΅ ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Ρ ΠΎΠΏΡΠΎΡΠ΅Π½Π½ΡΡ
(68,800,06%) Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ Π·Π°Π½ΠΈΠΌΠ°ΡΡΡΡ Π΄Π°Π½Π½ΡΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ, ΠΎΠ΄Π½Π°ΠΊΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Ρ 45,160,07% ΠΈΠ· Π½ΠΈΡ
Π½Π΅ ΠΏΡΠ΅Π²ΡΡΠ°Π΅Ρ ΠΏΡΡΠΈ Π² Π³ΠΎΠ΄. Π£ Ρ
ΠΈΡΡΡΠ³ΠΎΠ², ΠΏΡΠΎΡΠ΅Π΄ΡΠΈΡ
Π΄Π²Π° ΠΈ Π±ΠΎΠ»Π΅Π΅ ΠΎΠ±ΡΡΠ°ΡΡΠΈΡ
ΠΊΡΡΡΠ°, ΠΎΠ±ΡΠ΅ΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΠΌΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π²ΡΡΠ΅ (p0,05). ΠΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡ Ρ ΠΏΠΎΠΌΠΎΡΡΡ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ Π²ΡΠΏΠΎΠ»Π½ΡΡΡ 51,110,07% Π²ΡΠ°ΡΠ΅ΠΉ. Π‘ΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ², Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈ ΡΠ΅Π·Π΅ΡΠΈΡΡΡΡΠΈΡ
ΠΊΠΎΡΡΠ½ΡΠΉ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½Ρ Π€ΠΠ, ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π² 2,5 ΡΠ°Π·Π° Π±ΠΎΠ»ΡΡΠ΅, ΡΠ΅ΠΌ Ρ
ΠΈΡΡΡΠ³ΠΎΠ², ΠΎΠ±Π»Π°Π΄Π°ΡΡΠΈΡ
Π½Π°Π²ΡΠΊΠ°ΠΌΠΈ ΡΠ΅ΠΊΠΎΠ½ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΉ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° (p0,05). ΠΡΡΠ½Π°Π΄ΡΠ°ΡΡ ΠΎΠΏΡΠΎΡΠ΅Π½Π½ΡΡ
(48,390,08%) Π²ΡΠΏΠΎΠ»Π½ΡΡΡ Π΄Π΅Π±ΡΠΈΠ΄ΠΌΠ΅Π½Ρ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠΎΠΏΡΡΠΊΠΈ ΠΎΡΡΡΠΎΡΠΈΡΡ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΌΠΈ ΡΡΡΠ΄Π½ΠΎΡΡΡΠΌΠΈ, Ρ ΠΊΠΎΡΠΎΡΡΠΌΠΈ ΡΡΠ°Π»ΠΊΠΈΠ²Π°ΡΡΡΡ Π²ΡΠ°ΡΠΈ, ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΎΠΉ Π€ΠΠ (40,000,02%), ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΠ³ΠΎ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°ΡΠΈΡ (40,000,02%), Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ Π½Π° ΠΎΡΠ²ΠΎΠ΅Π½ΠΈΠ΅ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ (33,300,07%). Π’ΠΎΠ»ΡΠΊΠΎ ΡΡΠΎΠ΅ (6,600,07%) ΠΎΠΏΡΠΎΡΠ΅Π½Π½ΡΡ
ΡΡΠΈΡΠ°ΡΡ, ΡΡΠΎ ΠΈΠΌ ΡΠ΄Π°Π΅ΡΡΡ Π΄ΠΎΡΡΠΈΡΡ Π·Π°ΠΏΠ»Π°Π½ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ; 93,300,03% Ρ
ΠΈΡΡΡΠ³ΠΎΠ² ΡΠΎΠΎΠ±ΡΠΈΠ»ΠΈ ΠΎ ΡΠΎΠΌ, ΡΡΠΎ Π½Π΅ Π²ΡΠ΅Π³Π΄Π° ΠΏΠΎΠ»ΡΡΠ°Π΅ΡΡΡ Π΄ΠΎΠ±ΠΈΡΡΡΡ ΠΆΠ΅Π»Π°Π΅ΠΌΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ².
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π² Π ΠΎΡΡΠΈΠΈ ΠΌΠ°Π»ΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π°, ΠΎΠ±ΡΠ΅ΠΌ ΠΏΠΎΠ΄ΠΎΠ±Π½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ² Π½Π΅Π·Π½Π°ΡΠΈΡΠ΅Π»Π΅Π½. ΠΡΠ΅ΠΎΠ±Π»Π°Π΄Π°ΡΡ Π²ΡΠ°ΡΠΈ Ρ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΡΠΌΠΈ Π½Π°Π²ΡΠΊΠ°ΠΌΠΈ Π°ΡΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. Π€Π°ΠΊΡΠΎΡΡ, ΠΊΠΎΡΠΎΡΡΠ΅ Π·Π°ΡΡΡΠ΄Π½ΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π΄Π°Π½Π½ΠΎΠ³ΠΎ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ Π² Π½Π°ΡΠ΅ΠΉ ΡΡΡΠ°Π½Π΅, ΡΠ²ΡΠ·Π°Π½Ρ Ρ ΠΌΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ ΠΎΠ±ΡΡΠ΅Π½ΠΈΡ, ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ°ΠΌΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π€ΠΠ, ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ΠΌ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΠ³ΠΎ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°ΡΠΈΡ Π΄Π»Ρ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ, Π½Π΅Ρ
Π²Π°ΡΠΊΠΎΠΉ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ Ρ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ² Π΄Π»Ρ ΠΎΡΠ²ΠΎΠ΅Π½ΠΈΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ
ΠΠ ΠΠΠΠΠΠΠΠ ΠΠΠΠΠΠ©ΠΠΠΠΠ Π’Π ΠΠΠΠΠ¦ΠΠ’ΠΠΠ ΠΠΠΠΠΠ« ΠΠ Π ΠΠΠΠΠ©ΠΠΠΠ ΠΠ§ΠΠΠ ΠΠΠΠ‘ΠΠ£ΠΠ―Π ΠΠΠΠ ΠΠΠΠ ΠΠΠ ΠΠΠΠΠΠΠ ΠΠΠΠ ΠΠΠΠΠ ΠΠΠ‘Π’Π ΠΠΠΠΠ’Π ΠΠΠ‘ΠΠΠΠΠ’ΠΠ’ΠΠΠ
Treatment of avascular necrosis of the femoral head is an issue of current interest while it affects young and employable people. So far there is no well-defined strategy of management which would help to postpone hip arthroplasty and further revision procedure. Hip sparing surgical treatment of avascular necrosis of the femoral head by bone grafting prior to head collapse proved to be a viable option not only during early stages of disease but also at advanced stages. Platelet-rich plasma (PRP) addition to treatment plan potentially helps improving bone regeneration in situ.In this article the authors present a case of a 37 years old patient with avascular necrosis of the femoral head at a fragmentation stage (type 4B by ARCO). The authors centrifuged 15 ml of autologous whole blood (1500 RPM) obtained by a special double-contoured syringe. During the surgical stage of treatment PRP and morselized bone graft were mixed to introduce and impact into the debrided zone of avascular necrosis. The authors also introduced 0.3β0.4 ml of PRP into the debrided zone of avascular necrosis after bone grafting. At 6 months follow-up CT images of the studied patient demonstrated signs of bone reorganization and no loss of femoral head sphericity. Preoperative Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) prior to treatment were 60, 45 and 33 points respectively. Postoperative VAS, HHS and HOOS scores were 10, 78 and 78 respectively. In the authorsβ opinion, impaction bone grafting enhanced by PRP helps obtaining good and excellent outcomes not only at early but also at advanced stages of avascular necrosis.ΠΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠΉ Π½Π΅ΠΊΡΠΎΠ· Π³ΠΎΠ»ΠΎΠ²ΠΊΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ ΠΏΠΎΡΠ°ΠΆΠ°Π΅Ρ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΌ Π»ΠΈΡ ΡΡΡΠ΄ΠΎΡΠΏΠΎΡΠΎΠ±Π½ΠΎΠ³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ°. ΠΠ° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ ΠΎΡΡΡΡΡΡΠ²ΡΡΡ ΡΠ΅ΡΠΊΠΈΠ΅ Π°Π»Π³ΠΎΡΠΈΡΠΌΡ Π΅Π³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΠ΅ ΠΎΡΡΡΠΎΡΠΈΡΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ, Π° ΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎ, ΠΈ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. ΠΡΠ³Π°Π½ΠΎ- ΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅Π΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΎΡΠ°Π³Π° Π½Π΅ΠΊΡΠΎΠ·Π° Π½Π° ΡΡΠ°Π΄ΠΈΡΡ
Π΄ΠΎ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌ Π²Π°ΡΠΈΠ°Π½ΡΠΎΠΌ, ΠΏΡΠΈ ΡΡΠΎΠΌ Π΄Π°Π½Π½Π°Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ°ΠΊΡΠΈΠΊΠ° ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ ΠΈ Π½Π° Π±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠ·Π΄Π½ΠΈΡ
ΡΡΠ°ΠΏΠ°Ρ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΡ
ΠΏΡΡΠ΅ΠΉ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΡ
ΡΡΠΈΠ»ΠΈΡΡ ΡΠ΅Π³Π΅Π½Π΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π» ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° Π΄Π»Ρ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π°ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ ΠΎΠ±ΠΎΠ³Π°ΡΠ΅Π½Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ°ΠΌΠΈ ΠΏΠ»Π°Π·ΠΌΡ (PRP β platelet-rich plasma).Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΈΠΌΠ΅Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ PRP Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° 37 Π»Π΅Ρ Ρ Π°Π²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠΌ Π½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ Π³ΠΎΠ»ΠΎΠ²ΠΊΠΈ Π»Π΅Π²ΠΎΠΉ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ Π½Π° ΡΡΠ°Π΄ΠΈΠΈ ΡΡΠ°Π³ΠΌΠ΅Π½ΡΠ°ΡΠΈΠΈ (4B ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ARCO). PRP ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ ΠΏΡΡΠ΅ΠΌ ΡΠ΅Π½ΡΡΠΈΡΡΠ³ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 5 ΠΌΠΈΠ½ ΠΏΡΠΈ ΡΠΊΠΎΡΠΎΡΡΠΈ 1500 ΠΎΠ±/ΠΌΠΈΠ½ 15 ΠΌΠ» Π°ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, ΠΎΡΠΎΠ±ΡΠ°Π½Π½ΠΎΠΉ Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π΄Π²ΠΎΠΉΠ½ΠΎΠΉ ΡΠΏΡΠΈΡ. ΠΠ΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎ ΠΏΠ΅ΡΠ΅Π΄ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΈΠ·ΠΌΠ΅Π»ΡΡΠ΅Π½Π½ΡΠ΅ ΠΊΠΎΡΡΠ½ΡΠ΅ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΡ ΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΠΎΠ±ΡΠ΅ΠΌ PRP ΡΠΌΠ΅ΡΠΈΠ²Π°Π»ΠΈ ΠΈ ΠΏΠ»ΠΎΡΠ½ΠΎ ΡΡΡΠ°ΠΌΠ±ΠΎΠ²ΡΠ²Π°Π»ΠΈ Π² Π»ΠΎΠΆΠ΅ Π³ΠΎΠ»ΠΎΠ²ΠΊΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ, ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π²ΡΠ΅Π΅ΡΡ ΠΏΠΎΡΠ»Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ Π½Π΅ΠΊΡΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΊΠ°Π½ΠΈ. Π ΡΠΏΡΠΈΡΠ΅ ΠΎΡΡΠ°Π²Π»ΡΠ»ΠΈ 0,3β0,4 ΠΌΠ» ΠΎΠ±ΠΎΠ³Π°ΡΠ΅Π½Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ°ΠΌΠΈ ΠΏΠ»Π°Π·ΠΌΡ, ΠΊΠΎΡΠΎΡΡΡ Π²Π²ΠΎΠ΄ΠΈΠ»ΠΈ Π² Π·Π°ΠΌΠ΅ΡΠ΅Π½Π½ΡΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠ°ΠΌΠΈ Π·ΠΎΠ½Ρ Π½Π΅ΠΊΡΠΎΠ·Π°. Π§Π΅ΡΠ΅Π· 6 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π½Π° ΠΈΠ·ΠΎΠ±ΡΠ°ΠΆΠ΅Π½ΠΈΡΡ
ΠΠ’-ΡΡΠ΅Π·ΠΎΠ² ΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ³ΡΠ°ΠΌΠΌΠ°Ρ
ΡΠ°Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΈΡΡ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΡΠ΅ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, ΡΠΎΡ
ΡΠ°Π½ΡΠ»Π°ΡΡ ΡΡΠ΅ΡΠΈΡΠ½ΠΎΡΡΡ Π³ΠΎΠ»ΠΎΠ²ΠΊΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ. ΠΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΡΡΡ Π±ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° ΠΏΠΎ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎ-Π°Π½Π°Π»ΠΎΠ³ΠΎΠ²ΠΎΠΉ ΡΠΊΠ°Π»Π΅, ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Π₯Π°ΡΡΠΈΡΠ° ΠΈ ΡΠΊΠ°Π»Π΅ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΏΡΠΈ ΠΎΡΡΠ΅ΠΎΠ°ΡΡΡΠΎΠ·Π΅ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° (HOOS) Π΄ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 60 ΠΌΠΌ, 45 ΠΈ 33 Π±Π°Π»Π»Π° ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, ΠΏΠΎΡΠ»Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ β 10 ΠΌΠΌ, 78 ΠΈ 78 Π±Π°Π»Π»ΠΎΠ².Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ Π·ΠΎΠ½Ρ ΠΎΡΠ°Π³Π° Π°Π²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ Π½Π΅ΠΊΡΠΎΠ·Π° ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠ°ΠΌΠΈ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΎΠ±ΠΎΠ³Π°ΡΠ΅Π½Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ°ΠΌΠΈ ΠΏΠ»Π°Π·ΠΌΠΎΠΉ ΠΏΡΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠΈΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΎΡΡΡΠΎΡΠΈΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π½Π° ΡΠ°Π½Π½ΠΈΡ
, Π½ΠΎ ΠΈ Π½Π° Π±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠ·Π΄Π½ΠΈΡ
ΡΡΠ°Π΄ΠΈΡΡ
ΠΠΠΠΠ
ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠ° ΠΏΡΠΈ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Ρ ΠΊΠΎΡΡΠ½ΡΠΌ Π΄Π΅ΡΠ΅ΠΊΡΠΎΠΌ ΡΠΈΠΏΠ° 3 ΠΏΠΎ AORI: ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ
Background. Replacement of extensive bone defects during revision knee arthroplasty (RKA) is a certain problem. The development of additive technologies allows us to produce an individual titanium augment to restore the lost bone tissue. The aim of the study is to show the possibility of replacing extensive tibia defects with an custom made augment during revision knee artroplasty. Case presentation. The patient is 66 years old. At the age of 58, due to secondary knee osteoarthritis in 2 years interval, the patient underwent total knee arthroplasty: left in 2012, right in 2014. Subsequently, several revision interventions were required for early periprosthetic infection of the right knee joint. From 2015 to 2018, due to the infection remission, the function of the right knee joint was satisfactory. In 2018, the patient admitted to our clinic with the periprosthetic infection relapse. Due to the previous treatment, the patient had type 3 bone defect according to the AORI classification. A two-stage revision knee arthroplasty was performed. To compensate the extensive tibial defect, the individual tibial implant was manufactured using additive technologies, and a semiconstrained endoprosthesis was implanted. There was no relapse of infection during the observation. There is deficit of active extension, there are no radiological signs of the implant instability. Conclusion. In our case, we were able to achieve satisfactory results in patient with a complex anamnesis and extensive bone defects. The use of individual implant helped to avoid arthrodesis, preserve the weight-bearing of the lower limb and articulation in the knee joint. The use of implants made using 3D technologies is a promising solution for compensating defects of types 2B and 3 according to the AORI classification.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ°ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΠ±ΡΠΈΡΠ½ΡΡ
ΠΊΠΎΡΡΠ½ΡΡ
Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ² ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° ΠΏΡΠΈ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π½ΡΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ. Π Π°Π·Π²ΠΈΡΠΈΠ΅ Π°Π΄Π΄ΠΈΡΠΈΠ²Π½ΡΡ
ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΠ·Π³ΠΎΡΠΎΠ²ΠΈΡΡ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΠΉ ΡΠΈΡΠ°Π½ΠΎΠ²ΡΠΉ Π°ΡΠ³ΠΌΠ΅Π½Ρ Π΄Π»Ρ Π²ΠΎΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΡΡΡΠ°ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ. Π¦Π΅Π»Ρ ΡΠ°Π±ΠΎΡΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΡ ΠΎΠ±ΡΠΈΡΠ½ΡΡ
Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ² Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠΈ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎ ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½Π½ΡΠΌ Π°ΡΠ³ΠΌΠ΅Π½ΡΠΎΠΌ ΠΏΡΠΈ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. ΠΠΏΠΈΡΠ°Π½ΠΈΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° 66 Π»Π΅Ρ. Π Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ 58 Π»Π΅Ρ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠ³ΠΎ Π³ΠΎΠ½Π°ΡΡΡΠΎΠ·Π° 3 ΡΡ. Ρ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»ΠΎΠΌ Π² 2 Π³ΠΎΠ΄Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ΅ Π±ΡΠ»ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ²: Π»Π΅Π²ΠΎΠ³ΠΎ Π² 2012 Π³., ΠΏΡΠ°Π²ΠΎΠ³ΠΎ Π² 2014 Π³. Π ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΌ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π½Π΅ΡΠΊΠΎΠ»ΡΠΊΠΈΡ
ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ² ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ°Π½Π½Π΅ΠΉ ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. Π‘ 2015 ΠΏΠΎ 2018 Π³. Π²Π²ΠΈΠ΄Ρ ΠΊΡΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΡΠ½ΠΊΡΠΈΡ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π±ΡΠ»Π° ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ. Π 2018 Π³. ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° ΠΎΠ±ΡΠ°ΡΠΈΠ»Π°ΡΡ Π² Π½Π°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΡ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ. Π ΡΠ²ΡΠ·ΠΈ Ρ ΡΠ°Π½Π΅Π΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ²ΡΠΈΠΌΡΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ Π½Π°Π±Π»ΡΠ΄Π°Π»ΡΡ ΡΠΈΠΏ 3 ΠΊΠΎΡΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠ΅ΠΊΡΠ° ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ AORI. ΠΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°. ΠΠ»Ρ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΠΈ ΠΎΠ±ΡΠΈΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠ΅ΠΊΡΠ° Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π°Π΄Π΄ΠΈΡΠΈΠ²Π½ΡΡ
ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ Π±ΡΠ» ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°Ρ Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠΈ, ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ ΡΠ°ΡΡΠΈΡΠ½ΠΎ ΡΠ²ΡΠ·Π°Π½Π½ΡΠΉ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·. Π Π΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π·Π° Π²ΡΠ΅ΠΌΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ, ΡΠΎΡ
ΡΠ°Π½ΡΠ΅ΡΡΡ Π΄Π΅ΡΠΈΡΠΈΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ°Π·Π³ΠΈΠ±Π°Π½ΠΈΡ, ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΌΠ΅ΡΠ°Π»Π»ΠΎΠΊΠΎΠ½ΡΡΡΡΠΊΡΠΈΠΈ Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ°Π΅ΡΡΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΌ Π½Π°ΠΌΠΈ ΡΠ»ΡΡΠ°Π΅ ΠΌΡ ΡΠΌΠΎΠ³Π»ΠΈ Π΄ΠΎΠ±ΠΈΡΡΡΡ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΡΠΎ ΡΠ»ΠΎΠΆΠ½ΡΠΌ Π°Π½Π°ΠΌΠ½Π΅Π·ΠΎΠΌ ΠΈ ΠΎΠ±ΡΠΈΡΠ½ΡΠΌΠΈ ΠΊΠΎΡΡΠ½ΡΠΌΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠ°ΠΌΠΈ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠ° ΠΏΠΎΠΌΠΎΠ³Π»ΠΎ ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ Π°ΡΡΡΠΎΠ΄Π΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΡΠΎΡ
ΡΠ°Π½ΠΈΡΡ ΠΎΠΏΠΎΡΠΎΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ ΠΈ Π°ΡΡΠΈΠΊΡΠ»ΡΡΠΈΡ Π² ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠΌ ΡΡΡΡΠ°Π²Π΅. ΠΠ° Π½Π°Ρ Π²Π·Π³Π»ΡΠ΄, ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ², ΠΈΠ·Π³ΠΎΡΠΎΠ²Π»Π΅Π½Π½ΡΡ
Ρ ΠΏΠΎΠΌΠΎΡΡΡ 3D-ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ, ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π΄Π»Ρ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ² ΡΠΈΠΏΠΎΠ² 2Π ΠΈ 3 ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ AORI
Accumulation of storage proteins in plant seeds is mediated by amyloid formation
Copyright: Β© 2020 Antonets et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Amyloids are protein aggregates with a highly ordered spatial structure giving them unique physicochemical properties. Different amyloids not only participate in the development of numerous incurable diseases but control vital functions in archaea, bacteria and eukarya. Plants are a poorly studied systematic group in the field of amyloid biology. Amyloid properties have not yet been demonstrated for plant proteins under native conditions in vivo. Here we show that seeds of garden pea Pisum sativum L. contain amyloid-like aggregates of storage proteins, the most abundant one, 7S globulin Vicilin, forms bona fide amyloids in vivo and in vitro. Full-length Vicilin contains 2 evolutionary conserved Ξ²-barrel domains, Cupin-1.1 and Cupin-1.2, that self-assemble in vitro into amyloid fibrils with similar physicochemical properties. However, Cupin-1.2 fibrils unlike Cupin-1.1 can seed Vicilin fibrillation. In vivo, Vicilin forms amyloids in the cotyledon cells that bind amyloid-specific dyes and possess resistance to detergents and proteases. The Vicilin amyloid accumulation increases during seed maturation and wanes at germination. Amyloids of Vicilin resist digestion by gastrointestinal enzymes, persist in canned peas, and exhibit toxicity for yeast and mammalian cells. Our finding for the first time reveals involvement of amyloid formation in the accumulation of storage proteins in plant seeds