vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2022.6.CLIN.7vmireaviz-577Research ArticleКлиническая медицинаClinical medicineДиагностика и лечение перипротезной инфекции после эндопротезирования тазобедренного сустава (обзор литературы)Diagnosis and treatment of periprosthetic infection after hip replacement (a review)https://orcid.org/0000-0001-7051-0848ДмитровИ. А.DmitrovI. A.

Дмитров Иван Александрович, аспирант кафедры травматологии и ортопедии; врач травматолог-ортопед

Москва

Moscow

dmitrovi93@mail.ruhttps://orcid.org/0000-0002-6736-9772ЗагороднийН. В.ZagorodniyN. V.

Загородний Николай Васильевич, член-корр. РАН, профессор, советник директора; заведующий кафедрой травматологии и ортопедии

Москва

Moscow

zagorodny-nv@rudn.ruhttps://orcid.org/0000-0003-1276-5484ОболенскийВ. Н.ObolenskiyV. N.

Оболенский Владимир Николаевич, кандидат медицинских наук, доцент кафедры общей хирургии лечебного факультета; заведующий отделением гнойно-септических осложнений № 3

Москва

Moscow

gkb13@mail.ruhttps://orcid.org/0000-0003-2330-2039ЛевальП. Ш.Leval'P. Sh.

Леваль Пулад Шах-Зарович, врач-хирург отделения гнойно-септических осложнений № 3; врач-хирург

Москва

Moscow

dr_bulat@mail.ruhttps://orcid.org/0000-0003-0604-6942ЗахарянН. Г.ZakharyanN. G.

Захарян Норайр Грайрович, кандидат медицинских наук, врач травматолог-ортопед; руководитель клиники травматологии-ортопедии К+31

Москва

Moscow

unkas1103@mail.ruhttps://orcid.org/0000-0003-3477-172XАпресянВ. С.ApresyanV. S.

Апресян Владислав Сергеевич, аспирант кафедры травматологии и ортопедии

Москва

Moscow

apresyanvlad@mail.ruhttps://orcid.org/0000-0003-4686-7892ПанинМ. А.PaninM. A.

Панин Михаил Александрович, кандидат медицинских наук, доцент кафедры травматологии и ортопедии; врач травматолог-ортопед отделения ортопедии

Москва

Moscow

panin-mihail@yandex.ruhttps://orcid.org/0000-0001-5770-7304СамковичД. А.SamkovichD. A.

Самкович Дмитрий Александрович, студент

Москва

Moscow

dmitry.samkovitch@gmail.comhttps://orcid.org/0000-0002-0876-1301АлиевР. Н.AlievR. N.

Алиев Расул Николаевич, кандидат медицинских наук, врач травматолог-ортопед отделения ортопедии, доцент кафедры травматологии и ортопедии

Москва

Moscow

rasulmed@yandex.ruhttps://orcid.org/0000-0003-0677-2960ГригорянА. А.GrigoryanA. A.

Григорян Арцрун Андраникович, клинический ординатор кафедры травматологии и ортопедии

Москва

Moscow

Artsrun3204@mail.ruРоссийский университет дружбы народов; Городская клиническая больница № 31РоссияRUDN University; City Clinical Hospital No. 31Russian FederationРоссийский университет дружбы народов; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияRUDN University; Pirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Городская клиническая больница № 13РоссияPirogov Russian National Research Medical University; City Clinical Hospital No. 13Russian FederationГородская клиническая больница № 13; Европейская клиника травматологии и ортопедии (ECSTO)РоссияCity Clinical Hospital No. 13; European Clinic of Traumatology and Orthopedics (ECSTO)Russian FederationГородская клиническая больница № 31РоссияCity Clinical Hospital No. 31Russian FederationРоссийский университет дружбы народовРоссияRUDN UniversityRussian FederationРоссийский университет дружбы народов; Городская клиническая больница № 17РоссияRUDN University; City Clinical Hospital No. 17Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20220912202212686102Copyright © Дмитров И.А., Загородний Н.В., Оболенский В.Н., Леваль П.Ш., Захарян Н.Г., Апресян В.С., Панин М.А., Самкович Д.А., Алиев Р.Н., Григорян А.А., 20232023Дмитров И.А., Загородний Н.В., Оболенский В.Н., Леваль П.Ш., Захарян Н.Г., Апресян В.С., Панин М.А., Самкович Д.А., Алиев Р.Н., Григорян А.А.Dmitrov I.A., Zagorodniy N.V., Obolenskiy V.N., Leval' P.S., Zakharyan N.G., Apresyan V.S., Panin M.A., Samkovich D.A., Aliev R.N., Grigoryan A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/577Введение

Введение. Во всем мире частота выполняемых операций по поводу эндопротезирования тазобедренного сустава неуклонно растет и, хотя данная операция стала рутинной, вероятность развития послеоперационных осложнений достигает 4,3 % [1]. Наиболее опасным из них является инфекция в области эндопротеза и прилегающих к нему тканей, приводящая к снижению функции тазобедренного сустава и ухудшению качества жизни пациента, а в случаях отсутствия лечения – к генерализации инфекционного процесса. Своевременная диагностика и лечение инфекционного процесса и связанных с ним нарушений позволяет минимизировать неблагоприятные последствия перипротезной инфекции.

Целью настоящего обзора является анализ современных методов диагностики и лечения перипротезной инфекции, возникшей после эндопротезирования тазобедренного сустава.

Материалы и методы

Материалы и методы. Поиск тематической литературы осуществлялся по базам данных PubMed и Google Sholar.

Результаты

Результаты. Основные методы диагностики перипротезной инфекции включают: гистологическое и бактериологическое исследование биоптата, определение чувствительности к антибиотикам, анализ крови и синовиальной жидкости на содержание лейкоцитов, ИЛ-6, СРБ, ПЦР-диагностику инфекционных агентов. Лечение заключается в проведении ревизионного вмешательства и/или антибактериальной терапии.

Заключение

Заключение. Оптимальным методом диагностики перипротезной инфекции является бактериологическое исследование биоптатов, взятых интраоперационно. Предпочтительный метод лечения определяется тяжестью инфекционного поражения, степенью вовлечения прилегающих к эндопротезу тканей, коморбидным фоном пациента, природой инфекционного агента и включает повторное ревизионное вмешательство.

Introduction

Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.

Target

Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.

Materials and methods

Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.

Results

Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.

Conclusion

Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.

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The authors declare that there are no conflicts of interest present.