genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2023-29-5-481-486JZZCJBgenort-2860Research ArticleОригинальные статьиOriginal articlesВлияние предшествовавшего оперативного лечения на результаты тотального эндопротезирования тазобедренного сустава у молодых пациентов с диспластическим коксартрозомThe effect of previous surgical treatment on the outcome of total hip replacement in young patients with dysplastic coxarthrosishttps://orcid.org/0000-0002-1973-5192ТепленькийМ. П.TeplenkiyM. P.

Михаил Павлович Тепленький – доктор медицинских наук, врач ортопед-травматолог высшей категории, заведующий отделением, ведущий научный сотрудник

Курган

Mikhail P. Teplenkiy – Doctor of Medical Sciences, orthopedic traumatologist of the highest category, head of department, leading researcher

Kurgan

 

teplenkiymp@mail.ruКаминскийА. В.KaminskyA. V.

Андрей Владимирович Каминский – кандидат медицинских наук, врач ортопед-травматолог высшей категории, заместитель главного врача

Курган

Andrey V. Kaminsky – Candidate of Medical Sciences, orthopedic traumatologist of the highest category, deputy chief physician

Kurgan

 

drkav@mail.ruhttps://orcid.org/0000-0001-5068-6643ФозиловД. Т.FozilovD. T.

Джонибек Турдиевич Фозилов – аспирант, врач травматолог-ортопед

Курган

Dzhonibek T. Fozilov – graduate student, orthopedic traumatologist

Kurgan

turdievich25081995@gmail.ruНациональный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. ИлизароваРоссияIlizarov National Medical Research Centre for Traumatology and OrthopedicsRussian FederationНациональный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. ИлизароваРоссияIlizarov National Medical Research Centre for Traumatology and OrthopedicsRussian Federation202328102023295481486Copyright © Тепленький М.П., Каминский А.В., Фозилов Д.Т., 20232023Тепленький М.П., Каминский А.В., Фозилов Д.Т.Teplenkiy M.P., Kaminsky A.V., Fozilov D.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2860Введение

Введение. Дисплазия тазобедренного сустава различного генеза признается частой причиной развития коксартроза. В конечной стадии патологического процесса у данной категории больных операцией выбора является тотальное эндопротезирование тазобедренного сустава. Существуют различные точки зрения о влиянии предшествовавшего хирургического лечения дисплазии тазобедренного сустава на последующее эндопротезирование.

Цель

Цель. Определить влияние предшествовавшего хирургического лечения на результаты тотального эндопротезирования тазобедренного сустава у молодых пациентов с диспластическим и вторичным коксартрозом.

Материалы и методы

Материалы и методы. Проведен ретроспективный анализ результатов оперативного лечения 78 пациентов (58 женщин и 20 мужчин) (91 сустав) с диспластическим и вторичным коксартрозом (возраст 14–30 лет, средний возраст 24,3 ± 4,3 года), которым выполнено тотальное эндопротезирование тазобедренного сустава. Пациенты разделены на две группы: группу I (контрольную) составили 27 больных (33 сустава) с диспластическим коксартрозом, у которых эндопротезирование было первым оперативным вмешательством на суставе; в группу II (основную) включен 51 пациент (58 суставов), которым ранее выполнялись операции в области тазобедренного сустава.

Результаты

Результаты. У пациентов группы II продолжительность операции на 47,89 %, объем кровопотери на 16,92 % и частота осложнений на 42,1 % были выше.

Обсуждение

Обсуждение. В основной группе констатировано существенное увеличение частоты поздних осложнений в виде нестабильности импланта. Вместе с тем, удельный вес хороших функциональных результатов по критериям Harris у пациентов второй группы был выше в сравнении с исходами лечения пациентов первой группы. Заключение. Ранее выполненные реконструктивные вмешательства в области тазобедренного сустава увеличивают техническую сложность и агрессивность последующего тотального эндопротезирования, способствуют повышению риска поздних осложнений, но не оказывают существенного влияния на результаты лечения.

Introduction Hip dysplasia of various genesis is recognized as a common cause of coxarthrosis. Total hip replacement (THR) is the operation of choice for the patients with the final stage of the pathological process. There are different opinions on the impact of previous surgical treatment of hip dysplasia on THR.

The aim of the study was to explore the effects of previous surgical treatment on the outcomes of THR in young patients with dysplastic and secondary coxarthrosis.

Material and methods Surgical outcomes of 78 patients (58 females and 20 males; 91 joints) with dysplastic and secondary coxarthrosis (age 14-30 years, average age 24.3 ± 4.3 years) treated witrh THR were retrospectively reviewed. Patients we assigned to two groups. Group I (control) included 27 patients (33 joints) with dysplastic coxarthrosis primarily treated with THR. Group II (treatment group) included 51 patients (58 joints) who had previously undergone THR.

Results Patients of group II demonstrated longer duration of surgery by 47.89 %, greater blood loss by 16.92 % and the higher complication rate by 42.1 %.

Discussion The treatment group showed a significantly increased frequency of late complications in the form of implant instability. Patients of group II dermonstrated better functional results estimated with HHS as compared to the outcomes of patients of group I.

Conclusion Hip reconstructions performed earlier were associated with technical difficulties, aggressive THR procedure, a greater risk of late complications, but showed no significant effect on the outcomes.

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