Оптимизация ревизионной артропластики: роль индивидуальных артикулирующих спейсеров

Введение. Современная медицина стремится к постоянному совершенствованию хирургических методик и технологий для достижения максимально эффективных результатов лечения. Одной из ключевых областей современной ортопедической практики и неотъемлемой частью лечения пациентов с осложнениями после первичного эндопротезирования является ревизионная артропластика. Наиболее значимым при ревизионной артропластике считают первый этап, который заключается в удалении предыдущего имплантата и установке спейсера с антибиотиком, основная функция которого — заполнение «пустого пространства», локальное выделение антибиотика и обеспечение механической стабильности, что способствует сохранению костной ткани для установки ревизионного эндопротеза на окончательном этапе ревизии. В последние десятилетия артикулирующие индивидуальные спейсеры стали объектом повышенного внимания, представляя собой перспективное средство для оптимизации первого этапа ревизионной артропластики.

Цель работы — обобщить современные данные и представить комплексную информацию о спейсерах, используемых при двухэтапном ревизионном протезировании, включая методы их изготовления, физико-химические свойства, клиническое применение и возможности индивидуализации в рамках первого этапа ревизионной артропластики, а также текущие и перспективные направления в их развитии.

Материалы и методы. Поиск литературы за период 2018–2023 гг. проведен в электронных базах PubMed, eLibrary, Cochraine Library по поисковым словам и словосочетаниям: тотальное эндопротезирование, осложнения, ревизионная артропластика, артикулирующий спейсер, перипротезная инфекция, аддитивное производство, 3D-печать, total arthroplasty, complications, revision arthroplasty, articular spacer, joint spacer, periprosthetic infection, additive manufacturing, 3D printing.

Результаты. Проведенный сравнительный анализ использования фабричных, самодельных, динамических и статических моделей спейсеров показывает, что выбор для ревизионной артропластики крупных суставов артикулирующих спейсеров является наиболее актуальным. Фабричные спейсеры обладают рядом преимуществ, таких как стандартизированный размерный ряд, надежность и доступность использования в медицинских учреждениях. Однако они имеют ограничения использования при наличии выраженных дефектов костной ткани.

Обсуждение. Применение индивидуальных спейсеров представляет собой перспективное направление, поскольку такие спейсеры могут быть адаптированы под уникальные особенности каждого пациента. Однако, несмотря на большие ожидания от индивидуальных спейсеров, остается актуальной задача разработки оптимальных технологий для их быстрого прототипирования. Инвестиции в исследования и разработки в этом направлении имеют потенциал создания инновационных решений, способных значительно улучшить результаты ревизионной артропластики.

Заключение. Статья подчеркивает важность систематизации знаний о спейсерах и роль новых исследований в улучшении их дизайна и функциональности. Прогресс в области материаловедения, аддитивных технологий и персонифицированного подхода к изготовлению спейсеров расширяет возможности применения ревизионной артропластики и ее эффективность. Персонализированный подход и усовершенствованные методы локальной доставки лекарственных средств, обеспечивающие контролируемое высвобождение антибиотиков, могут значительно повысить результаты лечения перипротезной инфекции.

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