Влияние бариатрических операций на результаты тотального эндопротезирования при коксартрозе

Введение. Бариатрические операции позволяют эффективно лечить морбидное ожирение, которое часто бывает у пациентов с коксартрозом, однако насколько снижение веса после бариатрической хирургии влияет на результаты и частоту осложнений при тотальном эндопротезировании тазобедренного сустава (ТЭТС) изучено недостаточно.

Цель работы — определение влияния бариатрических операций на результаты тотального эндопротезирования тазобедренного сустава и функционального восстановления нижних конечностей с точки зрения наименьшего риска послеоперационных осложнений.

Материалы и методы. Проведено ретроспективно-проспективное когортное одноцентровое контролируемое исследование пациентов с коксартрозом 3–4 ст. (по классификации I. Kellgren и I. Lawrence, 1957). Пациенты были направлены для тотального эндопротезирования тазобедренного сустава, имели в анамнезе морбидное ожирение (индекс массы тела > 40 кг/м²) и выполненную бариатрическую операцию. Проводили исследование показателей: индекс массы тела, болевой синдром, функциональное состояние пациентов по шкале Харриса и количество осложнений.

Результаты. Исследование показало, что по уровню болевого синдрома на первые сутки после операции имела место значительная статистическая разница (р < 0,001) между пациентами основной группы и группы сравнения, — (6,3 ± 2,3) и (7,4 ± 2,3) балла соответственно. Результаты тестирования пациентов по модифицированной шкале Харриса через 12 месяцев после операции достигли максимума: основная группа — (90,2 ± 10,3) балла, группа сравнения — (86,5 ± 11,6) балла, при статистически значимой разнице результатов р = 0,021. При анализе по методу Каплана – Майера мы получили пятилетнюю выживаемость эндопротезов в основной группе исследования — 94,6 % (5,4 % осложнений), в группе сравнения — 77,2 % (22,8 % осложнений).

Заключение. Применение бариатрических операций у пациентов с морбидным ожирением и коксартрозом 3–4 ст. перед выполнением ТЭТС позволяет статистически значимо снизить риск послеоперационных осложнений на 17,4 % и повысить пятилетнюю выживаемость эндопротезов до 94,6 %.

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