Лечение пациентов с парапротезной инфекцией

Alexander  Dulaev; Alexandr  Tsed; Dmitriy  Dulaev; Andrey  Ovdenko; Nikita  Mushtin; Sergey Varzin

doi:10.21638/doi.org/10.21638/spbu11.2023.403

Authors

Alexander Dulaev Pavlov First Saint Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
Alexandr Tsed Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
Dmitriy Dulaev Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
Andrey Ovdenko Pavlov First Saint Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation ; Hospital for War Veterans, 21, ul. Narodnaya, St. Petersburg, 193079, Russian Federation
Nikita Mushtin Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
Sergey Varzin St. Petersburg State University, 7–9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation ; St. Petersburg Medico-Social Institute, 72а, Kondratevsky pr., St. Petersburg, 195271, Russian Federation

DOI:

https://doi.org/10.21638/doi.org/10.21638/spbu11.2023.403

Abstract

The review article presents the main questions of pathogenesis, early diagnosis, and surgical management of patients with paraprosthetic infection that developed after surgery for fractured limb bones and deforming arthrosis. The main factors that influenced the occurrence of purulent complications and the ways of their prevention, treatment, taking into account the current ideas about wound infection, are indicated. Pathogenetic mechanisms of paraprosthetic infection development are directly related to the presence of hematoma in the operated joint. Risk factors for large joint arthroplasty can be divided into three conditional types: general and local patient status; conditions for the operation; features of surgery. To detail the risk factors associated with the general or local status of the patient, two subtypes are highlighted — primary and secondary. The main subtype includes: 1) focus infection, located in the operated joint; 2) focus infection, located in the paraarticular tissues of the operated joint; 3) generalization of the infectious process —
sepsis. The additional subtype includes: 1) history of previous joint surgery; 2) critical changes in body mass index; 3) uncontrolled diabetes mellitus; 4) presence of systemic diseases associated with prolonged administration of glucocorticosteroids and cytostatics and others. Two-stage revision endoprosthesis in patients with chronic periprosthetic infection is the gold standard to date. In many ways, the success of treatment depends on the correctness of all stages, on the adequacy of diagnostic measures, the scrupulousness of compliance with surgical technique and is determined by the surgeon’s experience, as well as the equipment of the hospital.

Keywords:

paraprosthetic infection, periprosthetic infection, fracture, limb bones, deforming arthrosis, transplant, purulent complications, wound infection, diagnosis, treatment, prognosis

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References

Литература

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