обзоры и рецензии т р а в м а т о л о г и я и о р т о п е д и я р о с с и и 2013-4 (70)

Venous thromboembolic events including deep venous thrombosis of lower limbs, tromboembolia of the pulmonary artery as well as non-symptomatic venous thromboembolic events are identified via venography and are considered to be potentially life-threatening implications after such major surgeries as total hip and knee arthroplasty. The need for tromboprophylaxis is well realized at present, and there is a wide range of medications with the indication of post-surgical prophylaxis of venous thromboembolic events.In this report the attempt has been made to carry out the comparative analysis of various currently used functional national guidelines on prophylaxis of venous thromboembolic events after total hip and knee arthroplasty. Moreover, having done the research in the systems PubMed (http://www.ncbi.nlm.nih.gov/pubmed, 2007–2017 гг.) and eLIBRARY (http://elibrary.ru, 2007–2017 гг.) the data of the last 10 years of experience in administration of oral anticoagulants has been collected and thoroughly analyzed (dabigatran etexilat, rivaroxaban, apixaban) and antiaggregant (acetylsalicylic acid) in clinical practice, besides comparative data has been also collected based on results obtained from laboratory control of anticoagulative effect of thrombin and x-factor direct inhibitors, even though the opportunities that laboratory control can provide are so far highly limited.At present the efficacy of pharmacological prophylaxis of venous thromboembolic events after total hip and knee arthroplasty is absolutely proven, and the issues concerning the safety of anticoagulants administration are the main focus. These issues frequently require personalized approach to selection of medication for tromboprophylaxis in accordance with the patient’s characteristics and the type of surgery chosen. All these aspects should become the focus for further research.

The knee arthroplasty register was established in Vreden Russian Research Institute of Traumatology and Orthopedics on 01.01.2011 and during the following 3 years the data about 6530 primary (91,7%) and revision (8,3%) cases were collected. The average age of patients was 62,72 ±11,5 years with the prevalence of women both in primary (80%) and revision (70%) arthroplasty cohorts. The main group consisted from the patients with knee osteoarthritis (92%) with annual growth of the obese. Total cemented knee replacement without patella resurfacing was the most popular type of primary arthroplasty (96%) with the prevalence of PCL retaining implants (62,13±3,84%). Despite annual decrease of revisions due to infection they predominate under aseptic cases: in 2011 - 64,7% and 35,3%, in 2012 - 62,8% и 37,2% , in 2013 - 53,1% and 46,9% accordingly. The main reason for non-infected revision TKA was implant loosening (17%). This is the first attempt to describe the trends in knee arthroplasty based on data from register of Russian Research Institute of Traumatology and Orthopedics. It’s structure allows to perform multifactorial analysis of knee replacement surgeries and in the future to evaluate implants survival rate.

No abstract

Introduction. To restore the knee local cartilage lesions, a large number of alternative surgical techniques are used in clinical practice: isolated debridement of the lesion area, chondrogenesis stimulation, mosaic osteochondral grafting, cell technologies, collagen membranes (matrices), and a combination of the above methods. The purpose of this article was to compare the effectiveness of various surgical methods of treating patients with local cartilage lesions of the femur based on analysis of relevant publications. Materials and Methods. The review included 85 publications of domestic and foreign authors within 2005 to 2020. The search was carried out in electronic scientific databases PubMed and eLIBRARy. Results. The medium and long term outcomes of debridement and/or various options of chondrogenesis stimulating, despite their wide popularity, in terms of clinical, radiological, and histological indicators, are inferior to all other surgical techniques. Mosaic osteochondral auto-and/or allografting, as well as transplantation of autologous chondrocytes culture with a collagen membrane, are characterized by the best 15 to 20-year outcomes, allowing most patients to maintain the same level of activity as before the lesion occurred. The combination of matrices with other cellular products or microfracturing shows similar medium-term results, but it long-term efficacy remains unknown. Conclusion. The use of debridement and/or chondrogenesis stimulation should be limited to minimal defects. From both a clinical and an economic point of view, mosaic osteochondral grafting is the optimal method for the treatment of knee local cartilage lesions with an area up to 4 to 6 cm 2 . The combination of membranes with various cellular products or microfracturing is indicated in case of extensive local cartilage lesions or if mosaic osteochondral grafting is not appropriate.

Цель исследования. Изучить влияние дренирования и применения пероральных антикоагулянтов для профилактики ВТЭО в постоперационном периоде на величину скрытой, общей кровопотери, а также оценить динамику показателей красной крови у пациентов после тотального эндопротезирования коленного сустава на фоне комплексной тромбопрофилактики. Проспективно в исследование были включены 200 больных идиопатическим гонартрозом III стадии. Пациенты были разделены на две группы в зависимости от дренирования послеоперационной раны. Внутри каждой группы были выделены подгруппы, отличающиеся по используемому антикоагулянту: дабигатрана этексилат (220 мг по 2 капсуле 1 раз в день) и ривароксабан (10 мг 1 раз в день). В ходе исследовании была выполнена оценка объемов кровопотерь у пациентов после эндопротезирования коленного сустава в зависимости от дренирования и принимаемого в послеоперационном периоде антикоагулянта. В целом в анализируемой выборке средняя продолжительность оперативного вмешательства составила 89,3 минуты (95% ДИ 50-140 (ДИ -доверительный интервал)), объем интраоперационной кровопотери -200 мл (95% ДИ 50-900), скрытой -320 мл (95% ДИ 0-920), общая -648 мл (95% ДИ 80-1690). Полученные данные показывают, что прямые оральные антикоагулянты -дабигатрана этексилат и ривароксабан -не различаются между собой по влиянию на объем послеоперационной кровопотери. Проведенный статистический анализ показал, что установка дренажа приводила к большему объему кровопотери. Таким образом, при первичном эндопротезировании предпочтительным является ведение пациентов без дренирования послеоперационной раны. Ключевые слова: дабигатрана этексилат, ривароксабан, дренаж, кровопотеря, коленный сустав, тотальное эндопротезирование. The aim of study To estimate how drainage and administration of oral anticoagulants for the purposes of prophylaxis VTEC in the post-operational period influence the amount of blood loss (both hidden and general), and to evaluate the dynamic of the blood values in patients after they were exposed to total knee arthroplasty at a time when they were undergoing complex tromboprophylaxis treatment. We have been prospectively monitoring 200 patients with idiopathic gonarthrosis disease stage 3. The patients were devided into two groups according to the drainage of post-operational wound. Each group was also devided into two subgroups which only had a difference in the anticoagulant they were administered: dabigatran etexilate (220 mg 2 capsules per day) and rivaroxaban (10 mg 1 per day). As a part of the study the evaluation of the amount of blood loss in patients after total knee arthroplasty depending on the type of drainage and the anticoagulant administered during post-operational perdiod has been made. On the whole the evaluation of analysis set has shown that the average duration of an operation was 89.3 minutes (95% CI 50-140), the amount of intraoperative blood loss amounted to 200 ml (95% CI 50-900), hidden blood loss -320 ml (95%CI 0-920), total blood loss -648 ml (95%CI 80-1690). The gathered data demonstrat...

The health risks associated with transferring embryos classified as mosaic by preimplantation genetic testing for aneuploidies (PGT-A) are currently unknown. Such embryos produce PGT-A results indicating the presence of both euploid and aneuploid cells and have historically been deselected from transfer and grouped with uniformly aneuploid embryos as ‘abnormal’. In recent years, numerous groups have reported the intentional transfer of mosaic embryos in the absence of uniformly euploid embryos, largely observing births of seemingly healthy babies. However, it remains to be understood whether the embryonic mosaicism invariably becomes resolved during the ensuing pregnancy, or whether the placenta and/or fetal tissues retain aneuploid cells, and if so to what potential clinical effect. Here, we report two cases of mosaicism persisting from the embryonic stage to the established pregnancy. Case 1 involved an embryonic low-level segmental mosaic loss in Chromosome (Chr) 1, which was confirmed in amniocentesis as well as in brain tissue of the products of conception. This pregnancy was terminated due to the chromosomal pathologies associated with 1p36 deletion syndrome, such as severe intellectual disability. Case 2 involved a low-level mosaic Chr 21 trisomy, which was confirmed with chorionic villus sampling and amniocentesis. The ensuing pregnancy was terminated after ultrasound identification of severe abnormalities in the placenta and fetus. Together, these two cases should be taken into account for risk-benefit assessments of prospective mosaic embryo transfers.

Surgical treatment results for 13 patients with local deep defects of the articular surface of femoral condyle are presented. Surgical treatment was performed in two steps. At first step diagnostic arthroscopy with removal of loose intraarticular bodies, resection of injured menisci and harvesting of fat body tissues for multipotent mesenchymal stromal cells (MMSC) isolation were applied. Second step consisted of knee arthroplasty; zone of defect was covered with collagen membrane Chondro-Gide under which MMSC were implanted. Control arthroscopy with biopsy of articular surface fragment in the zone of defect restoration was performed to four patients (30.8%) 2 years after arthroplasty. It is shown that after surgical intervention cartilage regeneration goes on owing to fibrillar cartilage formation. In 2 years follow up good results were achieved in 92.3% of cases that proved the efficacy of the elaborated technique for restoration of knee joint function and slowing down of degenerative-dystrophic changes development