Aims.The aim of the study was the development and clinical approbation of the method of treatment of purulent arthritis with the formation of ankle ankylosis. Materials and MethodsTwenty-two patients underwent surgery after ankle trauma complicated by inflammation (18 male and 4 females ranging in age from 28 to 62). To open the ankle joint, an anterior approach was used. After opening the cavity of the joint, surgical treatment of the purulent-necrotic focus with necrotic sequestrectomy and resection of the tibia and talus bones were performed within the limits of healthy bone tissue, after which a compression/distraction device was applied. Distraction in the area of the resection of the tibia and talus bones artificially created a cavity in the ankle joint simultaneously. Through additional punctures in the projection of external and internal ankle bones, a perforated drain was placed in the created cavity. [Bonesaw-lines] of the tibia and talus bones were drawn together to the dimensions of the drain tube. In the postoperative period, sanitation of the purulent-necrotic focus was performed by means of continuous draining of the created cavity with antiseptic solutions. After the bacterial inoculation cultures were negative three times, the draining tube was removed, and gradually the tibia and talus bones were moved closer. The external fixation device was switched to the mode of consistent stabilisation with the possibility of putting weight on the damaged extremity. Fixation in the device continued until the X-ray picture of bone ankylosis in the ankle was obtained ResultsFor all patients we were able to achieve stable remission of the inflammation process and formation of a strong bone ankylosis in the ankle. The sanitation period of the purulent-necrotic focus was 14-16 days. After removal of the drain and compression in the external fixation device, the patients were allowed to move on crutches with moderate weight on the operated extremity. Duration of fixation in the device was 16-20 weeks. During 5 years of continuous follow-up, no relapses of inflammation in the ankle joint were observed. Conclusions.The suggested method makes it possible to solve the problem of ending inflammation in the ankle by means of forming bone ankylosis during surgical treatment of purulent osteoarthritis.
Научно-исследовательский институт травматологии, ортопедии и нейрохирургии ФГБОУ ВО «Саратовский государственный медицинский университет имени В.
Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) – two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.
Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) - two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.
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