Features of the Effect of Various Forms of Vitamin D on the Bone and Joint System

Dulaev, A. K.; Цед, А. Н.; Filchenko, Irina; Муштин, Н. Е.

doi:10.24884/1607-4181-2018-25-2-19-31

Cited by 6 publications

(1 citation statement)

References 79 publications

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“…Трансплантация почки, к сожалению, не позволяет добиться значительного улучшения качества костной ткани, так как предполагает длительную иммуносупрессивную и гормональную терапию. Снижение минеральной плотности костной ткани, а также параартикулярные патологические изменения приводят к увеличению риска перелома шейки бедренной кости [4,5], а также к дегенеративным изменениям тазобедренного сустава [6][7][8]. Тотальное эндопротезирование тазобедренного сустава у пациентов с терминальной стадией хронической болезни почек является сложной задачей.…”

Section: актуальностьunclassified

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Цед

Dulaev

Муштин

et al. 2019

Traumatology and Orthopedics of Russia

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Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (>600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

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Section: актуальностьunclassified

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Цед

Dulaev

Муштин

et al. 2019

Traumatology and Orthopedics of Russia

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Influence of anemia on the perioperative blood loss during total hip arthroplasty in patients with end-stage renal disease

Dulaev¹,

Цед²,

Муштин³

et al. 2019

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The OBJECTIVE was to determine the effect of anemia on the volume of blood loss during total hip arthroplasty in patients with end-stage renal disease. MATERIAL AND METHODS. The study was based on the data of 41 patients with pathology of hip joint who underwent primary hip replacement. In the group 1 – the group of comparison (n=20), there was no correction of anemia. In the group 2 – the main group (n=21), erythropoietin was applied 2 months before the operation, until the blood hemoglobin level exceeded 100 g/l, hematocrit – more than 30 %. RESULTS. In the first group of patients, there was the severe anemia: hemoglobin – (88.6±4.6) g/l, the number of red blood cells – (2.7±0.3·1012)/l, hematocrit – (27±2) %. In the second group, 2 months after using erythropoietin, hemoglobin level was (114.9±7.1) g/l, red blood cell count was (3.6±0.4·1012)/l, hematocrit was (33±2) %. Blood coagulation time before operation was (15.1±2.4) min in the first group, (8.7±1.8) min in the second group. Statistically significant difference was noted in blood loss: 59.2 %. In the first group, red blood cell mass transfusion was required in the volume of (554±205) ml for 18 patients (26 doses), plasma – in the volume of (641±67) ml for 20 patients (40 doses). In the second group, blood transfusion was performed for 3 patients in the volume of (321±116) ml. An inverse correlation between blood hematocrit, blood clotting time and blood loss was noted. The correlation coefficient was 0.9. CONCLUSION. The inverse correlation was indicated between the level of hematocrit, blood clotting time and blood loss. The use of erythropoietin in advance of reaching a blood hematocrit of >30 % could significantly reduce the risk of bleeding, reduce the amount of operating blood loss and reduce complications in the postoperative period.

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Features of diagnosis of osteo-articular pathology in total hip and knee arthroplasty in patients with end stage renal disease

Цед¹,

Dulaev²,

Муштин³

et al. 2019

The Scientific Notes of the Pavlov university

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Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской Федерации,

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Features of the Effect of Various Forms of Vitamin D on the Bone and Joint System

Cited by 6 publications

References 79 publications

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Influence of anemia on the perioperative blood loss during total hip arthroplasty in patients with end-stage renal disease

Features of diagnosis of osteo-articular pathology in total hip and knee arthroplasty in patients with end stage renal disease

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