The Use of Transexamic Acid for Total Hip Arthroplasty in Chronic Hemodialysis Patients

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

doi:10.24884/0042-4625-2018-177-4-47-51

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Еще одной актуальной проблемой лечения пациентов, получающих гемодиализ, является развитие тяжелых периоперационных кровотечений [21,22]. Причем источником кровотечения может служить как сама операционная рана, так и другие органы (желудочно-кишечные кровотечения, инсульты).…”

Section: Discussionunclassified

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Мушкин

Dulaev

Цед

2020

Traumatology and Orthopedics of Russia

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РезюмеАктуальность. Хирургическое лечение заболеваний и травм позвоночника у пациентов, находящихся на гемодиализе, является одной из самых сложных проблем хирургической вертебрологии, поскольку связано с повышенным риском инфекционных осложнений и периоперационной летальности. Описание случая. Пациентка 59 лет обратилась в клинику с жалобами на боли в спине. Выявлен спондилит Th8-9 позвонков, осложненный эпидуральным и паравертебральным абсцессом с неврологическими нарушениями, возникшими на фоне двусторонней пневмонии. Пациентка в течение 18 лет получает гемодиализ по поводу терминальной стадии ХБП, осложненной уремической остеодистрофией. Хирургическая санация и стабилизация позвоночника проведена в один этап из заднего доступа с использованием титанового сетчатого имплантата в сочетании с костной аутопластикой и задней инструментацией. Достигнут регресс неврологических нарушений, купирован болевой синдром. В позднем послеоперационном периоде дважды развивалась нестабильность задней фиксации, потребовавшая рестабилизации. В течение 3,5 лет после операции повторных обращений в связи с болевым синдромом в спине не было. Заключение. Наличие аппаратуры для проведения гемодиализа и мультидисциплинарный подход позволяют добиться положительных результатов хирургического лечения воспалительных заболеваний позвоночника у пациентов с терминальной стадией ХБП.Ключевые слова: инфекционный спондилит, хирургическое лечение, хронический гемодиализ, хроническая болезнь почек.

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Section: Discussionunclassified

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Мушкин

Dulaev

Цед

2020

Traumatology and Orthopedics of Russia

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“…Потребность в эндопротезировании тазобедренного сустава у пациентов, получающих гемодиализ, в 6,6 раза выше по сравнению с больными, не страдающими заболеваниями почек, и составляет 35 на 10 000 [4]. Объем периоперационной кровопотери при первичной артропластике значительно повышен и может достигать 2000 мл [5]. Увеличенный объем кровопотери связан с многофакторными нарушениями в системы гемостаза.…”

Section: актуальностьunclassified

Application of Desmopressin and conjugated estrogens to reduce the volume of blood loss during arthroplsty of the hip joint in patients with end stage renal disease

Муштин¹,

Цед²,

Dulaev³

et al. 2020

The Scientific Notes of the Pavlov university

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The objective was to determine the possibilities of using desmopressin and conjugated estrogens during primary hip joint arthroplasty in patients receiving renal replacement therapy.Methods and materials. The material for the study was data on 53 patients with pathology of the hip joint, who underwent primary arthroplasty from 2016 to 2018. All patients were divided into 2 groups. Group 1 (n=23) – patients not suffering from kidney diseases. Group 2 (n=30) – patients receiving renal replacement therapy. Each group was divided into 2 subgroups: 1 subgroup – comparisons, where the combination of desmopressin/conjugated estrogens was not used. 2 subgroup – control, where desmopressin was used at a dosage of 0.4 mg/kg 2 hours before the incision, conjugated estrogens was used at a dosage of 0.6 mg / kg of body weight within 5 days before the operation.Results. In group 1 (patients not suffering from kidney disease), there was no statistically significant difference between the subgroups. In group 2 (patients receiving hemodialysis), there was a statistically significant difference in the volume of blood loss. Thus, in the subgroup without using additional techniques, the volume of intraoperative blood loss was 769.5±389.3 ml; in the second subgroup (using desmopressin and estrogens) – 479.1±245.2 ml. The difference was statistically significant, p<0.05. The efficiency was 27.9 %.Conclusion. The additional use of conjugated estrogens at a dose of 0.6 mg/kg of body weight within 5 days before the operation, desmopressin at a dose of 0.4 mg/kg of body weight 2 hours before the incision reduced blood loss by 27.9 %. The use of combination of conjugated estrogens and desmopressin in patients not suffering from kidney disease did not affect the amount of blood loss.

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“…2). Как видно из представленной таблицы, у больных, находящихся на заместительной почечной терапии, наблюдалась значительная анемия в предоперационном периоде, что требовало дополнительной подготовки к эндопротезированию [20,21]. При сравнении показателей пациентов с выполненной трансплантацией почки и без заболевания почек статистической разницы в предоперационном уровне гематокрита крови не отмечается.…”

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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The Use of Transexamic Acid for Total Hip Arthroplasty in Chronic Hemodialysis Patients

Cited by 5 publications

References 18 publications

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Application of Desmopressin and conjugated estrogens to reduce the volume of blood loss during arthroplsty of the hip joint in patients with end stage renal disease

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

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