RU2393788C1 - Method of treating early deep suppurations after hip joint endoprosthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to methods of treating deep suppurations after hip joint endoprosthesis. Method includes surgical treatment of suppurative focus, its irrigation with antiseptic solutions, proteolytic enzymes and application of primary sutures. In order to eliminate residual cavity after necroses dissection, inguino-lumbar muscle is passed behind endoprosthesis neck and sewn to walls of residual cavity. Gluteus medius muscle and muscle, straining broad fascia of the thigh, are passed in front of endoprosthesis neck, sewing them to walls of residual cavity and inguino-lumbar muscle.

EFFECT: application of invention allows to eliminate residual cavity, terminate early deep suppuration, preserve endoprosthesis, carry out wound healing by primary tension, prevent recurrence of suppurative process and improve patient's life quality.

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Description

The present invention relates to medicine, in particular to methods for treating early deep suppuration after hip replacement.

As a prototype, we chose a method consisting in the surgical sanitation of the suppuration foci, drainage of the wound with the introduction of antiseptic solutions and proteolytic enzymes and the application of primary sutures (see A.V. Kaplan et al. "Purulent traumatology of bones and joints." - M .: Medicine, 1985, pp. 366-367).

However, the known method does not allow to eliminate the residual cavity after excision of non-viable tissue and save the endoprosthesis. The wound heals for a long time, which leads to repeated operations and worsens the quality of life of the patient.

The objective of the proposed technical solution is to eliminate the residual cavity, stopping early deep suppuration, preservation of the endoprosthesis, wound healing by the type of primary tension, prevention of recurrence of the purulent process and improving the quality of life of the patient.

The problem is solved due to the fact that in the method, including the surgical treatment of the purulent foci, its irrigation with antiseptic solutions, proteolytic enzymes and the application of primary sutures, to eliminate the residual cavity after excision of the necrotic tissue, the ileo-lumbar muscle is posterior to the back of the endoprosthesis neck and hemmed to the walls of the residual cavity, and the midgluteus muscle and the muscle straining the wide fascia of the femur, are carried out in front of the neck of the endoprosthesis, hemming to the walls of the residual cavity and iliopsoas muscle.

The method is as follows. Transfistulose staining of wound tissues with a brilliant green solution in combination with a hydrogen peroxide solution in a ratio of 1: 1 and transfistulose access to the hip joint with mobilization of the gluteus maximus muscle and the muscle straining the broad fascia of the thigh are performed. Then excised necrotic tissue changes. Dislocate the endoprosthesis head from the femoral component. Necrotic tissue is removed from the subacetabular region. The iliopsoas muscle is mobilized. The endoprosthesis head is inserted into the acetabulum. After that, the iliopsoas muscle is carried out into the residual cavity behind the neck of the endoprosthesis and is sutured to the walls of the residual cavity. The gluteus maximus muscle and the muscle straining the broad fascia of the thigh are inserted into the residual cavity in front of the neck of the endoprosthesis and are sutured to the walls of the residual cavity and the iliopsoas muscle. Produce drainage of the wound. Layered suture of the wound.

Clinical example. B-th 3., 45 years old, East. Disease No. 230431.

Clinical diagnosis: "Right-sided idiopathic coxarthrosis of the III degree."

The operation "Primary total hip arthroplasty" was performed on August 14, 2007. On the ^4th day, early deep suppuration of the left thigh wound was noted. Radiography and fistulography results: contrast is visualized in the area of the acetabular component and around the neck of the endoprosthesis. Ultrasound results: there is a cavity in the neck of the endoprosthesis of 3 × 3.5 cm in size.

Operation "Surgical treatment of purulent foci, necrectomy, muscle plastic of the residual wound cavity of the neck of the endoprosthesis, drainage of the femoral wound."

A solution of brilliant green mixed with a 3% solution of hydrogen peroxide was introduced into the fistula. To examine the cavity of the endoprosthetic joint, a dislocation of the endoprosthesis was performed. Excision of non-viable tissue was performed. A cavity was formed in the neck of the endoprosthesis. The cavity around the neck of the endoprosthesis is covered by the ilio-lumbar muscle in the back, and in the front by the muscle straining the broad fascia of the thigh, and by the gluteus maximus. Drainage. Suture of the wound.

The patient was examined 1.5 years after the operation - there is no recurrence of a purulent process.

The method has been successfully applied in the treatment of 28 patients with deep early suppuration after endoprosthetics with primary wound healing and relief of purulent process in 26 patients.

A method of treating early deep suppurations after hip replacement allows preserving the patient’s endoprosthesis, has a low risk of arterial thrombosis of the vascular pedicle and necrosis of the islet muscle flap, and provides minimal surgical damage to the anatomical structures. In addition, the method significantly reduces intra- and postoperative blood loss, provides relief of early deep suppuration, wound healing by the type of primary intention, prevents the recurrence of purulent process, creates opportunities for early activation and rehabilitation of the patient, improves the quality of life. The method is pathogenetically substantiated, affordable, simple in technical design and can be applied in urban, regional surgical and trauma hospitals.

Claims (1)

A method for treating early deep suppurations after total hip arthroplasty, including surgical treatment of a purulent foci, its irrigation with antiseptic solutions, proteolytic enzymes and the application of primary sutures, characterized in that the ileo-lumbar muscle is placed under the back of the neck to remove the residual cavity after excision of necrosis, it is to the walls of the residual cavity, and the gluteus maximus muscle and the muscle straining the wide fascia of the thigh, are carried out in front of the neck of the endoprosthesis otosis, hemming them to the walls of the residual cavity and the iliopsoas muscle.