RU2562597C1 - Method of preventing postoperative complications of joint endoprosthetics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopaedics, and can be applied for prevention of postoperative complications of joint endoprosthetics. For this purpose after installation of endoprosthesis elements napkin with collagen soaked with antibiotic is laid into wound, with further wrapping of joint fragments of bones. Edge of napkin is tightly introduced on the entire perimeter between each element of implant and adjoining bone.

EFFECT: method ensures reduction of haemorrhage and risk of hematoma formation, filling hollows inside of joint as a result of collagen swelling, increased time of presence and concentration of antibiotic in liquid contents of postoperative wound and increased efficiency of its local effect.

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Description

The method is designed for use in medicine, in particular in traumatology and orthopedics for cementless endoprosthetics of large joints.

One of the main reasons for the decrease in the survival rate of endoprostheses of large joints is the development of a deep para-prosthetic infection. The incidence of such complications in primary endoprosthetics ranges from 0.8% to 2.4%. [Magnan B .; Regis D .; Corallo F. Antibiotic-loaded cement spacer for two-stage revision of infected total hip replacements // Orthopedic Department, University of Verona, Italy. Bone and Joint Surgery -British Volume, Vol. 87-B, Issue SUPP.II, 188, 2005]. One of the reasons contributing to the development of infectious complications is the postoperative hematoma in the operated joint. It is caused by bleeding, primarily from bone tissue. Traditionally, wound drainage is used to evacuate blood [Prokhorenko V.M. Primary and revision hip arthroplasty. -Novosibirsk: ANO "Clinic NIIITO", 2007. - P. 117]. However, the total volume of blood loss in this case is significant, since there is no direct effect on the direct source of bleeding, which negatively affects the patient's condition.

Another option for the prevention of prosthetic infection is local antibiotic therapy. For this purpose, bone cement with an antibiotic is used [Kuropatkin G.V. Bone cement in traumatology and orthopedics. - Samara, 2006.- S. 26]. The disadvantage of this method is that bone cement is not used in all cases. For example, it is not needed for cementless endoprosthetics.

A known method for the prevention of postoperative complications, including the introduction into the surgical wound of a napkin with collagen and the antibiotic Collatamp IG, evenly distributed in its matrix, wrapping the femoral component of the endoprosthesis with this napkin, evenly distributing fragments of this napkin in soft tissues and, if necessary, using one wipes in the neck of the endoprosthesis [Skoroglyadov A.V. with osavt. "Local antibiotic prophylaxis for endoprosthetics of large joints at risk using the Collatamp IG implant" Methodical recommendations. M., 2013]. Collagen swells and an antibiotic leaves the surrounding tissues, acting on them for a certain time [Logroscino G., Malerba G., Paganon E., et al. The use of collatamp in total hip arthroplasty // Acta Biomed. 2011 -Aug; 82 (2) P. 154-159].

Moreover, it is known that one of the complications of endoprosthetics is the formation of a hematoma of a postoperative wound, localized, as a rule, in the voids formed during excision of tissues of the joint cavity [Volokitina EA and others. "Local intraoperative and early postoperative complications of hip replacement //" Genius of Orthopedics "2009, No. 3, - P. 71-77]. It is also known that for hemostasis in case of hemorrhage from the spinal bone of the acetabulum, local hemostatic agents are used, for example, the Tachocomb collagen plate or hemostatic sponge, which are applied to the wound surface of the bone [A. Gorodnichenko. and others. "The use of TachoComb in traumatology and orthopedics for hip joint surgery // posted on the Internet: URL: http: //www.mediasphera.ru/journals/pirogov/detail/279/4212> August 14, 2007; the placement date has been confirmed at the Internet archive URL: http: /web.archive.org/web/*/http: //www.mediasphera.ru/journals/pirogov/detal/279/4212>]. It is also known that the above-mentioned napkin with collagen and antibiotic Collatamp IG has hemostatic, reparative and local antibacterial action and is designed to provide local hemostasis and reduce the risk of developing a local infection by applying to the bleeding area [Collatamp IG implantable material is placed on the website on the Internet URL: http: //rlsnet.ru/pcr_tn_id_55167.htm> February 06, 2013; the placement date is confirmed at the Internet archive URL: http: //web.archive.org/web/20130206220700/http: //www.rlsnet.ru/pcr_tn_id_55167.htm]. In addition, it is known that after surgery on bone tissues, for example, during fractures, and the administration of a drug based on hydroxyappatite and collagen, and an implant (metal fixator), the bone defect is wrapped with an absorbable collagen film, which provides optimal conditions for restoring bone structure and function, prolonging the effect of the drug introduced into the wound [RU 2253393 C1 10.06.2005].

However, the lack of tight contact of the implant with a bone section does not allow to sufficiently reduce the rate of bleeding from it, which affects the total volume of blood loss. The absence of a collagen sponge in the area of direct implant-bone contact reduces the chances of better integration of the bone into the structure of the endoprosthesis elements.

The essence of the invention lies in the combination of essential features ensuring the achievement of the desired technical result, such as a decrease in blood loss, an increase in the effectiveness of local antibiotic exposure and the stability of a cementless endoprosthesis.

The essential features of the invention are that after installing the elements of the endoprosthesis, a napkin with collagen soaked in antibiotic is placed in the wound, articular fragments of bones are wrapped with it, and the edge of the napkin is tightly inserted along the entire perimeter between each element of the implant and the adjacent bone. The advantages of this method are:

- fixing the edge of the napkin directly at the site of the bone cut and wrapping the bone creates the effect of “tampon”, which allows you to mechanically reduce the speed, and therefore the total amount of bleeding,

- collagen swelling leads to the filling of voids inside the joint cavity, which reduces the risk of blood accumulation, and the formation of a hematoma.

- the presence of the antibiotic in the liquid contents of the postoperative wound increases in time and in concentration, which means that the effectiveness of its effect on surrounding tissues increases.

- the presence of a collagen sponge directly between the implant and the adjacent bone affects the regeneration of the latter, its growth into the structure of the elements of the endoprosthesis and, ultimately, the stability of the cementless endoprosthesis.

The proposed method is as follows.

In the process of surgery, produce an arthrotomy of the joint. According to the technology provided by one or another variant of endoprosthetics, the articular ends of the bones are treated. Set the elements of endoprostheses in the prepared bed. As a rule, a small space remains between the bone and the endoprosthesis due to the individual parameters of the treated bone of the patient. Into the resulting gap between the edge of the bone cut and the elements of the endoprosthesis, the edges of a collagen soaked in antibiotic are inserted tightly with a sharp tool. The elements of the endoprosthesis are compared with each other, and the remaining free part of the napkin is placed around the elements of the joint. If free space remains in the joint cavity, additional collagen wipes are laid. The wound is sutured tightly, the joint is drained with a tube.

Clinical example

Patient P., born in 1926, was admitted to the hospital with a diagnosis of Fracture of the femoral neck. The patient underwent arthroplasty with a bipolar endoprosthesis with cementless fixation of the leg. During the operation, an arthrotomy was performed, the femoral head was removed and the canal of the femur was successively increased in size with rasps. The endoprosthesis leg of cementless fixation was inserted into it. After the tight fit was completed, minimal gaps (crevices) remained between the leg and the inner surface of the proximal femur due to the fact that the shape of the rasp and the legs of the endoprosthesis do not perfectly match each other. The edges of a collagen napkin (impregnated with an antibiotic) are tightly inserted into these gaps with a thin metal plate along the entire perimeter of the contact between the bone and the endoprosthesis. The outer edges of the wipes are wrapped around the proximal femur. A bipolar head is installed on the neck of the endoprosthesis, which is inserted into the acetabulum. The wound is sewn up tight with the installation of a drainage system. The patient is allowed exercise therapy, walking on crutches with limited load on the operated limb. Total drainage blood loss was 20% less than with conventional wound drainage after endoprosthetics. The wound healed by primary intention. No postoperative infection was observed.

Claims (1)

A method for the prevention of postoperative complications of joint replacement is that after installing the elements of the endoprosthesis, a napkin with collagen soaked in antibiotic is placed in the wound, articular fragments of bones are wrapped, characterized in that the edge of the napkin is tightly inserted around the entire perimeter between each element of the implant and the adjacent bone.