No abstract

Цель исследования: сравнение эффективности различных курсов периоперационной антибиотикопрофилактики (ПАП) при хирургическом лечении открытых травм кисти у детей. Дизайн: смешанное ретро-и проспективное сравнительное исследование. Материалы и методы. У 40 детей, получивших хирургическое лечение по поводу открытых травм кисти, проводили ПАП цефуроксимом в максимальной разовой дозировке: препарат вводили за 30 минут до оперативного вмешательства и в течение 24 часов (группа 1, n = 20) или 72 часов (группа 2, n = 20) после операции. Методы исследования включали общий анализ крови (ОАК), ежедневную термометрию, оценку общих показателей (уровень лейкоцитов и скорость оседания эритроцитов на третьи сутки после операции, температура тела) и местных проявлений воспаления (гиперемия и болезненность раневых краев, количество и качество патологического отделяемого из раны). Результаты. При суточном введении антибиотика на 10,0% чаще встречалась субфебрильная гипертермия, а при трехсуточном введении на 5,0% чаще отмечался лейкоцитоз в ОАК. В группе 1 гиперемия и болезненность краев раны наблюдались у 5,0% пациентов, а в группе 2-у 15,0%. Все различия не имели статистической значимости (р > 0,05). Заключение. При хирургическом лечении открытых повреждений кисти у детей эффективна ПАП цефалоспоринами 2-го поколения; 72-часовое применение антибиотика после операции не имеет преимуществ перед 24-часовым применением. Ключевые слова: травма, кисть, периоперационная антибиотикопрофилактика, дети.

Objective. Antibiotic prophylactics in surgery is a standard of medical care for many surgical interventions. It is “a very short course”: starts immediately before surgery and lasts no more than 24 hours after it. There were no any information found after a broad search on pathomorphology of consolidation zone in open fracture and morphometry of bone callus structures under various modalities of perioperative antibiotic prophylactics. Purpose. To find out reparation degree and inflammatory changes in bone tissue in the area of consolidation in open femoral fracture in experimental animals under various modalities of perioperative antibiotic prophylactics. Material and methods. 60 outbred male guinea pigs were taken into the experiment. The experimental animals were divided into 3 groups, 20 individuals in each. Animals from Group I, so-called “AB-1”, were given antibiotics 30 minutes before surgery and then for 8 hours after it during one day. Animals from Group II, so-called “AB-3” were administered antibacterial drug for 3 days of postoperative period. Guinea pigs from Group III (Controls) had no antibiotic therapy. The modeling of femur open fracture was performed according to the developed methodology for modeling and treatment of open fractures of tubular bones in experiment. Results. When comparing reparative processes in AB-1 and AB-3 groups, similar regeneration processes in femoral fracture were noted. They were accompanied by: formation of endostal and periosteal callus with abundantly vascularized connective tissue; formation of significant amount of newly formed bone trabeculae; insignificant presence of leukocytes in the lumen of bone marrow canal, what may be explained by peculiarities of postoperative management of laboratory animals. In the Control group, growth of newly formed bone trabeculae was less intensive ( less by 16.3%); there also were 2-fold increase in connective tissue volume and actively proliferating zones of cartilage tissue. Conclusion. Thus, findings of morphological examination indicate that in the experimental group with short 24-hour perioperative antibiotic prophylaxis, bone tissue consolidation had minimal inflammatory changes and better formation of new bone trabeculae.

Hydroxyapatite coatings were deposited for 1, 2, and 3 h on NiTi substrates using plasma-assisted radio frequency sputtering. The matrix consisted of NiTi B2 and NiTi B19’ phases and Ti2Ni, Ni3Ti, and Ni4Ti3 intermetallic compounds. The surface coating was monoclinic hydroxyapatite. Increasing the deposition time to 3 h made it possible to form a dense hydroxyapatite layer without visible defects. The phase contrast maps showed that the coating consisted of round grains of different fractions, with the smallest grains in the sample deposited for 3 h. The wettability tests showed that the coating deposited for 3 h had the highest surface energy, reflected in the proliferation density of the MCF-7 cell line.

Relevance. The rapid development of new technologies in surgery has opened up broad horizons for the implementation of complex surgical interventions. At the same time, the duration of operations was reduced, the invasiveness decreased, and broad operational approaches began to go into the past. However, the infectious process in the area of operative action remains an acute problem of surgery today. Infections of the surgical area (OSIW) are infections that develop within 30 days after surgery or within a year after installing the prosthesis (heart valves, blood vessels or joint).Aim. Develop an algorithm for perioperative antibiotic prophylaxis for open tubular fractures based on experimental research.Methods. An experimental study was conducted on 60 adult guinea pigs, which created a model of an open femur fracture. All animals were divided into 3 groups depending on the timing of the introduction of antibacterial drugs. The degree of local manifestations was assessed according to the developed scale from 0 to 2 points, where 0 is the total absence of inflammatory manifestations, and 2 points is their maximum manifestation. The signs of inflammation were also evaluated in the general clinical blood test.Results. During the experiment it was revealed that the introduction of antibacterial drugs for open fractures of tubular bones is necessary for prophylactic purposes. An increase in the timing of the introduction of antibiotics to three days or more is not rational, since there are no significant differences compared with a shorter course of antibiotic prophylaxis. Conclusions. Experimental perioperative antibiotic prophylaxis (PAP) on the model of an open fracture of the tubular bone indicated the possibility of introducing the PAP algorithm for open hand injuries in children.