Хирургия позвоночника 3/2007 (c. 59-64) анестезиология и реаниматология © М М. .Н Н.. Л Ле еб бе ед де ев ва а и и д др р. ., , 2007 Хирургия позвоночника 3/2007 (c. 59-64) анестезиология и реаниматология М М. .Н Н.. Л Ле еб бе ед де ев ва а и и д др р.. Технологии кровосбережения в хирургии сколиоза

To study the chronic intestinal insufficiency in patients with degenerative spine and large joint diseases as a possible independent risk factor in a perioperative period. Material and Methods. The study included 200 case histories selected by double-blind sampling out of 823 histories of patients with degenerative diseases of the spine and hip who received non-steroid anti-inflammatory drugs. All patients underwent highly traumatic surgical procedures, and clinical analysis of gastrointestinal tract, fiberoptic gastroduodenoscopy, fibercolonoscopy, phonoenterography, chronography, and dysbiosis test were performed to all of them. Results. The developed scale of chronic intestinal insufficiency signs represents a significant prognostic criterion for treatment selection in patients with degenerative spine and large joint diseases. It suggests that 74 % of patients have chronic intestinal insufficiency as a baseline clinically significant pathological condition. Conclusion. Chronic intestinal insufficiency is an essential risk factor in patients with degenerative diseases of the spine and large joints in perioperative period.

Background. Periprosthetic joint infection in the early postoperative period is a severe infectious complication. Its development, as a rule, is associated with the exogenous surgical wound infection, with the iatrogenic factor at the forefront. Clinical case description. A 73-years-old female with left-sided idiopathic 3rd stage hip osteoarthritis and concomitant pathology with a high degree of comorbidity underwent left hip arthroplasty with a cement-fixed “Endoservice” endoprosthesis. In the early postoperative period (4th to 6th days), against the background of chronic calculous cholecystitis exacerbation and gastrointestinal dysfunction, clostridial septicemia developed as a result of bacterial translocation. The timely diagnosis of the endogenous nature of this infection and the targeted antibiotic therapy prevented the surgical wound and endoprosthesis infection. The Harris score for the function of the left hip at discharge was 78 points. Conclusion. The presented clinical case demonstrates the importance of careful preoperative planning, especially in the patient with identifying somatic pathology of infectious nature, the need to detail the organ-specific microbiota as a mandatory procedure, as well as the prevention of periprosthetic joint infection during orthopedic operations, taking into account the data obtained.

Deep periprosthetic joint infection (PJI) is a severe complication after primary and revision hip joint arthroplasty resulting in multiple interventions on the joint. The present paper describes a rare case of early deep hip PJI of odontogenic etiology. The patient suffered from early PJI after a planned procedure of left hip joint arthroplasty. Antibacterial therapy without surgical debridement was performed in an outpatient unit which resulted in a late, on day 12th after surgery, admittance of the patient to hospital with continued administration of antibiotics. Treatment tactics was selected upon patient’s admission basing on patient complaints, medical history of the disease, clinical signs and findings of roentgenological, laboratory and bacteriological examinations. Two-stage treatment consisting of revision, removal of implant, debridement, biopsy and wound drainage by a swab was performed and followed by empiric antibacterial therapy (for 5 days). Targeted antibacterial therapy was prescribed basing on bacteriological test findings. Together with dentists the authors examined oral cavity of the patient, identified a site of chronic infection and undertook the focused treatment by dental extraction and sanitation of the oral cavity. Postoperative period after the first stage was uncomplicated. Second stage of revision (re-arthroplasty of left hip joint) was performed on week 36 of the surgical time-out with a good clinical outcome: 80 points on Harris hip score in 40 weeks after the second stage. Presented clinical case illustrates the existence of hematogenous mechanism of postoperative microorganism dissemination from the chronic infection nidus with subsequent progression of inflammation at the surgical site, including PJI. In the present case the Actinomyces odontolyticus was isolated from periprosthetic tissues and parodontal recesses which allowed the authors to suggest a highly probable cause for early PJI by Actinomyces odontolyticus translocation into periprosthetic tissues of the hip joint. However, strain sequencing is required for the complete verification. The described case confirms the need for debridement of chronic infection nidus prior to joint arthroplasty aiming at prevention of hematogenous periprosthetic infection.

; 2 Новосибирский государственный технический университет, Новосибирск При позвоночно-спинномозговой травме (ПСМТ) полиорганная недостаточность констатируется в первые часы после повреждения с развитием жизнеугрожающих состояний на фоне нейрогенного шока. Важнейшей составляющей интенсивной терапии является лечение клинической формы кишечной недостаточности-пареза кишечника. Цель исследования: оценка способа прогнозирования/диагностики пареза кишечника на основе компьютеризированного анализа кишечных шумов по данным фоноэнтерографии и показателям внутрибрюшного давления (ВБД). На этапах интенсивной терапии пациентов с ПСМТ проводилась оценка степеней пареза кишечника по клиническим проявлениям (1-я группа, n=14; 2-я группа, n=14). Методы компьютерной фоноэнтерографии и измерения ВБД использовались только во 2-й группе. Также во 2-й группе исследования определяли частоту кишечных шумов (ЧКШ) и показатели уровней ВБД в режиме реального времени, вычисляли коэффициент паретичности (по формуле: Кр = ВБД/ЧКШ). В 1-й группе исследования степень тяжести пареза определяли только по клиническим данным. Мощность кишечных шумов во 2-й группе характеризовалась быстрым их затуханием при возникновении пареза ЖКТ с минимальными клиническими проявлениями кишечной недостаточности (КН) на 7-10-е сутки (р=0,003). Выявлена обратная корреляционная зависимость между ЧКШ и ВБД при r=0,8. Также установлена корреляционная зависимость между степенью пареза ЖКТ и Кр при r=0,78 (р=0,008). При увеличении текущего показателя Кр в сравнении с начальным более чем на 500% прогнозировали вероятность развития пареза ЖКТ и пересматривали тактику антипаретичной терапии. В результате исследования выявлена корреляционная зависимость между степенями пареза ЖКТ и ВБД при r=0,9 на 7-10-е сутки. Максимальные клинические проявления пареза были на 7-10-е сутки в обеих группах. Но степень тяжести пареза во 2-й группе была меньше, чем в 1-й, в результате своевременного изменения тактики интенсивной терапии после оценки субклинических проявлений пареза, что и лежит в основе предложенного способа прогнозирования и ранней диагностики пареза кишечника. Ключевые слова: позвоночно-спинномозговая травма, прогнозирование, диагностика, парез, кишечная недостаточность.