; 2 ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург В исследование были включены 96 пациентов с костными анкилозами тазобедренного сустава (ТБС). Из них 24 пациента с костными анкилозами на фоне анкилозирующего спондилоартрита (АС), 10 пациентов с анкилозами гетеротопической оссификации (ГО) и 62 пациента с анкилозами ятрогенной этиологии. При проведении исследования учитывались следующие показатели: степень отклонения конечности в ТБС от функционально выгодного положения, шкала Харрис, EQ-5D-5L, визуально-аналоговая шкала (ВАШ) текущего состояния, Oswestry и ВАШ боли в монолатеральном коленном суставе, состояние средней ягодичной мышцы, интраоперационное изменение офсета и длины конечности, остаточная деформация бедренной кости. По данным корреляционного анализа было установлено, что основное влияние на сроки эндопротезирования оказывает степень сохранения опорной функции конечности, которая зависела от типа анкилоза. Длительность отсутствия движений в ТБС и степень изменений анатомии ацетабулярной области и бедренной кости также зависели от причины формирования анкилоза и оказывали непосредственное влияние на итоговые результаты эндопротезирования тазобедренного сустава. Выявленные закономерности указывают на необходимость строго индивидуального подхода к определению показаний и сроков выполнения эндопротезирования тазобедренного сустава пациентам данной категории. Ключевые слова: тотальное эндопротезирование тазобедренного сустава, анкилоз тазобедренного сустава, артродез, анкилозирующий спондилоартрит, гетеротопическая оссификация, опорная функция конечности. The study included 96 patients with bone hip ankylosis. 24 of them was a patient with ankylosing spondylitis (АС), 10 patients with ankylosis heterotopic ossification (HO) and 62 patients after hip arthrodesis. We studied: the degree of deviation of the limb at the hip by a functionally advantageous position, Harris, EQ-5D-5L, Visual Analogue Scale (VAS) condition of the patient, Oswestry and VAS pain is monolateral knee scales, gluteus medius condition, intraoperative change of offset and leg length, and postoperative femur deformation. According correlation analysis of total hip replacement periods directly related to the degree of conservation of the supporting limb function which depends directly on the type of ankylosis. The results of the total hip replacement depended both on the duration of ankylosis and on the degree of changes in the anatomy of the acetabular region and femur on the side of ankylosis. The revealed laws point to the necessity of a strictly individual approach to the definition of indications and timing of hip arthroplasty for these patients. TOTAL HIP IN CASE OF HIP BONE ANKYLOSIS DIFFERENT ETIOLOGY, REASONS

Prosthetic joint infection (PJI) after primary hip arthroplasty (PHA) in most cases results in severe surgical and socioeconomic problems. Along with improving the technical support of arthroplasty and antibiotic prevention schemes, a key point in reducing the rate of infectious complications is predicting of PJI in each individual patient. The purpose of the study was to reveal the key features of our patients with infectious complications after PHA in comparison with the patients with a successful outcome of arthroplasty. Materials and Methods. The outcomes of 249 cases of PHA were evaluated retrospectively. 115 of them subsequently developed PJI (main group) and 134 were without infectious complications (control group). The comparative analysis of the groups was aimed at identifying the key preoperative, intraoperative and postoperative factors for PJI, as well as combinations of the factors characteristic for our patients. Results. The risk group for the development of infectious complications included patients undergone hip surgery (p<0.001), body mass index >40 kg/m 2 (p = 0.170), preoperative hemoglobin <115 g/L (p = 0.063), duration of the operation >90 min (p<0.001), intraoperative blood loss >410 ml (p<0.001), CRP >69 mg/L on day 4 th to 5 th after PHA (p<0.001), as well as a combination of 4 or more of the above factors (p<0.001). Conclusion. We believe that the correction of the management tactics of such patients taking into account the identified risk factors will reduce the incidence of PJI after PHA.

Hip joint endoprosthetics is one of the most common methods of treating patients with dysplastic coxarthrosis often accompanied by plenty of technical difficulties, both at the stage of preoperative planning and directly during the surgery. This issue is caused by pronounced anatomical and biomechanical changes in joint on the background of dysplasia together with difficulty in positioning the components of endoprosthesis and risk of traction injury to the sciatic nerve when bringing down the proximal femur. This article presents clinical experience of treating patients with dysplastic coxarthrosis associated with congenital hip dislocation using subtrochanteric shortening osteotomy. Postoperative follow-up of patients after 3, 6 and 12 months and assessment of the life quality according to the Harris Hip Score and SF-36 questionnaires demonstrated good long-term treatment results, absence of postoperative complications, restoration of supporting function of the operated limb and improvement in life quality of the patients under study. The results of clinical observation were supplemented by analysis of current medical periodicals with the aim of recommending this treatment method for traumatologists and orthopedists performing similar operations in patients with hip joint dysplastic osteoarthrosis.

Введение Доля больных с переломами шейки бедренной кости составляет, по данным различных авторов, 2,5-4,0% от общего числа пациентов с переломами костей скелета [11, 15, 23]. Такие переломы