porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo13169porozendo-13169Research ArticleОригинальное исследованиеOriginal studyИнтраоперационные осложнения у пациентов с системной красной волчанкой при выполнении тотального эндопротезирования тазобедренного суставаIntraoperative complications in patients with systemic lupus erythematosus during total hip replacementhttps://orcid.org/0000-0002-3470-9726КушнареваИ. Г.KushnarevaI. G.

Кушнарева Ирина Геннадьевна

115522, Москва, Каширское шоссе, 34А 

Irina G. Kushnareva

Kashirskoye shosse 34A, Moscow, 115522

dr.kushnareva@yandex.ruhttps://orcid.org/0000-0001-5793-4689ПопковаТ. В.PopkovaT. V.

Попкова Татьяна Валентиновна - д.м.н.

115522, Москва, Каширское шоссе, 34А 

Tatyana V. Popkova - PhD.

Moscow

popkovatv@mail.ruhttps://orcid.org/0000-0002-5626-7404МакаровМ. А.MakarovM. A.

Макаров Максим Анатольевич - к.м.н.

115522, Москва, Каширское шоссе, 34А 

Maksim A. Makarov - Cand. Sci. (Med.)

Moscow

ortopedniir@mail.ruФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»РоссияScientific and Research Rheumatology Institute n.a. V.A. NasonovaRussian Federation2024050120252731219Copyright © Кушнарева И.Г., Попкова Т.В., Макаров М.А., 20252025Кушнарева И.Г., Попкова Т.В., Макаров М.А.Kushnareva I.G., Popkova T.V., Makarov M.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/13169ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Системная красная волчанка (СКВ) — хроническое заболевание неизвестной этиологии, характеризующееся системным иммуновоспалительным поражением жизненно важных органов. Тяжелым осложнением СКВ являются асептические некрозы костей, которые характеризуются выраженным болевым синдромом, нарушением функции суставов, снижением качества жизни и инвалидизацией. Несмотря на то, что эндопротезирование тазобедренного сустава является технически отработанным методом оперативного лечения, пациенты с СКВ по-прежнему составляют группу повышенного риска развития осложнений на всех этапах периоперационного периода.

ЦЕЛЬ

ЦЕЛЬ. Описать влияние СКВ на развитие интраоперационных осложнений при выполнении эндопротезирования тазобедренных суставов.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. В исследование включены 133 пациента с диагнозом СКВ, которым за период с 1998 по 2021 гг. выполнено тотальное эндопротезирование тазобедренного сустава. Все оперативные вмешательства выполнялись в травматолого-ортопедическом отделении НИИ ревматологии им. В.А. Насоновой. В группе больных СКВ преобладали женщины, соотношение женщин и мужчинам составило 7,3:1 соответственно. Средний возраст пациентов на момент операции — 36,6±12,6 года.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Эндопротезирование тазобедренного сустава всем пациентам (n=133) выполняли стандартно в положении пациента на здоровом боку из переднебокового доступа Хардинга. В 75 случаях (56,3%) была выполнена дополнительная фиксация вертлужного компонента винтами. В 10 случаях был наложен серкляж на проксимальный отдел бедренной кости по причине перелома, возникшего при разработке костномозгового канала. Для уточнения факторов, влияющих на развитие интраоперационного перелома, пациенты с СКВ были разделены на 2 группы: первая группа (n=10) — с интраоперационным переломом, вторая (n=123) — без перелома. Проведена сравнительная характеристика первой и второй групп. Еще одно осложнение на этапе оперативного лечения — повышенный объем кровопотери, потребовавший переливания эритроцитарной взвеси. Таких пациентов было 54 (40,6%). В отношении пациентов с повышенным объемом кровопотери мы сравнили клинико-лабораторные характеристики больных непосредственно перед оперативным лечением с повышенным объемом кровопотери и без такового.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. В исследовании мы провели анализ полученных интраоперационных осложнений. Мы не получили подтверждение влияния суточной и кумулятивной доз ГК, а также степени активности и течения СКВ на риск интраоперационного перелома. Достоверно выше вероятность перелома оказалась у пациентов с исходно сниженной минеральной плотностью костной ткани.

В отношении повышенного объема кровопотери у пациентов с СКВ, достоверно выявлена связь с исходной анемией (сниженным уровнем гемоглобина и гематокрита) в предоперационном периоде (p<0,001).

BACKGROUND

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic disease of unknown etiology characterized by systemic immuno-inflammatory damage to vital organs. A serious complication of SLE is aseptic bone necrosis, which is characterized by severe pain syndrome, impaired joint function, decreased quality of life and disability. Despite the fact that hip replacement is a technically proven method of surgical treatment, patients with SLE are still at increased risk of complications at all stages of the perioperative period.

AIM

AIM: the aim of the work is to describe the effect of SLE on the development of intraoperative complications during hip replacement.

MATERIALS AND METHODS

MATERIALS AND METHODS: The study included 133 patients diagnosed with SLE who underwent total hip replacement between 1998 and 2021. All surgical interventions were performed in the traumatology and orthopaedic department. The group of patients with SLE was dominated by women, the ratio of women to men was 7.3:1, respectively. The average age of patients at the time of surgery was 36.6±12.6 years.

RESULTS

RESULTS: Hip replacement in all patients (n=133) was performed as standard in the patient’s position on the healthy side from the anterolateral Harding access. In 75 cases (56.3%), additional fixation of the acetabulum component with screws was performed. In 10 cases, a cerclage was applied to the proximal femur due to a fracture that occurred during the development of the bone marrow canal. To clarify the factors influencing the development of an intraoperative fracture, patients with SLE were divided into 2 groups: the first group (n=10) — with an intraoperative fracture, the second (n=123) — without a fracture. The comparative characteristics of the first and second groups are carried out. Another complication at the stage of surgical treatment is an increased volume of blood loss, which required transfusion of erythrocyte suspension. There were 54 such patients (40.6%). In relation to patients with increased blood loss, we compared the clinical and laboratory characteristics of patients immediately before surgical treatment, with and without increased blood loss.

CONCLUSION

CONCLUSION: In the study, we analyzed the resulting intraoperative complications. We have not received confirmation of the effect of daily and cumulative doses of HA, as well as the degree of activity and course of SLE on the risk of intraoperative fracture. The probability of fracture was significantly higher in patients with initially reduced bone mineral density. With regard to the increased volume of blood loss in patients with SLE, a significant association was found with baseline anemia (reduced hemoglobin and hematocrit levels) in the preoperative period (p<0.001).

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The authors declare that there are no conflicts of interest present.