bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2017-62-2-70-74bloodjour-65Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОПЫТ ЭНДОПРОТЕЗИРОВАНИЯ В ЛЕЧЕНИИ ГЕМОФИЛИЧЕСКОЙ АРТРОПАТИИEXPERIENCE OF JOINT REPLACEMENT IN THE MANAGEMENT OF HAEMOPHILIC ARTHROPATHYhttps://orcid.org/0000-0002-2049-850XЗоренкоВ. Ю.ZorenkoV. Yu.https://orcid.org/0000-0002-4143-3094ПолянскаяТ. Ю.PolyanskayaT. Yu.

125167, г. Москва

Полянская Татьяна Юрьевна, кандидат мед. наук, старший научный сотрудник, врач травматолог-ортопед научно-клинического отделения реконструктивно-восстановительной ортопедии для больных гемофилией

Moscow, 125167

Polyanskaya Tatyana Yu., MD, PhD, senior researcher, traumatologist-orthopaedic surgeon, orthopedic department for hemophilia patients

polyantat@rambler.ruhttps://orcid.org/0000-0003-1464-8652КарповE. Е.KarpovE. E.

125167, г. Москва

https://orcid.org/0000-0001-7140-2152СадыковаН. В.SadykovaN. V.

125167, г. Москва

https://orcid.org/0000-0003-2602-5006ВасильевД. В.VasilievD. V.

125167, г. Москва

https://orcid.org/0000-0001-5111-0881МишинГ. В.MishinG. V.

125167, г. Москва

https://orcid.org/0000-0001-9285-5206СампиевМ. С.SampievM. S.

125167, г. Москва

https://orcid.org/0000-0002-2962-1455ГолобоковA. В.GolobokovA. V.

125167, г. Москва

https://orcid.org/0000-0002-5361-4765ПетровскийД. Ю.PetrovskyD. Yu.

125167, г. Москва

Moscow, 125167 

ФГБУ «Гематологический научный центр» Минздрава РоссииРоссияNational Research Center for HematologyRussian Federation2017120320196227074Copyright © Зоренко В.Ю., Полянская Т.Ю., Карпов E.Е., Садыкова Н.В., Васильев Д.В., Мишин Г.В., Сампиев М.С., Голобоков A.В., Петровский Д.Ю., 20192019Зоренко В.Ю., Полянская Т.Ю., Карпов E.Е., Садыкова Н.В., Васильев Д.В., Мишин Г.В., Сампиев М.С., Голобоков A.В., Петровский Д.Ю.Zorenko V.Y., Polyanskaya T.Y., Karpov E.E., Sadykova N.V., Vasiliev D.V., Mishin G.V., Sampiev M.S., Golobokov A.V., Petrovsky D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/65

Представлен опыт 675 эндопротезирований (616 первичных, 59 ревизионных) у 425 больных (у 383 гемофилия А, у 42 гемофилия В) в возрасте от 18 до 76 лет. У 18 больных течение гемофилии было осложнено наличием ингибитора. У 90% больных имелись положительные антитела к гепатиту С, 3 больных были ВИЧ-инфицированными. Выполнено 552 эндопротезирования коленных суставов, 115 – тазобедренных суставов, 5 – плечевых, 3 - локтевых суставов. У больных ингибиторной формой гемофилии проведено 23 эндопротезирования коленных суставов, 3 – тазобедренных суставов. Средняя продолжительность «выживаемости» эндопротезов составила 6 лет (от 4 мес до 20 лет). У 8,8% больных потребовалось ревизионное эндопротезирование, из них у 5,5% установлена асептическая нестабильность компонентов эндопротеза, у 3% – глубокая инфекция. Среди больных ингибиторной формой гемофилии частота развития инфекционных осложнений была значительно выше – 11%. Несмотря на повышенные риски развития осложнений у больных гемофилией, эндопротезирование является единственным эффективным методом в лечении терминальной стадии артропатии. У больных гемофилией необходим индивидуализированный подход в обеспечении гемостаза и профилактической антибактериальной терапии.

We report our experience of 675 (616 primary, 59 revision) joint replacements in 425 patients performed in one hospital. There were 383 patients with hemophilia A and 42 patients with hemophilia B (age from 18 to 76 years). Inhibitor was detected in 18 hemophilia patients. 90% of patients had positive antibodies to hepatitis C (anti-HCV+), 3 patients had HIV infection. There were 552 knee, 115 hip, 5 shoulder and 3 elbow replacements. 23 knee and 3 hip replacements were performed in hemophilia patients with inhibitor. The average follow-up of implants was 6 years (from 4 months to 20 years). There were revision replacements in 8.8% of cases: 5.5% patients with aseptic loosening and 3% patients – with deep infections. In hemophilia patients deep infection occurred much more frequent – 11%. The significantly higher rate of complications (11%) was observed in patients with inhibitors. In spite of elevated risks for the development of complications in hemophilia patients joint replacement is the only effective procedure in the treatment of end-stage arthropathy. Hemophilia patients need an individualized approach in providing hemostasis and prophylactic antibacterial therapy.

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