ÎÐÈÃÈÍÀËÜÍÛÅ ÑÒÀÒÜÈ ÓÄÊ 616.728.2 089.28 002.3 089.844 ÈÑÏÎËÜÇÎÂÀÍÈÅ ÎÑÒÐÎÂÊÎÂÛÕ ËÎÑÊÓÒΠÈÇ ËÀÒÅÐÀËÜÍÎÉ ØÈÐÎÊÎÉ ÌÛØÖÛ ÁÅÄÐÀ  ËÅ×ÅÍÈÈ ÏÀÖÈÅÍÒÎÂ Ñ ÃÍÎÉÍÛÌÈ ÎÑËÎÆÍÅÍÈßÌÈ ÏÎÑËÅ ÝÍÄÎÏÐÎÒÅÇÈÐÎÂÀÍÈß ÒÀÇÎÁÅÄÐÅÍÍÎÃÎ ÑÓÑÒÀÂÀ Ð.Ì. Òèõèëîâ, À.Þ. Êî÷èø, Â.Ë. Ðàçîðåíîâ ÔÃÓ «Ðîññèéñêèé íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò òðàâìàòîëîãèè è îðòîïåäèè èì. Ð. Ð. Âðåäåíà Ðîñìåäòåõíîëîãèé», äèðåêòîð ä. ì. í. ïðîôåññîð Ð. Ì. Òèõèëîâ Ñàíêò-Ïåòåðáóðã Áëèæàéøèå è îòäàëåííûå ðåçóëüòàòû ëå÷åíèÿ 37 ïàöèåíòîâ ñ îñòåîìèåëèòîì ïðîêñèìàëüíîãî îòäåëà áåäðåííîé êîñòè è îáëàñòè âåðòëóæíîé âïàäèíû, â òîì ÷èñëå 26 áîëüíûõ ñ ãëóáîêîé ïåðèïðîòåçíîé èíôåêöèåé ïîñëå ýíäîïðîòåçèðîâàíèÿ òàçîáåäðåííîãî ñóñòàâà, áûëè ïðîñëåæåíû â ñðîêè îò 6 äî 44 ìåñÿöåâ ïîñëå ïðîâåäåíèÿ îïåðàöèé ïî ðàçðàáîòàííîé ìåòîäèêå, ïðåäïîëàãàþùåé ðàäèêàëüíóþ õèðóðãè÷åñêóþ îáðàáîòêó èíôåêöèîííûõ î÷àãîâ è îäíîìîìåíòíîå çàìåùåíèå îáðàçóþùèõñÿ ïîëîñòåé ïîñðåäñòâîì íåñâîáîäíîé ïëàñòèêè îñòðîâêîâûì ëîñêóòîì èç ëàòåðàëüíîé øèðîêîé ìûøöû áåäðà. Õîðîøèå ðåçóëüòàòû áûëè äîñòèãíóòû ïðè ñðåäíèõ ñðîêàõ íàáëþäåíèÿ 21,3±9,2 ìåñÿöåâ â 70,6% íàáëþäåíèé, à ðåöèäèâ îñòåîìèåëèòè÷åñêîãî ïðîöåññà áûë îòìå÷åí ëèøü â 5,9% ñëó÷àåâ. Ïðîâåäåííûé àíàëèç ñîáðàííîãî êëèíè÷åñêîãî ìàòåðèàëà ïîçâîëèë óòî÷íèòü ïîêàçàíèÿ è ïðîòèâîïîêàçàíèÿ ê âûïîëíåíèþ ðàññìîòðåííîé îïåðàöèè. The short-term results of treatment and follow-up in 37 patients with the osteomyelitis of proximal femoral part and the area of acetabulum including 26 patients with deep periprosthetic infection after hip replacement were followed in period from 6 till 44 months after the carrying out of operations according to worked up technique supposing the radical surgical debridement of infectious nidi and the singlestage replacement of cavities by means of island flap from lateral wide hip muscle. Good results were received at the medium terms of observation 21,3±9,2 months in 70,6% of cases and the recidivation of osteomyelitis was detected in 5,9%. The carried out analysis of clinical material allowed to determine indications for the operation and contraindications to surgery. Êëþ÷åâûå ñëîâà: ýíäîïðîòåçèðîâàíèå, òàçîáåäðåííûé ñóñòàâ, îñòåîìèåëèò, ïåðèïðîòåçíàÿ èíôåêöèÿ, íåñâîáîäíàÿ ïëàñòèêà, îñòðîâêîâûé ëîñêóò. Key words: hip replacement, osteomyelitis, periprosthetic infection, plastic surgery, island flap. Ëèòåðàòóðà 1. Àêæèãèòîâ, Ã.Í. Îñòåîìèåëèò / Ã.Í. Àêæèãèòîâ [è äð.]. Ì. : Ìåäèöèíà, 1986. 203 ñ. 2. Áåëîóñîâ À.Å. Ïëàñòè÷åñêàÿ, ðåêîíñòðóêòèâíàÿ è ýñòåòè÷åñêàÿ õèðóðãèÿ / À.Å. Áåëîóñîâ. ÑÏá. : Ãèïïîêðàò, 1998. 744 ñ. 3. Êè÷åìàñîâ, Ñ.X. Òîïîãðàôî-àíàòîìè÷åñêèå îáîñíîâàíèÿ è êëèíè÷åñêîå èñïîëüçîâàíèå ïåðåäíåëàòåðàëüíûõ ñëîæíûõ êîæíûõ ëîñêóòîâ áåäðà / Ñ.X. Êè÷åìàñîâ, À.Þ. Êî÷èø // Âåñòí. õèðóðãèè. 1991. Ò.146, ¹ 3. Ñ. 7479. 4. Íèêèòèí, Ã.Ä. Õèðóðãè÷åñêîå ëå÷åíèå îñòåîìèåëèòà / Ã.Ä. Íèêèòèí [è äð.]. ÑÏá. : Ðóññêàÿ ãðàôèêà, 2000. 287 ñ. 5. Ïàò. 299031 ÐÔ, ÌÏÊ À 61  17/56. Ñïîñîá ïëàñòèêè îñòðîâêîâûì ìûøå÷íûì ëîñêóòîì ïîñëå ðàäèêàëüíîé õèðóðãè÷åñêîé îáðàáîòêè îñòåîìèåëèòè÷åñêîãî î÷àãà â îáëàñòè âåðòëóæíîé âïàäèíû / Ð.Ì. Òèõèëîâ, À.Þ. Êî÷èø, Â.Ë. Ðàçîðåíîâ, Í.Ý. Ìèðçîåâ // Èçîáðåòåíèÿ. Ïîëåçíûå ìîäåëè. 2007. ¹14 (2 ÷.). Ñ. 430. 6. Ïøåíèñíîâ, Ê.Ï. Ìèîïëàñòèêà ëîñêóòàìè ñ îñåâûì êðîâîñíàáæåíèåì ïðè èíôåêöèîííûõ îñëîæíåíèÿõ ýíäîïðîòåçèðîâàíèÿ òàçîáåäðåííîãî ñóñòàâà / ÒÐÀÂÌÀÒÎËÎÃÈß È ÎÐÒÎÏÅÄÈß Ê.Ï. Ïøåíèñíîâ, Â.Â. Äàíèëÿê, Â.Â. Êëþ÷åâñêèé // Âåñòí. òðàâìàòîëîãèè è îðòîïåäèè èì. Í.Í. Ïðèîðîâà. 1998. ¹ 4. Ñ. 3236. 7. Ïøåíèñíîâ Ê.Ï. Ïðèíöèïû ðåêîíñòðóêöèè íèæíåé êîíå÷íîñòè / Ê.Ï. Ïøåíèñíîâ // Èçáðàííûå âîïðîñû ïëàñòè÷åñêîé õèðóðãèè. 2003. Ò. 1, ¹ 9. Ñ. 345. 8. Ðóêîâîäñòâî ïî ýíäîïðîòåçèðîâàíèþ òàçîáåäðåííîãî ñóñòàâà / ïîä ðåä. Ð.Ì. Òèõèëîâà, Â.Ì. Øàïîâàëîâà. ÑÏá., Êàçàíü: ÎÎÎ Àëìîëèò, 2008. 324 ñ. 9. Ñîâðåìåííûå òåíäåíöèè ïëàñòèêè ëîñêóòàìè ñ îñåâûì òèïîì êðîâîñíàáæåíèÿ íà íèæíåé êîíå÷íîñòè / Ð.Ì. Òèõèëîâ [è äð.] // Âåñòí. òðàâìàòîëîãèè è îðòîïåäèè èì. Í.Í. Ïðèîðîâà. 2007. ¹ 2. Ñ. 7175. 10. Òèõèëîâ, Ð.Ì. Îïûò èñïîëüçîâàíèÿ îñòðîâêîâîãî ëîñêóòà èç ëàòåðàëüíîé øèðîêîé ìûøöû áåäðà äëÿ çàìåùåíèÿ îñòåîìèåëèòè÷åñêèõ äåôåêòîâ â îáëàñòè âåðòëóæíîé âïàäèíû / Ð.Ì. Òèõèëîâ, À.Þ. Êî÷èø, Â.Ë. Ðàçîðåíîâ, Í.Ý. Ìèðçîåâ // Òðàâìàòîëîãèÿ è îðòîïåäèÿ Ðîññèè. 2005. ¹ 3. Ñ. 2629. 11. Allen, P.W. Results of impaction grafting in revision hip arthroplasty at two to seven years using fresh and irradiated allograft bone / P.W. Allen, C.H. Aldam // ÐÎÑÑÈÈ 4(50) 2008 7 ÎÐÈÃÈÍÀËÜÍÛÅ ÑÒÀÒÜÈ Hip. 2003. Vol. 13. P. 111. 12. Gross, A.E. Revision arthroplasty of the acetabulum with restoration of bone stock / A.E. Gross // Clin. Orthop. 1999. N 369. P. 198. 13. Lie, S.A. Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register / S.A. Lie [et al.] // J. Bone Joint Surg. 2004. Vol. 86B, N 4. P. 504509. 14. Mc Craw J.B. Atlas of muscle and musculocutaneous flaps / J.B. Mc Craw, P.G. Arnold. Norfolk : Hampton Press Publ. Co., 1986. 436 p. 15. Rand, N. Osteomyelitis of the pelvis / N. Rand, R. Mosheiff, Y. Matan // J. Bone Joint Surg. 1993. Vol. 75-B, N 5. P.731733. 8 4(50) 2008 16. Templeton, J.E. Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study / J.E. Templeton [et al.] // J. Bone Joint Surg. 2001. Vol. 83-A. P. 17061711. 17. Tunney, M.M. Detection of prosthetic hip infection at revision arthroplasty by immunofluorescence microscopy and PCR amplification of the bacterial 165 rRNA gene / M.M. Tunney [et al.] // J. Clin. Microbiology. 1999. Vol. 37, N 10. P. 32813290. Êîíòàêòíàÿ èíôîðìàöèÿ: Êî÷èø Àëåêñàíäð Þðüåâè÷, ä.ì.í. ïðîôåññîð, çàìåñòèòåëü äèðåêòîðà ïî íàó÷íîé è ó÷åáíîé ðàáîòå. ÔÃÓ «ÐÍÈÈÒÎ èì. Ð.Ð. Âðåäåíà Ðîñìåäòåõíîëîãèé» 195427, Ñàíêò-Ïåòåðáóðã, óë. Àêàäåìèêà Áàéêîâà, ä. 8. E-mail: info@rniito.org ÒÐÀÂÌÀÒÎËÎÃÈß È ÎÐÒÎÏÅÄÈß ÐÎÑÑÈÈ