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"Тrauma" Том 15, №4, 2014

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Treatment of sepsis with purulent - inflammatory diseases of joints

Authors: Pobel A.N.,Klyackiy Y.P., Tribushnoy O.V, Pobel E.A., Trufanov I.I., Gordienko Y.A. - S I «Zaporizhzhia Medical Academy of Postgraduate Education of Ministry of Health of Ukraine»

Categories: Traumatology and orthopedics

Sections: Clinical researches

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Introduction. Septic complications remain one of leading reasons of lethality patientsof traumatology permanent establishments. Meaningfulness of problem is determined the high number of unsatisfactory ends of treatment and increase of amount of cases of generalization of inflammatory process.

Purpose of work development of principles of treatment and prophylaxis of at patients with septic arthritis’s of large joints.

Materials and methods. For achievement of the put purpose the results of treatment were investigational by us 54 patients. The troubleshooting routine of inspection included: analysis of blood and urine, glucose of blood, biochemical indexes of function of liver, buds, X-ray and computer tomography of joint. The complex of bacteriologicexaminations consisted of microbiological study of wounds in a dynamics: character of microflora, sensitiveness of the sown microorganisms to antibacterial preparations, blood test on a hemoculture.

Results of treatment and their discussion. The followings constituents were included in the algorithm of treatment: preoperative preparation, punction, and then synosteotomy of joint with the subsequent draining, for the permanent washing and leadthrough of measures of intensive therapy (antibiotic therapy, detoxification, immunal therapy). 48 with septic arthritises the wide synosteotomy of joint, which allowed to carry out the detailed revision and deleting from his cavity of free bone fragments, was made patients. To 6 patients with festering arthritises, in connection with destruction of bone structures, the resection of joint is executed with the purpose of arthrodesis by Ilizarov’s osteosintes. Draining and washing of cavity of joint carried out through the perforated vinil tubes during three weeks. In connection with high distribution of penicillin-resistant cultures of gram-negative cocci and their possible association withgram-negative cocci we utilized cefalosporin of III-IV of generations pathogenic exciters (ceftriakson, cefepim). Resistance to these antibiotics utillized combination of vankomicin with ciprofloksacin. A positive effect in treatment was got at setting combination of ciprofloksacin with rifampicin.

Depending on weight of violations of indexes of homeostasis treatment, directed on suppression of endotoxicosis, was appointed. Specific immunocorrection consisted in introduction of immunal preparations: hyperimmune plasma, immunoproteins, timalin, timogen. Select tactic of treatment of sepsis at patients with the festerings defeats of large joints were given by possibility fully stoping an inflammatory process and get good results for 50 patients.

Conclusions. The offered medical program provides good results in treatment of heavy category of patients with septicarthritises the flow of which is complicated a sepsis. Hospitalization of patients of this category must be carried out in the the earliest possible date in the specialized separation. Permanent monitoring of microbal landscape separated from a joint grounds for the leadthrough of adequate etiotropic antibiotic therapy.

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