(4) 4-8_Utilização de “espaçador de cimento”
Transcrição
(4) 4-8_Utilização de “espaçador de cimento”
Utilização de “Espaçador de Cimento” para o Tratamento de Artroplastia Total de Quadril Infectada Maurício Morita Sugiyama1, Marcelo Itiro Takano2, Lauro Cardozo Magalhães Filho1, Daniel Arruda Mello1, Rodrigo Moretti Arantes2, Richard Armelin Borger2, Rubens Salem Franco2, Roberto Dantas Queiroz3. 5(6802 2VDXWRUHVDSUHVHQWDPDGHVFULomRGRWUDWDPHQWRGHDUWURSODVWLDWRWDOGHTXDGULO LQIHFWDGDXWLOL]DQGRDWpFQLFDGHUHYLVmRHPGXDVHWDSDVFRPHPSUHJRGHHVSDoDGRUGH FLPHQWR Descritores: Artroplastia, infecção. 6800$5< 7KHDXWKRUGHVFULEHVWKHWUHDWPHQWRILQIHFWHGWRWDOKLSDUWKURSODVW\XVLQJWKHWZR VWDJHWHFKQLTXHZLWKFLPHQWHGVSDFHULPSODQW Keywords: Arthroplasty; infection. ,1752'8d®2 $LQIHFomRQDDUWURSODVWLDWRWDOGRTXDGULODSUHVHQWDLQFLGrQFLDGHQRVVHUYLoRV HVSHFLDOL]DGRVPHVPRFRPRVDYDQoRVQDWpFQLFDFLU~UJLFDFXLGDGRVGHDVVHSVLDDQ WLVVHSVLDHDQWLELRWLFRSURÀOD[LD 1. Estagiário do grupo do quadril do serviço de ortopedia e traumatologia do HSPE - IAMPE 2. Medico assistente do grupo do quadril do serviço de ortopedia e traumatologia do HSPE - IAMPE 3. Chefe do grupo do quadril e diretor do serviço de ortopedia e traumatologia do HSPE - IAMPE Técnicas em Ortopedia 2010; 4:4-8 87,/,=$d®2'(´(63$d$'25'(&,0(172µ 1RVFDVRVGHLQIHFo}HVFU{QLFDVHVWiLQGLFDGDDUHWLUDGDGRLPSODQWH$SyVDPSOR GHVEULGDPHQWRHOLPSH]DGROHLWRLQIHFWDGRHGHVYLWDOL]DGRRFLUXUJLmRWHPFRPRRSomR DUHYLVmRHPXPRXGXDVHWDSDVVHPSUHDVVRFLDGRVjDQWLELRWLFRWHUDSLD$UHYLVmRHP XPDHWDSDHQYROYHDVXEVWLWXLomRLPHGLDWDSRUQRYDDUWURSODVWLD$VLPSOHVUHWLUDGDp UHVHUYDGDSDUDSDFLHQWHVFRPVD~GHGHELOLWDGDQRVFDVRVFRPSOH[RVRXFRPJUDQGHV SHUGDVyVVHDV 1DV UHYLV}HV HP GXDV HWDSDV WHPRV D RSomR GD XWLOL]DomR GR HVSDoDGRU &RP D IXQomRGHPDQWHURFRPSULPHQWRHSUHHQFKHURHVSDoRPRUWRVHXXVRpUHFRQKHFLGRQD OLWHUDWXUDDWXDO (PWRGRVRVWLSRVGHWUDWDPHQWRpGHVXPDLPSRUWkQFLDDFXOWXUDGHPDWHULDOFROKL GRQRLQWUDRSHUDWyULRGHSUHIHUrQFLDGHWUrVVtWLRVFLU~UJLFRVGLIHUHQWHVHFRPPDWHULDO yVVHRDVVRFLDGR 'HVFUHYHUHPRVDVHJXLUDWpFQLFDRSHUDWyULDGDUHYLVmRHPGRLVWHPSRVSDUDRWUD WDPHQWRGDDUWURSODVWLDWRWDOGRTXDGULOLQIHFWDGDDWUDYpVGDXWLOL]DomRGHXPHVSDoDGRU LPSUHJQDGRFRPFLPHQWR ,1',&$d¯(6 ,QIHFo}HVFU{QLFDV ,QIHFo}HVVXEDJXGDV )UDFDVVRGRGHVEULGDPHQWRUDGLFDOHDQWLELRWLFRWHUDSLDQRSyVRSHUDWyULRLPHGLD WRGHLQIHFo}HVKHPDWRJrQLFDVDJXGDV (VWRTXHyVVHRVXÀFLHQWH 3DFLHQWHFOLQLFDHSVLFRORJLFDPHQWHDSWRSDUDRSURFHGLPHQWR 7e&1,&$&,5Ó5*,&$ $DYDOLDomRUDGLRJUiÀFDSUpRSHUDWyULDpIXQGDPHQWDOSDUDDGHÀQLomRGDHVWUDWp JLFDFLU~UJLFD 1DUDGLRJUDÀDVmRIUHTHQWHVRVVLQDLVGHVROWXUDQRLPSODQWHHGHiUHDVFRPLP SRUWDQWHRVWHyOLVHÀJ 5HDOL]DPRV R SRVLFLRQDPHQWR H DERUGDJHP ODWHUDO GD DUWLFXODomR FR[RIHPRUDO SHODWpFQLFDGH+DUGLQJHPRGLÀFDGRSRU3DVFDUHOÀJ Técnicas em Ortopedia 2010; 4:4-8 5 7pFQLFDVHP2UWRSHGLD 6 Figura 1 - Radiografia nas posições frente e perfil visualizando soltura de componente femoral e áreas de lise Figura 2- Posicionamento do paciente para abordagem cirúrgica. Em destaque, cicatrizes previas e fistula purulento ativa. $DERUGDJHPVHJXHVHFRPRGHVEULGDPHQWRDPSORGHWRGRWHFLGRGHVYLWDOL]DGRH UHPRomRGRVLPSODQWHV 2FRPSRQHQWHDFHWDEXODUQmRFLPHQWDGRpJHUDOPHQWHPDLVIiFLOGHUHPRYHUTXDQ GRKiVLQDLVGHVROWXUDRXQmRLQWHJUDomR1DUHWLUDGDpLPSRUWDQWHVHUPHWLFXORVRHPL QLPL]DUDSHUGDyVVHD-iRFRPSRQHQWHIHPRUDOSRGHDSUHVHQWDUDOJXPDVGLÀFXOGDGHV ,QIHFo}HV SUHFRFHV SRGHP QmR UHVXOWDU HP DIURX[DPHQWR GRV LPSODQWHV FLPHQWDGRV HQTXDQWRQDVWDUGLDVRXFU{QLFDVVmRJHUDOPHQWHDVVRFLDGRVFRPDIURX[DPHQWRVpSWLFR (PERUDVHMDUHODWLYDPHQWHIiFLOUHPRYHUXPDKDVWHOLVDGRPDQWRGHFLPHQWRDUHPRomR GRPDQWRGHFLPHQWRVROLGDPHQWHÀ[RH[LJHLQVWUXPHQWDOHVSHFLDOHH[SHULrQFLDSDUD HYLWDUFRPSURPHWHUDH[WUHPLGDGHVXSHULRUGRIrPXU8PDSRVVLELOLGDGHpDRVWHRWRPLD WURFDQWpULFDHVWHQGLGD7RGRHVIRUoRGHYHVHUIHLWRSDUDUHPRYHUWRGRRFLPHQWRyVVHR GHYLGRDRDXPHQWRGRULVFRGHUHFRUUrQFLDGDLQIHFomRTXDQGRXPDJUDQGHTXDQWLGDGH GHFLPHQWRyVVHRFRQWDPLQDGRpGHL[DGRSDUDWUiV Figura 3- Foto intra operatório apresentando fêmur pós limpeza, debridamento e retirada de componente femoral e cimento Técnicas em Ortopedia 2010; 4:4-8 87,/,=$d®2'(´(63$d$'25'(&,0(172µ 2XVRGHHVSDoDGRUHVDUWLFXODGRVWHPSRUiULRWHPVHWRUQDGRDWpFQLFDSDGUmRQRV SURWRFRORVGHUHYLVmRHPGXDVHWDSDV2HVSDoDGRUPDQWpPRFRPSULPHQWRGRPHPEUR HSURSRUFLRQDIXQomRDUWLFXODULPSHGLQGRDUHWUDomRGRVWHFLGRV(VSDoDGRUHVDUWLFX ODGRVFRPDQWLELyWLFRDVVRFLDGRWrPDSUHVHQWDGRHOHYDGRVQtYHLVWHUDSrXWLFRVSRUDWp TXDWURPHVHV(PGHFRUUrQFLDGHWDLVYDQWDJHQVDUHYLVmRWRUQDVHPDLVIiFLO ([LVWHPQRPHUFDGRHVSDoDGRUHVSUpPROGDGRV2HPSUHJRGHVWHVIDFLOLWDRLQWUD RSHUDWyULRSULQFLSDOPHQWHSHODSRVVLELOLGDGHGRXVRGHLQVWUXPHQWDOSDUDWHVWHVGHHV WDELOLGDGHHWDPDQKR'HYHPRVHVWDUDWHQWRVjOLPLWDomRGHWDPDQKRVGRVHVSDoDGRUHV SUpPROGDGRV'LIHUHQWHPHQWHGRVLPSODQWHVFRQYHQFLRQDLVQmRGLVSRPRVGDWRWDOLGD GHGRVWDPDQKRVQHFHVViULRV 3DUDDGHTXDomRGRWDPDQKRGDSRUomRFHIiOLFDUHDOL]DPRVPROGDJHPPDQXDOFRP FLPHQWRDXPHQWDQGRRYROXPHGRFRPSRQHQWHÀJ 1DVVLWXDo}HVHPTXHQmRGLVSRPRVGRHVSDoDGRUSUpPROGDGRSRGHPRVFRQIHF FLRQiORGHIRUPDWRWDOPHQWHPDQXDOXWLOL]DQGRHVWUXWXUDLQWHUQDÀRGH.LUVFKQHUHRX KDVWHGH.XQWFKHUFRPRFXLGDGRGHHVWDEHOHFLPHQWRGHRIIVHWDGHTXDGR $SyVDDGHTXDomRGRWDPDQKRHWHVWHVGHHVWDELOLGDGHHPUHODomRjDOWXUDGRFRP SRQHQWH UHDOL]DPRV D À[DomR GR LPSODQWH VRPHQWH QD SRUomR IHPRUDO SUR[LPDO FRP FLPHQWRHPDSUR[LPDGDPHQWHFPSUR[LPDO8WLOL]DPRVFDERGHFHUFODJHPSUR[LPDO SDUDUHGXomRGDRVWHRWRPLDÀJ $SyVRSRVLFLRQDPHQWRÀQDOGRLPSODQWHUHDOL]DPRVRIHFKDPHQWRSRUSODQRVGH IRUPDDQiORJDjWpFQLFDFRQYHQFLRQDO Figura 4 - Espaçador pré-moldado com aumento de volume da cabeça com cimento ósseo associado à antibiotico Técnicas em Ortopedia 2010; 4:4-8 Figura 4 - Espaçador pré-moldado com aumento de volume da cabeça com cimento ósseo associado à antibiotico 7 7pFQLFDVHP2UWRSHGLD 8 &8,'$'263Ð623(5$7Ð5,26 'HYHPRVVHPSUHGHL[DUFODURDRSDFLHQWHTXHRHVSDoDGRUQmRpXPLPSODQWHFRQ YHQFLRQDO'HVWDIRUPDSDUDHYLWDUPRVFRPSOLFDo}HVUHODFLRQDGDVFRPDHVWDELOLGDGHH FRPSURPHWLPHQWRGRHVWRTXHyVVHRUHVLGXDOpIXQGDPHQWDODUHVWULomRWRWDOGDFDUJDQR PHPEURRSHUDGREHPFRPRHYLWDUDPSOLWXGHVGHPRYLPHQWRH[DJHUDGDV &20(17É5,26 (PERUDDFLUXUJLDHPXPHVWiJLRDLQGDpSRSXODUHPDOJXQVFHQWURVHXURSHXVD UHYLVmRHPGRLVHVWiJLRVSUHGRPLQDQD$PpULFDGR1RUWH2VUHVXOWDGRVGDVGXDVIDVHV FRPHVSDoDGRUHVHDQWLELyWLFRWrPVLGRFODUDPHQWHPHOKRUHVQDOLWHUDWXUD &RPSOLFDo}HV D HVVD WpFQLFD VmR GHVFULWRV FRPR IUDWXUD H OX[DomR GR LPSODQWH HPERUDFRPWD[DVDFHLWiYHLVGHFDGDXPDVVRFLDGDVjHUUDGLFDomRGDLQIHFomRWrPVLGR UHODWDGRV 'XUDQWHRLQWHUYDORHQWUHDVIDVHVRVDQWLELyWLFRVLQWUDYHQRVRVGHYHPVHUDGPLQLV WUDGRVVREDVXSHUYLVmRGHXPFRQVXOWRUGHGRHQoDVLQIHFFLRVDV([FHOHQWHVUHVXOWDGRV LQFOXLQGRDVWD[DVGHFXUDGDLQIHFomRHQWUHD1RHQWDQWRDGXUDomRLGHDOGH DQWLELyWLFRVLQWUDYHQRVRVHRUDLVRXQmRIRLHVWDEHOHFLGRDSHVDUGRVPXLWRVUHODWRV 5HIHUrQFLDV%LEOLRJUiILFDV &DOODJKDQ-RKQ-5RVHQEHUJ$DURQ*5XEDVK+DUU\(HG$GXOW+LS7KH(GLWLRQ/LSSLQFRWW:LOOLDPV:LONLQV )LW]JHUDOG5+7KHLQIHFWHGWRWDOKLSDUWKURSODVW\FXUUHQWFRQFHSWVLQWUHDWPHQW,Q:HOFK5%HG7KH+LS3URFHHGLQJV RIWKH7ZHOIWK2SHQ6FLHQWLÀF0HHWLQJRIWKH+LS6RFLHW\6W/RXLV&90RVE\ %XFKKRO]+:(OVRQ5$(QJHOEUHFKW(/RGHQNDPSHU+5RWWJHU-6LHJHO)0DQDJHPHQWRIGHHSLQIHFWLRQRIWRWDOKLS UHSODFHPHQW-%RQH-RLQW6XUJ%U /LHEHUPDQ-5&DOODZD\*+6DOYDWL($HWDO7UHDWPHQWRIWKHLQIHFWHGWRWDOKLSDUWKURSODVW\ZLWKDWZRVWDJHUHLP SODQWDWLRQSURWRFRO&OLQ2UWKRS &DEULWD+%HWDO3URVSHFWLYHVWXG\RIWKHWUHDWPHQWRILQIHFWHGKLSDUWKURSODVWLHVZLWKRUZLWKRXWWKHXVHRIDQDQWLELRWLF ORDGHGFHPHQWVSDFHU&OLQLFV6mR3DXORYQ Técnicas em Ortopedia 2010; 4:4-8