Differentiated tactics for surgical treatment of purulent sacroiliitis depending on the clinical and radiological stage under ASAS criteria

Purulent lesion of the sacroiliac joint (sacroiliitis) is a severe surgical pathology of the musculoskeletal system and requires surgical treatment in the department of purulent surgery. The purpose was to analyse the tactics of surgical treatment of purulent sacroiliitis in combination with infusion and antibacterial therapy depending on the clinical and radiological form of the disease. 27 patients with purulent sacroiliitis were studied. Patients were divided into forms: stage 2 ASAS – 40.7%, stage 3 ASAS – 33.3%, stage 4 ASAS (panarthritis) – 26.0%. Depending on the forms, patients received combination therapy: conservative treatment (antibiotics, blockades, infusions), economical or radical joint resection with drainage, bacteriological control, detoxification. 11 (40.7%) patients with synovitis who were treated only conservatively and 9 (33.3%) patients with arthritis who had additional economical resection fully recovered. Among 7 (25.9%) patients with panarthritis who underwent radical resection, 1 developed septic shock, which led to lethal outcomes, and 3 underwent repeated operations due to ligature fistulas. 25 (92.5 %) patients – complete recovery, 1 – periodic recurrences. It was found that treatment should consider the form of the disease; immediate resection in septic flow with bacterial control reduces chronisation and relapses, and the combined strategy is effective in avoiding complications, but requires early diagnosis and a multidisciplinary approach. The results obtained confirmed the feasibility of a differentiated approach to the choice of surgical tactics for the treatment of purulent sacroiliitis depending on the stage of ASAS, which can be considered when developing clinical protocols