Хирургия Гнойно-Некротических Осложнений Диабетической Стопы

Бенсман, В. М.

doi:10.18411/b-2016-012

Cited by 6 publications

(8 citation statements)

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“…Известно, что разобщение процессов ремоделирования кости у больных с ДНОАП при сохранении нагрузки на конечность приводит к изменениям как количества, так и качества костной ткани, что, в свою очередь, еще больше провоцирует снижение прочности трабекулярной массы [19]. Этому способствует снижение синтеза коллагена, нарушение кальциевого обмена и костного ремоделирования [25].…”

Section: гнойная остеологияunclassified

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Sudnitsyn,

Kliushin,

Stupina

et al. 2023

jour

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Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage.Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection.Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT.Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %.Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology.Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient conditions for the solution of the set of the surgical tasks in this category of patients. The introduction of half-pins into the apparatus system provides the necessary fixation time with the possibility of functional load on the operated segment in patients in the postoperative period.

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Section: гнойная остеологияunclassified

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Sudnitsyn,

Kliushin,

Stupina

et al. 2023

jour

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“…Однако осложнения со стороны ампутационной культи развиваются у многих пациентов с сахарным диабетом (до 40%), которые в свою очередь составляют до 50-70% в структуре всех нетравматических ампутаций нижних конечностей. К причинам развития хронических ран культи относятся отягощенный коморбидный фон, сепсис, неправильный выбор уровня ампутации, гематомы культи, макро-и микроангиопатии, высоковирулентная, в том числе нозокомиальная инфекция [1][2][3][4]. Этот тип хронических ран почти всегда сопровождается гнойно-некротическим процессом, включающим длительную интоксикацию, реинфекцию раневой поверхности с образованием в лучшем случае келоидного рубца, а иногда годами не заживающих свищей и поверхностных ран в области ампутационной культи нижней конечности.…”

Section: обоснованиеunclassified

Successful application of conditioned culture medium for the treatment of a chronic wound of an amputation stump: a clinical case

Черепанин

Pavlova

Kalsin

et al. 2022

Journal of Clinical Practice

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Background: Amputation of the lower extremities is a necessary procedure to save a patient with critical arterial and neurotrophic disorders in the lower extremities. The amputation stump-related complications develop in many patients with diabetes mellitus (up to 40% of the total population). Clinical case description: Patient Yu., 64 years old, was admitted on October 19, 21 for an outpatient treatment of purulent-necrotic wounds of the amputation stump of the right lower limb. А high amputation was performed on September 24, 2021 due to thrombosis of the femoral-tibial bypass, installed on September 08, 2021 (bypassing below the knee joint gap with a Vascutek 7 mm synthetic prosthesis on the right) and the development of critical ischemia of the right lower limb with necrosis of the distal phalanges of the right foot toes. The wound was assessed according to the Bates-Jensen scale (BJ) and examined according to the developed protocol. The wound treatment was carried out according to an individual plan using a conditioned culture medium from mesenchymal stem cells (CM-MSCs), which stimulates angiogenesis and improves remodeling and recovery in the wound area. CM-MSC application made it possible to reduce the healing time and achieve a scarless closure of the tissue defect. Conclusion: The use of CM-MSC can be an effective method for healing a purulent-necrotic postoperative wound resulting from amputation of a limb in patients with critical ischemia of the lower extremities.

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Введение. Одной из ведущих причин инвалидности по зрению у взрослого населения является возрастная макулярная дегенерация (ВМД), особенно ее неоваскулярная форма [4, 20].В настоящее время доказана ведущая роль в патогенезе неоваскулярной ВМД нарушений регуляции эндотелиального сосудистого фактора роста (vascular endothelial growth factor, VEGF) [11, 21]. Интравитреальное введение (ИВВ) ингибиторов VEGF является эффективным методом лечения этого заболевания, способным приводить к улучшению зрения [9,15, 18, 19, 22].

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“…В Российской Федерации в настоящее время зарегистрированы два ингибитора ангиогенеза для интравитреального применения -ранибизумаб и афлиберцепт [1,3]. Накопленный большой опыт применения ранибизумаба обозначил проблему резистентности или тахифилаксии неоваскулярной ВМД к антиангиогенной терапии [2,6,10,12,13, 16, 22]. Регистрация в Российской Федерации в 2016 году афлиберцепта представляется наиболее перспективным путем решения проблемы тахифилаксии за счет смены ингибитора ангиогенеза.Цель исследования.…”

unclassified

“…В настоящее время доказана ведущая роль в патогенезе неоваскулярной ВМД нарушений регуляции эндотелиального сосудистого фактора роста (vascular endothelial growth factor, VEGF) [11, 21]. Интравитреальное введение (ИВВ) ингибиторов VEGF является эффективным методом лечения этого заболевания, способным приводить к улучшению зрения [9,15, 18, 19, 22].…”

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Assessment of efficiency of change of inhibitor of angiogenesis at a takhifilaksiya of a neovascular age makulyarny degeneration to systematic antiangiogenic therapy

Kulikov,

Sosnovsky,

Gribanov

et al. 2017

Bulletin of the Russian Military Medical Academy

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One of possible ways of overcoming a takhifilaksiya to antiangiogenic medicines at patients with a neovascular age makulyar degeneration is medicine change. The short-term assessment of efficiency of change of antiangiogenic medicine in actual practice was a research objective. Two groups of examinees with a neovascular age makulyarny degeneration and indications to the 6 th injection of inhibitor of angiogenesis are created. In the first group (7 patients, 9 eyes) carried out intravitrealny introduction of an aflibercept at an interval of a month, in the second group (8 patients, 8 eyes) – each 2 months. Estimated visual acuity according to tables of Early Treatment Diabetic Retinopathy Study, thickness of the central retina according to an optical coherent tomography. At patients of the first group in 1 month after the 2 nd intravitrealny introduction of an aflibercept visual acuity significantly hasn’t changed: increase according to tables of ETDRS has made 1±6 signs. Thickness of the central retina opposite has authentically decreased (p0,05) by 137±223 microns. At patients of the second group in 1 month after the 2nd intravitrealny introduction of an aflibercept of significant changes of visual acuity according to tables of Early Treatment Diabetic Retinopathy Study hasn’t occurred (p0,05). Unlike the first group of reliable reduction of thickness of the central retina it is noted, average decrease has made 24±82 microns (p0,05). Thus change of medicine for antiangiogenic therapy doesn’t give increase in visual functions. At the same time, monthly introduction of an aflibercept leads to significant decrease in thickness of the central retina and provides significantly the best anatomic result, than introduction at an interval of two months that can affect visual acuity maintenance duration in the long term.

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Хирургия Гнойно-Некротических Осложнений Диабетической Стопы

Cited by 6 publications

References 0 publications

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Successful application of conditioned culture medium for the treatment of a chronic wound of an amputation stump: a clinical case

Assessment of efficiency of change of inhibitor of angiogenesis at a takhifilaksiya of a neovascular age makulyarny degeneration to systematic antiangiogenic therapy

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