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UDC: 616.379-008.64+ 616-005.4+ 616-009.88
OSTEOMYELITIS IN PATIENTS WITH COMPLICATED FORM OF DIABETIC
FOOT SYNDROME
Rajabov Doston O`ktamovich
Assistant of the Department of Faculty and Hospital Surgery, Bukhara Medical Institute,
Bukhara City, Republic of Uzbekistan, ORCID ID 0000-0002-5294-1692
rajabov.doston@bsmi.uz
Annotation:
Diabetes mellitus, today is a worldwide problem. The number of patients is
steadily growing from year to year and according to WHO, for the last 30 years, has
increased more than 5 times, and at the moment is more than 500000 million people, in the
Republic of Uzbekistan, about 300000 thousand people, that is about every 11 adults in the
world suffer from this disease. According to the number of complications, diabetes mellitus
is one of the main causes of death (AsfandiyarovaN.S., 2015, Dedov I.I., 2018, Chuan L.L.,
2013, Pan X., 2020). The most significant complication, at present, is diabetic foot
syndrome, which affects about 8-10% of all patients with diabetes mellitus and is the main
cause of all lower limb amputations at various levels. One of the complications of SDS, is
osteomyelitis of the bones of the foot, developing against the background of infection of soft
tissues and bones of the foot, with diabetic neuropathy and osteoarthropathy, according to
one study complicates the course of the disease in 15% of patients (Hinchliffe.,2016,
Walsh.,2017., Marphy- Lovoie.,2021), according to other data up to 50-60% ( Lazaro
Martinez.,2019., Antsyferov M.B., 2007, Dedov I.I., Jeffcoate W., 2004) and leads to limb
amputations. "International Working Group on the diabetic foot, 2015", considers the "gold
standard" in the diagnosis of osteomyelitis in SDS, clinical, radiographic picture,
bacteriology and histology of bone tissue. Detected microflora growth and histologic
findings of bone infection are important for the diagnosis.
Keywords:
diabetes mellitus, osteomyelitis, osteoarthropathy neuropathy, amputation.
Аннотация:
Сахарный диабет сегодня является общемировой проблемой. Число
больных неуклонно растет из года в год и, по данным ВОЗ, за последние 30 лет
увеличилось более чем в 5 раз, и на данный момент составляет более 500000
миллионов человек, в Республике Узбекистан около 300000 тысяч человек, то есть
примерно каждый 11 взрослый в мире страдаю от этого заболевания. По количеству
осложнений сахарный диабет является одной из основных причин смертности
(Асфандиярован.С., 2015, Дедов И.И., 2018, Чуан Л.Л., 2013, Пан Х., 2020). Наиболее
значительным осложнением в настоящее время является синдром диабетической
стопы, который поражает около 8-10% всех пациентов с сахарным диабетом и
является основной причиной всех ампутаций нижних конечностей на различных
уровнях. Одним из осложнений СДС, является остеомиелит костей стопы,
развивающийся на фоне инфицирования мягких тканей и костей стопы, при этом
диабетическая невропатия и остеоартропатия, по данным одного исследования,
осложняют течение заболевания у 15% пациентов (Hinchliffe., 2016, Walsh., 2017.,
Marphy- Lovoie., 2021), по другим данным достигает 50-60% (Лазаро Мартинес., 2019.,
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Анцыферов М.Б., 2007, Дедов И.И., Джеффкоут У., 2004) и приводит к ампутациям
конечностей. "Международная рабочая группа по диабетической стопе, 2015"
рассматривает "золотой стандарт" в диагностике остеомиелита при СДС,
клиническую, рентгенологическую картину, бактериологию и гистологию костной
ткани. Выявленный рост микрофлоры и гистологические данные о костной инфекции
важны для постановки диагноза.
Ключевые слова:
сахарный диабет, остеомиелит, остеоартропатия, нейропатия,
ампутация.
Xulosa:
Qandli diabet bugungi kunda global muammo hisoblanadi. Bemorlar soni yildan-
yilga muttasil o'sib bormoqda va JSST ma'lumotlariga ko'ra, so'nggi 30 yil ichida bu
ko'rsatkich 5 barobardan ko'proqqa oshgan va ayni paytda 500 000 milliondan ortiq,
O'zbekiston Respublikasida 300 000 mingga yaqin kishi, ya'ni dunyodagi har 11 kattadan
bittasi ushbu kasallikdan aziyat chekmoqda. Asoratlar soni bo'yicha qandli diabet o'limning
asosiy sabablaridan biridir (Asfandiyarovan.S., 2015, Dedov I. I., 2018, Chuan L. L., 2013,
Pan X., 2020). Hozirgi vaqtda eng muhim asorat diabetik tovon sindromi bo'lib, u barcha
diabetik bemorlarning taxminan 8-10 foiziga ta'sir qiladi va turli darajadagi barcha pastki
oyoq amputatsiyalarining asosiy sababidir. DTS ning asoratlaridan biri bu oyoq
suyaklarining osteomiyelitidir, u yumshoq to'qimalar va oyoq suyaklarining infektsiyasi
fonida rivojlanadi, diabetik neyropatiya va osteoartropatiya, bir tadqiqotga ko'ra,
bemorlarning 15 foizida kasallikning rivojlanishini murakkablashtiradi (Hinchliffe., 2016,
Walsh., 2017., Marphy- Lovoie., 2021), boshqa ma'lumotlarga ko'ra 5060% ga etadi (Lazaro
Martines., 2019., Antsiferov M. B., 2007, Dedov I. I., Jeffkout U., 2004) va pastki
muchalarning amputatsiyasiga olib keladi. "Xalqaro diabetik tovon ishchi guruhi, 2015
"DTS osteomiyelit diagnostikasi, klinik, rentgenologik rasm, bakteriologiya va suyak
gistologiyasida" oltin standart " ni ko'rib chiqadi. Aniqlangan mikrofloraning o'sishi va
suyak infektsiyasining gistologik dalillari tashxis qo'yish uchun muhimdir.
Kalit so'zlar:
qandli diabet, osteomiyelit, osteoartropatiya, neyropatiya, amputatsiya.
Introduction:
Diabetic foot syndrome, one of the severe complications of diabetes mellitus, the leading
role in the development of which is played by neuropathy and/or ischemia (macro and
micro), subsequently ulcerative defects may develop. Which, with prolonged and ineffective
treatment, can affect the bony structures of the feet, and subsequently lead to the
development of osteomyelitis, and as a consequence, lead to subsequent amputations at
various levels. In the studies of many authors, there are data on changes in the extracellular
matrix and tissue reorganization with a significant decrease in collagen formation, changes
are directly related to peripheral neuropathy, angiopathy (micro and macro), and often
occurring osteoarthropathy (Lipsky, Armstrong.,2005, Brem., 2007, Lopez- Lopez., 2014,
Zaitseva E.L., Doronina L.P., Molchkov., 2015). Long-existing, non-healing wounds (ulcers)
of the feet often lead to infection of bone tissue and the development of a severe
complication-osteomyelitis. This pathology is difficult to treat, in which it is very important
to know the microflora for the most effective prescription of antibacterial therapy and the
choice of method and adequate scope of surgical tactics.
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Purpose of the study:
analysis of groups of patients with neuropathic and neuroischemic
forms, with lesions of bones and joints of the feet according to clinical and radiological
studies, patients with clinical foot ischemia confirmed by USG were excluded from the
analysis.
Materials and Methods:
Patients with diabetic foot syndrome (DFS) complicated by osteomyelitis and osteoarthritis
who went for consultative appointments and were treated as outpatients or inpatients in the
department of purulent surgery were analyzed retrospectively. A total of 204 patients were
included in the control group over 2 years:
Group 1: women - with osteomyelitis and osteoarthritis of the phalanges of fingers,
metatarsal bones, interphalangeal and metatarsophalangeal joints 88 (mean age 53.4 years);
men - 24 (mean age 60.3 years).
Group 2): osteomyelitis and osteoarthritis of the bones and joints of the tarsal, talus, talon,
navicular, talon-cuboid, talon-palate joints - 92 women-68 (mean age 56,4 years), men-24
(mean age 60,4 years). Duration of diabetes mellitus from 1-47 years in the first group: DM
1type- 20 patients, DM 2 type- 92.In the second, duration of diabetes mellitus from 3- 32
years. DM 1 type-4 patients, DM 2 type-88 patients.
Characteristics of diabetes mellitus in the groups of patients
Diabetes mellitus
Group I
Group II
Insulin
84
76
Without insulin.
28
16
Compensation
40
36
Subcompensation
60
44
Decompensation
12
12
When a patient was referred, at the stage of specialized medical care for patients with
suspected osteomyelitis or osteoarthritis in the complicated form of SDS, the diagnostic
protocol included: clinical data, foot thermometry (infrared electronic thermometer UNI-T
UT 301D), radiography of the bones of the feet, ultrasound angioscanning of peripheral
arteries of the lower extremities, MRI if osteoarthropathy was suspected,
were
supplemented with clinical (localization of ulcer defects, wound depth, bone probing) and
laboratory data (leukocytosis, C-reactive protein, COE), as well as before surgical treatment
for osteomyelitis, computer tomography of the feet was used. All patients were referred for
surgical treatment to the department of purulent surgery according to the indications.
Results and Discussion:
In the analysis of patients hospitalized in the department of purulent surgery with
osteomyelitis and osteoarthritis, with complicated form of diabetic foot syndrome it was
revealed that at pre-hospital stage glycemia indices (mean values of glycated hemoglobin
HbA1c) amounted to 12.7% with target 7.0-7.5%) in 128 (62.7%) patients were in the stage
of subcompensation and decompensation.
Therefore, endocrinologist carried out
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intensification of sugar-lowering therapy in accordance with the algorithms of specialized
medical care. The basal insulin was connected to the sugar-lowering therapy in tablet form
or the patient was transferred to the basal-bolus scheme of insulin therapy. Limb unloading
with the use of "Total contact cast". , unloading shoe was prescribed to all patients with
osteomyelitis and was used until complete elimination of the inflammatory process and
epithelization of wounds. Unloading in each case was applied individually, the average
duration was (3-14 months).
Cause of osteomyelitis and osteoarthritis development in the groups
Reason
Osteomyelitis and
osteoarthritis of the
phalanges of the
fingers, metatarsal
bones,
interphalangeal and
metatarsophalangeal
bones
Group I
Osteomyelitis
and
osteoarthritis
of the bones
and joints of
the
tarsal,
talus,
talus-
cuboid, talon-
cuboid, talon-
femoral bones
I group
Osteomyelitis and
osteoarthritis of the
phalanges
of
fingers, metatarsal
bones,
interphalangeal and
metatarsophalangeal
bones Group II
Osteomyelitis
and
osteoarthritis
of the bones
and joints of
the
tarsal,
talus,
talus-
cuboid, talon-
cuboid, talon-
femoral bones
II group
Trauma
4
4
4
4
Ulcer
52
52
28
52
Unknown
56
56
60
60
Frequency of bone and joint lesions in patient groups
Group 1
Osteoarthritis
Group 1
Osteomyelitis
Group 11
Osteoarthritis
Group 11
Osteomyelitis
68
44
64
28
Associated ICMT - skin and soft tissue infections in groups
ICMT
Group 1
Group 11
Wound
68
48
Fistula
28
36
Phlegmon
20
16
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Initial hospitalization in a specialized hospital or repeated earlier within 4-6 months by
group
Distal lesion, group I
Proximal lesion, group II
Primary- 44
Primary-56
Repeat-68
Repeat-36
Conclusion:
Based on our findings we can say that such complications as osteomyelitis and osteoarthritis
of the bones of the foot in patients with SDS who are on insulin therapy, as well as those
taking tablets, but most often patients on insulin therapy in the stage of subcompensation
and decompensation, most often the cause of this pathology is unknown, the presence of
trophic ulcer is second in importance, osteoarthritis affects the joints of the feet most often,
repeated hospitalizations and surgical treatment are largely necessary.
Literature:
1. Antsiferov M.B., Galstyan G.R., Tokmakova A.Y., Dedov I.I. Diabetic foot syndrome.
Diabetes Mellitus, 2001, 2: 2-8. /Antsiferov MB, GalstyanGR, Tokmakova AYu, Dedov II.
Diabetic foot syndrome. Sakharny Diabet, 2001,
2. Artykova D.M., Shagazatova B.H., Urunbaeva D.A. et al. Diabetic foot syndrome.
Bulletin of the Council of Young Scientists and Specialists of Chelyabinsk.Bulletin of the
Council of Young Scientists and Specialists of the Chelyabinsk Region. 2015; 2 (9): 70-76.
3. Clinical guidelines for the diagnosis and treatment of diabetic foot syndrome. Wounds
and wound infections, 2015, 2 (3): 63-83./ Clinical guidelines for the diagnosis and
treatment of diabetic foot syndrome. Rany i Ranevye Infektsii, 2015, 2 (3): 63-83.
4. Apelqvist J, Bakker K, van Houtum WH, Schaper NC, International Working Group on
the Diabetic Foot (IWGDF) Editorial Board . Practical guidelines on the management and
prevention of the diabetic foot: based upon
5.Dedov I.I. Diabetes mellitus: development of technologies in diagnosis, treatment and
prevention.2010; 3: 1-13
6.Dedov I.I., Shestakova M.V., Vikulova O.K. State Register of Diabetes Mellitus. State
Register of Diabetes Mellitus in the Russian Federation: 2014 status and prospects.
Federation: 2014 status and prospects of development. Diabetes Mellitus. 2015; 18 (3): 5-22.
7.Dedov I.I., Shestakova M.V., Galstyan G.R. et al. Algorithms of specialized medical
assistance to patients with diabetes mellitus. Algorithms of specialized medical care for
patients with diabetes mellitus; Edited by I.I. Dedov, M.V. Shestakova. Dedov, M.V.
Shestakova (7th issue). Diabetes mellitus. Abet. 2015; 18 (1S): 1-112.
