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UDC: 616.379-008.64+ 616-005.4+ 616-009.88
SURGICAL TREATMENT OF OSTEOMYELITIS AND OSTEOARTHRITIS OF
BONES AND JOINTS OF THE FOOT IN PATIENTS WITH SDS
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 (DM) affects more than 5% of the world population. The
third disease in the structure of causes of death is DM [I.I. Dedov, T.L. Kuraeva, V.A.
Peterkova, V.V. Potemkin, E.G. Starostina, N.E. Yuldashova, N.E. Suleimanova, Z.H.
Lapasova, N.N. Yormukhamedova, Finucane MM, Danaei G, Ezzati M, Ahmad O, Singh
GM, Danaei G, Farzadfar F, Stevens GA, Woodward M, Wormser DK, Jeon CY, Murray
MB, Lipsky B., Berendt A., Deery H.G.,Currently, there are more than 350000 thousand
officially registered patients in Uzbekistan. Various foot problems occur in every second
patient with diabetes, the number of lower limb amputations in patients with diabetes in the
Republic of Uzbekistan is 20-30 times higher than the number of amputations in patients
without diabetes. Lethality, in case of amputation at the level of the shin, is 5-20%, at the
level of the thigh 10-40% of operated patients [Askarov T.A., Hamdamov B.Z., Akhmedov
R.M., Safoev B.B., Jalilova Z.O., Dovlatov S.S., Teshayev SH.J.]. Diabetic foot syndrome
(DFS) is diagnosed in 8-10% of diabetic patients [DedovI.I., Udovichenko O.V., Grekova
N.M., Galstyan G.R., Shestakova M.V., Vikulova O.K.,]. In 20-25% of cases in patients
with SDS there are various purulent-necrotic lesions [Golbraik VA, Sitarkov SV, Bensman.,
Hall P.A., Levison D.A., Woods A.L., Kellock D.B., Watkins J.A., Barnes D.M., Gillett
C.E., Camplejohn R., Dover R., Khamraeva F. M., Nazarova S. K., Fayzieva M. F.].
Purulent-necrotic manifestations of SDS are the most frequent cause of amputation and
mortality of patients in this category of patients [Grekova N.M., Bordunovsky V.N.,
Ignatovich I.N., Bensman S.V., Burleva E.P., Aszmann O.C., Boulton AJ.M.,].
Key words:
diabetes mellitus, osteomyelitis, osteoarthropathy, amputation.
Ассистент кафедры факультетской и госпитальной хирургии Бухарского
медицинского института, город Бухара, Республика Узбекистан, ORCID ID 0000-
0002-5294-1692
Аннотация:
Сахарным диабетом (СД) страдает более 5% населения земного шара.
Третьим заболеванием в структуре причин смертности является сахарный диабет [И.И.
Дедов, Т.Л. Кураева, В.А. Петеркова, В.В. Потемкин, Е.Г. Старостина, Н.Е. Юлдашова,
Н.Е. Сулейманова, З.Х. Лапасова, Н.Н. Йормухамедова, Финукан М.М., Данаи Г.,
Эззати М., Ахмад О., Сингх Г.М., Данаи Г., Фарзадфар Ф., Стивенс Г.А., Вудворд М.,
Вормсер Д.К., Джон СИ, Мюррей М.Б., Липски Б., Берендт А., Дири Х.Г., в настоящее
время
в
Узбекистане
насчитывается
более
350000
тысяч
официально
зарегистрированных пациентов. Различные проблемы с ногами возникают у каждого
второго пациента с сахарным диабетом, количество ампутаций нижних конечностей у
пациентов с сахарным диабетом в Республике Узбекистан в 20-30 раз превышает
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количество ампутаций у пациентов без сахарного диабета. Летальность при
ампутации на уровне голени составляет 5-20%, на уровне бедра - 10-40%
оперированных пациентов [Аскаров Т.А., Хамдамов Б.З., Ахмедов Р.М., Сафоев Б.Б.,
Джалилова З.О., Довлатов С.С., Тешаев Ш.Дж.]. Синдром диабетической стопы (СДС)
диагностируется у 8-10% больных сахарным диабетом [Дедови.И., Удовиченко О.В.,
Грекова Н.М., Галстян Г.Р., Шестакова М.В., Викулова О.К.,]. В 20-25% случаев у
пациентов с СДС наблюдаются различные гнойно-некротические поражения
[Голбрайк В.А., Ситарков С.В., Бенсман В.А., Холл П.А., Левисон Д.А., Вудс А.Л.,
Келлок Д.Б., Уоткинс Дж.А., Барнс Д.М., Джиллетт С.Э., Кэмплджон Р., Довер Р.,
Хамраева Ф. М., Назарова С. К., Файзиева М. Ф.]. Гнойно-некротические проявления
СДС являются наиболее частой причиной ампутаций и летальности пациентов у этой
категории больных [Грекова Н.М., Бордуновский В.Н., Игнатович И.Н., Бенсман С.В.,
Бурлева Е.П., Асманн О.С., Боултон А.Дж.М.,].
Ключевые слова:
сахарный диабет, остеомиелит, остеоартропатия, ампутация.
Xulosa:
Qandli diabet (qd) dunyo aholisining 5% dan ko'prog'iga ta'sir qiladi. O'lim
sabablari tarkibidagi uchinchi kasallik Diabetes mellitus [I. I. Dedov, T. L. Kurayeva, V. A.
Peterkova, V. V. Potemkin, E. G. Starostina, N. E. Yuldashova, N. E. Sulaymonova, Z. X.
Lapasova, N. N. Yormuhamedova, Finukan M. M., Danai G., Ezzati M., Ahmad O., Singx
G. M., Danai G., Farzadfar F., Stivens G. A., Vudvord M., Vormser D. K., jon si, Myurrey
M. B., Lipski B., Berendt A., Diri H. G., hozirgi vaqtda O'zbekistonda 350 mingdan ortiq
rasmiy ro'yxatdan o'tgan bemorlar mavjud. Qandli diabet bilan og'rigan har ikkinchi
bemorda turli xil oyoq muammolari yuzaga keladi, O'zbekiston Respublikasida qandli diabet
bilan og'rigan bemorlarda pastki muchalarning amputatsiyalari soni qandli diabetsiz
bemorlarda amputatsiyalar sonidan 20-30 baravar ko'p. Pastki oyoq darajasida amputatsiya
paytida o'lim darajasi 5-20%, kestirib, operatsiya qilingan bemorlarning 10-40% ni tashkil
qiladi [Askarov T. A., Hamdamov B. Z., Ahmedov R. M., Safoev B. B., Jalilova Z. O.,
Dovlatov S. S., Teshayev sh.j.]. Diabetik tovon sindromi (DTS) qandli diabet bilan og'rigan
bemorlarning 8-10 foizida aniqlanadi [Dedovi.I., Udovichenko O. V., Grekova N. M.,
Galstyan G. R., Shestakova M. V., Vikulova O. K.,]. 20-25% hollarda DTS bilan og'rigan
bemorlarda turli xil yiringli-nekrotik lezyonlar kuzatiladi [Golbrayk V. A., Sitarkov S. V.,
Bensman V. A., Xoll P. A., Levison D. A., Vuds A. L., Kellok D. B., Uotkins J.A., Barns D.
M., Gillett S. E., Kempljon R., Dover R., Hamrayeva F. M., Nazarova S. K., Fayziyeva M.
F.]. DTS ning yiringli-nekrotik namoyon bo'lishi ushbu toifadagi bemorlarda pastki
muchalar amputatsiyasi, o'limining eng keng tarqalgan sababidir [Grekova N. M.,
Bordunovskiy V. N., Ignatovich I. N., Bensman S. V., Burleva E. P., asmann O. S., Boulton
A. J.M.,].
Kalit so'zlar:
qandli diabet, osteomiyelit, osteoartropatiya, amputatsiya.
Introduction:
Diabetes mellitus in the XXI century is one of the most complex diseases, often leading to
disability and death of patients. The most severe, difficult to treat, is diabetic foot syndrome,
and some of the most complex are osteomyelitis and osteoarthritis of bones and joints of the
foot, the course of this disease, in some cases can lead to amputations at various levels.
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Objective of the study:
To analyze the results of immediate and early results of surgical treatment of patients with
lesions of distal and proximal ocelli of the foot, in complications of infection associated with
diabetic foot syndrome .Patients with neuropathic and neuroischemic forms of SDS, with
clinical and radiological data of lesions of bones and joints of the feet, patients with foot
ischemia proven by USDG were excluded from the study by us.
Materials and Methods:
We analyzed patients with SDS complicated by osteomyelitis or osteoarthritis in distal and
proximal lesions of the bones of the feet, treated as inpatients, in a specialized department of
purulent surgery, for three years. The control group included 306 patients. The group of
patients with distal lesions included -168 patients, with proximal lesions - 138.
Patient groups
Lesion level
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Average age of the patient
52,2 ±12,4
54,2 ±14,4
Seniority of SD
1 to 48 years
4 to 33 years old
SD I
30 patients
6 patients
SD II
138 patients
132 patients
Analysis of diabetes mellitus in groups
Diabetes mellitus
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Insulin
126
114
Without insulin.
42
24
Compensation
60
54
Subcompensation
90
66
Decompensation
18
18
Cause of osteomyelitis and osteoarthritis of the feet in distal and proximal lesions
Etiology
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Unknown
6
6
Ulcer
78
42
Trauma
84
90
Frequency of bone and joint lesions in groups
Disease
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Osteomyelitis
102
96
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Osteoarthritis
66
42
Laboratory tests in patient groups
Laboratory values
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
COE average
32,5 ±19,4
30,3 ±17,6
Leukocytosis, less than 4x or
grea10
9
ter than 12x10
9
54
12
P/N shift greater than 10
0
0
Hb less than 100 g/L
24
42
Initial or repeat hospitalization after 3-4 months
Hospitalization
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Primary
102
84
Repeat
66
54
Distal lesion, primary hospitalization
In our case, the I metatarsophalangeal joint was affected secondary to an extensive ulcer,
and disarticulation of the joint was performed.
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Hospitalization after 3 months: complication from the primary surgery - osteomyelitis of the
1st metatarsal bone and deep ulcer.
Proximal lesion and re-hospitalization
Primary, phlegmon drainage only.
Radiologically: bone-joint lesion, no surgical treatment was performed, only immobilization
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Результаты лечения через 3-4 месяца после операции
Group
Distal bone lesions in the
feet
Proximal lesions of the
bones of the feet
Relapse
6
12
The presence of a wound
42
18
Healing
90
78
Results and discussion:
According to the results of the study, we believe that in distal forms of osteomyelitis and
osteoarthritis, surgical treatment is indicated: joint or bone resection with soft tissue
necrectomy, in case of phlegmon or abscesses, excision of ulcers, wounds: is indicated from
functional access in non-porous parts of the foot, removal of infected tendons throughout
combined with mechanical wound treatment combined with ultrasonic low-frequency
cavitation followed by primary plasty, full-thickness skin flap on a wide stalk or suturing of
the wound. In rehabilitation after surgery for resection of metatarsal bones, orthopedic shoes
with unloading of the forefoot of the full epithelialization, in the case of joint resection,
primary immobilization plaster cast until wound healing, followed, if indicated, the use of a
bandage "Total contact cast" + unloading crutches.
In proximal lesions, osteonecrectomy or resection of infected, altered bone withexcision of
wounds, ulcers or fistulas, in case of paraosseal or paraarticular phlegmons, access was
performed on the back and lateral surface. Wound treatment was performed mechanically
and by ultrasonic cavitation to remove sequestered bone fragments and pathologic tissues,
cavities were actively drained with contrapertures with suturing or skin flap plasty. In the
postoperative period, immobilization with a plaster cast and limb unloading with crutches,
followed by "Total contact cast" when osteonecrectomy or resection of joint surfaces, defect
repair and immobilization until complete consolidation.
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Conclusion:
To date, there is no consensus, algorithms in the diagnosis and treatment of osteomyelitis
and osteoarthritis of the bones of the foot as a complication of diabetes mellitus. In the distal
form of the lesion, radical surgical treatment is more indicated; in the case of proximal
lesions, active drainage of the wound cavity, osteonecrectomy, bone resection with primary
skin plasty with full-layer soft tissue flaps are shown. With radical treatment of distal forms
and staged treatment of proximal forms of lesions, the limb bearing capacity can be
preserved. In the postoperative period and during rehabilitation, immobilization of the limb
with the use of various fixation and immobilization bandages and unloading of the limb with
the use of crutches is indicated.
Literature:
1.Tsvetkov V.O., Kolovanova O.V., Ezhova L.G., Gusarova T.A. Informativeness of
bacteriological examination of bone tissue in diabetic foot syndrome // Diabetes Mellitus,
2019, No. 5, P. 428-435 (SCOPUS).
2.Tsvetkov V.O., Kolovanova O.V., Mikayelyan L.S., Gambaryan K.U., Solovieva A.M.
Osteomyelitis of diabetic foot: balance between radical surgical treatment and prolonged
antibiotic therapy from the position of a surgeon // Consilium Medicum, 2020, 22(4), P. 61-
65 (VAK).
3. Tsvetkov V.O., Kolovanova O.V., Gorshunova E.M., Kozlov J.A., Gobedgishvili V.V.
Two-phase amputation among critically ill patients with gangrene of lower limbs as a way to
improve treatment outcome. Cohort study // Annals of Medicine and Surgery, 2020, 60, S.
587-591 (SCOPUS).
4. Sudnitsyn A.S., Stupina T.A., Varsegova T.N., Stogov M.V., Kireeva E.A., Mezentsev
I.N.. Pathomorphological and pathochemical characteristic of the osteomyelitis focus in
patients with diabetic osteoarthropathy (Charcot foot). Diabetes mellitus. 2022;25(4):368-
377. (In Russ.)
5. Purulent-necrotic lesions in the neuroischemic form of diabetic foot syndrome / V.A.
Mitish [et al] // Surgery. Journal of N.I. Pirogov.-2014.- № 1.-C. 48-53.
6. Giurato L., Meloni M., Izzo V., Uccioli L. Osteomyelitis in diabetic foot: A
comprehensive overview. World J Diabetes. 2017 Apr 15;8(4): 135-142
7. Przybylski MM, Holloway S, Vyce SD, Obando A: Diagnosing osteomyelitis in the
diabetic foot: a pilot study to examine the sensitivity and specificity of Tc white blood cell-
labeled single photon emission computed tomography/computed tomography. Int Wound J
2016, Jun;13(3):382-9
8. Nogueral T.M., Alcalá A.L., Beltrán L.S., Cabrera M.G., Cabrero J.B., Vilanova J.C.
Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and
Osteomyelitis in the Diabetic Foot RadioGraphics Vol. 2017, 37, No. 4
