RU2454944C1 - Method of treating patients with neuropathic infected ulcers in case of "diabetic foot" syndrome - Google Patents
Method of treating patients with neuropathic infected ulcers in case of "diabetic foot" syndrome Download PDFInfo
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- RU2454944C1 RU2454944C1 RU2011106433/14A RU2011106433A RU2454944C1 RU 2454944 C1 RU2454944 C1 RU 2454944C1 RU 2011106433/14 A RU2011106433/14 A RU 2011106433/14A RU 2011106433 A RU2011106433 A RU 2011106433A RU 2454944 C1 RU2454944 C1 RU 2454944C1
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- neuropathic
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- diabetic foot
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- 208000025865 Ulcer Diseases 0.000 title claims abstract description 13
- 231100000397 ulcer Toxicity 0.000 title claims abstract description 13
- 238000000034 method Methods 0.000 title claims abstract description 11
- 208000008960 Diabetic foot Diseases 0.000 title claims description 6
- 208000011580 syndromic disease Diseases 0.000 title claims description 5
- 230000002981 neuropathic effect Effects 0.000 title claims description 3
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 10
- 230000007547 defect Effects 0.000 claims abstract description 5
- 210000000988 bone and bone Anatomy 0.000 claims description 3
- 230000001054 cortical effect Effects 0.000 claims description 3
- 206010017711 Gangrene Diseases 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 4
- 230000015572 biosynthetic process Effects 0.000 abstract description 3
- 208000037976 chronic inflammation Diseases 0.000 abstract description 3
- 230000006020 chronic inflammation Effects 0.000 abstract description 3
- 230000000694 effects Effects 0.000 abstract description 2
- 230000001575 pathological effect Effects 0.000 abstract description 2
- 238000001356 surgical procedure Methods 0.000 abstract description 2
- 239000000126 substance Substances 0.000 abstract 1
- 210000002683 foot Anatomy 0.000 description 7
- 230000001228 trophic effect Effects 0.000 description 5
- 230000018109 developmental process Effects 0.000 description 3
- 206010012601 diabetes mellitus Diseases 0.000 description 3
- 230000035876 healing Effects 0.000 description 3
- IAZDPXIOMUYVGZ-UHFFFAOYSA-N Dimethylsulphoxide Chemical compound CS(C)=O IAZDPXIOMUYVGZ-UHFFFAOYSA-N 0.000 description 2
- 206010061218 Inflammation Diseases 0.000 description 2
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- 230000003115 biocidal effect Effects 0.000 description 2
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- 210000001255 hallux Anatomy 0.000 description 2
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- 210000000878 metatarsophalangeal joint Anatomy 0.000 description 2
- 230000001172 regenerating effect Effects 0.000 description 2
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- 210000001519 tissue Anatomy 0.000 description 2
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 241000222122 Candida albicans Species 0.000 description 1
- 206010007134 Candida infections Diseases 0.000 description 1
- 206010056340 Diabetic ulcer Diseases 0.000 description 1
- 208000027244 Dysbiosis Diseases 0.000 description 1
- 208000003790 Foot Ulcer Diseases 0.000 description 1
- 206010020751 Hypersensitivity Diseases 0.000 description 1
- 102000004877 Insulin Human genes 0.000 description 1
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- 238000005406 washing Methods 0.000 description 1
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Abstract
Description
Предлагаемое изобретение относится к медицине, в частности к хирургии, и может быть использовано при лечении больных сахарным диабетом с рубцово-трофическими язвами стопы в области фаланг пальцев, межфаланговых или плюснефаланговых суставов.The present invention relates to medicine, in particular to surgery, and can be used in the treatment of patients with diabetes mellitus with cicatricial trophic foot ulcers in the area of the phalanges of the fingers, interphalangeal or metatarsophalangeal joints.
В качестве прототипа выбран способ, заключающийся в проведении некрэктомии гнойного очага, промывании раны антисептиками, разгрузке стопы, устранении отека, инсулино- и антибиотикотерапии (см. Дедов И.И. и соавт. Диабетическая стопа // Практическая медицина. М., 2005, - С.76-77).As a prototype, a method was selected consisting of necrectomy of a purulent lesion, washing the wound with antiseptics, unloading the foot, eliminating edema, insulin and antibiotic therapy (see Dedov I.I. et al. Diabetic foot // Practical Medicine. M., 2005, - S.76-77).
Однако известный способ не предусматривает воздействие на репарацию тканей, не учитывает особенности диабетических язв и возможности развития побочных эффектов антибактериальной терапии (аллергия, кишечный дисбактериоз, кандидоз), особенно опасных на фоне диабетической ангионефропатии. Кроме того, способ не дает возможности стимулировать быстрое заживление раны, не предупреждает развитие гангрены и не способствует формированию опороспособной стопы.However, the known method does not include effects on tissue repair, does not take into account the characteristics of diabetic ulcers and the possibility of developing side effects of antibiotic therapy (allergies, intestinal dysbiosis, candidiasis), which are especially dangerous against the background of diabetic angionephropathy. In addition, the method does not make it possible to stimulate the rapid healing of the wound, does not prevent the development of gangrene and does not contribute to the formation of support foot.
Задача предлагаемого изобретения - восстановить репарацию патологического очага хронического воспаления, предупредить развитие гангрены и способствовать формированию опороспособной стопы.The task of the invention is to restore the repair of the pathological focus of chronic inflammation, prevent the development of gangrene and contribute to the formation of support foot.
Поставленная задача решается за счет того, что в способе, включающем некрэктомию гнойного дна язвы, по поверхности раневого дефекта выполняют сквозную остеоперфорацию обоих кортикальных слоев кости, нанося 8-9 каналов на 1 см2 по радиальным направлениям от центра к периферии на расстоянии 5-6 мм друг от друга.The problem is solved due to the fact that in the method, including necrectomy of the purulent bottom of the ulcer, through the surface of the wound defect, through osteoperforation of both cortical layers of the bone is performed, applying 8-9 channels per 1 cm 2 in radial directions from the center to the periphery at a distance of 5-6 mm apart.
Способ лечения больных с нейропатическими инфицированными язвами при синдроме "Диабетическая стопа" поясняется чертежом, где на фиг.1 изображен профиль нейропатической язвы области плюснефалангового сустава первого луча стопы и остеоперфорация по радиальным направлениям от центра язвы к периферии.A method of treating patients with infected neuropathic ulcers with the "Diabetic foot" syndrome is illustrated in the drawing, where Fig. 1 shows a profile of a neuropathic ulcer in the metatarsophalangeal joint of the first foot ray and osteoperforation in radial directions from the center of the ulcer to the periphery.
Способ осуществляют следующим образом. Производят некрэктомию гнойного дна язвы и рубцовых краев раны до капиллярного кровотечения. Затем спицей Киршнера по всей поверхности раневого дефекта выполняют сквозную множественную остеоперфорацию 1, 2, 3, 4, 5 обоих кортикальных слоев кости, нанося по расходящимся радиальным направлениям от центра к периферии 8-9 каналов на 1 см2 на расстоянии 5-6 мм друг от друга. Накладывают повязку с димексидом и заднюю гипсовую лонгету.The method is as follows. A necrectomy of the purulent bottom of the ulcer and cicatricial edges of the wound is performed until capillary bleeding. Then, through the Kirschner spoke, through the entire surface of the wound defect, through multiple osteoperforation of 1, 2, 3, 4, 5 of both cortical bone layers is performed, applying 8-9 channels per 1 cm 2 at a distance of 5-6 mm in diverging radial directions from the center to the periphery from friend. Apply a bandage with dimexide and a back plaster cast.
Клинический пример: Б-ой К., 63 г., ист. б-ни №246672. Клинический диагноз: "Сахарный диабет (тип II), декомпенсированный, тяжелого течения. Нейроишемическая форма синдрома "Диабетическая стопа": трофическая язва внутренней поверхности основной фаланги первого пальца правой стопы". Под проводниковой анестезией произведено тангенциальное иссечение гнойно-некротического дна трофической язвы и рубцовых краев раны до капиллярного кровотечения. Спицей Киршнера через дно иссеченной язвы произведена сквозная радиальная остеоперфорация основной фаланги первого пальца правой стопы - 8 радиальных каналов через дно трофической язвы насквозь, через всю толщу основной фаланги первого пальца. Повязка с димексидом (1:8). В послеоперационном периоде отмечены активное рубцевание и краевая эпителизация раневого дефекта. Гнойное воспаление купировано, сформирована опороспособная стопа.Clinical example: B. K., 63, East. b-no. 246672. Clinical diagnosis: "Diabetes mellitus (type II), decompensated, severe course. Neuroischemic form of the syndrome" Diabetic foot ": trophic ulcer of the inner surface of the main phalanx of the first toe of the right foot." Under conduction anesthesia, a tangential excision of the purulent-necrotic bottom of the trophic ulcer and cicatricial edges of the wound before capillary bleeding was performed. Kirschner spoke through the bottom of the excised ulcer through radial osteoperforation of the main phalanx of the first toe of the right foot - 8 radial channels through the bottom of the trophic ulcer through, through the entire thickness of the main phalanx of the first finger. Dressing with dimexide (1: 8). In the postoperative period, active scarring and marginal epithelization of the wound defect were noted. Purulent inflammation is stopped, the support foot is formed.
Способ лечения больных с нейропатическими инфицированными язвами при синдроме "Диабетическая стопа" стимулирует регенераторные возможности тканей в области трофической язвы, создает условия к заживлению раны с уменьшением сроков ее заживления, позволяет купировать гнойное воспаление, предупредить развитие гангрены, сформировать опорную нижнюю конечность. Способ патогенетически обоснован, доступен, технически прост, обеспечивает восстановление нарушенной ранее регенерационной способности тканей очага хронического воспаления в минимальные сроки.A method of treating patients with neuropathic infected ulcers with the Diabetic Foot Syndrome stimulates the regenerative capabilities of tissues in the area of a trophic ulcer, creates conditions for healing of a wound with a reduction in its healing time, allows suppressing purulent inflammation, prevents the development of gangrene, and forms a supporting lower limb. The method is pathogenetically justified, affordable, technically simple, and provides restoration of previously damaged regenerative capacity of tissues of the focus of chronic inflammation in a minimum time.
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| RU2011106433/14A RU2454944C1 (en) | 2011-02-21 | 2011-02-21 | Method of treating patients with neuropathic infected ulcers in case of "diabetic foot" syndrome |
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Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU96100999A (en) * | 1996-01-16 | 1998-03-27 | Российский научный центр "Восстановительная травматология и ортопедия" им.акад.Г.А.Илизарова | METHOD FOR TREATING KNEE JOINT OSTEOARTHROSIS |
| RU2209595C2 (en) * | 2001-05-15 | 2003-08-10 | Привалов Валерий Алексеевич | Method for surgical treatment of chronic osteomyelitis |
| RU2228715C1 (en) * | 2002-10-14 | 2004-05-20 | Павлов Юрий Икарович | Method for surgical treatment of chronic ischemia of lower limbs |
| RU2328997C1 (en) * | 2006-12-29 | 2008-07-20 | Федеральное государственное учреждение науки "Российский научный центр "Восстановительная травматология и ортопедия" имени академика Г.А. Илизарова Федерального агентства по здравоохранению и социальному развитию" | Method of treatment of patients with perforated leg vein valve insufficiency complicated by trophic ulcers |
| RU2360617C1 (en) * | 2008-01-21 | 2009-07-10 | Владимир Михайлович Крестьяшин | Way of treatment of koenig's disease at children and teenagers |
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Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU96100999A (en) * | 1996-01-16 | 1998-03-27 | Российский научный центр "Восстановительная травматология и ортопедия" им.акад.Г.А.Илизарова | METHOD FOR TREATING KNEE JOINT OSTEOARTHROSIS |
| RU2209595C2 (en) * | 2001-05-15 | 2003-08-10 | Привалов Валерий Алексеевич | Method for surgical treatment of chronic osteomyelitis |
| RU2228715C1 (en) * | 2002-10-14 | 2004-05-20 | Павлов Юрий Икарович | Method for surgical treatment of chronic ischemia of lower limbs |
| RU2328997C1 (en) * | 2006-12-29 | 2008-07-20 | Федеральное государственное учреждение науки "Российский научный центр "Восстановительная травматология и ортопедия" имени академика Г.А. Илизарова Федерального агентства по здравоохранению и социальному развитию" | Method of treatment of patients with perforated leg vein valve insufficiency complicated by trophic ulcers |
| RU2360617C1 (en) * | 2008-01-21 | 2009-07-10 | Владимир Михайлович Крестьяшин | Way of treatment of koenig's disease at children and teenagers |
Non-Patent Citations (4)
| Title |
|---|
| БАЗЛОВ С.Б. Морфологическое обоснование применения реваскуляризирующей остеотрепанации в лечении осложненных ишемических форм Диабетической стопы. - Успехи современного естествознания, 2005, №12, с.63-64. ЗУСМАНОВИЧ Ф.Н. Реваскуляризирующая остеотрепанация в лечении больных облитерирующими заболеваниями конечностей. - Курган, 1996, с.23-26. FISTAL E.J. REVASCULARISING OSTEOTREPANATION SABFASCIALS BURNS OF THE LOWER EXTREMITIES Donetsk, Ukraine. Trauma. 2005. Vol.6 №1 p.37-39. * |
| пример, формула. * |
| реферат. * |
| формула. * |
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