Novosti
Khirurgii

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Year 2018 Vol. 26 No 6

GENERAL & SPECIAL SURGERY

G.P. KOTELNIKOV, S.E. KATORKIN, E.A. KORYMASOV

CLINICAL AND PATHOGENETIC CONCEPT OF DIAGNOSTICS AND COMPLEX TREATMENT OF PATIENTS WITH COMBINED PATHOLOGY OF VENOUS AND MUSCULOSKELETAL SYSTEMS OF THE LOWER EXTREMITIES

Samara State Medical University, Samara,
The Russian Federation

Objective. To advance treatment effectiveness of patients with chronic venous insufficiency of the lower extremities through the introduction of the clinical and pathogenetic concept of diagnosis and treatment based on the correction of the functional state of the muscular-venous pump.
Methods. A prospective, controlled clinical trial of patients (n=452) with clinical classes C3-C6 was conducted. The analysis in the comparison group (n=224) made it possible to identify the causes of unsatisfactory results, to develop the concept of diagnosis and treatment of chronic venous insufficiency, which was prospectively applied in the main group (n=228).
In the postoperative period, biomechanical stimulation of the lower limb muscular-venous pump was used in the main group patients(n=186) to correct the spring, balancing, and jog functions of the feet under static and dynamic load, as well as locomotor reconstruction of the walking pathology. Stimulation was performed in the vertical position of the patient in the frequency range from 2 to 30 Hz with fifteen-minute duration of the stimulation session.
Treatment efficacy was assessed by the VCSS scale, indices of volumetric blood flow in the deep vein system, and malleolar extremity volume after surgical treatment and after 12 months.
Results. A combined lesion of the venous and musculoskeletal systems was revealed in 402 (88.9%) cases. The combination of surgical treatment and biomechanical stimulation resulted in the improvement in the evacuation function of the muscular-venous pump. In the course of treatment, the bioelectrical activity of the gastrocnemius muscle increased, the volume outflow of blood in the muscular system decreased, the gait parameters and kinematics of the joints approached the values of healthy individuals. After 12 months, with a total assessment of the treatment effectiveness, a statistically significant predominance of good (74.1%) and a decrease in unsatisfactory results from 19.2% (comparison group) to 3.1% in the main group were obtained.
Conclusions. Surgical treatment of chronic venous insufficiency should be complemented by a complex of surgical and rehabilitation measures aimed at stimulating the muscular-venous pump and correcting the pathology of the musculoskeletal system.

Keywords: chronic venous diseases, chronic venous insufficiency, musculoskeletal system, functional diagnostics, clinical analysis of movements, muscle-venous pump
p. 677-688 of the original issue
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Address for correspondence:
443079, The Russian Federation,
Samara, Karl Marx Ave., 165 b,
Clinics of Samara State Medical University,
Department and Clinic of Hospital Surgery,
tel.: +7 927 206 71 02,
e-mail: katorkinse@mail.ru,
Sergey E. Katorkin
Information about the authors:
Kotelnikov Gennady P., Academician of RAS, MD, Professor, Head of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7456-6160
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Korymasov Evgenii A., MD, Professor, Head of the Department of Surgery of the Institute of Vocational Education, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-9732-5212
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