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indexed in Scopus
Year 2013 Vol. 21 No 3
GENERAL AND SPECIAL SURGERY
G.P. KOTELNIKOV, I.I. LOSEV, Y.V. SIZONENKO, S.E. KATORKIN
PECULIARITIES OF DIAGNOSTICS AND TREATMENT TACTICS OF PATIENTS WITH COMBINED LESION OF THE MUSCULOSKELETAL AND THE VENOUS SYSTEMS OF THE LOWER LIMBS
SBEE HPE “Samara State Medical University”
The Russian Federation
Objectives. To improve the treatment of patients with a combined pathology of the musculoskeletal and venous systems of the lower limbs through a comprehensive multidisciplinary approach to choice the optimal treatment tactics.
Methods. The results of a comprehensive survey of 452 patients with a combined pathology of the musculoskeletal and venous systems of the lower limbs have been analyzed. Clinical and instrumental studies (ultrasound dopplerography, computer tomography, plantography, goniometry, functional electromyography) were carried out. The patients with the pathology of the musculoskeletal system and accompanying chronic venous diseases of C3-C6 classes were subjected to a combined operative intervention (n=401) aimed to correct insufficiency of the peripheral venous hemodynamics and lymph outflow. Evaluation of life quality of patients was done using the questionnaire “SF-36 Healf Status Survey”. Criteria of the evidence-based medicine were used to evaluate the long-term results of surgical treatment (up to 3 years).
Results. C3 class was diagnosed in 168 (37%), C4 – in 124 (27%), C5 – in 102 (23%) and C6 – in 58 (13%) of all patients. Non-traumatic pathology of the feet was diagnosed in 404 (89%), arthrosis of the foot joints – in 203 (45%) patients. Clinical analysis of movements revealed the abnormalities of the step cycle and functional insufficiency of the lower limbs. Density of the skin and subcutaneous tissue increased up to 8,2±0,16 HU, the muscles in the back compartment of the shin – up to 4,3±0,18 HU. A combined pathology of the musculoskeletal and venous systems leads to the development of congestive arthrogenic syndrome. At C5-C6 classes the formation of chronic compartment syndrome is considered to be possible. At comorbidity of venous pathology of C3-C6 classes it is required to correct firstly the venous insufficiency. Orthopedic surgery was performed within 1-3 months after rehabilitation.
Conclusions. During medical rehabilitation of patients with combined lesions of the musculoskeletal and the venous system of the lower limbs, the multidisciplinary approach is considered to be necessary. The designed criteria of the systemic functional approach in diagnostics and treatment help to avoid common mistakes in treatment of the given category of patients.
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443079, Rossiiskaia Federatsiia, g. Samara, pr. K. Marksa, d. 165 "B", Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika travmatologii, ortopedii i ekstremal'noi khirurgii, laboratoriia klinicheskoi biomekhaniki,
Sizonenko Iaroslav Vladimirovich
Kotelnikov G.P. Academician of RAMS, Honoured Science Worker of the Russian Federation, MD, professor, a head of the department and clinic of traumatology, orthopedics and emergency surgery, Rector of SBEE HPE “Samara State Medical University”.
Losev I.I. MD, professor of the department and clinic of traumatology, orthopedics and emergency surgery, Vice-rector on clinical affairs of SBEE HPE “Samara State Medical University”.
Sizonenko Y.V. PhD, a head of the clinical biomechanics laboratory of SBEE HPE “Samara State Medical University”.
Katorkin S.E. PhD, an associate professor of the hospital surgery chair and clinics of SBEE HPE “Samara State Medical University”.