Novosti
Khirurgii

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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.

Keywords: chronic venous insufficiency, foot deformation, functional diagnostics, correction
p. 42 – 53 of the original issue
References
  1. Kotel'nikov GP, Ryzhov PV, Losev II, Chernov A.P. Lechenie povrezhdenii i zabolevanii golenostopnogo sustava i stopy [Treatment of injuries and diseases of the ankle and foot]: monografiia. Moscow, RF: GEOTAR-Media; 2012.– 362 p.
  2. Zhukov BN, Katorkin SE, Iarovenko GV, Myshentsev PN, Sizonenko IaV. Biomekhanika dvizhenii pri khronicheskoi limfovenoznoi nedostatochnosti nizhnikh konechnostei [Biomechanics of movements in chronic lymphatic venous insufficiency of the lower extemities]. Flebologiia. 2011;5(2):33–37.
  3. Sushkou SA, Kukhtenkov PA, Nebylitsin IuS, Sushkova OS. Fenotipicheskii simptomokompleks displazii soedinitel'noi tkani pri nedostatochnosti glubokikh ven u bol'nykh varikoznoi bolezn'iu [Phenotypic symptom complex of connective tissue dysplasia with deep vein insufficiency in patients with varicose disease]. Novosti Khirurgii. 2006; 14(2):32–37.
  4. Sushkou SA. Oslozhneniia pri operativnom lechenii varikoznoi bolezni nizhnikh konechnostei [Complications of the surgical treatment of the lower extremities varicose veins]. Novosti Khirurgii. 2008;16(1):140–51.
  5. Grinevich TN. Venoznye trombozy v travmatologii i ortopedii: trudnosti diagnostiki [Venous thrombosis in traumatology and orthopedics: difficulty of diagnosing]. Novosti Khirurgii. 2010;18(1):124–32.
  6. Jablonski M, Turzanska K, Gorzelak M, Posturzynska A, Wojcik B, Pluta R. Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important? Chir Narzadow Ruchu Ortop Pol. 2008 Nov-Dec;73(6):381–85.
  7. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–83.
  8. Kotel'nikov GP, Shpigel' AS. Dokazatel'naia meditsina. Nauchno obosnovannaia praktika [Evidence-based medicine. Evidence-based practice]: monografiia. Moscow, RF: GEOTAR-Media; 2012. 336 p.
  9. Ivanov VI. Kompartment-sindrom: diagnostika, klinika, lechenie [Compartment syndrome: diagnosis, clinical features, treatment]. Vestn Travmatologii i Ortopedii im NN Priorova. 2006;(3):80–86.
  10. Katorkin SE, Osadchii AS, Zhukov AA, Isaeva ES. Znachenie komp'iuternoi tomografii v diagnostike khronicheskogo kompartment sindroma u patsientov s troficheskimi iazvami nizhnikh konechnostei venoznoi etiologii [The role of computed tomography in diagnosing of chronic compartment syndrome in patients with trophic ulcers of the lower limbs of venous etiology]. Vestn Eksperim i Klin Khirurgii. 2012;V(2):330–34.
  11. Wulker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int. 2012 Dec;109(49):857–67.
  12. Shurnas PS. Hallux rigidus: etiology, biomechanics, and nonoperative treatment. Foot Ankle Clin. 2009 Mar;14(1):1–8.
  13. Schuh R, Trnka HJ, Sabo A, Reichel M, Kristen KH. Biomechanics of postoperative shoes: plantar pressure distribution, wearing characteristics and design criteria: a preliminary study. Arch Orthop Trauma Surg. 2011 Feb;131(2):197–203.
  14. Christenson JT, Prins C, Gemayel G. Subcutaneous fasciotomy and eradication of superficial venous reflux for chronic and recurrent venous ulcers: mid-term results. Phlebology. 2011 Aug;26(5):197–202.
  15. Zhukov BN, Katorkin SE, Zhukov AA, Kravtsov PF, Isaeva ES. Kliniko-funktsional'nyi analiz variantov operativnykh vmeshatel'stv pri oslozhnennykh formakh khronicheskoi venoznoi nedostatochnosti s pozitsii dokazatel'noi meditsiny [Clinical and functional analysis of the choice surgery in complicated forms of chronic venous insufficiency from the point of evidence-based medicine]. Khirurg. 2012;(7):45–51.
Address for correspondence:
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,
e-mail: ysizonenko@yandex.ru,
Sizonenko Iaroslav Vladimirovich
Information about the authors:
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”.
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